Healthy Sleep Habits for Kids with Dr. Vaishal Shah

Podcast Transcript

Nada:   Hi, thank you for joining us, I'm your host Nada Youssef, and you're listening to Health Essentials Podcast by Cleveland Clinic. Today, we're broadcasting from Cleveland Clinic main campus here in Cleveland, Ohio, and we're here with Dr. Vaishal Shah. Dr. Shah is board certified in sleep medicine and pediatrics, and we're here to talk about sleep, specifically newborns up to five years of age. So if you're a new parent stay tuned. Thank you so much for being here today.

Dr. Shah:  Thank you for inviting me.

Nada:   Please remember this is for informational purposes only, and it's not intended to replace your own physician's advice. So before we jump into topics, I didn't tell you this, but I'm going to ask you like three questions completely off topic just to get to know you on a personal level.

Dr. Shah:  Sure, no problem.

Nada:   All right, so when you're feeling anxious or down, what do you do to cheer yourself up and for some peace of mind?

Dr. Shah:  Sure. So I love to play sports. Table tennis, actually, and swimming. So those are my cheering up or relaxation techniques. And sleeping, of course is a big one.

Nada:   Of course you have to say that. What about the best day of your life?

Dr. Shah:  When I matched here for residence at Cleveland Clinic.

Nada:   That's awesome. And then if you had to get a tattoo right now where would it be?

Dr. Shah:  Oh boy. That's a tough one. Probably my arm.

Nada:   Yeah? Do you know what you want?

Dr. Shah:  No, I haven't thought about it.

Nada:   Okay, great. All right let's jump into topic. So, our brains are very active while we're sleeping. We don't usually think about it that way, but it helps us with our brain health which results in mental and cognitive health. So, let's talk about everything from newborn to five years of age. So sleep quantity really varies for everyone, but let's talk about that age and how many hours of sleep they need?

Dr. Shah:  Yeah, so, it really depends on in the time period of that age. I'm going to give you an example, an idea of general ranges. So newborns can sleep basically 16 to 20 hours, and I tend to joke with the parents that their job is to sleep. So typically newborns, for six months don't have what we call circadian rhythm, means their brain has developed differentiation between night and day. It starts developing between three to six months, and that's when you start seeing a little chunk of sleep at night increasing. A simple way to know or remember is in three to six months, a kid should have about one stretch at night about three to six hours.

Dr. Shah:  By six months most of the kids should be able to get at least one good stretch between that amount of time, and it gradually increases over the period of time until you are five years of age and so forth. Newborns tend to have nap, wake up, feed, do some activity, go back to sleep. So that's their pattern. And then gradually a chunk and one or two naps, that's developing around six months of age. Once you get to about between six months to one year, the sleep starts getting more and more consolidated. Most of the kids can get about six to eight hours at a chunk at night plus one or two naps during the day time.

Dr. Shah:  Naps can be highly variable between 15 minutes to three hours, and sometimes there is no specific time when they're napping and so forth. It starts getting more and more regular after that. Most of the kids do tend to get rid of naps by age five, some get rid of them earlier, around three years or two years, sometimes I've seen. Some get rid of them later and so forth. Generally in the toddler age, kids need between 11 to 13 hours of sleep. Right before preschool, about 10 to 12 hours of sleep, but that's a range. Some kids will have variations of more or less sleep.

Nada:   Okay. So naps real fast. Sometimes I hear don't have them sleep such a long nap because they won't sleep at night, but then I hear the better the nap the better the sleep at night. Which one is true?

Dr. Shah:  So actually, both are true. It's person by person. So I tend to see both kinds of situations. Generally, our approach is if the child is taking a nap and nighttime falling asleep is still not affected, usually there is no concern for that and so forth. If child is taking a prolonged nap and has trouble falling asleep at bedtime, then we try to work around that and restructure the sleep time and so forth.

Nada:   Okay, so you adjust based on the child.

Dr. Shah:  It's just based on the child, yes.

Nada:   Okay. So, some parents claim their children slept through the night very early on just a few months old, some it's been 18 months and still nothing. I know you've talked about the circadian rhythm from three to six months they're still just starting to get it. So if a baby is sleeping through the night at three months, is that actually legit? What sleep training do you suggest for newborns?

Dr. Shah:  Yeah, so myself as a parent, I have a nine month old.

Nada:   Congrats.

