Our three sons are aged 15, nine and four years old. We have long had trouble getting all of them to sleep on time at night so they can be alert at kindergarten and at school the next day. They want to watch TV, play with their computers or other electronic devices. What are proper sleep times for these ages? The teachers of my older sons told me that the boys have some difficulty paying attention in class and seem to be tired. Do you have any ideas on how to teach them good sleep habits? S.B., Seattle, Washington, US.
Judy Siegel-Itzkovich comments:
New sleep guidelines for children from age four months to 18 years were recently issued by the American Academy of Sleep Medicine. They stated that from age four months to a year, babies need 12 to 16 hours of sleep. From age one to two years, 11 to 14 hours are needed, while from age three to five years, the recommended amount of sleep drops to 10 to 13 hours. From age six to 12 years, 9 to 12 hours are required, while from 13 to 18, the number of hours is between eight to 10 hours. All of these numbers include naps during the day.
Sleep hygiene, which includes practices like providing a cool and quiet sleeping environment or reading before bed time to help kids unwind, is increasingly popular among parents looking to ensure their children get a good night’s rest. A sleep expert from the University of British Columbia (UBC) nursing Prof. Wendy Hall comments that “good sleep hygiene gives children the best chances of getting adequate, healthful sleep every day. And this is critical in promoting children’s growth and development,” said Hall, who conducted a meta-analysis of many studies on the subject. “Kids who don’t get enough sleep on a consistent basis are more likely to have problems at school and develop more slowly than their peers who are getting enough sleep.”
The UBC review (produced at a university in the westernmost province of Canada) aimed at systematically analyzing the evidence for sleep hygiene across different countries and cultures and focused on 44 studies from 16 countries. The focus was on four age groups in particular: infants and toddlers, preschoolers, elementary-school-age children and teens. These studies involved some 300,000 kids in North America, Europe and Asia.
“We found good-to-strong endorsement of certain sleep hygiene practices for younger kids and school-age kids – regular bedtimes, reading before bed, having a quiet bedroom and self-soothing (in which you give them opportunities to go to sleep and go back to sleep on their own, if they wake up in the middle of the night,” explained Hall.
Even for older kids, keeping a regular bedtime was important. The review found research papers showing that adolescents whose parents set strict guidelines about their sleep slept better than kids whose parents didn’t set any guidelines.
Hall and co-author Elizabeth Nethery, a doctoral student in nursing at UBC, also found much evidence for limiting the use of electronic devices just before bedtime or during the night when kids are supposed to be sleeping. Studies in Japan, New Zealand and the US showed that the more exposure kids had to electronic media around bedtime, the less sleep they had.
One big problem with school-age children is it can take them a long time to get to sleep, so avoiding activities like playing video games or watching exciting movies before bedtime was important, Hall said.
Many of the studies also highlighted the importance of routines in general. A study in New Zealand showed family dinner time was critical to helping adolescents sleep.
Information provided by Chinese studies and one Korean study linked school-age children’s and adolescents’ short sleep duration to long commute times between home and school and large amounts of evening homework. With more children coping with longer commutes and growing amounts of school work, Hall suggested that this is an important area for future study in North America.
Surprisingly, there wasn’t a lot of evidence linking caffeine consumption (in cola, tea and coffee) before bedtime to poor sleep; it appeared to be the total intake during the day that matters.
While Hall said more studies are needed to examine the effect of certain sleep hygiene factors on sleep quality, she would still strongly recommend that parents set bedtimes, even for older kids, and things like sitting down for a family dinner, establishing certain rituals like reading before bed, and limiting screen time as much as possible.
She concluded that sleep education can form part of school programming. “There was a project in a Montreal school where everyone was involved in designing and implementing a sleep intervention – the principal, teachers, parents, kids, and even the parent advisory council. The intervention was effective, because everyone was on board and involved from the outset.”
I am a 35-year-old woman who has two children. My husband and I want another baby, but we have been trying for over a year without success. My fertility specialist did not find any physical problem in me or in him for my failure to get pregnant except that I am 25 pounds overweight. I was wondering if there is any dietary advice that could raise the chances of my getting pregnant. A.N., Elmira, New York, US
Dr. Olga Raz, head of the clinical nutrition department in the Health Sciences Faculty of Ariel University in Samaria, Israel, replies:
Creating a new life seems to be a simple process – sperm and egg meet and the process begins. The fertilized ovum is implanted in the uterine wall, where it grows until the embryo is formed. The word “seems” is key, because pregnancy is a very complex process that is influenced by many factors – physiological, hormonal, environmental (such as pesticides, smoke pollution and radiation). But there is another factor, which in the past was less known, and which is completely under our control. It is nutrition!
