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Caitlin Whyte (Host): Welcome to CheckupChat with EvergreenHealth. I'm Caitlin Whyte. Today we have Dr. Poornima Ramadas here with us to discuss a very important topic to many parents. Now, I too love a good nap, but for new parents or parents of young kids, sleep or lack thereof can be very challenging for both parents and babies and toddlers.

Well, Dr. Ramadas, thank you so much for joining us here on CheckupChat. We'll start off by having you tell us a bit about youself.

Poornima Ramadas, MD (Guest): Hi, thanks for having me. I'm Dr. Poornima Ramadas. I'm a Board Certified Family Doctor, which means I trained to care for all ages, from pregnancy, birth to newborn, all the way to geriatric care. I'm also American Board of Obesity Medicine certified. So I basically chose family medicine because I loved the diverse panel of patients and I love helping families in all stages of life.

Host: I love it. So let's get into our topic today. Doctor we know sleep is important. It's drilled into us as adults, that we're supposed to get eight hours a night, but for infants and new parents figuring out and maintaining a proper sleep schedule can be so challenging at first. Tell us what's so important about sleep for infants and toddlers and what parents should be paying attention to in terms of developing a healthy sleep pattern for their little one.

Dr. Ramadas: Sleep training is teaching your kid how to sleep independently. I get a lot of common questions like, you know, when do you start? Where are you starting? Is it too late? And it's really never too late. It's harder when they're more mobile, but it's always good to start with sleep hygiene at any stage in life, even in adulthood, because with kids, you want to make sure they're developing and meeting their milestones. And for adults, poor sleep can lead to depression and agitation and if you have children, you want to make sure that you have the energy to enjoy them, and you want to spend time with your family. So it really helps both parents and kids to maintain a proper sleep schedule and get enough sleep.

Host: Absolutely. So you mentioned that term sleep training. Can you get into that a bit more and some common questions you get from patients about that process?

Dr. Ramadas: Yeah. So the most common question I get is when do you start? So to teach your kid, how to sleep independently again is what sleep training is about. Generally, when we're talking about babies, we wait until they're usually about 12 pounds, or around the three to four months of age. And that's generally because they're getting enough nutrition during the day.

So that means that they can have the long hour stretches at night where they don't need to be fed. So it also the time around three, four months, where you hear about the sleep regression, the four month sleep regression. And that's really when a kid is going from two stages of sleep to four stages of sleep like an adult.

So this is the perfect time to get a routine so that they're used to sleeping independently and again, you want to try to start when the kid is younger and not as mobile, because it's just a little easier, but if you start at any time in childhood, just having general good sleep hygiene, it's never too late for that.

Host: And then what happens as kids get older? How should their sleep routine change? And when do you start limiting naps?

Dr. Ramadas: Yeah, that's a great question. You know, there's definitely some normal sleep parameters that we generally coach parents about. A lot of my information here is from the American Academy of Family Physicians. So newborn state, it's definitely less sleep because kids are needing one, every one to three hours, they need to be woken up to be fed for normal development. And then as we talked about the, around the four month stage, when they're about 12 pounds, their total sleep time will range from about 12 to 16 hours, including naps.

And that means that naps are about three times a day. And around 12 months of age, that can drop to two naps a day. When they are about one to three years old, their total sleep time, including naps is about 11 to 14 hours in a day, which includes about usually these kids have about one nap a day. And then around three years of age, about 50% of kids don't actually nap.

So if you're one of those parents where like my kid doesn't nap, you're not alone; 50% of three-year-olds don't actually nap. But the ideal amount of sleep time is about 10 to 13 hours in a day, including a hopeful one nap. Around five years of age, naps usually stop. That's about 95% of five-year-olds don't actually nap, but around the group, the five to 12 year olds in the same group of needing nine to 12 hours of sleep, and then age 13 to 18, kids need about eight to 10 hours of sleep a night. And if they're sleeping during the day, that might be an indication that they actually have a sleep disorder and are not getting enough sleep at night.

Host: Well, that leads me into my next question. Even the most diligent of parents, sometimes infants or toddlers just can't get on that schedule. So what should you do if you have a child who is one of those who just can't seem to get on a consistent sleep schedule, and then how do you know if your child is getting enough sleep either way?