Dr. Shah:  Thank you. So, we did sleep training with my own child. So, there is no right or wrong time when you should do the sleep training. A lot of parents prefer early, because they need their own sleep and they work the next day. I generally say the earlier you do it, the easier it is. We're doing three to six months, once you are seeing those stretches, or after six months when you are seeing the stretches of sleep, that's when you want to start. The key is to start with a consistent one, two, or three step bedtime routine. If you have habits such as rocking, feeding, and so forth, they need to be earlier in that routine. After that, what you need to develop is teach the child to be able to fall asleep independently. So, sleep is a learned process, it's not something happens to us naturally. We all learn to fall asleep.

Nada:   So how old does the baby need to be to put them down and have them sleep independently without you rocking them to sleep?

Dr. Shah:  It can be anytime between three to six months.

Nada:   Anytime between three to six months?

Dr. Shah:  Yes. Once you start seeing those stretches of sleep, longer stretches, that's when you should start training. If they are crying you can soothe them, but don't let them fall asleep on you. Kids learn, the brain associates certain situations with falling asleep, those are what we call sleep associations. We all have that. I need certain size of pillow in order to help myself fall asleep. All of us experience that we need certain temperature or softness of bed or other things to fall asleep. Same way, kids learn that too. So if they are associating you as a parent and falling asleep on you, in the middle of the night when they wake up, they're looking for that, and that's why they have a hard time falling back asleep.

Dr. Shah:  So what you want to do is once they're calm, put them in the bed awake, and let them self soothe and learn to fall asleep and so forth.

Nada:   Okay. So with self soothing. I have two little kids, but they're not newborns anymore, but when they were newborns, even if I put them in a different room, as soon as I heard a coo I would get up and go feed them and find out what's wrong. Can we talk about that? Are you supposed to get up as soon as they make a little bit of a noise? How do you know they're self soothing or not?

Dr. Shah:  Sure. It can be really anxiety producing to feed the newborn and early age child and so forth. Even if they cry slightly, it's "okay there is something wrong with it." So, all of us communicate by talking. Kids communicate by cooing or crying. So all the cries are not abnormal. So what you want to understand is learn to differentiate between his cry is indicative of something, such as I'm hungry, such as I need a diaper change or so forth, or just child is trying to communicate with you. In that particular situation, what you want to do is if child needs help to soothe, yes you should help soothe. But again same concept. When they are awake, put them back into the crib and help them to self soothe.

Nada:   Okay.

Dr. Shah:  So it's not necessary that you respond to everything, but if there is kids need, you should certainly respond, but still teach them to fall asleep by themselves.

Nada:   Can you talk a little bit about the abc's of sleep when it comes to little kids and babies?

Dr. Shah:  And abc you mean the routine or the steps or so forth?

Nada:   Yes.

Dr. Shah:  Okay. So, in general, there are certain what we call sleep hygiene issues and so forth. For younger kids it's a little bit different than teenager, adolescents, or school age. So what you need is a conducive environment, so nice room temperature or slightly cooler, a good comfortable crib with a firm bed, and nothing in the bed, to prevent the risk of sudden infant death. It needs to be dark, and there needs to be no disturbances such a noises and other things in general. As I said, after that, once I train them you need to develop a routine because kids learn indirectly. A newborn or early infant, you cannot teach by just saying "go to bed and you're going to fall asleep."

Dr. Shah:  Instead, your brain gradually learns to think that my first step in bedtime is feeding, then changing clothes, maybe one more thing, and then I'm getting to bed. So then they develop the pattern that every time after the third step, this is my bedtime and I'm going to fall asleep.

Nada:   So to prevent SIDS, I want to talk about that. Babies should be sleeping on their back, correct? And then on the crib so many parents could have little cool things hanging around or pillows or teddy bears. What do you suggest the crib should look like for safety?

Dr. Shah:  So, first you want to make sure the crib has been passed through the safety standard. American Academia of Pediatrics or several other associations similar to that have published the safety standards and so forth. Second, you need a firm mattress or bed or so forth. You can put a bed sheet on top of that, but nothing else beyond that. So kids generally do not need pillows and other toys and so forth, because kids may or may not be able to roll over or move their head and so forth and they could choke or so forth with those. So they need to sleeping on their back until they are at least one years of age or at least they can easily roll over and move their head around. And nothing else in there.

Nada:   So the only time that you can start putting a baby on their stomach is when they are able to lift their head or they're able to turn?

Dr. Shah:  I would, generally based on the recommendations, I would suggest after one year, and so forth.

