Bucket Emptying: How Much Your Child Really Needs (and What To Do If They're Not Getting It)

This episode is brought to you by BioGlan Smart Mines, new term, fresh start and every child meets it differently. One isn't sleeping, one can't switch off a busy mind, one's carrying big feelings they can't quite name. I've been there as a parent and these are gummies I genuinely recommend. Sugar-free and designed to support growing minds, balance moods and restful sleep. Find them online and in store at Holland and Barrett. Sleep is a thing most parents worry about, in fact it preoccupies our thoughts at our times in those early years and then we quietly stop prioritising it once our child has passed the toddler phase. Today I want to change that because understanding what sleep is actually doing in a developing brain changes how seriously you take the amount. I'm covering the functions of sleep, why it is the foundation of everything else, what the guidelines actually say by age, the science of learnt associations and five things which genuinely help. I'm Dr Mary-Han and this is how not to scrap your kids. We talk about sleep quite often don't we as rest you know as the absence of being awake but that framing really undersells sleep enormously. The sleep is not recovery from the day, I want you to think of it this way instead. Sleep is the biological condition under which the day becomes useful. Let me explain what I mean by that. During sleep and specifically during the deep slow wave and the remit stages of sleep, so rapid eye movement stage, the brain is doing four things which it cannot do while your child is awake and busy. The first is consolidating learning. I always think this is the little librarian going around with the trolley and filing things. So the experiences, the information and the skills your child has encountered during that day, they're transferred from their short term to their long term memory during the sleep and this is called memory consolidation and the research is unambiguous. Children who sleep less remember significantly less of what they've learnt that day. So without adequate sleep the learning doesn't stick in the same way. To every hour cut from a child's sleep is not just lost rest, it's also lost learning. So that's the first. The second is sleep is resetting their emotional regulation. So the brief under Cortex what we talk about quite often the bit behind the forehead is the part of the brain which manages impulse control, emotional regulation and rational thinking and it's exquisitely sensitive to sleep deprivation. As we all know because we've all experienced it, you know, under-sled children do not look tired in the way that you might expect. They actually look and respond, dysregulated, impulsive and emotionally reactive. And some research has found that chronic sleep deprivation in children produces symptoms which closely mirror those of ADHD, difficulties concentrating, poor impulse control, emotional volatility. So that means that some children who are struggling to regulate and not actually primarily dysregulated, they're simply chronically under-sled. Number three, so the third reason is the body repairs itself during sleep. Roughly 80% of the body's growth hormone is released during deep sleep. The immune system does its maintenance work at night. Cortisol, the stress hormone, drops to its lowest point during sleep and rises to wake us in the morning. So the physical repair that the body needs cannot happen during waking hours at the same level of efficiency. And fourth, sleep protects mental health. Chronic sleep deprivation is one of the most consistent predictors of anxiety and depression in children and other lessons. The relationship is bidirectional. So what that means is anxiety disrupts sleep and disrupted sleep increases anxiety, which is why addressing sleep is often the front line intervention when children are struggling emotionally. You can't effectively treat childhood anxiety, for example, or dysregulation while leaving chronic sleep debt unaddressed. So when we talk about sleep, we're not talking about a preference or a nice to have, we're talking about the foundation on which learning, regulation, growth, immunity and mental health all rest. Cut it short consistently and everything built on top of it becomes less stable. Now, before I get into the guidelines, an important point to make is that sleep is not identical across all children. It's not identical across all adults. There is genuine individual variation within every age group. And some of this is constitutional. So your child may simply need slightly more or slightly less than another child, the same age and neither is wrong. There's also something called a chronotype, which you may well have heard of before. And it's the body's natural preference for either earlier or later sleep, which is partly genetic and partly developmental. So most toddlers and young children are naturally early rises. My son, my eldest, was one of those and he always woke up with a number five. The time he woke up always began with a number five and then could be 520, 540, 501. But that's what we often get when we get toddlers and young children. And some school age children are two. Others, particularly from puberty onwards, shift significantly towards evenings. And this adolescent sleep phase shift is biological not behavioural. It's why there's been lots of research evidence that has suggested that for adolescents starting with school day later in the morning and then finishing later in the afternoon or early evening would be better, although it's obviously not something that we have certainly implemented within the UK. But from around puberty, so this explains why this is happening from around puberty. And we know that puberty again has huge