Contrary to common sentimentality, I believe our imaginations do have certain limitations. My imagination, for example, can only guess when I came down with this cold. My imagination has repeatedly demonstrated a profound ignorance of my chances of winning a poker hand. My imagination inflates the figures in my bank account and tells me that my brown belt matches my black pants. While some matters are more subjective than others, I have generally found that my imagination really likes to wing it.
When I was 4, I imagined that if a vitamin each day would keep me healthy, then an entire bottle of them might leave me looking like Popeye. I don't really remember the syrup of ipecac my mother used to bring them all back up, but she will remind me about it without invitation. My point here is that all of us have been that child at one time, armed with little more than a forever-speculating imagination, and we have all depended on others to deliver that dose of reality, of expertise, of care. This is one of many natural roles for a parent, and it is rarely more important -- or more complicated -- than at bedtime.
Pediatric sleep presents obstacles, beginning with the difficulty of helping an infant adapt to the day/night cycle and ending with curfews, "Lights Out," and cries of "Hey -- I was playing that!" A tremendous amount lies at stake in terms of a child's cognitive, physical, and emotional development. Yet, in pediatric sleep medicine, the lines remain frustratingly blurry.
For starters, the definition of "normal" is itself elusive. This topic has been addressed brilliantly and at length by Dr. Judith Owens of the Children's National Medical Center (click here to view some of her work). She asserts that "normal" sleep for a child must be defined individually within developmental, parental, social, cultural, and environmental contexts. Widely-available guidelines such as total sleep time by age and when to phase out napping remain essential structural elements of pediatric sleep. Nonetheless, in the light of the real-life variables that may affect a child's sleep at any given point in their development, these normative guidelines decay into murky abstractions.
As such, it becomes easy for a parent to lose perspective on the matter. One of the first challenges for a physician faced with a pediatric sleep problem is to identify who actually has the problem: the parent, the patient, or another family member. As most of us are aware, one person's sleep problem can produce symptoms for the whole house. To boot, children naturally have difficulty gauging their own sleep quality and rarely reveal a disorder directly to a physician. Even when symptoms are reported or observed, these symptoms are often not viewed in pediatric terms. A child's symptoms for a certain disorder may differ dramatically from those of an adult with the same disorder. Adults with obstructive sleep apnea syndrome, for example, tend to report excessive daytime sleepiness, while children tend to demonstrate the apparent opposite, hyperactivity.
A parent cannot be expected to untangle all of these possibilities alone, and likewise, neither can a child. Still, many parents operate under the dismissive misconception that a child will simply "grow out" of their sleep problem. While accurate occasionally, the idea stands at odds with the above mentioned role of a parent. Serious problems like persistent bedwetting, night terrors, apnea, and narcolepsy can be dangerous by themselves to a child's development, but more than this, these signs may indicate complex underlying physical, environmental, or psychological issues that extend beyond the child's sleep. A child "growing out" of a sleep problem faces it armed with nothing but time and a huge, but only half-baked, imagination. A child's sleep health depends on a parent who can maintain both an awareness of how a child is sleeping and an open dialogue with a pediatrician or sleep specialist who can place signs and symptoms in their proper context. Parents usually know when something is wrong, but the rest need not be left to the imagination.
Sam Cross, a Registered Polysomnographic Technologist, is the lab manager for Parkway SleepHealth Centers, a comprehensive sleep health facility in Cary, NC that specializes in the diagnosis and treatment of sleep disorders.
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