Tuesday, October 26, 2010

When the tables are turned: Trixie's adventures when her son gets his tonsils out

Denise and I have met parents who are so scared of putting their child through surgery to remove tonsils that they overlook how awful things are for their chid without the surgery. So, we see kids who desperately need their tonsils removed and whose parents, with the best of intentions, have convinced themselves that a tonsillectomy is worse than disrupted sleep, fatigue, failure to thrive, repeated bouts of infection and subsequent antibiotics, etc. This is a case of the devil you know not being as bad as the one that you don't know.

Trixie, of course, is not one of these parents. When her darling son had his second bout of strep throat and Trixie performed a complicated medical procedure called"looking at the back of his throat with a flash light" and saw that her DS's tonsils were the size of small plums, she pleaded with her pediatrician to consider tonsillectomy. After six more bout of strep, one of which migrated to Trixie herself, she scored a visit to the otorhinolaryngologist or ear' nose and throat doc. Thinking that she had finally found an advocate, since this man presumably feeds his children by removing the tonsils of other children, Trixie was shocked when the surgeon suggested that"we do not remove tonsils because they are large". The poor little darling had to get strep yet again to be taken seriously.

So, what am I talking about? Well, two things, I think. One is that, if your child has a chronic condition that is affecting his or her sleep, then get the problem fixed. The effects of long term insufficient sleep in a child is very serious and, if the cause is big tonsils, then resolving the issue is relatively simple.

The second is that sometimes you really need to be an advocate for your child and that may mean ditching Miss Manners and being downright pushy.

Monday, August 23, 2010

We Know Who this is REALLY About

Why, YOU, of course, sleepy parent.  We know that the reason you are concerned about your child's sleep is because it impacts your own.  Trixie remembers taking a class for New Moms when she herself was a new mom and listening to another class member complaining about her baby's sleep pattern.  The little tot was going to bed at 8 and was waking at seven or seven-thirty in the morning.  The rest of the class was shocked to hear that a baby would actually someday maybe perhaps sleep through the night.  But not this mother.  No, no, no.  She had always slept until 8:30 or 9 in the morning and didn't understand why the baby wouldn't sleep later.  So, the rest of the class immediately got up and strangled her for being so, um, STUPID.  And SELF-CENTERED. 

However, once cooler heads prevailed, that mom's desire to go back to her old life of sleeping until 9AM started to sound less selfish and more like, um, the rest of us.  Whether it's sleeping in or peeing with the bathroom door closed or eating in a restaurant without a children's menu, we all give up a lot for our kids.  And when we are sleep deprived, it makes it that much harder to deal with all that we've sacrificed.  So, the sleep patterns of those little darlings become even more important to us to control.

If your children, like Trixie's, wake up at the CRACK OF DAWN, it's okay to push bedtime back a bit.  It is our belief that all children under the age of 12 should have a bedtime of no later than 10PM.  For kiddos under the age of 6, it should be by 9PM.  If your kids don't have issues with sleep other than waking up early just to DRIVE YOU NUTS, then push bedtime back by half an hour or so to keep them asleep past the rooster's first crow.

An actual informative discussion of sleep scheduling could take another entire post, so we will leave it here for now, with more to come on scheduling.

Tuesday, August 17, 2010

Don't Fall Victim to SPS!

Denise and I frequently observe a phenomenon that is common enough that we have decided to name it as a syndrome: Stupid Parent Syndrome.  Sadly, it seems that even non-stupid parents can succumb to SPS and that sleep-deprivation can lead to SPS.  Here are some symptoms and some suggestions on avoiding this syndrome.

