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Be Well for Parents - August 2011

Feature: 5 Problems That Can Affect Your Child's Sleep

Feature: 5 Problems That Can Affect Your Child’s Sleep

Books, teachers, backpacks…alarm clocks. A new school year means transitioning from a laissez-faire summer schedule to a bright-eyed school-year regimen. But that’s not the only challenge kids – and parents – face.

“The biggest myth out there is that sleep disorders are not very common among children. But 25 to 30 percent, if not more, of all children have some kind of sleep disorder,” says Cleveland Clinic Children’s Hospital sleep specialist Jyoti Krishna, MD, Head of the Pediatric Sleep Disorders Program.

Children spend one-third to one-half of their lives asleep, yet sleep issues are rarely brought up at the doctor’s office.

“What goes on at night is just as important as what happens in the daytime,” says Dr. Krishna. So be sure to bring any of the following problems up with your child’s physician:

1. Behavioral issues. You may think your hyperactive or inattentive 5-year-old has attention deficit-hyperactivity disorder (ADHD). But sleep disorders such as sleep apnea can masquerade as ADHD.

“Some kids on ADHD medications may actually have sleep problems,” says Dr. Krishna. Talk to your child’s doctor; a full battery of testing can sort things out.

2. Snoring. Between 10 and 30 percent of kids snore, which is harmless except in the 2 percent of children with sleep apnea (abnormal pauses in breathing during sleep). Enlarged adenoids and tonsils can contribute to sleep apnea by partially blocking the airway.

“Usually the first course of therapy is to get the tonsils and adenoids taken out,” says Dr. Krishna. “This may be appropriate for some children, but not all. The clinical exam alone may be misleading.”

If your child snores, gasps or snorts during sleep, he recommends sleep testing to confirm apnea before going through with surgery.

3. Sleep deprivation. Few parents realize that experts recommend 10 to 11 hours of sleep per night for kids 6 to 12, and nine hours per night for kids 12 to 18. Very few children get that much sleep due to poor sleep habits, caffeine use and electronic distractions — TV, texting, tweeting — in the bedroom, says Dr. Krishna.

A 2006 National Sleep Foundation poll found that in the hour before bedtime, three out of four 11-to-17-year-olds were watching TV and about two out of five were talking on the phone or texting. “It is a fair guess that those numbers are higher today,” he says. “Parents should make some rules surrounding bedtime because these habits are eating their way into nighttime sleep.”

4. Insomnia. Insomnia — the inability to fall or stay asleep — doesn’t plague just adults. One in seven kids of elementary school age also reports difficulty falling asleep, often due to anxiety, bedtime fears or other emotional challenges.

For persistent cases of insomnia, consult your child’s pediatrician, says Dr. Krishna. He or she may refer your child to a pediatric psychologist or sleep specialist. Most cases of childhood insomnia can be successfully treated with behavioral modification or cognitive therapy.

5. Needing naps. Beyond age 5 or 6, most kids should be able to function all day without napping, Dr. Krishna says. For kids who are excessively sleepy, taking a “sleep history” can be invaluable.

For example, asking teens about difficulty falling asleep and about difficulty waking up can point to insufficient sleep, to hypersomnia (the overpowering urge to sleep throughout the day) or to delayed sleep phase syndrome (in which the biological clock is set later than usual). Getting the right diagnosis means avoiding the wrong medications, says Dr. Krishna.

When sleep studies are recommended, they are conducted overnight in a comfortable bedroom-like “lab,” and a parent can be present.

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Tip: Be Smart About Kids’ Meals & Activity

Tip: Be Smart About Kids’ Meals & Activity

To prepare your kids to tackle tough subjects in school, feed them healthy meals and get them up off the couch. Research has shown that from the toddler years through age 8, kids who eat healthy diets develop higher IQs than kids who eat a lot of processed foods high in refined sugar, starch and fats. Studies also show that kids’ IQs and math scores improve with increased aerobic activity.

Parents Children's Health Essentials – August 2011 Issue

Feature: Caffeine Dos and Don’ts

Feature: Caffeine Dos and Don’ts

Caffeine comes in many forms, some better than others. Beverages that combine caffeine with other ingredients – from stimulants in energy drinks to flavor shots in lattes – may have unwelcome side effects.

To find out how are you and your family are doing when it comes to the wise use of caffeine, Cleveland Clinic registered dietitians offer these dos and don’ts:

Don’t get more energy than you bargained for.

Yes, energy drinks contain caffeine. But they also contain stimulants, additives and supplements, such as guarana, taurine and ginseng. Guarana (an herbal version of caffeine) is about 2.5 times stronger than caffeine and is released into the body more slowly, delivering a steady boost of energy.

“Combining guarana with caffeine and other stimulants may produce a synergistic effect that makes the effects more powerful — and that isn’t necessarily a good thing,” says Tara Harwood, MS, RD, CSP, LD. “You can develop heart palpitations, an increased heart rate and elevated blood pressure.”

It’s important to check the label on an energy drink before taking aspirin to avoid a medical emergency, says Ms. Harwood: “Guarana combined with ephedra and aspirin can cause stroke or death.”

Registered dietitian Laura A. Jeffers, MEd, RD, LD, adds that “because substances like taurine and guanine mimic the effects of caffeine in the body, they should be considered when monitoring your daily caffeine intake.”

Do boost athletic performance the right way.

Energy drinks are often used to enhance sports performance. However, “the ingredients in energy drinks do not necessarily improve performance and can be hazardous to health,” says Ms. Harwood.

For young athletes, the use of energy drinks is discouraged by the American Academy of Pediatrics because the effects of caffeine, stimulants and other additives on the developing heart and brain are unknown.

