Episode 17: Kids and Sleep (Part 2): Screens, ADHD, and Routines

Show notes:

Welcome back to part two of our special three-part episode on kids and sleep, in recognition of Children’s Awareness Month this June to reflect on how we can prioritize our children’s health and well-being.

In part one, Dr. Andrea Roth, Dr. Allison Shale, and I discussed common sleep behaviors and treatments for children. Today, in part two, we’re diving even deeper. Next time, in part three, Dr. Andrea, Dr. Allison, and I will wrap things up by answering your questions, listeners. Everything you’ve submitted through YouTube, Instagram, Facebook, and of course, our website, sleepopolis.com.

Transcript

Dr. Shelby: How are you sleeping? Are you sleeping? I’m Dr. Shelby Harris, licensed clinical psychologist and Director of Sleep Health at Sleepopolis, where we dive deep into all things sleep.

If you like Sleep Talking with Dr. Shelby, take a second right now to like this video on YouTube or give us a five star rating through Spotify or Apple podcasts. I know it seems simple, but it helps us reach a lot more people to get them the rest they deserve. And if you’re tired of hitting that snooze button, hit the subscribe button instead. A new episode of science-backed sleep tips is available every other Wednesday.

Welcome back listeners to part two of our special three-part episode on kids and sleep in recognition of Children’s Awareness Month this June to reflect on how we can prioritize our children’s health and well being.

Remember, if you have questions for future episodes, you can always add them to the episode comments below if you’re watching this on YouTube. You can also send questions via Facebook or Instagram, @sleepopolis and @sleepdocshelby.

Now, let’s reintroduce our guests. With over 10 years experience treating children in schools, hospitals, and private practice, psychologist Dr. Andrea Roth is known for her expertise in sleep and anxiety for children. Versed in a wide range of childhood concerns, Dr. Andrea loves providing insight and support to parents to ensure that when kids master new skills, their caregivers also gain the knowledge and confidence to be as supportive as possible.

Bringing another 10 years of experience to us today is Dr. Allison Shale, a psychologist and director of Shale Psychology. Specializing in anxiety, ADHD, depression, sleep disturbances, and behavior problems, Dr. Allison aims for children to feel understood and heard while providing parents with tangible strategies and insight that can benefit the entire family and last a lifetime.

And I’m also so honored to be co-authoring an upcoming book for parents on kids’ sleep with them as well. So keep an eye out for that.

Dr. Andrea, Dr. Allison, welcome to Sleep Talking with Dr. Shelby. I’m really excited to have you here.

Dr. Allison Shale: Thanks.

Dr. Andrea Roth: Thank you. We’re so excited.

DS: Now, screens. This is, like, such a big issue. And I think about, in my school district, they give screens now, they give an iPad to kids starting in kindergarten for school, and I think about my eighth grader and all of his work is on an iPad, and he has so much homework. He has one book from like 1995 that’s a French book. Everything else is on iPad.

So like, it’s only gonna get worse, as he gets older with more and more homework. So how do you deal with screen time when a kid or even like a toddler, they’re just on the iPad at night and you’re having to try and get it away from them?

AS: Well, I think there’s kind of two parts to it. The first is a lot of times we’ll talk to parents about what the child’s watching because there are certainly things that are like better to watch before bed. Maybe things that are calmer, not aggressive fighting, not having the volume up to a thousand, right? Watching something on a TV versus watching on an iPad in terms of the blue light and all of that stuff. Not having things kind of right in their face, not that endless loop that the iPad can also have.

DS: Okay.

Dr. Allison: I think that in most situations, the consistency and the rule and the boundary is so much more important than saying if an hour is better than 90 minutes, because I think if parents say this is when screens go away, that’s when screens need to go away. That needs to be kind of the expectation of whatever it is that you’re doing.

And a lot of times in that initial conversation with people, we’ll talk about how much screen time they’re having. We’ll talk about if they feel good about it. And most of the times, no matter where they say they’re at, most of the times people say, I wish we were doing less. And so a lot of times that can be a really good first point.

So if they say we give them two hours a day, maybe we’ll say, well, why don’t you cut it back to 90 minutes? Right? So a lot of times I go off of, in terms of time, I go off of what they’re doing to, again, make it realistic. We’re not going to, some kids, if you’re on it for four or five hours, we’re not going to say let’s cut it back to 30 minutes. That’s probably not possible.

DS: Yeah.

