Dr. Dan Ariely wrote a very interesting post yesterday about business education, its value, and how he proposes to increase its value and utility. I especially like the epigraph by Derek Bok.David Brooks published an interesting column in today's New York Times about the qualities that make a good C.E.O. His conclusions, however, were different than Dr. Ariely's.
In response to my recent posting on teaching an older child how to fall asleep on her own, a reader wrote:Recently, our 6 year old has started to have a very difficult time falling asleep. He actively tries not to, complaining that sleep is boring and that he doesn't know how to go to sleep. Advice?
Last week a friend emailed me something he had seen on the internet about a court case that had come before the Northern Territory Supreme Court in Darwin, Australia last summer. A 48 year old man who stood accused of "gross indecency and intercourse without consent" with a female houseguest, pleaded not guilty to the charges, claiming he was asleep at the time.
There is no "correct" answer for when the best age is to modify a child's sleep behavior. Usually, the best time to do this is when the parents have come to the conclusion that their child's sleep behavior has become too disruptive, and needs to change.
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.
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.
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.
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."
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.
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.
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.
"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."
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.
It is hard to think of a tragedy more heart-wrenching than the unexpected death of a previously healthy infant who is placed in her crib at night and dies in her sleep without warning. Crib death, or sudden infant death syndrome (SIDS) affects otherwise healthy infants, and is the leading cause of death in babies between the age of 1-12 months.
"Is it normal for a 7 year old to climb into bed with his parents in the middle of the night, every night?", with the age and gender of the child varying according to who is asking and at whom they are glancing pointedly while doing so, is a question I am asked at least once a month, whether in clinic, or at talks that I give.
Many children with ADHD suffer from an underlying physical disorder causing fragmented and disrupted sleep, such as obstructive sleep apnea, or periodic limb movement disorder, which is either the sole or main cause of their ADHD.
The question remains whether we want the school day planned in such a way so that our children's learning is optimal, or so that it is merely acceptable, while making sure that parents are able to get to work on time. It should be recognized that these (and other) conflicting needs result in a compromise which is not always to the children's advantage.
It is very important to remember that getting a good night's sleep, both in terms of quality and quantity, is no less important for one's physical health than eating right, or getting enough exercise, and that in children it has been shown that the lack of a good night's sleep is associated with negative cognitive, developmental and behavioral consequences.
According to a report in the British Newspaper “The Guardian” from 3/08/2009, Dr. Paul Kelley, headmaster of Monkseaton Community High School in North Tyneside, England, has proposed sweeping changes in the timetable at his institution, which would entail having classes start at 11 AM, instead of the more usual 9 AM. This comes following testing...