There are a number of well-known and important recommendations for women who are planning pregnancy, for example, stopping smoking and drinking alcohol and also having adequate sleep. I will focus mainly on dietary considerations.
One of the recommendations that many have already internalized is taking folic acid supplements even before you become pregnant, whether planned or not. It is now recommended that any fertile woman who has a chance of becoming pregnant take folic acid pills. This is because many studies indicate that taking folic acid significantly reduces the risk of damage to the development of the fetus’s brain and spinal cord.
The recommended dosages range from 400 to 800 micrograms a day and up to five milligrams in cases where there is a history of previous pregnancies with such fetal problems. “The Americans went further with the issue and enriched all types of flour intended for the food industry with folic acid.
An equally important but less familiar recommendation is weight loss for women who are overweight. This is because obesity in pregnancy affects the woman herself, which increases the risk of gestational diabetes, high blood pressure, preeclampsia and even a prolonged delivery that increases the risk of cesarean section. In addition, maternal obesity can also affect the health of the fetus, which even after its birth in adult life will be at increased risk for heart disease, diabetes, obesity and more.
In contrast to the practice of weight loss during pregnancy, moderate weight loss is permitted in the first trimester of pregnancy – of course, only with the care and supervision of a clinical dietitian. If the woman is very thin, however, this underweight may pose a risk to both herself and the fetus and develop into metabolic diseases in the future.
The problems associated with too-low or too-high a weight are caused by disruption of hormonal balance. Insulin is one of the important hormones associated with maternal obesity, and it will also affect fetal health. A woman’s obesity is associated with decreased fertility. In many cases, a moderate weight loss before getting pregnant improves hormonal balance. The desired body-mass index for a woman who gets pregnant ranges from 20 to 24. Not everyone can reach these numbers, but each can do the most to lower, in the case of obesity, or raise, in case of excessive thinness, her BMI.
Interestingly, a new Nurses’ Health Study conducted at Harvard University that encompassed more than 18,000 women examined the relationship between nutrition and fertility. There were some interesting results: The weight of the woman is an important factor in getting pregnant. The diet should be based on complex carbohydrates and comprise more than half the daily calorie intake. The study showed that before getting pregnant, women should eat non-lean dairy products with 0% fat. Even an occasional serving of ice cream raises the chance of getting pregnant. However, after getting pregnant, you should return to low-fat dairy products.
Trans fats, which are mainly in potato chips and French fries, industrial popcorn, industrial pastries, baked dough and butter should be avoided when you want to become pregnant. Make sure that food products have less than 0.5 grams per 100 grams of packaged food. Choose dairy products with 5% to 9% fat. But those who cannot eat dairy products for various reasons can eat proteins from low-fat sources such as chicken, turkey, fish, beef fillet/sirloin), legumes, whole grains and nuts. The recommended carbohydrates are complex carbohydrates such as legumes, whole grains, buckwheat, oatmeal, quinoa and the like.
Eating simple carbohydrates is not recommended for pregnant women. Avoid both white and brown sugar, as well as honey, corn syrup and date honey. Also keep away from foods containing a lot of sugars such as sweetened cereals, snacks, pastries and soft drinks.
Pregnant women should not eat plain white rice, white flour and the products made from it (not including high-quality durum flour). Choose healthful fats before pregnancy: These include olive oil, avocado, canola and tahini. When pregnant, avoid raw foods (sushi, beef carpaccio and fish) and cheese with mold. Check your levels of iron, ferritin, vitamin B12, and vitamin D. If there is a deficiency, take a diet or take multivitamins for pregnant women. Do moderate physical activity depending on the state of the pregnancy.
Always consult your obstetrician and a clinical dietitian about nutrition and supplements.
If you want an Israeli expert to answer your medical questions, write to Breaking Israel News health and science senior reporter Judy Siegel-Itzkovich at email@example.com with your initials, age, gender and place of residence and details of the medical condition, if any.