Scott Webb (Host): We all need sleep, of course, and this is especially true for our kids. And my guest today is here to explain the value of sleep for our kids and give us some suggestions for how we can help them to sleep better. I'm joined today by Dr. Nora Fahden. She's a pediatrician with Stanford Medicine Children's Health.

 This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Doctor, it's so nice to have you back on. Today, we're going to talk about sleep in children. I was mentioning to you, I had one good sleeper who's still a good sleeper at 21, and the other one doesn't really favor sleep. She wasn't a napper. She's not a sleeper. She's a robot, we like to call her. But let's talk about other people's kids today. And in general, what are the most common causes of sleep issues and does it vary by age?

Dr. Nora Fahden: You know, it's such a good question. It's such an important topic. I think, far and away, the most common cause of sleep problems in children is something that we'd call behavioral insomnia, which is a little maddening to parents because it kind of makes it seem like it's like, I don't know, not a real condition or just not like a medical problem or maybe minimizes the problem. But it really has something to do with like something around the child's bedtime routine or something that is happening when they wake up. There's something about the child's behavior or the family's behavior or the sleep environment. There's something going on there that's impacting the kid's sleep. And that's true for an infant, or a toddler, or school age child, or a teenager. The less common causes of sleep problems are actually like the physical medical problem. But those are real and that's why you should talk to your pediatrician. So, those would be like sleep apnea or restless legs, uncontrolled asthma or poorly controlled eczema. So, there are definitely medical reasons that would impact kids' sleep. But again, the most common concern is behavioral insomnia.

Host: That's really interesting. I'd never heard of that. I've never really thought about that, and we probably have to do an entirely separate podcast and really roll up our sleeves and dig in. But if I'm hearing you right, so there's medical, physical, and then this other behavioral component or reasons why children's sleep may suffer. So, I think I know the answer to this one, but why is getting good sleep so important, especially for kids?

Dr. Nora Fahden: For kids, it's important in so many different areas. So, you know, physically, it's really important. When kids are deeply asleep, that's when they grow. That's when they grow tall. Parents are always asking me, you know, "How can I make my kid taller?" Some do, but getting good

Host: sleep--

Make them sleep, right?

Dr. Nora Fahden: Yeah, that's when they grow. It impacts their cognitive development, their ability to focus. It impacts their ability to regulate their emotions and problem solve. So emotionally, cognitively, physically sleep is huge for kids.

Host: Yeah. And for those of us parents, the one hosting and those of us in the audience, you know, maybe if they're first time parents, they don't quite understand the value of sleep. But for those of us who've been through this and know what it's like to deal with sleepy children or children that didn't get enough sleep the night before, we know that that can make for some nightmarish days, if you will. So, from you, from an expert, what happens if kids can't or don't get enough sleep?

Dr. Nora Fahden: Yeah. And, you know, I have a toddler, so I'm speaking not only as a doctor, but first hand experience.

Host: Sure. Yeah

Dr. Nora Fahden: Yeah. When kids don't get enough sleep, it looks a little different than an adult. So, like maybe an adult doesn't get enough sleep and they're groggy or slow or, you know, sleepy, as you might expect. When kids don't get enough sleep, it's kind of the opposite. They get wired, kind of hyper, kind of wild. Like for a younger kid, it's harder for them to handle transitions, harder for them to calm down. For an older kid, again, they may not be overtly sleepy, but they might have a hard time focusing on their homework or a hard time paying attention in class. They might act out and be more impulsive. So, those are signs that your kid might not be getting enough sleep or good quality sleep.

Host: Yeah. I was just nodding my head, you know, all of that stuff checks out in my experience. And I was mentioning to you before we got rolling here that my son, even still at 21, can just sleep for 10, 12, 14 hours without breaking a sweat. It makes me wonder, you know, how much sleep is enough? Or maybe how much sleep is too much sleep? And is it bad, you know, if you've got a kid who can sleep more than other kids? Just take us through that. Like, what's your perspective as an expert? How much sleep is enough?

Dr. Nora Fahden: I think sometimes parents, a common misconception they have is I'll be talking to a parent, maybe their child is 10 years old, and they'll say, "Oh, well, you know, they get eight hours of sleep a night." And that's actually not enough. I mean, the eight hours is for a much older teen or an adult. So, a general guide is for four to 12 months, they need a good 12 to 16 hours, including naps. Like in the blog, we go through this list. But, you know, one to two years, 11 to 14 hours, including naps; three to five years, 10 to 13 hours; six to 12 years, they actually need nine to 12 hours of sleep a night. They're still actively growing. And same thing, 13 to 18 years. I usually say eight would be the bare minimum. Really, more like nine to 10.

And then, regards to your question, is there too much? A lot of times when you see teens who will sleep, 12, 14 hours on the weekend. What, it's really showing you is that they built up a sleep deficit during the week, or over the course of many weeks and months. So, they stayed up late cramming for a test or finals. And then, once they are able to sleep, their body remembers and will try to make up for it. The downside to that is then you kind of give yourself jet lag, because then Monday rolls around and your body is confused about when my wakeup time is supposed to be. So in one sense, it's good to make up for lost sleep. But in the other sense, it can have this negative impact of making it harder going forward to stick to a good sleep schedule.

