Connections is a quarterly newsletter for primary care providers covering the latest developments and advances in medicine at OHSU. Learn about the many clinical, education and outreach resources available to you and your patients.
From OHSU Doernbecher Children’s Hospital
Elizabeth Super, M.D., FAAP, DABSM
Dr. Super is a pediatric sleep medicine physician with a special interest in children with complex medical comorbidities.
If there is a silver lining to staying at home during the pandemic, it may be that children and adolescents have more opportunity for sleep! But are they?
We know adults are experiencing disrupted sleep with rising levels of anxiety and depression, likely related to pandemic stress, uncertainty and reduced physical activity and socializing. Children have the same stressors at this time, but quality sleep can be protective of their physical and mental health.
As providers, we can help parents and youth navigate getting sufficient sleep by asking about sleep habits at every virtual or in-person visit with every school-age child or adolescent. Spending five to 10 minutes discussing the importance of sleep is a good reminder, and may open discussion for suggesting simple interventions and guidelines.
At each visit:
Review recommended sleep times by age with parents
- 11–13 hours for toddlers
- 10–12 hours for children 5–12
- 9.5 hours for adolescents
Parents should set bedtimes accordingly for younger children, but with adolescents, parents may want to discuss goals together in setting sleep/wake times. Later bedtime during the pandemic may still allow for adolescents to get adequate sleep due to later school start time.
Consider a “prescription” for bedtime and wake time with families. On weekends, bedtime/wake time can be an hour later, but not more than an hour. The body’s clock starts to shift if the routine is overly disrupted.
One key to knowing if children and teens are getting enough sleep is if they wake up naturally at the usual time. The body thrives on schedules!
Recommend a structured bedtime and bedtime routine with parental involvement — even in adolescents
Everyone benefits from a 30-minute wind-down of relaxing activities in dim lighting.
Parents are often involved in bedtime routines of younger children, including baths, story time, tuck-in routines and more.
As children shift into adolescence, those routines tend to slip away. Parents may want to restart a bedtime routine with their older children as special protected time to talk or read together.
Set limits on screen time
Encourage setting limits around nighttime media for everyone, so that electronics are turned off or removed from the bedroom at least 30 minutes before bedtime.
Suggest creating a separate space for activity, so that the bed is associated with sleep
The bed should be used only for sleeping, and sleep should be confined to the bed.
Homework, Zoom meetings and gaming should take place outside of the bed. Parents can help their children and teens set up alternative spaces for these activities.
Good sleep hygiene should help relieve basic insomnia and sleepiness issues. However, if a patient has persistent disrupted sleep, it can be a sign of mental health issues or breathing disturbance, such as sleep apnea, that should be investigated.
By prioritizing sleep in children, we can help them grow and develop during this difficult time.
New OHSU Doernbecher Specialty Pediatric Clinic to open in Happy Valley
Dr. Super and other OHSU Doernbecher specialists will be seeing patients in our new specialty clinic in Happy Valley, opening this spring.
Pediatric specialties offered at this location include sleep medicine, endocrinology, orthopaedics, cardiology, gastroenterology, dermatology, pulmonology and urology.
For convenient specialty care for residents in the eastern Portland metro area, the new clinic location is 10151 S.E. Sunnyside Road, Suite 110, Clackamas, Oregon.
When to refer or consult
- When there is clinical concern for obstructive sleep apnea (persistent snoring, mouth breathing or witnessed apneas)