Maggie McKay (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Today, we're speaking with. Dr. Sonia Varghese, a pediatric neurologist, about all things brain.

Dr. Varghese, to start, thank you so much for making the time. I know you are busy and we appreciate you being here.

Sonia Varghese, MD: Definitely. Thank you for having me today.

Host: So, how critical is sleep to brain function? Let's just dive right in.

Sonia Varghese, MD: Well, that's a really good question. Sleep is actually one of the most important things that our body needs, especially our brain. In the pediatric population, sleep really helps with trying to have the brain develop and grow, really even just remembering everything that our kiddos learn in school that day. So, it's from top to bottom, getting sleep is just very important.

Host: So, sleep is crucial to kids, of course, for everybody, but especially kids because they're growing. For each of the major stages, how often should children from toddlers to teens be sleeping each night?

Sonia Varghese, MD: Yeah. This is a great topic to talk to with my teen patients. But starting from when you have a baby, they do require more sleep than the rest of us. So, really, under one, it kind of ranges from 12 to 14 hours. Newborns obviously sleep more. But under one, probably 12 to 14 hours. And then, as kids get older, so school-aged kids or preschool-aged kids, we stay around 12 hours of sleep.

And then, when our patients and our kids are in, let's say, elementary school, we say 10 to 12 hours of sleep. So, I think around 10 hours for school-aged kids, just to kind of keep that in mind, that's a good number to try to follow. Now, as our kids get a little bit older, middle school to high school, there is a little bit of adjustment. You can get maybe eight to 10. But lower than that eight, you're really going to have some sleepiness during the day and some other kinds of cognitive slowing with not getting as much sleep. But yeah, so for school aged kids, 10 to 12 is a great goal to try to reach. And then, for our high schoolers, eight to 10. They don't really like when I say that, so I say at least nine. But it's tough, I know.

Host: Yeah. I always remember when our son got in the teen years and he slept so long on days he could. And I had to like check in. I'm like, "Is he alive?" It was crazy, because they go from not very much sleep to just sleeping, like you said, 14 hours. Are there signs of potential sleep disorders that parents should be watching out for?

Sonia Varghese, MD: Yeah. Sleep disorders can really get missed easily. So, one thing to look for, I mean, you know, you're kid better than anyone else. If they are having any changes in behavior, if they just seem more tired than usual, and then if you're noticing any kind of drop in grades, there's a lot of things that could contribute, but sleep is one big thing that you try to go back and see if there's anything in the past couple days, past couple weeks that maybe is messing up their sleep. So really, just paying attention to any changes in their behavior and school performance.

Host: So then, if you notice that, how would those be diagnosed and then treated?

Sonia Varghese, MD: I would initially talk to the pediatrician. And our pediatricians are great. They have training in a lot of these issues. And if it's something that the pediatrician has a concern about, they will refer to Neurology. and so in Neurology, there are a couple of tests that we can do. One, it's really just talking to the patient and the family, trying to get more of a history, asking what time to go to bed, how they're sleeping, family history of sleep issues. Oh, and another big one. Do they snore? I love asking that question. Kids are like, "No, but mom and dad snore," or it's usually, "Dad snores." But yeah, "So do they snore?" Things like that. And then, depending on the answers, there's a sleep study we can get. And that will tell us if there's any issues like sleep apnea, which I would say it's common in a lot of our patients that we see that have sleep concerns. So, we would diagnose sleep apnea with a sleep study.

Host: Let's talk about seizures, Dr. Varghese. I know people may have a dramatic picture in their mind of what a seizure looks like, but some types of seizures are actually very subtle, right?

Sonia Varghese, MD: That is very true. So, seizures, what I tell my patients, seizures can look like anything really. They range from staring spells, just kind of a behavioral arrest, where you could just see a kid just kind of staring off and not really moving, and they go right back to what they were doing before.

I have some kiddos that parents have noticed they'll be in the middle of eating and they'll just stop. And then, all of a sudden, they will pick right back up to what they were eating before. So, it could be just like that. There could be just some like facial twitching or some rhythmic movements of one extremity. You could have the entire side. So, there's many different ways that seizures can present.

Host: So, let's say a parent noticed that, and they suspect a seizure. Is that an emergency? What should they do?

Sonia Varghese, MD: If a parent notices or even a teacher, I always ask, you know, have the teachers noticed anything or have they noticed the kids kind of staring off in class. So if they do notice that, they should bring it up to their pediatrician. And then, from that point, the pediatrician can do an exam, get some more information, and refer to Neurology if needed.

I would say, for a parent to take a patient to the emergency room, that would be for one of those big, like shaking seizures, or if it's a prolonged event where they're not responding to you and any signs of troubled breathing, that definitely is an emergency. I would go ahead and call 911.

Host: Got it. Let's pivot to headaches, which I know you see in your clinic. When do headaches in children or teens become enough of an issue that they really would benefit from an assessment from a neurologist?