AS: And we want the kids to be successful and the parents to be successful.

DS: But small changes when it comes to screen time. Don’t just pull it away.

AS: Yes, that’s what I think.

DS: What about you, Andrea?

AR: I completely and totally agree. I think that screen time right now, like you said, it’s like this hot, huge topic. I, the number of families that I get that come in and say, they’re, they’re like humiliated. They’re, the shame, they’re like, we let Bobby have, like, 20 minutes of Bluey before bed and I’m so sorry and I know we shouldn’t. And I’m like.

DS: I know.

AR: It’s fine. Everyone’s fine. We’re alive. I also love a good Bluey. Like, it’s okay. The shame that they feel about it is just wild. And, and-

AS: Yeah, yeah.

AR: I, cause it’s blown up. It’s like, if you show your kid a screen within six hours of bedtime, they’re never gonna sleep. You’re a terrible parent. And so I think it is. It’s all about this middle ground. And I think that what the field is coming to recognize, and even within, you know, the researchers coming to show us, is that there has to be this kind of happy medium.

Screens are unavoidable. We’re not going to get screens out of our kids schools entirely. Like, we’re not going to get it out of the home. We’re not going to get them out of schools. They have to be part of our existence. And so how do we learn to live with them in a way that still works with sleep, so, right?

It’s like, it’s not just the type of screen. It’s the content of the screen. Is it something that’s like sucking you in or is it something that you can kind of like naturally turn off? And then can we be a little bit thoughtful about is it the last thing we do before bed? I think that it’s just like everything that’s, it’s, it’s flexibility and fidelity.

Like it’s gotta be following the ideal, but we have to also kind of make that work with our real life.

DS: Yeah. And I think, you know, I grew up – my mom won’t want me to admit this, but I grew up with a TV in my bedroom, right?

AR: Same! And my

AS: dad’s a sleep doctor! Ha ha ha!

AR: Same!

DS: I grew up with a TV in my bedroom. I mean, we didn’t know any better. And for many, many years, I needed to have a TV to be able to fall asleep at night. I was a fine sleeper, but it made it very obvious for me that I had that connection made. And I’ve tried really hard to try and break that habit, but I think that’s what you need to think about. Like, do you need an hour of TV every night to be able to fall asleep?

Do you have other ways to kind of soothe yourself and relax, or is that the only thing?

AS: Right.

DS: And the blue light is not as terrible as people make it out to be. It’s not like going to ruin everything. And we find in kids and adults, it’s not horrible. It’s more of like, are they staying up? Are they getting more agitated from it? Are they getting more activated? Whatever it might be, that they’re delaying sleep. That’s the bigger issue.

Now, overstimulation before bed, like the roughhousing, the exciting games, is it just like a lot of, not to make generalizations, but a lot of dads like to roughhouse before bed. I think about my husband, likes to do that with my son. Do you recommend against that? Does it matter? Where are you on that?

AR: So, I think it’s interesting because I feel like there’s this idea that like bedtime has to be perfectly calm, roughhousing has to stop by like X o’clock and bla bla bla bla bla. And I have heard other experts talk about like, no, that’s fine. I think that if they need that rough and tumble play, that’s fine.

You just build it into the evening routine and maybe like put it up front so that they can start settling.

DS: Okay.

AR: I think, again, it’s this idea of like the happy medium. I think unfortunately with a two parent household sometimes second parent doesn’t come home until later and you know that’s kind of like the way that they play with their kid. We have to allow for that a little bit as long as like again that parent that has the psychoeducation of you can do that, but then you need to be thoughtful about the clock and starting to downshift at some point as well. It just can’t be like the last thing you do before bed.

DS: Yeah.

AR: Allison, what about kids with ADHD? Just because like you, I feel like see that so much more than I do.

AS: In terms of like the rough housing and the wildness and some of that?

DS: Yeah.

AR: Yeah. And get more of that kind of like really active motor that we kind of see sometimes in kids with ADHD.

AS: Yeah, I mean, I think that kind of wind down I mean, I talk to parents all the time about just like wind down. And again, it’s just like knowing your kid, right? Some kids can, even with ADHD, can just like get into bed and put their head down and like be good.

AR: Mm hmm.

AS: Some kids really do need, like that kid I was talking about he needs that like 20, 25 minutes in bed with dad and that’s kind of his calm down sort of time. So it makes things take a little longer, but they’re accounting for it.

DS: Yeah.