Nada:   After one year, okay great. So, lets talk about a little bit older, let's talk about kids that are potty trained, or going through potty training. They wake up at night, probably. Not even them, as a parent, a lot of parents go in and make sure you get up, let's go use the bathroom. So how do you suggest we potty train and still keep a good sleep schedule or habits?

Dr. Shah:  Yeah, that's a tough question. However, what you want to do is understand the child well. What is child looking for? During that older age, you're probably talking about after the toddler age right before the school and so forth. First thing you want to make sure in the middle of the night when they're waking up is there an abnormal reason for that such as sleep apnea or any other problems going on? Stomach reflux, pain, other things? Second, all of us can wake up about two to six times a night normally, including kids. So those are called normal awakenings, those are not the problem unless kid has trouble falling asleep without needing help.

Dr. Shah:  So if they're needing help and they're needing to go to the bathroom are other things and so forth, you want to ask why is that? Is it because child is holding back during the day time or do we need to change the pattern during the daytime and get the child to the bathroom right before going to bed? To make those changes to be able to prolong the sleep itself.

Nada:   So that's important to talk about, that daytime habits or your lifestyle can really affect your sleep. So what you're eating, when you're sleeping, what time you're eating, what time you're sleeping, to make sure that aligns so you can have a good night of sleep.

Dr. Shah:  Absolutely yes. More consistency every day, better it is for sleep.

Nada:   Okay, consistency. Great, so a lot of moms also find themselves doing nighttime feedings regularly. My own sister just had a baby, so there's a lot of nighttime feedings, especially hard for breastfed babies that wake up for that. And it's not even just hungry, it's just like you said it's comfort, almost like they're used to it now. What do you suggest for those moms?

Dr. Shah:  Yeah, and we went through that same phase. So generally what you want to do, unless they're under three to six months, they may still need a feeding in the middle of night. After that, most of the kids should be able to go through the night, a chunk at least six straight hours without feeding in the middle of the night. So if they're waking up in the middle of the night, it may not always be to feed, and so forth. But their brain is used to feeding, so they may cry, and you may feel that they need feeding and so forth. So what I would recommend is gradually phase out after six months or so forth, take out the first middle of night feeding which is most problematic and so forth.

Dr. Shah:  So if you are feeding 2:00, 3:00 in the middle of night, that's the first one you gradually want to reduce and so forth. Again having a routine at bedtime and moving that feeding early into the routine teaches the child that right before falling asleep I'm not going to feed rather than there is something else. So kids are not using that in the middle of the night to soothe them and fall asleep and so forth.

Nada:   Sure.

Dr. Shah:  Then you gradually can remove the other feedings like earlier feedings and so forth which is acceptable. Sometimes we suggest what we call dream feeding. So let's say if they need earlier in the night, 9:00 or 10:00 or so forth, kids in drowsiness can still feed. So you can feed them without waking them up and put them back in the crib and they will still fall asleep or stay asleep. We did same with our own kid, and we are done with all the nighttime feeding.

Nada:   Well, some moms like myself didn't have such an easy one with my second child. With my second child, she was very thirsty all the time, and she would wake up at night more than twice, and by that time she was on formula, she was 18 months in, and my doctor suggested that I make her just wake up and she's going to have to cry herself to sleep because she's so used to waking up and getting some warm milk. Let's talk about that, because that's not just hard on the kid but to be the one listening to a baby crying for a week at night was very difficult.

Dr. Shah:  Yeah, it's absolutely right. So, question is does crying out work? Yes, it can. Is it easy? Probably not. So there are several parents who are able to do that, but that does not mean that it works for everyone. There are several gradual methods you can implement to teach the child, and modify those things. Again, when you use the crying out method, you need a lot of patience, because when you try that for the first few nights, you're going to have prolonged crying. They can cry up to 90 minutes. So if you can get through that, yes implement that. If not, then gradual method such as if the child needs help yes you respond, and soothe or calm them.

Dr. Shah:  However, again, not letting them fall asleep on you or with other circumstances such as rocking, feeding, and so forth. Gradually get them back to the crib. Also, you want to find an alternate plan. So if they're crying, instead of feeding, what other methods are soothing? Most of the parents know their babies well, or children well. So if you have other methods you want to try, implement that to soothe and then put them back when they're awake.

Nada:   Okay great. So even with you, you said you have a nine month old you said?

Dr. Shah:  Yes.

Nada:   So, a lot of parents feel like if the baby sleeps a long time, they need a diaper change. Some parents will almost force a diaper change in the middle of the night. Do you suggest that? Is that a good idea? Or is that also encouraging a habit that you shouldn't?