Host: Yeah. So in some cases, maybe parents don't realize it, which is why it's so great to have your expertise that maybe the kids aren't sleeping enough. And in my case, my son, you know, it's probably an indication when the 21-year-old is sleeping 12, 14 hours, maybe he didn't get enough sleep, you know, yesterday or last weekend. And it kind of builds up over time, of course. What could we do to help, doctor, to help our kids sleep better?

Dr. Nora Fahden: One of the best things to do to help your kids sleep better at night is to look at what's going on during the day. So, you know, are they getting enough playtime outside? Are they getting enough exposure to natural light, time outside, running around, getting enough exercise during the day? Are they getting adequate nutrition during the day, making sure that they're eating meals and snacks and not skipping meals like some of our teenagers do. So, having a good routine during the day can help a lot at night, especially that exposure to natural light and getting enough exercise during the day really helps.

For younger children, really sticking to your limits, like, you know, talking to other adult members of the household or, you know, other caregivers and getting on the same page about what's our routine at night, what are our limits around sleep at night, and sticking to it. And then, for older teens, trying to what we call anchor, try to anchor the time they wake up. So, a lot of families put all this energy into trying to get their kid to go to bed, go to bed, go to bed. And for older teens, try to get them to commit to a time to wake up. And that helps train their bodies, "Okay, I got to be up within about the same..." You know, give yourself a one-hour window, eight to nine or something, and then try to stick to that on the weekends and during the week.

Host: Doctor, I know these sort of noise machines, the white noise machines and various types of machines and speakers and things, maybe people use their smart speakers, but I know that this has become fairly popular in helping kids to sleep. And I was sharing with you my own personal anecdotes of, you know, my mom always having something running, trying to get me to go to sleep, which is why I have to sleep with the TV on, but that's a different podcast. But other people today, doctor, let's talk about that. Let's talk about these sleep machines, and do you recommend them?

Dr. Nora Fahden: Sure. Like a sound machine or white noise machine, I would put that in the category of like a sleep aid, you know, something to help your baby sleep. They're usually more like targeted towards the very young infants. I think they can be helpful for very young infants, because they sort of like mimic the environment like in utero, in the womb. So if you think about like a very young baby surrounded by the whooshing sound of mom's blood flow and all the ambient noise. So, there's that thought that for a very young infant having a sound machine on can help soothe them to sleep. You know, for my daughter, she was like, "Yeah, you can crank that as loud as you want." It didn't touch her. But some families, a sound machine alone can be very helpful. And then, some piece of a sound machine is just practical. Like, if you live in a place where your one kid needs to be in the living room doing homework, and then your baby maybe shares a wall with that room and you just need to drown out the sound of the rest of the family, then a sound machine is great for that.

 Two, like, caveats. One of them is you don't necessarily want to crank the sound machine as loud as it goes. The AAP, American Academy of Pediatrics, has very helpfully said that, you know, 50 decibels would be the loudest that you want to go. Lower than that is perfectly safe. You don't want to put it like right next to the baby's head. Kind of common sense things. And then, the other thing is some families are like, "Oh my gosh, my baby's going to get addicted to the white noise, and they're going to need the white noise forever." And if that's a concern, as the kid gets older, you can kind of just turn it down a notch, teeny tiny bit, you know, over the course of days or weeks and sort of like taper off or wean off the use of the sound machine and that works well too.

Host: I just want to finish up here, doctor. The sleep issues we're talking about, when does it become or reach a point where we need to go to see you, go to see the doctor when we've tried, you know, all of our best efforts have failed and we just can't help our kiddos get the proper amount of sleep or good sleep or whatever it might be. When should we reach out?

Dr. Nora Fahden: I really think considering how important sleep is for the whole family, you know, not only the child, but everybody in the household. Sleep is so essential. I really don't think there's too small of a sleep problem to bring it up with your pediatrician. So yeah, I wouldn't wait until you've exhausted every single option and you've read one million sleep training books like I did for my toddler. But, you know, I would just bring it up right away with your pediatrician and start to get some support, no matter what age your child is. And that's especially true if your child is neurodiverse in some way. So, you know, autism or ADHD, there are certain conditions we know that make good sleep really difficult. And so, it's really important for families to get the support they need.

Host: Yeah, that's perfect. And always good to hear that even an expert like yourself read a million books about--

Dr. Nora Fahden: Oh, my gosh. I mean, at least six, like cover to cover.

Host: Yeah. And we're at the pediatricians all the time anyway, you know, just make a little list of things. "Oh yeah, let's talk about sleep." Sure. So anyway, it's always great to have you on and your expertise. Thank you so much. And you stay well.

Dr. Nora Fahden: Thanks so much for having me.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.