Dr. Ramadas: Yeah, that's great question again. So, you know, with, I'll start off with, how do you know your kid is getting enough sleep? There's a few ways you can kind of tell, you know, are they having attention issues during the day? Sometimes attention or ADD can sometimes be misdiagnosed because they're actually not sleeping enough at night. So that's something to look out for. Are they gaining a lot of weight? Poor sleep can lead to increased appetite during the day. For infants, are they really fussing during the end of the night, maybe their bedtime is too late. So those are some things to look out for. And generally, yeah, it's understandable to not get the same time, to go to sleep sometimes because we have busy schedules and most people work is so different and you know, it's tough, but things to look out for in the room, things that you can modify for infants, do they have distractors in their bedroom? Things like a mobile about the bed. That can be more distracting than helpful when they're sleeping. So you want to remove that. Are you aiming for around the same time to wake them up and out them to sleep? Is the room dark? You know, you want to try using those blackout curtains if you can. Is the room cool enough. That's really important, making sure that they're not wearing too many clothes. For babies, they shouldn't be having any blankets in the bed.

Very thin pajamas are important. Temperatures should range for about 68 degrees Fahrenheit to 72 degrees, which is about 20 to 22 Celsius in the room. So keeping it cool enough is important. And for older kids, toddlers, are they having too much to drink before they go to sleep? Do they have a TV in the room? When's the last time they watched television or looked at a phone. Those are all things that can really affect overall quality sleep for kids.

Host: So if we've tried several approaches and we've played with timing and things like that, when should parents start to be concerned if those aren't working, when should they maybe head to the doctor or look into the issue a bit more?

Dr. Ramadas: One thing I want to reiterate or reassure parents is that many sleep issues are part of normal development and normal challenges for caregivers and kids, because it's part of growing up and, you know, milestones, but I'd say any time a parent feels like things aren't normal. If you know, you kind of have a sixth scents. They, things are not going so well. It's never bad to ask your, your family doctor, your pediatrician. If, if things, if that's an okay thing that they're going through. Some things to look out for, that we look out for as physicians in babies, is it possible reflux or is a kid really fussy when they're being put down or they're being put down too quickly after feeds. Sometimes babies don't like to be laid on their back when that happens. So that's something to look out for. Do they have some crutches, like falling asleep on the parent or falling asleep to food and then parents kind of tip toeing them into the bed. So that can be a sleep association crutch we call it. Is the kid waking up really confused? That could be a sign of nightmares. Do people smoke in the house? Is there any problems with breathing at night for the child? Is the kid overweight? That could maybe be associated with sleep apnea for the child. And another thing we need maybe possible is do they complain a lot of leg pain or a lot of kicking at night that could even be restless leg syndrome.

So there's quite a few things to look out for. And again, definitely if you feel something's not going so right so definitely talk to your doctor. There's really no certain time where you have to wait, just ask right away in your next appointment.

Host: Well, let's dig into that a bit more. What is the role that parents play in monitoring our child's sleep and encouraging healthy habits just in general? How important are our parents of course?

Dr. Ramadas: Oh yeah. Caregivers, parents, you know, they're the most important part of a child's development because we're the adults. So we're the ones that have to guide them to build those healthy habits. And remember developmentally choosing what type of method you do to get that sleep in. It's it's really important for the development. And again, as I mentioned before, poor sleep in the adults, because the kid isn't sleeping well, it can lead to adult depression and you don't want to have behavioral issues with the adult either because it affects how you take care of the kid as well. So it's definitely important hand-in-hand to get quality sleep and do the best you can to maintain those routines.

Host: Well, doctor, as we wrap up here, is there anything else parents should know about sleep training, naps, sleep for our kids in general, or any other tips or tricks that you have from your work?

Dr. Ramadas: Yeah. You know, again, every parent is very different. Every child is very different, so don't feel bad about which method you choose. Kids developmentally, if they're getting quality sleep, they will turn out developmentally as they're supposed to. Whether you choose crying it out or if you decide to do a more pampered approach. I do have recommendations on some websites that are, I usually give to my patients. The American Academy of Pediatrics has two websites.

They have healthychildren.org, brightfutures.org, which is great. Some books to look into, Happiest Baby by Harvey Carp MD which is he's a pediatrician, Good Night Sleep Tight, is the sleep lady. She's a social worker who has developed a method called the sleep wave shuffle. And then we have some great apps that I like to use.

There's the CDC milestone app where you can track your kids developments on an app and make sure that they're hitting the right milestones. Then there's a Sprout and Huckleberry, which is great for during your pregnancy and sleep guidance as well. And What To Expect is another one of those too.

Host: Well, so much great information here. Thank you so much, doctor. And hopefully some new families get some good sleep tonight. To find a primary care partner to care for your family through every season of life, head to evergreenhealth.com. This has been CheckupChat with EvergreenHealth. I'm Caitlin Whyte. Stay well.