Dr. Shah:  Sure, so it's not always necessary, babies can go longer. It's more so parental preference. We don't, with my child. But first thing in the morning we do a diaper change. So, if you have a preference yes you can, but that can also sometimes wake up the children in the middle of the night. So you have to choose between letting them sleep versus waking them up for a diaper change and so forth. There's no guideline to what is right, here, but generally I would suggest that kids can go at least six to eight hours even without a diaper change. So if you allow to sleep or if you are okay with that, then go ahead. It's more or less parental preference.

Nada:   It's a parent approach. All right, so whether a child, infant or toddler, is dealing with something like separation anxiety, or unable to self soothe and they always are like you said used to mom and dad to go to bed, what coping mechanisms do you suggest for these ages to help them to get back to bed?

Dr. Shah:  Yeah, so, this probably will more apply to preschool age and so forth, because that's when we start seeing some of the anxiety. We commonly see fear such as there is an animal in the room or I see somebody in the room or dark is fear producing or there is a witch in the room, which are not real facts these are just fears. So first, we work with kids to gradually learn to handle the fears better by helping them either relax during those situations or so forth. Once you go there, about half of the battle is won.

Dr. Shah:  After that, if parents are still helping, what we try to do is what we call gradual extinction methods, we help parents to gradually get out of the room. It can be done by either moving yourself by distance or what we call checking method. So checking on the child every certain minutes until child is comfortable and able to fall asleep independently, and increasing the time between the checks. So there are several methods for that. We go case by case basis and we will apply a step by step plan for the parents to get help.

Nada:   And then nowadays with technology blooming, there are monitors everywhere that people can put for their babies that they can also see if they are up or sleeping and that hopefully will help as well. Let's talk about toddlers. When they wake up and they come to your room and they say "can't sleep," what is a parent to do? Do you make it ... because again, the self soothing and everything as a baby, that also comes as a toddler to go back to bed and sleep. What do you do with a toddler?

Dr. Shah:  Yeah, so a lot of times we see parents dealing with that as a very tough problem, because now child is sleep deprived, parent is sleep deprived, and parents have to get up and let them sleep in their room, right? The problem is, when you let them sleep in your room when they already have learned to sleep in their own bedroom, then it's very difficult to get back and so forth. So, for a short period of time, your own sleep may be a little bit disturbed but the key is whatever bedtime routine and situation you had, to get them back to that bed and help replicate that, because that's how they'll learn to fall asleep.

Dr. Shah:  If you are present at the bedtime when child is falling asleep, you need to gradually remove yourself by either of the methods I described. Once that happens over the period of the next few weeks, in the middle of the night also, children learn that it's not so bad when I wake up and they come less for help, and they tend to self soothe and be able to fall asleep.

Nada:   Okay, so a lot of parents will think "it's okay, it's just a toddler, it's just a three year old or a four year old or five year old, they just want to cuddle and I'm okay with that." Is there ever a good age to do that or is it always better from early on to have them separated in their own room so they don't get used to the habit?

Dr. Shah:  So there are no specifications. Generally, infants have a lot of need because they are feeding and so forth earlier. So you want to pass that earlier time, particularly when they've got a lot of nighttime needs. Once we see longer stretches, that's the easiest time. There is no particular set duration, whether it be six months or one year or so forth, it's up to parental comfort. Sometimes it's a lot of times parents are anxious to have the children in the other room and so forth. Also there could be cultural differences.

Dr. Shah:  A lot of different cultures, there might not be enough rooms for kids to have another room and so forth, so lots of variations to that. Generally the most important thing is earlier you do it, easier it is for you. If you have a preference to co-sleep, you need to keep in mind if it’s disrupting your child's sleep and also your sleep or not. If it's a problem you want to gradually get them out of it, which is almost always the case when I see patients or families in the clinic.

Nada:   Okay, so let's talk about maybe weekend or seasonal hours. Is it okay to adjust and change bedtime hours based on the season or because it's a weekend? Like you see it starts being lighter longer and it's harder to put the kids to bed, especially four or five year olds. Is it okay to adjust it on the weekends for them? Does that ruin their circadian rhythm?

Dr. Shah:  Yeah, absolutely. So generally, the more consistent you are, the easier it is. Particularly older kids I tend to see that having consistency in bedtime and wake up time over weekends and weekdays is not going to take away anything from you. Kids tend to like to play video games at bedtime because it's fun because all the peers are playing at night. So online, they're basically working with peers to play half the night or so forth. But by just moving or shifting those times, they're not losing any time during later. So more closer to weekdays you are, the better, ideally say within an hour or so forth, bedtime and wake up time.

