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Published August 11, 2012, 11:30 PM

Sleepy-time struggles: Well-known pediatrician addresses one of parents biggest concerns in new book on sleep

FARGO - Exhausted parents everywhere, get out the pajamas. It’s time to do something about sleep. Children’s sleep schedules have become a top parenting topic, regularly featured in parenting magazines.

By: Sherri Richards, INFORUM

FARGO - Exhausted parents everywhere, get out the pajamas. It’s time to do something about sleep.

Children’s sleep schedules have become a top parenting topic, regularly featured in parenting magazines.

Before a speech in Fargo last spring, early childhood family educator Mary Sheedy Kurcinka said protecting a child’s sleep was her most repeated piece of advice. Tips from Sheedy Kurcinka’s book “Sleepless in America” were included in this fall’s Cass County Extension parenting newsletter.

Local physicians say parents often ask about sleep. How much sleep should my child get? How can I help her fall asleep?

Now America’s preeminent pediatrician Dr. Harvey Karp, whose infant-soothing techniques are taught to parents across the nation in Lamaze and parenting classes, has released a new “Happiest Baby” book – a “guide to great sleep” for 0- to 5-year-olds.

“In addition to triggering a host of daytime behavior problems like tantrums, crankiness, aggression, impulsivity and defiance, sleep deprivation results in ‘three strikes’ against learning: poor attention, poor knowledge acquisition and poor memory,” Karp writes in a chapter about 1- to 5-year-olds. “Studies have also shown an association in little kids between too little sleep and health issues later. … It appears that there’s a critical period in the early years when inadequate sleep undermines development, even if sleep habits improve later on.”

Children process memories during REM sleep, Karp says. And crucial growth hormones are secreted during deep, slow wave sleep, says Dr. Seema Khosla, a physician with the North Dakota Center for Sleep in Fargo.

Khosla doesn’t treat patients under the age of 18, but she’s regularly asked by coworkers and patients about their children’s sleep. Some have difficulty initiating sleep. Some fight to stay up late only to be sleepy the next day, which causes their school performance to go down.

Though not an expert in children’s sleep, Khosla, a mother of three, thinks parents often underestimate how much sleep their kids really need. An overtired child won’t act sleepy, but rather wired and hyper, she says.

“If your child doesn’t wake spontaneously, it is because they’re not getting enough sleep,” she says.

One thing Khosla says she learned about kids and sleep during her training: “Most of kids’ sleep problems are really because of the adult, parent behavior,” she says. “It’s natural for them to push and fight and try to get their way. It’s a matter of establishing routine and boundaries.”

Dr. Praveen Kumar, a pediatrician with Essentia Health in Fargo, hears from parents when their toddlers, who previously slept continuously, begin a cycle of night waking. “That makes the parent also a bit concerned because their night is interrupted,” he says.

Karp points out that when kids don’t sleep well, neither do their parents. This sleep deprivation can lead to depression, illness, marital conflict and obesity.

“The No. 1 complaint parents of young children have today is they’re exhausted,” Karp said in a phone interview with The Forum last week. “Parents today are being stretched in so many different directions.”

Families don’t have the same support network they used to, and many parents today haven’t had any experience taking care of children until they have their own, Karp adds. He says there are many misunderstandings about sleep, such as whether it’s OK to rock a child to sleep in your arms.

His new book discusses the science of sleep, and utilizes tips from his other books and DVDs, “The Happiest Baby on the Block” and “The Happiest Toddler on the Block,” to create good sleep habits in infants and cooperation in older children.


Karp promotes a “wake-and-sleep technique,” where parents gently rouse their sleeping baby when placing him in the crib. “These few seconds of drowsy waking are essential for teaching your baby to self-soothe,” he writes.

He also advocates the use of white noise, something he says he’s really trying to educate people about.

“People think if baby sleeps well swaddled, they don’t need white noise. But it’s necessary, because once you remove the swaddling, everything falls apart,” Karp says.

“The white noise helps them sleep through teething and growth spurts through the first year and even beyond for some families,” he says, adding that its effectiveness depends on the type of white noise used. While high-pitched white noise is good for calming crying babies, a lower, rumbly white noise helps people fall asleep, he says.

Karp’s “Happiest Baby” CD features a specially engineered white noise sound, he says. The track is also available on iTunes.

Karp, Kumar and Khosla all stress the importance of a bedtime routine. Kumar refers to it as “sleep hygiene.”

Some of their universal tips include:

  • Dim the lights 30 to 60 minutes before bedtime. Bright lights delay the release of melatonin, a hormone that helps bring on sleep.

  • No screen time or rough play an hour before bed.

  • Give the child a warm bath and massage. This relaxes the child, and going from the warm water to the cooler air reduces the child’s body temperature, a natural sleep cue.

  • Include special time with Mom or Dad, such as bedtime stories, lullabies or prayers.

  • Karp says good bedtime routines start when a child wakes up, with plenty of outdoor play, a healthful diet and sufficient daytime sleep.

It’s important parents don’t use the child’s bedroom as a place for time outs, Kumar says. “The kid should not correlate the room as a punishment room,” he says.

Khosla has heard of pediatricians recommending melatonin, an over-the-counter supplement, for children who have trouble falling asleep, which she finds a bit disconcerting.

In his book, Karp mentions melatonin as a medicine that can help children with serious sleep problems, though he says parents should always consult a doctor and only use a reputable brand.

But Karp’s strategies focus mainly on that pre-bed and bedtime routine. He says teaching children to self-soothe at an early age, eliminating sleep disruptions (external ones like light or internal disturbances such as hunger), and the right bedtime (not too early or late) will help all children sleep through the night – a dream for any parent.