Dr. Henry Paul, MD

Psychiatrist, Author and Educator

GETTING CHILDREN BACK TO SLEEP AS SCHOOL STARTS

September 5th, 2014

School Daze: Getting Kids Sleep Habits Back on Track (CBS News) offers suggestions for getting children back into a normal sleep routine after the lazy days of summer. Staying up late and sleeping until noon, no longer works when you have to get up for school.

Make sure that your children get enough sleep – at least eight hours. Talk to them about the importance of sleep on their overall health and their performance in school, both academically and on the athletic field.

If you suspect more serious sleep issues make sure to contact your pediatrician. Here are some blogs that I recently wrote that look more closely at sleep disorders and how to treat them.

Email me if you have further questions. I hope this is a safe and happy school year for all of you and your children.

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

SEXTING NEEDS TO BE PART OF SEX EDUCATION

July 2nd, 2014

A new study, “Sexting and Sexual Behavior Among Middle School Students”, published in Pediatrics online on June 30, 2014, says that more middle school children are sexting and that parents may be justified in assuming that more is going on, specifically sex.

“Even among kids as young as 11 to 13, those who sext are also sexually active,” Eric Rice, who led the study at the University of Southern California in Los Angeles, told Reuters Health in an email. “Parents, teachers, social workers and pediatricians all need to recognize that sexting is a contemporary adolescent sexual behavior. We need to be teaching kids about the ramifications of sexting as part of our sexual education programs,” he added.

After reading through the study, I would have to agree that the sexting does lead to more promiscuous behavior. I also believe that it is more important than ever that parents talk to their kids about sex and that the discussion includes talking about sexting.

The first thing for parents to do is to understand sexting. This is new for many parents and it is a behavior that brings with it many new problems to be dealt with. Sexting was first recognized in 2005, and according to Wikipedia, Sexting is the act of sending sexually explicit messages, primarily between mobile phones. What does this mean? It means that your teen has sent nude or semi-nude photographs of themselves electronically.

According to the new study, out this week, researchers have discovered that middle school students, not just teens are sexting. Here’s what the research found:

Three-quarters of the middle schoolers had easy access to texting-capable phones
20 percent of students with text-capable cell phone access said they had received at least one sext and almost five percent had sent one.
Students who had received a sext were about seven times more likely to be sexually active than those who hadn’t
Students who had sent a sext were about three times more likely to be sexually active
In total, 11 percent of the kids surveyed said they were sexually active. And 30 percent of them said that the last time they had sex it was unprotected.

The most important think we can do to avoid promiscuous behavior and all the dangers that ensue is provide appropriate education for our teenagers. You need to remember that teenagers and tweens want to hear accurate information from their parents and studies have shown that the more information they get from their parents the longer they generally wait to have intercourse.

In general, where academics and family values are stressed, the onset of having sex is delayed. Parents should make themselves available, be honest, use correct names for body parts, and admit when they do not know something. Sexting might certainly fit into the latter! You should not worry that too much education will encourage sexual behavior, but rather understand that it demystifies it for kids. You also need to be openly monitoring your child’s cell phone. Tell your child you will be checking their phone and looking to see who they are texting.

If you have concerns about your teen or tweens behavior do not be afraid to reach out to the school or to your child’s pediatrician. Trust your instincts, but above all talk to your child often and be honest.

CDC SAYS 1 IN 68 CHILDREN IS ON THE AUTISM SPECTRUM – SO WHAT DOES THAT REALLY MEAN?

March 28th, 2014

This morning, almost every news outlet ran a story about the latest CDC study stating one in 68 children has Autism. Lenny Bernstein reported today in The Washington Post “To Your Health” section that “ The number of U.S. children with autism has surged to one in 68, the Centers for Disease Control and Prevention reported Thursday, a 30 percent increase since the agency estimated just two years ago that one child in 88 suffered from the disorder.

The new estimate, based on a review of records in 2010 for eight year olds in 11 states, also showed a marked increase in the number of children with higher IQs who fall somewhere on the autism spectrum, and a broad range of results depending on where a child lives. Only one child in 175 was diagnosed with autism in Alabama, while one in 45 was found to have the disorder in New Jersey.”