AS: It benefits him It seems to be beneficial for the relationship. So again not seeing things as so rigid of like you cannot do that that really works for them. For this kid who happens to have ADHD, you know? So I think it’s more about knowing your kid and how much, you know, kind of come down time they need to be able to get into bed and not spend 45 minutes tossing and turning until they actually fall asleep. We’d like them to fall asleep quicker than that so they don’t get restless when possible. So again, you can’t control everything, but if you can, that helps.

AR: Right, that’s such a good point. It is so also kid to kid based.

AS: Oh yeah.

AR: You’re right.

DS: I think we often make these generalizations with,, like ADHD that they’re always going to have trouble falling asleep or staying asleep. Not all the time, but I think we do, like you were saying, we have to know our kid, know what’s helpful, and if that stuff’s not helpful enough, then there are other options that we can go to.

So it’s not always black and white, but for parents or any guardians listening, are there any guidelines or kind of red flags that then indicate that, okay, I’ve done these things. I’ve worked on the screen time. I’ve worked on a wind down. I’m keeping consistent.

I mean, we didn’t really talk about caffeine or sugary foods, but we’re obviously not giving them lots of caffeine in the evenings and loads of sugary foods. But are there things that once you’ve tried all those sleep hygiene recommendations, that would then make you say, okay, it’s time to contact a psychologist versus a sleep specialist? Like where would a parent want to go as the next steps there?

AR: I feel like, for me, the line is always if there is some sort of co-occurring behavioral, emotional, psychiatric, something going on. I think that, I don’t know, for me, pediatric sleep is just so behavioral. Like, if you’re an infant, it’s developmentally appropriate that infants sleep all over the place. When you’re an adult, it’s so complicated because there’s so much hormonal stuff.

DS: Yeah.

AR: That’s your lane. But for me, pediatric sleep is just undeniably behavioral. Rarely is it a kid who just like is a bad sleeper. I, I just don’t buy into that. I find that it’s just so very behavioral and I think if there’s like anything extra, I think my younger clinicians here, you’d say if there are any extra spice to them, like, they got to go to someone who maybe is a little more trained in working with children that have co-occurring diagnoses or someone like a psychologist, like a social worker that knows a little bit more about that kind of emotional behavioral treatment.

DS: Allison?

AS: I mean, I agree. I think that a lot of people’s first line of defense is maybe a sleep consultant, a sleep coach. They maybe know someone who used them as a newborn, who helped with sleep training, or something like that, and then maybe they test that out. And I think for a lot of people, they do then get some support around scheduling, timing, sleep hygiene, things like that.

And very often, there are people who come in and they say like, I worked with a sleep specialist, she helped me with XYZ, but we’re still running into trouble because my kid won’t stay in the bed, right? That one often jumps out to me as something that a sleep consultant might not know as much about in just not having the training in behavioral work and reinforcement and punishment and shaping behaviors and things like that.

And then of course, like Andrea said, right, when people say, my kid’s really anxious or my kid has this diagnosis, then, you know, I think a therapist, a psychologist, a social worker is a better bet in terms of getting a more comprehensive look at what’s going on and how we need to treat it.

DS: Because it’s not just behavioral on the kid’s end, it’s behavioral a lot of times on the parent’s end.

AS: Right. And that’s what Andrea said. You know, Andrea and I both, our sleep work is very parent heavy. A lot of times when parents reach out, they’ll say something about their kid. And my response is almost always, well, actually, I’m going to just meet with you. And if we then decide that your child needs to be seen, we can do that, but it is going to be much easier for us to focus on you and change you and then see how your child responds to that. And that throws people off. Big time.

DS: And that’s really surprising to a lot of parents, yeah.

AS: Yeah, throws them off. They’re like, but no, no, no, you need to know her. She’s so anxious. And I’m like, I totally get it. Let’s just see what you’re doing in response to that anxiety that maybe, you know, maybe you think you’re helping it, but you’re actually not. And that is sometimes a light bulb moment for people that they’re doing all these things with such good intentions in terms of how they respond, and then sometimes they do need an outsider to say, well, when we think about it like this, maybe that’s actually part of what’s maintaining this problem. And that’s an easier conversation to have also when the kid’s not there.

AR: We are also trained to ask some questions that would lead us to send them to a sleep specialist, like in a hospital setting, into a clinic, or back to a family doctor or pediatrician. So we do have these like red flags that we look for in regards to like apnea or restless leg or any sort of kind of medical diagnosis that we know very well, like we don’t deal with that.