The major finding of SPS is doing almost anything that a child requests.  This includes and is not limited to these symptoms:
  • Feeding the child sugar close to or after bedtime
  • Allowing a child under the age of 10 to drink caffeinated beverages, including Mountain Dew or a Starbucks Mocha (chocolate and espresso, in case you don't know)
  • Allowing the child to dictate his or her bedtime
  • Agreeing with the child when the child states that he or she Will Not Go to Sleep
  • Supporting the child when the child insists that he or she Needs TV to Fall Asleep
  • Jumping out of bed everytime a baby (over the age of 6 months) makes a noise and then MOVING the baby around to make sure he or she is okay thus WAKING the baby.
Here are some ways to avoid SPS:
  • Set rules for bedtime and MAKE YOUR CHILDREN FOLLOW THE RULES
  • Do not feed your child sugar or espresso or caffeine, especially not within 4 hours of bed
  • Remember that YOU ARE THE BOSS OF THEM
  • Keep in mind that babies have been sleeping for MILLENNIA without constant observation, so your baby will be fine, too (rule of thumb here: if your baby (over the age of six months) got herself into a position, she can get herself out of it)
  • NO ONE needs TV to fall asleep.  Humans fell asleep without the use of televisions for many years (at least according to Trixie's husband, who was born in the 1950's and is therefore Old) and there has been no detectable change in the genetic code that supports the need of TV to initiate sleep in the Modern Human.
Remember that you are in control (even when that doesn't appear to be the case.)  So, you have the POWER to make all of this happen.  There, you are now an official Superhero. 

Oh, wait, we can hear you already:
"My three-year old will not go to sleep without the TV on.  He demands that the TV stays on until he is asleep."

Really?  He "demands" it?

We think not.  We think that you have allowed it to happen and that this may be how it happened:
Once, when you were VERY tired and the little bugger WOULD NOT GO TO SLEEP, you allowed him to stay up watching TV until he fell asleep and then you put him to bed.  Then you went to sleep and it was good.  So, the next night, when Jakie threw a tantrum, you may have succumbed to the innocuous sound of the theme song from the Backyardigans again.  And then, in order to avoid those bedtime tantrums, a pattern was established and now the cunning, clever little tot gets TV EVERY NIGHT.

So, the pattern was established.  Now, my friend, it's time for a new pattern.  Remember that it only took a few nights to make the old pattern and it will only take a few nights to make the new pattern.  IT WILL NOT BE PRETTY: there will be tantrums and drama and angst and exhaustion.  And then there will be a new pattern, without a TV or a sugary snack or whatever else it is that your darling says she cannot sleep without.

So, Superhero, go forth and conquer the bedtime hour!  Use your new Superpowers to avoid SPS!

Sunday, August 15, 2010

So What Does Weight have to do with Sleep Apnea anyway?

Good question. And, since we know everything, we will attempt to answer it and will follow with a little about one of Denise's recent patients.

If your child is overweight, his or her lungs can't move as well in the chest. That's because the big belly is pushing up against the diaphragm and the diaphragm needs to be able to move up and down to pull air into the lungs. The other thing that happens is that there is extra *stuff* (the technical term is "tissue") in the back of the throat, at the entrance to the pipe that goes to the lungs. So, during sleep, the number of times that you breathe in a minute decreases PLUS the diaphragm is having trouble moving down because it's being pushed up by belly fat PLUS there's extra stuff in the back of the throat. Not good. But wait, there's more! During dream sleep, all of the voluntary muscles in the body are paralyzed; the diaphragm is not a voluntary muscle, but all of the muscles in the ribcage and neck are and so they can't help the diaphragm out. So, now, there's lots of extra stuff flapping around in the back of the throat, the diaphragm is compressed by the belly fat, and there's NO ONE AROUND TO HELP. This makes for a BAD SCENE. BTW, the stuff flapping around in the back of the throat usually makes a noise, for which the technical term is SNORING. Write that down. (just kidding.)

So, in the pediatric sleep lab at the World's Greatest pediatric hospital, we see lots of overweight kids who snore. And sometimes we can get a little lazy (especially since we know everything) when we see an overweight kid come in and we want to leap to the conclusion that the patient has obstructive sleep apnea. And, a lot of the time, we would be right.

However, as Denise discovered the other night, there is a reason that we get paid the big bucks to stay awake all night long watching our little angels sleep: sometimes the overweight kids don't have sleep apnea and are tired in the daytime or have disturbed sleep patterns for another reason.