Dr. Shah:  Longer and longer you let it go, eventually it becomes a problem. So earlier you try to fix that it's easier. It's much easier to fix wake up time first, because you can wake up yourself and gradually work backwards towards the bedtime, if you're completely off circadian rhythm.

Nada:   So one hour is okay. So let's talk a little bit about sleep deprivation. How does sleep deprivation affect a baby or an infant? How do we know that they're sleep deprived?

Dr. Shah:  So a lot of times when they're sleep deprived, mostly younger kids will be more and more irritable during the day time. Or you may see them rubbing their and instead of a child being happy and responding to you, they will be more and more crying and looks like they are pushing ...

Nada:   Bad moods.

Dr. Shah:  Yeah, bad mood and stuff. Those are initial signs. It could affect the development over a longer period of time. We have fewer studies showing that, it’s harder to do a study which is prolonged for a long time and look backward and see that or not. But certainly we have seen that kids who are getting enough sleep tend to learn better later on in their life starting from a young age. Particularly in first six years kids are learning things pretty quickly. So sleep is pretty important in all ages, but particularly during that time.

Nada:   Sure, when my five year old starts having behavioral issues, she's much meaner, she's moody, I'm like "she needs a nap." Does that ever make up for lost sleep? Naps? Or is that not a thing?

Dr. Shah:  So, typically one chunk at night, a longer chunk, is much better than a chunk at night and a nap. But again, that's after five years once they are done with the. Younger kids can still have naps and which are usually part of the development and health of them. So after five years if children are napping, there could be still a small number of kids that could be normally like that, but there's usually something going on. So, a very short nap if they're really sleepy, 15, 20 minutes can help them to just be awake and get over that, but the longer naps are usually going to create problems with falling asleep at bedtime.

Nada:   I see. Well I have no control because as soon as she gets in the car, it's something about the car, she falls asleep.

Dr. Shah:  Yeah.

Nada:   So let's talk about how does a sleep deprived parent take care of a sleep deprived child? Because I recently read, I'm not sure if you saw the article that just came out and said for parents, the first four to six years after having a child, they are sleep deprived. I didn't know it was that long, but how do you change that? What is your stance on that?

Dr. Shah:  So, that's absolutely true. It's not probably four to six years, we see it in the older kids also. Probably first four to six years are tough. Generally, what you want to do is define your own sleep needs first. Most of adults need about seven to eight hours, some are a little bit more than that. Earlier you train the kids to be able to sleep independently and easier, better it is overall for you. Sometimes it's hard, and parents give up too quickly. A lot of times they're sleep deprived it's harder to do sleep training within that period of time, because child is crying, you have to wake up in the middle of the night, still have to go to work tomorrow.

Dr. Shah:  However it's a short term pain for a long term gain. Basically, if you invest for a few weeks on training them, it becomes much easier later on that they are sleeping longer thus you are sleeping longer.

Nada:   So you're saying that parents, even if you're sleep deprived, if you start sleep training early while you're sleep deprived, it'll be easier for you because you're making your kids a little bit more independent, right?

Dr. Shah:  Not only independent and probably sleep deprived because kids are not sleeping. So once they are sleeping better ...

Nada:   You're fixing your own issue.

Dr. Shah:  Correct. And we have gone through this phase. In first three to six months of our own kid, everybody was sleep deprived. Once we did training, now it's much easier for us to get seven or eight hours of sleep and continue to perform well in the daytime.

Nada:   All right, so if mom and dad are doing everything right, and the baby, infant, or toddler still won't sleep through the night, then what? Is there something we can do? Is there something we can track down? Is that when we see a specialist?

Dr. Shah:  Generally, sleep logs. A lot of times if kids have other issues such as sleep apnea or they're experiencing stomach reflux or pain or other problems or anxiety or so forth, we work on those issues first when they come to our clinic, followed by gradually seeing how much they improve, and if they need more help implementing certain strategies and so forth.

Nada:   I see. Okay so let's talk a little bit about sleep disorders. If there is a sleep disorder with the child ... well, this is geared more towards babies, a fussy baby or sleep disorder, something like colic, when they say it's a colic-y baby, what does that mean? What is colic? It almost sounds like we don't know what it is.

