Deirdre Budd’s Blog

Archive for the ‘Children and Sleep’ Category

For some years now we have known that an off-kilter body clock can throw off our sleep-wake cycle, eating habits, body temperature and hormones—and mounting evidence suggests a malfunctioning clock may also underlie the mood cycles in bipolar disorder.

In a Indiana University, a new study led by psychiatrist Alexander Niculescu, researchers found that children with bipolar disorder were likely to have a mutated gene, which codes for a particular  protein, crucial to circadian clock function. The team’s previous work identified alterations to this gene, and other clock genes, in animal models of bipolar disorder.  In the new study, the scientists compared the genomes of 152 bipolar children, with those of 140 typical children. (Children were studied because their moods cycle more rapidly than the moods of bipolar adults, and a quicker cycle suggests a stronger connection to the circadian clock.) The team found that the bipolar children were more likely to have one of four alterations to this particular gene. The investigators suspect that these mutations prevent the body from producing the right amount and type of protein to support normal circadian rhythm.

Previous studies have demonstrated that altering the sleep wake cycle has a profound effect on mood. Regulating sleep wake can improve extreme  mood cycles but the experts were not sure why, until animal studies showed  a connection to  the genes that control the setting of circadian rhythms.

Gerard CM, Harris KA, Thach BT are quoted in the Journal of Pediatrics in 2002 following two studies on swaddling. One was entitled ” Spontaneous Arousal in Supine Infants while Swaddled and Unswaddled During REM and Quiet Sleep” This study examined 26 infants swaddled and put to sleep on their backs. Over all this study demonstrated that swaddled babies slept for longer periods and had shorter arousals during REM sleep. They woke less during deep sleep than unswaddled babies. This study concluded that swaddled babies sleep longer and their parents also sleep longer as baby is safe, warm and sleeping better.

The second study “Physiological Studies on Swaddling” involved 37 infants introduced to swaddling at an older age and examined their acceptance of sleeping on their backs. This study demonstrated that the majority of infants, including 78% who normally slept on their tummies (prone), accepted sleeping this supine position. The authors concluded that it is never too late to swaddle, and even older babies can be helped to sleep on their backs and stay asleep longer when swaddled.

Then in 2005 a research project titled “The influence of Swaddling on Sleep and Arousal Characteristics of Healthy Infants “by Franco Patricia MD, PhD et al. Which was reported in Pediatrics Vol 115: 1317-131, examined the arousal threshold for auditory stress in swaddled sleeping infants. This study demonstrated that swaddling promoted sleep continuity, and decreased spontaneous arousal. This was also associated with increased responses to environmental auditory stress. Concluding that swaddling makes babies sleep longer but also makes them more alert to dangerous situations.

Despite  a popular misconception that swaddling is detrimental to a childs motor development, there appears to be no evidence to substantiate this. As long as babies are swaddled for naps and night sleep, but are allowed freedom of limb movement during wake periods, there is no reason to believe that swaddling is anything other than positive. Swaddling a child in a cotton or other breathable material, provides deep pressure, a feeling of being held without physical contact, security, comfort and safe warmth as there are no loose blankets which could cover baby’s head and face. Some babies will wriggle free of swaddling and as baby grows and develops this is a natural progression.

Overall there are far more benefits to swaddling a child, than to leaving a child who has not yet developed good limb co-ordination skills, with limbs free and likely to strike themselves when startled.

Infants and young toddlers with obstructive sleep apnea and sleep disordered breathing experience significant improvement following surgical treatment of the ailment, according to an invited article in the June 2009 issue of Otolaryngcology-Head and Neck Surgery

Sleep disordered breathing (SDB) in children, from infancy through puberty, while similar to adult sleep apnoea, actually has different causes, consequences, and treatments. A child with SDB does not necessarily have this condition when they become an adult. The consequences of pediatric obstructive sleep apnoea include snoring; sleep deprivation (which can cause moodiness and behavioural issues); abnormal urine production; slowed growth and development; and attention deficit and attention deficit hyperactivity disorders.

The study evaluated 73 cases in which children younger than two years old were treated for obstructive sleep apnoea through the removal of the adenoids, tonsils, or both (adenotonsillectomy). Those treated through surgery experienced significant improvement on the apnoea-o index (AHI), an index that measures the severity of sleep apnoea. Those treated medically, but not surgically, exhibited no improvement after treatment.

