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When Your 200-Month-Old Can’t Sleep Through the Night

Her presentation was crowded because so many pediatricians are seeing these kids. In a study presented as an abstract at this meeting, researchers looked at national survey data about the sleep habits of 49,050 children from 6 to 17, to see how many were getting enough sleep. They used the A.A.P. guidelines for sufficient sleep: a minimum of nine hours a night for younger children and eight for adolescents.

Dr. Hoi See Tsao, a pediatric emergency medicine fellow at Hasbro Children’s Hospital and the Warren Alpert Medical School of Brown University, who was the lead author on the study, got interested in the subject when she worked as a teacher and noticed that many of her students were tired in class. The researchers found that 31.9 percent of the 13- to 17-year-olds did not get sufficient sleep.

The study looked at the association between how much sleep kids were getting and whether they appeared to be “flourishing” according to several measures. When parents and caretakers were asked about how their children were doing, the adolescents who were not getting eight hours of sleep a night had a 34 percent increase in the odds of not showing interest or curiosity about learning new things, a 34 percent increase in the odds of not staying calm when faced with a challenge, and a 36 percent increase in the odds of not doing all their required homework.

Younger children who were not getting sufficient sleep (that is, an average of nine hours on weeknights for those 6 to 12) also had higher chances of not showing these flourishing markers — in fact, their parents were 61 percent more likely to report that they did not show interest in learning new things.

This is a cross-sectional study, which shows association, not causation, but “it reinforces the importance of having children get enough sleep, the importance of setting good bedtime routines, a good sleep environment,” Dr. Tsao said. This may mean changes in the home, she said, but also advocacy on a community level, changes in the school system — school start times, homework loads — and a rethinking of how fully scheduled the days of children and adolescents ought to be.

[In California, a new law will shift school start times to help teens get more sleep.]

The consequences of sleep deprivation in adolescence include daytime fatigue, which can look like low energy and be marked by falling asleep in school, or like poor concentration and inattention. “The parent may be thinking the teen has A.D.H.D.,” Dr. Spinks-Franklin said, but in fact, attention deficit hyperactivity disorder is not something that develops suddenly in adolescence. And in addition to poor concentration, sleep deprivation may contribute to poor executive function, and an increased tendency toward bad judgment.

For some adolescents, this results in a more extreme picture, delayed sleep phase syndrome, in which they stay up later and later, trying to catch up by sleeping in on weekends, but shifting their circadian rhythms further away from being asleep at night and awake during the day. Treatment involves behavioral interventions, consistent wake-ups, scheduling changes and melatonin, but there is a high recurrence rate.

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