If there is an underlying medical reason as to why your child is struggling to sleep, you should not be coming to see us. We do not have those credentials.

DS: Yeah.

AR: I absolutely want you to go see the medical professional first. And so I think that that’s really important that we recognize those things too. I think that I just empathize so much with families and that your kid struggles to sleep and it seems like there’s like this create your own adventure of I don’t even know where to start.

DS: I know.

AR: There was research, gosh, years and years ago at that pediatric sleep meeting about, they did this like very casual survey of like where do families go if their child is struggling to sleep. And it was like the pediatrician and the sleep specialist and the clinics were like way down at the bottom. And it was like friends and family and social media and the internet. It’s just like-

DS: Wow.

AR: It’s so hard. I think that we take for granted that we are in this field or we are in any sort of field adjacent to child development. That we kind of have these ideas of where to go first when our child is struggling that the general public just doesn’t have.

DS: And I think to add one little thing to that is that when you were saying, like, apnea, restless leg, the simple things to think about and look for in your child are, is your child snoring? Any pauses in their breathing? Not just when they have like a cold, but more consistently happening. That’s definitely a reason to go see an MD sleep specialist, right? Any snoring in a child that’s consistent should be evaluated. And then with the restless legs, anything like that, a lot of children don’t report it.

They don’t, I mean, they’re not going to be like, I have restless leg syndrome. But they’re feeling like antsy in their legs. They have to get up, walk around. They feel this kind of restless feeling. And everyone describes it different. I had a kid once that described it as bugs crawling up their legs.

AR: Or burning.

DS: Yes, burning. That can impact their ability to fall asleep a lot of times too. So that’s when an MD sleep specialist would definitely come into play. And oftentimes we work together with MDs. You know, ADHD and apnea we know are often related and we know that kids who have apnea are very restless a lot of times, they don’t look sleepy.

So we want to address those issues and then sometimes we have to address more of the bedtime issues that are going to come up too, even if the apnea has been treated.

So let’s talk about rooms, right? So some don’t care about their room so much. Others are very particular about their room environment. What do you recommend to families when it comes to their bedding and the lighting situation? Do they have to have the lights on or off?

AR: I think that our general rules of thumb that, you know, I think you Google this and you get the answer. It’s cool, dark, and quiet, is ideally what we want. There are, again, these ideal temperatures in which we’re supposed to sleep at in the high 60s, the mid high 60s.

Is that everybody? No. We want it to be quiet. So I think if we think about where you live, I think if you live on a busy street, if you’re living in an urban setting, you know, having sound machines or something to muffle the noise is important. If you’re room sharing with a sibling or another family member I t hink that can be helpful. And then dark, you asked about light. Another thing that I think parents sometimes feel shameful for when they come to me, they’re like, oh, my kid sleeps with a nightlight. I don’t want them to. I know they’re not supposed to, I know it’s supposed to be so dark. And I always say like, that’s not true.

Yes. Do we want them sleeping with the overheads on? No, because that gets very kind of stimulating if they wake up or while they’re trying to fall asleep. I think we try as hard as we can to have nightlights be dimmer. I think we have them ideally not be like right in their eyeline.

DS: Yeah.

AR: But these are all things that we’re allowed to have. You know, it doesn’t have to be pitch black. It doesn’t have to be 68 degrees. It doesn’t have to be like pin drop silent. But I think these are the ideals that we like to have. Allison?

AS: I agree with all of that. And I think, you know, when it comes to noise machines, nightlights, things like that. It’s just being mindful of the level of them, right?

You’re not gonna crank that noise machine to 25 and put it right next to the kid’s bed, right? Maybe it’s on the other side of the room. Maybe it’s closer to your door so that it can muffle out if, you know, your child’s bedroom is off of a living space and it would be very loud and there’s a lot of other people around. Putting it by the door. Maybe even just putting it in the hallway, right? So there’s certainly ways that we can set up these things and they’re not so black and white of like, I heard all noise machines are bad, or my child can never sleep with a nightlight. And again, it’s about trying to get people to understand that there’s a middle ground for a lot of these things.

DS: Yeah.

AS: And again, having a flexible sleeper, one who, if there’s a little bit of light in the room, they can still fall asleep. That’s not such a horrible thing either. So then when you travel and go places that your child doesn’t need, can’t see your fingers kind of dark.