Dr. Shah:  So, again, it's a good question, we don't know. Is it stomach is upset? Are they feeling cramps? We don't have a great answer. Generally colic tends to be much more common before four months of age.

Nada:   Before four months. So newborn to four months they can be colicky but we don't know what it is.

Dr. Shah:  Yeah, typically one to four months is when it's big. And gradually it gets better. A lot of times you can try to soothe the baby during that particular phase and so forth, sometimes feeding or not feeding either can help. There are not a lot of parameters of medication to help that particular situation, but the good part is that most of the kids tend to gradually grow out of it after four months at some point in time.

Nada:   Well, that's good. Four months. But now, let's say, there are issues still going on with the baby when they're a little bit older. What sleep disorders are most commonly known for this age group?

Dr. Shah:  Sure. So, most commonly, insomnia as we talked about, insomnia could be related to trouble falling asleep or staying asleep. Sleep apnea is fairly common after about ... it could be in early ages but once they start having their tonsils and adenoids growing, which is two years or after, generally we tend to see them starting to snore or trouble breathing during the sleep and so forth. So that's the second most common problem we tend to see. A little bit later, so between three or four years to younger age, we start to see what is called parasomnias, so sleep terrors or what we call confusion arousal.

Dr. Shah:  That means they sit up, they look like they are still asleep, they may say one or two words, and they have a glazed appearance and go back to sleep. Whereas sleep terrors they would scream, cry, they may not look like they're fully awake and so forth. It can last from a couple of minutes to almost half an hour and so forth.

Nada:   Is this the same thing as night terrors?

Dr. Shah:  Yes, night terrors and sleep terrors are the same thing. So, those are the problems we start seeing in pre school age at some point.

Nada:   So, what is the cause of something like a night terror? Is it just something like a bad dream?

Dr. Shah:  No, actually night terror has nothing to do with dreams. So, we go through cycles of what we call dream sleep and non dream sleep. Sleep terrors are actually happening in non dream sleep. So non dream has a very deep phase of sleep called non dream sleep or slow wave sleep. Typically there is a lot of that in first half of the night. In order for our brain to have a good refreshing night of sleep, it has to switch between the stages. So when kids are switching between the non dream sleep and other stages of sleep, they sometimes get stuck partially being awake and sleep at the same point of time. So you see behaviors of what may look like sleep, but they are doing behaviors of like trying to talk which may not make sense in the context of the time.

Dr. Shah:  They may mumble or they're crying or screaming and so forth. Good sign is a lot of kids by the time they are teenagers or adults, they tend to grow out of it. However, a lot of kids have something underlying triggering it, such as sleep apnea or not having enough sleep, are the two most common triggers. So we try to treat those underlying problems if we find any, and go from there.

Nada:   Okay, so if they're not getting enough sleep, you would suggest maybe putting the kid to bed earlier.

Dr. Shah:  Extending either side. Bed earlier or allowing a little bit more sleep if they are still sleepy in the morning.

Nada:   Okay, great. Well, doctor Shaw, we are all done. But I wanted you to kind of ... I'm going to give you the floor and just ... there's a lot of moms out there and a lot of new dads that are going through the newborn phase. If you want to kind of just in conclusion talk about how to have the best sleep for them and for the parents as well.

Dr. Shah:  Absolutely. And as I said, we have gone through, I'm a new dad, we have an infant here and we have gone through similar situations probably all of you go through. Remember, it is important to take care of yourself also in order to take care of child better. So the earliest you get an opportunity to train your kids to have better sleep, it's going to be easier overall to help yourself also. Because we all have to work, right? We all have to do a lot of duties during the day time. So there are lots of resources available out there. Either look up the credible resources, either online or if you need help talk to your pediatrician, or find a specialist who can help you and figure out and navigate those early years and so forth.

Nada:   Thank you so much, it's been a pleasure.

Dr. Shah:  Thank you.

Nada:   Thank you so much for being here.

Dr. Shah:  Thank you for the opportunity.

Nada:   Sure. And if you would like to make an appointment with a sleep specialist for your child, please call the Cleveland Clinic Sleep Disorder Center at 216-636-5860, or visit clevelandclinic.org/sleep for some more information. And to listen to more of our Health Essentials podcasts from Cleveland Clinic experts, make sure you go to clevelandclinic.org/hepodcast or you can subscribe on iTunes. And for more health tips, news, and information, make sure you're following us on Facebook, Twitter, Snapchat, and Instagram, @clevelandclinic, just one word. We'll see you again next time.