The study’s authors also concluded that the rate and types of post-surgical complications were within acceptable levels.

According to a study published in the American Academy of Sleep Medicine  a new study has found that alcohol consumption during pregnancy and small body size at birth predict poorer sleep and higher risk of sleep disturbances in 8 year old children born at term.

Those children who experience even low levels of foetal exposure to alcohol tend to have a short sleep duration and across all nights have a lower sleep efficiency.  Children born by Cesarean section are also more likely to have shorter sleep (7.7 hours or less) Most of the sleep disorder symptoms are bedtime resistance or sleep disordered breathing.

These results are in accordance with the foetal origins of health and disease hypothesis and the many studies that show that an adverse foetal environment may have life long influences on health and behaviour.

The authors of this study report that small body size at birth may function as a crude marker on disturbances in the foetal environment and reslts show that amoung children born healthy and at full term a linear relationship exists between smaller body size at birth and poorer sleep quality at 8 years of age.

Sleep deficit in Adults is recognised as a contributing factor in traffic accidents and accidents while operating machinery however recent research looking at the outcomes of sleep deficit in children shows a co relation between daytime sleepiness and accidental injury.

The NICHD study of Early Childhood Care, a study of 1,300 children were followed from birth to adolescence to identify if frequent night wakings resulted in increased risk of injury. This study followed on from two previous studies in 2000 and 2005 where a modest  but consistent link was identified. It is not surprising that tired children have poorer motor co-ordination, attention span and concentration, factors which may increase the risk of injury. (Fallone Owens and Deane 2002) It has long been recognised that tired children are more oppositional to rules, behave more impulsively, take more risks and have more mood disturbances. Again this increases the risks of accidental injuries.

Although this new study also raises many questions about the level of injuries sustained and the co relation of parental sleep deficit which may impact on parental awareness and  their reaction to aspects of child safety, the outcomes strongly suggest that children’s sleep dysfunction impacts on peer relationships, learning, immune functioning, as well as a range of physiological social and cognitive abilities (Loughin et al 2002)

From an applied perspective, these findings reinforce the need to aggressively treat sleep difficulty in young children, as a means to maintain not just cognitive and social development, but also physical health. From a theoretical perspective, the findings underscore the complexity of risk for pediatric injury, and the need to consider the multifaceted aspects of risk in the development of  appropriate intervention strategies.

Do not ignore your child’s sleep disorder.

If you need help to resolve night wakings or other sleep disturbance contact Dream-Angus.com

Mums who have post natal depression have difficulty interacting with their children. The baby tries hard to  elicit response from mum and when mum’s respond,  but without facial expression, the child becomes distressed and cries inconsolably. Yet a mum who attends to her child and uses a sing song voice,  and recites nursery rhythms often finds that, if she does not complete the rhythm, the child does.

We have long been aware that children understand rhythm from early development but the newest study done on newborns in Netherlands highlights  just how early this is demonstrable. While in the womb the regular heartbeat of mum surely must contribute to this phenomenon.  Now there is also the possibility that this is one aspect of learning which may contribute to learning language.

What helps a child, who has no language understand the nuances of mothers vocal communication? It could be that tone of voice provides some colour as much as facial expression when seen along with hearing the voice.

For many years newborn children were put to sleep on their sides, or on their tummies. Mums were told that a baby sleeping on his/her tummy, can still lift his head and turn his face the other way. Babies were seen to push up slightly on their arms and hands to achieve this.

The biggest concern of new parents has always been the possibility of Sudden Infant Death. This is a tragedy when it occurs and no one wants this to happen to their child.   Consequently when research suggested that babies would be safer if put to sleep on their backs many parents and health professionals followed this advice.  However, putting baby to  sleep on his or her back does not offer the opportunity for baby to practice turning his or her head and improving muscle strength to the neck and shoulders. Consequently there is now much effort put into persuading mums that baby should have some “Tummy Time” on the floor while awake and while attended by a parent or parents.

Now I am regularly asked, “How much tummy time should my baby have and when?”  If baby is fed, clean and comfortable, and you are willing and able to spend some time on the floor,  giving your child a few minutes each day is fine.  Children learn to roll over and make their own tummy time too. Encourage this with simple toys.