What does all this mean to parents? First, if you suspect that your child may be on the spectrum [read my earlier blog this week on the signs of Autism] then you need to have your child seen by a professional who will make a diagnosis. You will also need to speak with the CSE (Committee on Special Education) at your child’s school to discuss testing. The testing will identify what support services the school will be able to offer your child through an Independent Education Plan, known as the IEP.

As frightening as this diagnosis may be for parents there are children on the autism spectrum that are able to lead productive lives. Many celebrated people have been diagnosed or are suspected of being on the autism spectrum. The best thing you can do is to learn about autism and be sure your child receives all the services available in your area.

The Signs of Autism — I Think My Child Might Be on The Spectrum

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

I THINK MY CHILD MIGHT BE ON THE SPECTRUM

March 24th, 2014

“I’m terrified, Doctor, Philip is almost two and he still hasn’t said a word. Could he be Autistic?”

Autism, today, is one of the most talked about, and feared, diagnoses for parents. Autism and Autism spectrum disorder (ASD) are both general terms for a group of complex disorders of brain development that affect each person in different ways, and can range from very mild to severe. Generally symptoms start before the age of three years old and last a lifetime. There are three types ASD’s; Autistic Disorder, Asperger Syndrome, and Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; also called “atypical autism”). All three are characterized by varying degrees of difficulty with social interaction, verbal and nonverbal communication and repetitive behaviors. These symptoms include:

Impaired social relatedness
Lack of social reciprocity
Decreased peer relationships
Sharing deficits
Delayed or lack of language
Odd/repetitive speech
Poor conversational skills
Rigidity
An obsessive need for sameness
Rituals
Motor mannerisms
Preoccupations with parts of objects or narrow interests

As with so many other psychiatric syndromes, we don’t know exactly what causes autism, but we do know that it is not caused — as had once widely been thought — by cold, inattentive, negligent or unloving parents. Autism seems to be a disorder connected with dysfunction in the central nervous system. While no clear lesion or specific neurotransmitter has been isolated as the cause, we know that genetics plays a role.

As for treating with medication, antipsychotic drugs have only proven helpful in a narrow range of symptoms including irritability, tantrums, some of the motor issues, the occasional high anxiety of these children (sometimes to the point of psychosis), and repetitive behaviors. Unfortunately, there is little pharmacological help for the core of Autism, which is impaired communication and decreased relatedness.

WHEN ARE SLEEP MEDICATIONS NECESSARY FOR CHILDREN?

March 14th, 2014

Recent studies show a striking rise in the prescription of sleeping pills for children by pediatricians and child psychiatrists. These doctors worry about the effects of disrupted sleep on children and mostly prescribe for this reason. This is alarming to me and many others in the field. Medications have side effects, and some could even lead to a habit forming situation. In general, I rarely prescribe a sleeping agent for children and teens. The few times that I do consider it necessary is when:

• The situation continues moderately to severely despite all other remedies.

• It is caused by another medication, which is necessary.

• It is part of a mental disorder, and the treatment does not affect the insomnia.

Most sleeping problems pass. As I mentioned in my earlier blogs, you need to try sleep hygiene techniques first. They almost always work! Other things that work include parent counseling and various behavioral interventions. Oh, and remember that too much technology, over-scheduling, and caffeine could all play a part. I can’t stress enough that medication should always be the last resort.

OTHER SLEEP DISORDERS IN CHILDREN AND TEENS – NIGHT TERROR DISORDER

March 11th, 2014

In my last couple of blogs, I have been discussing a group of sleep disorders in children called Parasomnias. I have addressed two of the four parasomnias in children; nightmares and sleepwalking. Today I will discuss night terror.

Night terror disorder is quite frightening for parents or to anyone who witnesses it. Typically the child bolts upright from sleep with eyes wide open (although often not able to recognize family members), appears frightened often to the point of panic, and is screaming, confused, and inconsolable. The heart rate is elevated; there is shortness of breath, and he might be sweating, as well. There is what appears to be acute terrifying distress. The child usually cannot be awakened. The episode usually occurs in the first third of the night, and he falls right back to sleep. There is amnesia for the event the next morning.