variations in terms of ages. We're getting some children going into puberty at sort of 9 or 10. Others are not going into puberty until about 13. But what happens around that time is melatonin, the hormone which triggers sleepiness, begins releasing later in the evening, sometimes by two hours or more. So this means a teenager who genuinely cannot fall asleep before 10 or 11 at night is not necessarily being difficult or choosing to stay up. Their brain chemistry has changed and fighting that entirely is fighting biology. So what we can do is work with it and avoid making it worse, which screens in the evening absolutely do. So how much sleep does your child actually need? And here are the evidence based guidelines which form the basis for most clinical guidelines. Please take into account that there are variations. Do not see this as an absolute concrete and then be overwhelmed and think, oh my goodness, me, my child is deficient in their sleep by a significant amount. You also want to take into account what appears to be the chronotype for your child and then also what may well be their natural predisposition. So guidelines take them carefully with the age and stage that your child is at. So toddlers age one to two need around 11 to 14 hours in total, but that includes their daytime nap. So if you're one year old, naps for an hour and a half at midday, they need nine to 12 and a half hours overnight to reach the lower end of the range. Pre-schoolers age three to five need about 10 to 13 hours. Many three and four year olds are still napping, which counts towards the total. Now, school age children age six to 12 need between nine and 12 hours. Now, this surprises a lot of parents. A seven year old who needs to be up at seven for school needs to be asleep, not starting their bedtime routine, not getting into bed, but actually asleep by 10 at the very latest to reach those nine hours. A most children this age need to be asleep by eight or eight 30 to reach their 10 or 11 hours, which is squarely in the middle of the recommended range. Teenagers age 13 to 18 need eight to 10 hours. Given the biological evening shift I mentioned, this often means a natural sleep window somewhere between 10 or 11 at night and seven or eight in the morning, which is why early school start times are a significant issue for adolescent sleep and why so many teenagers are running a chronic sleep window. sleep a deficit that nobody is calling a health problem. These are not aspirational targets. They are what developing brains require within the parameters of what's unique and special for your particular child or adolescent. So when children are consistently, doesn't matter if they're getting less every now and again, but when they are consistently getting less and not having any time to catch up, particularly at weekends, it shows not always in yearning and tired eyes, but in mood, in behavior, in learning, and that we tend to see that as parents and we also get to see that as teachers pretty much every day. So let's shift now to thinking about the distinction between the fine lens and the wide lens. As again, this is really crucial because the wide lens we're looking at the skills gap, the fine lens tends to focus on the problem. So the fine lens may well be my child will not go to sleep, they wake repeatedly through the night, they're up at five every morning, bedtime takes two hours, my child can only fall asleep with me in the room, my toddler wakes every hour, and I'm the only one who can reset all them. Now we can talk some specifics about some of these, these particular challenges, and please do email in contact at Dr. Maryhan if there are some very specific issues that you're struggling with around sleep. This episode is a broad to cover those, all of that sort of the broad aspects of it, and we can always drill down to some of the more fine lens. Now if we take a wide lens view, the vast majority of sleep problems have one of two root causes. Either learnt sleep associations, fundamentally what your child has been conditioned to need in order to fall asleep, or a circadian rhythm disruption, the body clock being set to the wrong time, and often I would say probably both are present. Neither is defiance, both were created over time, and both can be systematically changed. So I want to talk a little bit about learnt sleep associations because it's probably something that I've not covered directly, talked around it in previous episodes when we've covered sleep, but not directly. And I want to really highlight the research in this. So sleep associations are fundamentally the conditions under which your child has learnt to fall asleep. All of us adults and children have them. The difference is that most adult sleep associations are conditions they can recreate independently at any point in the night, a familiar pillow, a certain room temperature, silence or a fan. Now the problem for children is when their sleep association requires another person to provide it. Now here's the neuroscience behind why this matters. All humans cycle through stages of sleep throughout the night. We move between light, sleep, deep, and the rapid eye movement sleep, and we do that within an approximate 90 minute cycle. At the end of each cycle, we briefly and semi-consciously surface into a lighter state and check that our surroundings as they were when we fell asleep. Now if they are, we slip back into the next cycle without fully waking. If they're not, if the conditions have changed, if we wake properly and need those conditions restored before we can return back to sleep. So a child who falls asleep or needs a parent to fall asleep sitting beside them, and then they surface at two in the morning to find the parent gone, it's not being manipulative. They are experiencing that neurological