Denise's patient was 3 years old, about 36 inches and 80 (EIGHTY) pounds. In kids, a general rule of thumb for the first 6 years or so, is one pound per inch, so we see lots and lots of cute toddlers who are 36 inches tall and weigh 36 pounds or 5 year-olds who are 48 inches tall and weigh 50 pounds or so. This child's (can I say Butterball?) BMI was 43, well into the obesity arena. While talking to the patient's mom, Denise found out that the 3 year-old was still getting a bottle at night. Bad enough, but wait, there's more! When our beloved little Butterball awakened in the night, she was given MORE MILK. So, she was drinking about 24-32 ounces of WHOLE MILK at night, every night. Denise asked Butterball's mom why she wasn't given water and mom said it was because Butterball liked milk. Well, we like martinis, but we know not to drink 24 ounces worth of them after bedtime (that's what cocktail hour is for.)

So, Denise convinced Mom of Butterball to forgo milk for the night and to just give her water if she was thirsty. And, lo and behold, once our beautiful BB got some water, she didn't ask for another bottle, slept through the entire night and DIDN'T HAVE SLEEP APNEA.

The moral of the story? Damned if I know. HOWEVER, if your child gets up frequently during the night, remember to revisit what you're doing to get the little darling back to sleep or you could be conditioning your sweetiepie to demand something that, while okay as an infant, isn't okay as a child or toddler or college freshman.

And if you want to wake Trixie with a martini, please remember the olives.

Saturday, August 14, 2010

An Apple a Day

Since Denise and I are perfect and know everything (just ask Trixie's Darling Husband), we know that you may have some actual real questions about when you should take your Little Darling to see the doctor. Like most of what we've written here so far and will write in the future, the answer is deceptively simple: if you are concerned about your child, you should talk to your pediatrician about it. If this is easier said than done, then you need to find a different pediatrician.

You and your pediatrician's office should be partners in crime, with the singular goal of getting your child to the age of eighteen without major physical damage (it is your singular job, as the parent, to keep said child clean, in school and out of jail.) If you don't feel like you are part of the pediatrician's team in this respect, then you should look for another office. And that's not terrible or bad or mean to the doctor. Remember this about doctors: almost all of them are HUMAN BEINGS, just like you. So, it might be a personality issue or a convenience issue with the office; bottom line is that you need to be comfortable with and able to communicate with your child's doctor.

While keeping in mind that you should call your doctor's office for anything that you feel is concerning, here are a few of the many reasons to call regarding sleep issues:
  • You have seen your child stop breathing during sleep (we hope that that was a no-brainer)
  • Your child consistently wakes up with a headache
  • Your non-teenage child complains of being tired on a daily or near-daily basis
  • There is a major change in sleep patterns (waking during the night; unable to wake in the morning; unable to fall asleep at night).

Friday, August 13, 2010

A Little Bit About Sleep

We, of course, know everything that there is to know about sleep, since we are official sleep technologists. We could, of course, regale you with stories of the suprachiasmatic nucleus and hypnagogic hallucinations, but that would just be showing off. Parents of our patients in the sleep lab, and sometimes the patients themselves, often ask us about sleep: when does deep sleep happen? When does dreaming sleep happen? Are deep sleep and dreaming sleep the same? So, for all of us who relied on Cliff Notes, this is what you need to know about sleep:
  • We all need sleep, especially parents, who may need it just to get away from the kids for awhile
  • Chemicals in our bodies keep us awake and put us to sleep, sort of like naturally occurring coffee in the morning and wine at night
  • Once we fall asleep, we go through a repeating pattern of light sleep-deep sleep-dream sleep
  • This pattern is very easy to see in kids. Just ask anyone who has ever taken a toddler who has been asleep for more than 30 minutes, changed the toddler's diaper and forced his body into footie jammies while he remained asleep.

That, friends, is pretty much all you need to know about sleep.