Although this is a dramatic event, it is not particularly serious in the long term. It occurs rarely and usually disappears by teenage years. Some hypothesized causes are fatigue, new environments, fever, obstructive sleep apnea, and stress of some sort. As with nightmares the way to handle this is to be reassuring and comforting and for you not to panic. Practicing good sleep hygiene is a parent’s best bet. If these night terror attacks become frequent and/or disrupt family life, the use of benzodiazepines for a short amount of time has been found helpful. Some parents have reported that 1-5 hydoxytryptophan, which is sold over the counter and metabolized to become serotonin in the body, has allayed these terror attacks.

Our next blog is bedwetting and it will conclude this short blog series on parasomnias.

SLEEP DISORDERS IN CHILDREN AND TEENS – SLEEPWALKING

March 6th, 2014

In the last blog, we discussed nightmares. Now, we are going to look at sleepwalking. This parasomnia is characterized by a child getting up and walking around. Eyes are open, but responsiveness is either absent or inappropriate. Walking around can vary from quiet walking to agitated running. There is usually a glassy dazed stare. Sometimes the child can go to the bathroom or engage in other activities. Rarely there is violence. There is amnesia for the event. After the episode, the child can be found sleeping somewhere in the house.

There appears to be a genetic contribution to causation. Additionally, sleep deprivation, a chaotic environment, stress, some sleeping pills, and antipsychotic drugs, stimulants, or antihistamines might cause these episodes. It is also associated with PTSD, panic disorder and possibly dissociative identity disorder. Some medical conditions including gastroesophageal reflux, fever, asthma, and obstructive sleep apnea are present.

As in other parasomnias, treatment becomes necessary if there is resultant family disturbance or increased frequency. Since children can hurt themselves by accidents such as falling down stairs or getting outside the house, safety measures have to be taken such as trying to make the first floor of a house the sleeping location, locking doors and windows, clearing obstructions, putting heavy drapes over glass windows, and possibly setting an alarm which will sound if the child gets out of bed. Treatment consists of clearing up any associated medical conditions and rarely the use of medication including the short term benzodiapine Klonopin or Trazadone.

OTHER SLEEP DISORDERS IN CHILDREN AND TEENS — NIGHTMARES

March 5th, 2014

Sandy has been scaring us. She seems to wake up screaming, terrified, and agitated. She bolts up. After a few minutes she goes back to sleep. It not only scares us but she doesn’t even remember the whole thing the next morning.

There is a group of sleep disorders called Parasomnias. These syndromes present as unusual behaviors or movements that occur during sleep. They occur mostly in children and are rarely serious. They usually are gone by adolescence and the most effective interventions are parent education and counseling. Medication is rarely needed for most cases. They are rarely associated with major mental disorders. The most common ones encountered in practice are Nightmares, Night Terrors, Sleepwalking, and Bedwetting.

I will discuss all four in my next few blogs, but we’ll start with nightmares today. Nightmares or bad dreams are quite common in young people. These are dreams in which the child experiences himself in danger, vulnerable, frightened, and helpless. There is great distress, sometimes even panic and horror. Common themes often involve being chased, drowning, and other frightening losses of control. These dreams usually happen in the second part of the night, and the child often wakes up scared and remembers the dream content.

The child is often quite anxious, possibly believing that the dream was reality. He has a fast heart rate and might be perspiring, as well. Children usually need soothing and reassurance. Sometimes from the content of the nightmare the parent will be able to figure out what might be causing a passing stress or anxiety and might be able to help. Of course, there might be causes for repetitive nightmares such as chronic stress/anxiety. Some physiological causes might be the administration of certain antidepressants or stimulant medication for ADHD and post-traumatic stress disorder. If nightmares have become disruptive to the point of interfering with functioning then treatment to decrease stress, a fitness program, relaxation therapy, yoga, and even meditation have all been reported to help. In the most severe cases, such as those following a severe stressor, medication has been used with success and includes the antidepressants Trazadone or Serzone, some mood stabilizer, and possibly a Benzodiazepine anti-anxiety drug for the short term (a week or so).

SOME IDEAS FOR HELPING CHILDREN SLEEP

February 27th, 2014

Joannie has been a poor sleeper all of her life but when she turned seven last year it got even worse. She goes to sleep late, wakes up a lot, and is always tired. I work two jobs and its exhausting me too. What can I do?

