How Serious Fatigue Can Affect Child Development

sefcacdTired kids=cranky kids. That’s obvious. But research shows that fatigue can hurt children in lots of other ways too. Here, Kathleen Powers talks to Will Wilkoff, M.D., about how parents can tell if a child needs more rest-and what to do to help.

“Your child,” says Dr. Wilkoff, of Brunswick, Maine, “has two personalities: one that’s well rested and one that’s not.” In the waiting room of his pediatric practice, Dr. Wilkoff says he’s seeing more and more of the tired side (along with parents who want him to make their real child return).

The author of two parenting books and a graduate of Harvard Medical School, Dr. Wilkoff says he was motivated to write his latest, Is My Child Overtired? (Simon & Schuster), to address a national sleep shortage. “Since Thomas Edison invented the lightbulb,” he says, “we’ve been extending our waking hours further and further beyond their healthy limits.” Indeed, the National Sleep Foundation reports that Americans get 20 percent less sleep than they did a century ago.

“People today,” Dr. Wilkoff says, “are trying to cram so much into twenty-four hours that many, many children–not to mention most of their parents–are sleep-deprived.” Here, he describes some of the serious effects that fatigue has on children’s behavior and emotions.

Are tired kids a trend?

Parents with cranky, anxious, and misbehaving children are consulting doctors like never before. In the past few years, the use of psychoactive drugs such as Prozac to manage these symptoms has grown so dramatically that many of us in the medical field see an alarming trend. Often, the child’s real problem is sleep deprivation.

Any parent knows that a too-tired toddler will be cranky, whiny, and more tantrum-prone. What are the signs in older kids?

A school-age child may act grouchy, moody, and withdrawn to the point where he doesn’t want to play with friends or stops showing interest in his usual hobbies.

Not getting enough sleep can also make a child distracted, easily frustrated and, in some cases, hyperactive. This last behavior might seem counterintuitive: When most of us get tired, we wind down, our emotions get quieter. But fatigue makes some adults and children more active, more intense. In kids, this behavior sometimes gets treated with drugs like Ritalin when trying to help them stay rested would be a better first step.

What about really troubling behavior-the kind that might lead you to think your child has a psychological problem. Can that be sleep-related?

Definitely. The signs of depression and fatigue, for example, closely mimic each other. A recent study of nearly 5,000 adolescents published in the journal of the American Academy of Pediatrics found that the two conditions may in fact be related.

Kids can also have fatigue-related fits, where they get that wild-eyed look and say shocking or nasty things. It can get so severe that parents might be concerned their child has something like bipolar disorder.

So how do you know if it’s fatigue talking?

You’re not going to know at that moment. My advice is to step back and say, My child is having an episode of bizarre, irrational, aggressive behavior, and revisit the issue the next day when everyone has gotten more sleep.

You may find your child’s behavior changes if she sleeps better for several days. If not, it’s time to talk to your doctor, who can recommend the next step.

In a time of upheaval in a family, should parents try to make sleep more of a priority?

I don’t think it’s realistic to think families can schedule more rest during a time of crisis, but you want to keep the child’s sleep patterns near the top of the priority list. Something I see quite often in my practice is how disruptive divorce in particular can be to children’s sleep. Parents who are sharing custody will often tell me that when they get their child back on Sunday, it takes until Wednesday for his behavior to get back in line. Some of this may be a result of the child being allowed to do anything he wants when he’s visiting the other parent over the weekend, but more often than not it’s related to fatigue, a result of one parent trying to pack a lot of activities into a short period of time.

How does fatigue’s emotional fallout affect schoolwork?

Studies have shown that: a lack of sleep significantly impairs children’s progress in school. In terms of its emotional effect, fatigue ratchets up the frustration level quite quickly. If a sixth-grader is doing her homework at ten o’clock at night, she’s more susceptible to getting upset if something stumps her and less likely to hang in there and do a good job. Just as parents, too, have less patience to help with schoolwork as the night wears on.

What can parents do?

Practice prevention. Get kids started on their homework earlier, and get them used to a regular nighttime schedule that includes a set bedtime with a wind-down period of one or two quiet activities.

But if you get stuck in one of those late-night meltdowns, suggest that your child go to bed, and offer to get her up early enough in the morning to finish.

Should you ever tell your child he’s “just tired” if he’s acting up?

Yes. You can teach children something critical by pointing out the link between their behavior and sleep. Tell them, “I’m sending you to your room because you’re misbehaving, and I think a lot of it is because you’re tired. Get some rest, and you’ll feel better.”

Some people resist sleeping when they need to their whole lives. I have three children, and two of them have learned very well what their limits are, and what happens when they get tired. But I’m not sure my oldest has figured it out yet. And she’s nearly 30.

What do you do with the kind of kid who just doesn’t like to go to bed–and stay there?

Give the child no options when it comes to bedtime. No TV, no reading, no video games, no sitting on the couch with Mom and Dad until he feels tired. Make him stay in the bedroom with the lights out. Otherwise, he’ll just stall as long as he can.

What about anxious sleepers? It seems like so much of the advice is conflicting: You want to comfort them, but you can’t be too soft and prolong the behavior.

I lean toward the harder line. Children are reassured by firm and confident parents. If you really need to comfort them, stay in their room to do so; it interferes with everyone’s rest if you let them get used to sleeping in your bed. I tell parents to sit beside the child’s bed until she falls asleep, then progressively move the chair farther across the room each night.

How can parents stay calm about sleep issues when they’re tired too?

They can’t. Parents need to be rested to be effective and compassionate with their children. For some families, big changes in their daily schedule will be needed to make sleep the priority it should be. But I think it’s worth it.

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