Sonia Varghese, MD: Oh, headaches. That's a topic we can discuss for hours and hours. But headaches, the two most common in children are migraines and tension headaches. A lot of kids and a lot of adults have headaches, maybe occasionally, but when your kid is complaining of headaches very frequently, Things to look for if they have any kind of slowing in the way they talk, if they are having any trouble thinking or having trouble in school. And you'll hear me mention school a lot because that's where we can kind of quantify if things are changing. So, any kind of changes in how they're doing in their school performance.

So, that helps us know this is not just a headache. It could be something that needs to have further workup. So, that's one big sign. Another reason to get worried-- or not worried-- but take your child to the pediatrician is if they are waking up in the middle of the night with the headache, or waking in the morning and having a really bad headache, those are signs that there might be some increased pressure in the brain. So, you would need to get a little bit more of an evaluation.

Host: Wow. I did not know that kids got migraines. That's awful. Finally, concussions, that's always an important topic. Can you give a quick rundown on when parents should seek emergency care for a head injury?

Sonia Varghese, MD: Yes. I'm from Texas and I love football as most of my friends know, but head to head or helmet to helmet collisions are one of the most common causes of concussions, but concussions can happen really just with a minor injury to the head. So, it's a little tricky because concussions are actually invisible injuries. It's not like when you break your arm, you get an x-ray and you see, "I have this broken arm." But with concussions, you have that impact, you get the damage to your brain. And it's hard to really know the extent of it.

So for parents, the biggest thing is if they notice-- and their coaches should also be involved-- let's say at a game, they do have a collision and their kid is looking a little dizzy or off balance, a little bit confused, have them sit out, have them evaluated right then. And at that point, this is why I always try to tell my patients, you have to take rest. That's the key, is to take rest from those contact sports. It can get you out of school for longer than a day or two. But really, giving your brain time to heal, that's the only way you'll be able to go back onto the field and try to perform at your 100% capacity.

I was able to talk to the school nurses at a conference, I think it was last week, and just talking about injury after having a recent head injury, that is one of the worst things that you could really do to yourself is if your brain doesn't have time to heal and you go back out there and have another injury, then you are just kind of piling on the damage onto the tissue that hasn't healed before. So, that's really where you start to see long-term effects.

Host: That's so scary. You mentioned helmet to helmet. Parents need to ensure that their children have a proper fitting helmet for activities like bicycling and skateboarding. Because I remember I noticed my son had outgrown his helmet. And I'm like, "This helmet doesn't fit at all. I mean, at least he was wearing it, but it was way too small. And even the thing in the back that adjusts, it was, no. We had to get a bigger one. But skateboarding made me so nervous too. So, talk about helmets and parents and keep an eye out, right?

Sonia Varghese, MD: Yes. So, helmets are very important. I used to joke with my nephew, "Hey, you're crazy around the house. You just wear a helmet all the time." And he actually would do it just to be funny. But it's one of the things that can try to protect your brain. So, the skull itself is kind of like a helmet, protecting our brain, but you can fracture that skull.

So, we want our kids to be as active as they can be, that's great. Get on your bike, go skateboarding, but you have to protect your skull as well as your brain. If you have an injury and you hit, for instance, concrete, your skull can protect your brain, but it depends on that impact. So when you have that helmet to take that pressure, that minimizes the risk of having bleeding or severe damage. They're making pretty cool helmets nowadays, so...

Host: As we start to wrap up, I would love to know how Pediatric Neurology became a passion of yours? What drew you to focus on this specialty?

Sonia Varghese, MD: My brother is actually a child neurologist, but I did not copy him, I promise. My family's from India and we used to go most of the summers. And my mom would take me to different churches and children's homes. And a lot of the kids that I met at the children's homes, they were neglected because of their disability.

And so, it was always something, as a kid, I just wanted to find cure. When I was little, I didn't understand. But that's kind of how my passion for helping kids that have any kind of neurologic issue, I would try to figure out, "Okay, well, what caused it? How can I help? How can I make them feel included and not neglected in any way? You know, their family could love them, but it's hard in the community for our patients that have a little bit of a different appearance or capabilities. So, that's kind of where my passion came from. And then, I guess, my brother went into it first. And I was like, "Okay, well, I'm going to do that too. I love it."

Host: Wow. I bet your parents are so proud of both of you. I mean, obviously, those trips made an impression. Did you ever tell your mom that that's what inspired you?

Sonia Varghese, MD: I did. I did tell her. She still says I copied my brother.

Host: Well, she should be glad you did, because that's awesome. Is there anything else in closing that you'd like to add?

Sonia Varghese, MD: No, just trying to emphasize the importance of taking care of your body and getting that sleep and letting yourself rest whenever you need to. And for parents, just making sure that they pay attention to how their kids are acting. And if there's any changes that are going on, just to reach out to your pediatrician. And we're always here and available for answering any questions.

Host: Well, thank you so much for sharing your expertise. This has been very helpful and educational, and useful especially to parents. Thank you.

Sonia Varghese, MD: Thank you so much.

Host: Again, that's Dr. Sonia Varghese. And if you'd like to find out more, please visit nh.team/pediatrics. To find a physician, visit novant health.org. For more health and wellness information from our experts, visit healthyheadlines.org. Thank you for listening.