DS: Yeah, I think we get so rigid in our society with these rules and these people who are online who are saying you have to follow this, do this exact thing, this protocol, whatever it might be to guarantee sleep. A, it doesn’t always guarantee sleep, and B, it creates, like you said, someone who might not be such a flexible sleeper, and C, I think it creates so much shame in people a lot of times.

AS: Yeah.

AR: Yeah.

DS: Not good.

AR: Oh, I agree. Oh, I think my first one is that, like, oh my god, I, Allison, I feel like yours might be like this, too. My first one, I feel like I had all those things in my mind. So she’s the one that we had to travel with, like, the black garbage bags everywhere we went.

AS: Oh, a hundred percent.

AR: And then my second is like, he’s like, whatever, like, I’ll, I’ll sleep. Maybe, maybe not.

AS: Much easier, right? Doesn’t have a noise machine. Doesn’t have that stuff. Absolutely. Yeah.

But you know, Shelby, what you said, I think there is a lot of shame. I think, you know, like, if you go somewhere, you put your baby down for a nap, or some of these things, and people go, wait, you left the noise machine on? I heard that’s bad for their ears. Or, well, why don’t you have blackout shades? You know, and I think, some of it’s not coming from the worst place, but as a parent, you’re kind of, you know, there’s always, there’s a lot of judgment. And I think there’s a lot of judgment about sleep. Think of newborns, right? How are they sleeping? Right? People think that’s like a curious question, but we feel a lot of pressure as if our child’s sleep is a reflection of who we are as a parent.

So I think that’s where some of that rigidity comes from. If I do all of these things, my child will be a good sleeper. I can tell the world. My child is a good sleeper. My neighbors did this with their child and he’s a good sleeper. So I must, right? There are so many parental emotions that go into these choices.

And so, again, that comes back to the same idea of why it’s so important that we work with the parents. Because we have to be able to validate their own- I get why you did this, to not be someone who’s shaming them for whatever choice they made.

And really, I try to also come from the framework of, you did this thing. You had really good intentions with why you did it, but it’s not getting you the result you want. That’s the only reason why we need to change it. We don’t need to change it because I don’t like it, or because I think I can do things better than you, right? It’s just purely because you’re coming to me saying, I don’t like what’s going on in terms of sleep in my house. Here’s what we’ve done. Tell me something different that I could try.

So, we try to start right from the beginning of, no shame, these were thoughtful decisions that you made, you tried them for a long time, often, and your kid isn’t sleeping, you’re not sleeping, so let’s do something different.

DS: I remember when I went back to work in Montefiore at the sleep clinic after having my first. I felt all this pressure to get him sleeping perfectly because I knew every patient of mine was going to ask me, how is he sleeping, as like a judgment on how I was as a sleep doctor.

AS: Yeah.

DS: It’s crazy. And even parents feel it so much.

AS: Yeah.

So Shelby, since you end every episode with something to sleep on, do you have one little nugget of advice for your listeners? Something to sleep on?

DS: The shame stuff is a big issue. I think there’s no shame in any of this stuff, and sometimes the shame makes you not want to seek out help more and just keep trying random things that you find on, I don’t know, Instagram or wherever else. If nothing is working, no shame. See someone who is qualified, who knows what they’re doing.

If you’re going to see a psychologist, for example, ask them how much sleep training have they had, right? How many patients have they seen? Have they done stuff? I think that’s really important is to just really have no shame and ask questions and see someone who will be able to help you properly.

AS: Yeah.

AR: Yeah.

DS: Dr. Andrea, Dr. Allison, thank you both for joining us for part 2 of this 3 part episode. I had so much fun diving into this with you. I hope the listeners could tell it was really a lot of fun. And I can’t wait to answer listener questions with you next time in part 3.

AS: Thanks.

AR: Thank you.

DS: Thanks for listening to Sleep Talking with Dr. Shelby, a Sleepopolis original podcast. Remember, if you’re tired of hitting the snooze button, make sure to hit that subscribe button right now in YouTube, Apple Podcasts, Spotify, or wherever you’re listening. And for even more sleep tips, visit sleepopolis.com and my Instagram page @sleepdocshelby.

Today’s episode was produced and edited by Freddie Beckley. Our Senior Director of Content is Alanna Nuñez. Our Head of Content is Molly Stout and I’m Dr. Shelby Harris. Until next time, sleep well.