Sleep Hygiene

Here are some things you can try that most likely will help to solve the problem.

First, make sure that a regular bed time (and wake time) is adhered to and that any bedtime rituals start thirty minutes before the desired sleep time. Bedtime rituals should include pleasant activities such as reading to your child, rubbing, and soothing. Sleep onset associations like being rocked or fed by you at the time of going to sleep should be minimized. For example, try to put the child in bed before falling asleep when rocking. Make sure that daily schedules are adhered to in all areas of life. Limit napping. Make sure your child has a balanced diet with enough food, gets adequate amounts of exercise, and is protected from excessive chaos in the house such as violence, shouting, emotional upheavals, and quarreling. Bedtime should be three to four hours after eating, and there should be no heavy exercise for at least two hours before going to bed. After dinner the atmosphere should be one of relaxation and quiet activities, and emotional issues should be avoided as should any rough play and caffeine. The room should be a normal temperature, and be dark and quiet without clocks or televisions. If needed, teach your child some relaxation techniques such as deep breathing. The major thing to keep in mind is that as sleep time approaches the goal is to induce a relaxed drowsiness, not an emotional or active time.

If a parent abides by these sleep hygiene suggestions the great majority of children will sleep well consistently. Of course from time to time there will be awakenings, especially if a child is sick, disturbed, or scared, but these are episodic and usually respond to gentle and firm reassurances and do not require special interventions. Do remember that not all children sleep exactly the same and there will be variation from child to child, but knowing your child’s natural patterns and adjusting your ways to your child’s rhythms go a long way to pleasant night times.

WHAT SHOULD WE EXPECT ABOUT SLEEP WITH CHILDREN?

February 25th, 2014

Our son Randy has always been a hyper-type but over the years he has received great school treatment and understanding. He was diagnosed as having ADD and has done well with tutoring and special programs. But he has never slept well and I read that his poor sleep can lead to all sorts of problems.

I want to focus my next few blogs on sleep disorders with children. I’ll discuss the sleep problems, sleep hygiene, the four parasomnias, and the use of medication. I want to start by making it clear that, in general, use of medication for common sleep problems for children and teenagers should be a last resort. While the use of sleeping pills (hypnotic medication) has grown astronomically in adults, this should not take place for our youth. What is important is what we call “sleep hygiene”, and that should be your first course of action.

It is important and often tedious for parents to do what is necessary to ensure that their child sleeps well and enough. Nearly all common behavioral sleep problems, such as bed time refusal, bed time resistance, difficulty falling asleep, frequent awakenings, getting up too early, and the like can be overcome without the use of medication.

Let’s first identify the sleep problems.

In general some sleep knowledge is helpful. Children sleep less as they get older. Newborns and infants can spend half of their time sleeping. But by four months old, regularity of sleep starts with the establishment of regular circadian patterns. These regular biological patterns contribute to regularities in sleep and waking, activity levels, hormone secretion, and other biological phenomena.

Although four months marks the establishment of some regularity of sleep cycles it is not usually until one year old that the frequency of night awakenings significantly diminishes. By four years old most children do not need to nap but often do need eleven to twelve hours of sleep. By early to mid-adolescence sleep patterns are quite close to those of adults who require about seven to eight hours of sleep.

Sleep problems

It should be noted that so-called sleep problems have a lot to do with what particular parents find tolerable in their children which in turn is affected by their own sleep patterns, the subculture in which a child is raised, and the overall tolerance of the household to a child’s awakenings. It is also important for parents to know what to expect at various ages in order to know when a sleep problem exists. It is important that a child gets enough sleep. A child who does not get enough sleep can be plagued by many problems which include:

Irritability
Impulsivity
Inattention
Moodiness
Aggressiveness
Fatigue
Learning problems
Child/parent interaction disturbances
Overweight
Having to be awakened regularly

In addition to the common causes of insomnia including stress, anxiety, stimulus overload, and caffeine, there are other causes which should be ruled out such as obstructive sleep apnea, restless leg syndrome, side effects of medication including ADHD and antidepressant medications, chronic illness, autism, developmental delays, ADHD itself, depression, and anxiety disorders. After these have been ruled out, common insomnia can be handled without the use of special sleep medications in almost all cases.