Choose sports drinks instead for strenuous workouts for the entire family. They’ll replace the water, electrolytes and carbohydrates you’ll lose through sweating and fueling the body. Drink cold water before and after exercise.

“Sports drinks are safe and encouraged for athletes who exercise outside in the heat for 60 minutes or longer or who engage in 30 minutes of intense start-and-stop activities, as in basketball,” says Ms. Harwood.

For light activities, forgo the sports drinks — they only add unwanted calories and sodium to your diet, she says. And speaking of diet, remind active young athletes that they need three meals and two to three nutritious snacks per day.

Don’t supersize your coffee.

When you grab your morning coffee, remember that size matters—as do strength and sweetness. “Portion sizes are a major problem; as size increases, so does the amount of caffeine,” says Ms. Jeffers.

The 100 to 145 milligrams of caffeine per standard 8-ounce cup of brewed coffee can climb much higher, depending upon brand and brewing method. You get a whopping 400 milligrams of caffeine in certain drinks from your favorite coffee shop. “Some people may drink two to three of these per day,” says Ms. Harwood.

"Caffeine in large doses can cause abdominal pain, increased anxiety and heart palpitations or arrhythmias,” she cautions. “At that level, caffeine tolerance can also develop, and withdrawal symptoms such as headache, drowsiness, and difficulty concentrating can occur.”

Weight gain can be another unwanted side effect of visiting coffee shops. “Coffee drinks made with milk and flavored syrups, and topped with whipped cream, add calories and fat that can sabotage the diet,” says Ms. Jeffers.

Do use caution with combinations.

Young adults going clubbing often order alcohol mixed with stimulant-containing energy drinks “to enjoy social drinking without getting sleepy,” says Ms. Harwood.

Caffeine and other ingredients in energy drinks produce a powerful stimulant effect that fights alcohol, which is a depressant. “This confuses the nervous system, which can trigger heart palpitations and abnormal heart rhythms,” she adds. The combination is especially dangerous for young adults with undiagnosed heart problems.

Because alcohol causes dehydration, it’s important to get plenty of water on a night out. “Try rotating alcoholic beverages with water to control the amount of alcohol you’re drinking and to rehydrate your body,” says Ms. Harwood.

Before trying an energy drink with alcohol at the bar, “always try the energy drink during the day, without alcohol, to see how your body responds to it,” Ms. Harwood advises. “Then, if you feel you need a stimulant when you’re out, show moderation by having only one of these drinks.”

The best ways to improve energy levels are to get plenty of sleep each night, to exercise during the day and to eat nutrient-dense foods, she says.

Do consider going green

Making green tea your morning beverage of choice can do wonders for your health. It contains just 15 to 30 milligrams of caffeine per cup. Ms. Jeffers notes that green tea:

  • Contains anti-oxidants to promote healthy aging and possibly fight cancer
  • Produces lipid-lowering and blood-pressure-lowering effects for heart health
  • Promotes anti-inflammatory effects that reduce risks of heart disease, arthritis and other illnesses

In addition, “Research suggests that regular green tea consumption may stimulate fat burning without increasing heart rate, as many caffeine-containing diet pills do,” says Ms. Harwood.

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Parents Children's Health Essentials – August 2011 Issue

Free Guide: Infertility

Juvenile Arthritis

The human reproductive system is so intricate that it’s no surprise that about one in six couples is unable to conceive after trying for a full year. Learn how the latest diagnostic and treatment options for infertility can help.

Recipe: Healthy Zucchini Bread

Recipe: Healthy Zucchini Bread

Made With Applesauce and Flaxseed

This zucchini bread recipe is lower in fat and cholesterol than other recipes and is safe for those with egg allergies. The ground flaxseed and water mixture serves as an egg substitute, and the applesauce replaces the oil.


2 tablespoons ground flaxseed
6 tablespoons water
1½ cups whole wheat flour
2 teaspoons baking powder
½ teaspoon baking soda
½ teaspoon salt
¼ teaspoon ground ginger
¼ teaspoon ground cinnamon
⅛ teaspoon ground nutmeg
¾ cup white sugar
½ cup unsweetened applesauce
2 cups grated zucchini

  1. Heat oven to 350 degrees. Spray a standard glass bread baking pan with non-stick cooking spray.
  2. Whisk together ground flaxseed and water in a large bowl. Allow to sit five minutes.
  3. Meanwhile, combine flour, baking powder, baking soda, salt and spices in a separate bowl. Set aside.
  4. Add sugar and applesauce to flaxseed mixture; beat for one minute. Stir in grated zucchini. Add dry ingredients, stirring just until moistened. Pour into prepared baking pan.
  5. Baked in preheated oven for 40 to 45 minutes or until inserted toothpick comes out clean. Cool 15 minutes in pan, then turn out on cooling rack and allow to cool completely.

Serves 16

Per serving:
Calories: 84
Fat: 0.5 g
Saturated Fat: 0 g
Protein: 1.9 g
Carbohydrate: 19 g
Sugar: 10 g
Fiber: 2 g
Cholesterol: 0 mg
Sodium: 144 mg
Potassium: 89 mg

Recipe from our Children’s Hospital Pediatric Nutrition Support Team

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Parents Children's Health Essentials – August 2011 Issue

Let's Move It! Mondays at Progressive Field

Your last chance to enjoy free, exclusive access to Progressive Field in downtown Cleveland is Monday, Aug. 15, between 11:30 a.m. and 1:30 p.m. Invite your friends to walk the warning track with you over the lunch hour on Let's Move It! Mondays - and stop by our booth for free giveaways and health information.