Sleeping Angels

How children's sleep affects their health and well being.

Dennis Rosen, M.D. is a pediatric sleep specialist who practices at Children's Hospital Boston. See full bio

May 2, 2009

Kids are NOT just little adults

The first rule of pediatrics, which all medical students learn on the first day of their rotation in the pediatric department, is that kids are not little adults. Because children are constantly growing and developing, certain interventions can (and sometimes must) be made which not only do not work in adults, but may prevent the problem from recurring in adulthood. Conversely, there are some therapies, standard in adults, which are unsuited for children. There are also outcomes of certain disease states in children, not seen in adults, of which one needs to be aware. Read More

April 30, 2009

Get those kids to bed on time!

There is an interesting study appearing in the May issue of Pediatrics by a Finnish group who found that short sleep duration (less than 7.7 hours/night) in children age 7-8 correlates with increased risk for attention deficit/hyperactivity disorder (ADHD). It certainly adds further evidence to the connection between sleep, behavior, and daytime function in kids, something which should not be news to any parent. Read More

April 28, 2009

Responding to a crying baby: how much is too much?

There is a big difference between being non responsive and indifferent to a child's crying, which can generate feelings of anxiety and abandonment, and not submitting or giving in to what s/he is demanding, which typically leads either to frustration, further crying, and escalation, or to acceptance. Read More

April 26, 2009

Concerns about negative long term effects of sleep behavior modification in children

One reader writes:

"I have tried sleep training in the past, when my daughter was an infant, but was not able to stick with it because of my fear that I was causing my child some psychological harm by not responding to her cries. I had a lot of questions nagging on me as I listened to her cries. Am I sending my child the message that mother is no longer responsive to her needs? Am I just teaching her learned helplessness? Will she be angry or confused? Is all of the intense crying going raise her stress hormones or damage her amygdala? These are the sorts of questions/fears that sabotage my efforts to adhere to sleep training. I would find it very helpful if you could discuss studies that have looked at the long-term consequences of sleep training. Are there studies comparing children who were sleep-trained to children who were not? I guess I just want some reassurance that letting my child cry it out until she learns to sleep won't cause her psychological harm". Read More

April 24, 2009

Solicitation for questions, comments, and suggestions for postings on specific topics

Dear Readers, I have been posting on this blog for the last several weeks, and feel it's been going well. I have especially enjoyed the feedback I've been getting, and would really like to encourage it, as this is probably the most fun part for me. So please send me your thoughts, comments, suggestions for topics, questions about children and sleep, and I'll try and incorporate them into future postings. Read More

April 22, 2009

Why it is so important for families to be involved in end of life decisions

Dr. Talya Miron-Shatz posted an entry on her blog Monday about the negative effect of involving families in making end of life and withdrawal of care decisions for critically ill patients in whom there is no hope for survival. She gives two examples, one of a young man terribly injured in a motor vehicle accident, the other of a very sick premature infant. In both, further intervention is seen by the medical team as futile, merely delaying the inevitable and needlessly prolonging suffering. Read More

April 17, 2009

Getting a toddler to fall asleep on her own instead of on her mother's breast

A reader wrote, in response to my last post:

Any suggestions about what to do with an almost 2 year old who still needs to falls asleep while nursing on mommy's breast. Isn't 2 years old too old for the Ferber Method?

My answer is: it depends. The first question I would ask is, is this arrangement satisfactory for the members of the family unit involved? If everyone is happy, why change it (a variation of the "if it ain't broke don't fix it" rule)? If, on the other hand, it isn't working (the nursing is taking up too much time, is interfering with her being able to sleep properly, or disrupting her interactions with the other members of the family), it is time to make changes. Read More

April 15, 2009

The baby who wouldn't sleep

"My 8 month old is only sleeping 6 hours a day, and it's killing me. I haven't had a good night's sleep since we came home from the hospital. This can't be normal!"

This is how my first meeting with the mother of my first patient on a wintry Thursday afternoon began a few months ago. " Anne", the proud but utterly exhausted mother of "Jacob", was at her wit's end. While absolutely adoring her son, who was sitting in her lap, babbling and smiling when he wasn't busy sucking on his fingers, alert and happy as a clam, she had come to the end of her rope. Not having slept properly for 8 months will do that to you. Read More

April 6, 2009

On vampires, ghosts, succubi and incubi

In response to my last posting, about a patient of mine whose house is haunted, Allison Jornlin wrote:

So what relationship did hypnogogic/hypnopompic hallucinations play in the haunting:

* Did the hallucinations cause the family to imagine ghostly happenings in the waking world?
* Did the hallucinations offer a gateway for some actual entity to come into the waking world?
* Did a ghost cause the sleep disorder which resulted in the hallucinations?

I'm interested in hearing Dr. Rosen's conclusions about this very intriguing case. Did Dr. Rosen experience the ghost himself? Are there any similar cases available for the interested research[er] to review?

Unfortunately, I did not get to personally meet or experience the ghost, and, despite trying to be as open minded as possible, am still not convinced that one actually exists. It is therefore not possible for me comment on what may have allowed him to enter the waking world and to become part of this family's life. However, it is important to stress that this child did not have hallucinations upon falling or arousing from sleep ("hypnogogic" and "hypnopompic", respectively), and felt (as did the rest of the family) that the ghostly presence and its activities were unrelated to his or their sleep. Read More

April 4, 2009

A ghost in the house

A few months ago, I took one of the most unusual patient histories that I've heard since starting my medical training over 21 years ago (I have changed some of the identifying details). I was seeing an 11 year old girl from a neighboring state who had been referred to my clinic because of difficulties sleeping that were felt to be causing excessive daytime sleepiness, behavioral problems and negatively affecting her school performance... In order to complete the sleep history, I asked her about hallucinations while falling asleep or waking up.

"Do you ever see or hear something you know isn't there as you are falling asleep or waking up?" I asked her.

"We have a ghost in our house" she answered. "His name is Simon". I looked over to her father to see his response, and was surprised to see him nodding his head in agreement. Read More

Sleep Basics

For many of us, sleep is the sweet balm that soothes and restores us after a long day of work and play. But for those for whom sleep is elusive or otherwise troubled, the issue is far more fraught. Most people, at some point in their lives, experience difficulty falling asleep.

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