PROVIDENCE, R.I. — A new study of parents, children and teachers finds that 37 percent of 494 youngsters in kindergarten through the fourth grade suffer from at least one sleep-related problem. That percentage is higher than expected and is an indication that pediatricians are not screening school-age patients adequately for sleep problems.
“Health-care providers often assume that grade-school youngsters get adequate sleep and that by and large any of their sleep troubles don’t have an impact on their school performance, but that is not the case,” said study leader Judith Owens, M.D. “The results underscore the importance of screening school-age children for sleep problems and the need for pediatricians to understand the possible consequences of disordered sleep on children's daily lives.”
The researchers questioned parents, children and teachers in a suburban school district in Rhode Island. The study found a host of sleep-related problems such as bedtime resistance, sleep-time anxiety, difficulty in falling or remaining asleep, bedwetting, snoring or gasping during sleep, and daytime sleepiness.
Most sleep-related problems, particularly bedtime struggles and night waking, were more prevalent among kindergartners through second-graders than among third- and fourth-graders. This finding may be due, in part, to parents of younger children being more vigilant in monitoring sleep behaviors than parents of older children, Owens said.
Both pediatricians and parents are usually aware of sleep issues in infants and toddlers. Bedwetting and sleep walking are what both groups generally think of as sleep problems among school-age children. Clearly there are other sleep issues going unrecognized, Owens said.
The findings appear in the February issue of the journal Developmental and Behavioral Pediatrics. Owens is an assistant professor of pediatrics at the Brown University School of Medicine. She directs the Pediatric Sleep Disorders Clinic at Hasbro Children’s Hospital in Providence.
Owens and colleagues are now testing a five-question sleep screening survey designed to help a pediatrician uncover 95 percent of a child’s sleep difficulties. Information from such a survey may help parents who don’t know how much sleep a child needs or cannot define a sleep problem. Other parents may need a wake-up call that a child needs more rest and regulation.
“Use of a sleep screening survey may provide an opportunity for dialogue between pediatrician and parent as to what are sleep problems and what are ways to intervene,” Owens said. “If a 6-year-old doesn’t have a regular bedtime and drops from exhaustion in front of the TV set, that’s when a pediatrician has to say, ‘In order for your child to function and do well, it is important the child gets 10 to 12 hours of sleep per night and a more regular bedtime.’
“A pediatrician should tie the message to something tangible and concrete, pointing out how the child acts when tired, such as cranky, irritable, or hyper, and describing how this negatively affects one’s ability to do well in school,” Owens said.
Information from teachers is not usually gathered in sleep studies of children, but Owens and colleagues say teachers must be queried.
“Educators see the daily impact of sleep problems on children. Teachers routinely observe children in a different environment and under a different level of stimulation than parents.”
Teachers in the study said that at least 10 percent of students struggled to stay awake. Compared to parents, teachers also noted higher levels of daytime sleepiness in younger versus older children.
“I think the 10 percent figure reported by these teachers is just the tip of the iceberg for grade-school children,” Owens said. “This is an age range that is normally physiologically alert during the day. Our job is to inform teachers of the host of daytime sleepiness cues. If teachers knew what to look for, beyond behaviors such as yawning, dozing off and not paying attention, we’d probably find a lot more kids in school with sleep problems.”
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