equivalent of waking on the street when they fell asleep in the bedroom. Something has changed, something feels wrong and they need to put it right. It's those 90 minute sleep cycles that when they then just have that moment of consciousness and they're not able to fall asleep quickly enough, that's often where we get the challenges. Now, and it isn't just in terms of the conditions when they wake up in the night, it's just fundamentally the conditions of which that they've learned sleep. The child who has to listen to an audio, you know, a teenager who needs to have a television program running on repeat on their laptop to fall asleep. Whatever that might be, this is what we're talking about. So a landmark systematic review, published in the journal sleep on one of the most widely cited papers in pediatric sleep medicine found that behavioral interventions, so these are things that are to do with different changes in behavior that specifically targeted sleep onset associations. So how they fall asleep and the connections that they have for that are among the most effective treatments for childhood sleep difficulties. The mechanism is consistent across the research. The child needs to learn to fall asleep in the conditions that they will find themselves in at two in the morning or any time that they're in that 90 minute wakeful moment. The starting conditions and the middle of the night conditions need to match. So you can see if that they fall asleep to an audio book and they wake up at two a.m. and that isn't there, then that's where the challenges come in. If they're used to you being with them and then you're not there, that's when they come out of bed and they come and find you. Now the useful question to ask yourself is this. Can my child restore their sleep association independently at two in the morning or do they need me to do it? A dummy that stays within arms reach, self-restaurable, white noise on a loop, self-restaurable, a comfortable object, self-restaurable, a parent in the room, not self-restaurable. Being fed, not self-restaurable, being rocked, not self-restaurable, you get the idea. This podcast is brought to you by BioGlan Smart Mines, the tasty gummies supporting young people sleep, mood and focus with high quality magnesium and carefully selected vitamins, amino acids and natural extracts to help your child's brain and body function at their best. It's that time of year again, new school, new college, new everything. The year seven in the blazer they'll grow into it by Christmas, the backpacker bigger than they are and here's the thing I come back to again and again. Every child meets this moment in their own way. One's lying awake at night, one can't quiet and a worrying mind, one's wobbly and out of sorts and can't tell you why. I remember it as a mom too, that knot of hope and worry as you wave them off at the gate. So these are gummies I'm genuinely happy to recommend because there's something for each of them. A nighttime gummy for sleep, a focus one for those busy brains, a mood and mind one for the wobbles, sugar-free and designed to support growing minds, balance moods and restful sleep, available online and in store at Holland and Barrett. So for parents and babies in young toddlers, this is not a verdict, genuinely this is not a verdict on the choices you made in those early weeks or months. Sleep associations form because they work and we need our sleep and feeding a baby to sleep works. I have done it many, many, many, many times. Sitting with a child until they settle works, I've equally done that many, many times. They're not mistakes and they are reasonable loving responses to a child who needed support with a hard thing. The question when the pattern has become unsustainable is how to gradually shift the association towards something your child can manage independently. So let's think about the skills that we're building and then I'm gonna move into the five things which actually help. So the two skills that we're building is one is in our child and one is in us and in our child what we're trying to build is a self-settling skill. So the ability to move from awake to asleep and return to sleep independently when they surface in the night. That's what we're building in our child. In us, we want to build calm at bedtime. The wind down hour is co-regulation in action. A stressed, rushed, brightly lit bedroom produces a wired child. A calm, consistent, warm wind down produces a sleepy one because their nervous system is borrowing the settling signals from us. So here are the five things which actually help. Number one, know your child's actual requirement and work backwards. Now, my caveat before we get into this is be mindful not to, no, it's easier said than done 'cause I've just told you to work backwards, yeah? But don't become overly obsessive with this. This is a benchmark. This is a genuine place to start. But just have a think about the times that your child has been the most refreshed, the times that your child has been most vibrant and then also the times that your child has been the most problematic and dysregulated as well as the guidelines I've suggested. And that will give you a reasonable benchmark for what your child needs. And one of the ways to think about this is, is your child waking naturally or are they being woken? Yeah? So take the guidelines I've just given you and work backwards from the time your child needs to wake And this is your-- target sleep time. It's not what they are doing right now, but that's your target. And remember that that target sleep time is not the bedtime routine starting. It's not like it's out, but actually asleep. So we want to add 30 minutes for settling, and then we have our bedtime. If your child is currently needing you to soothe, then you might need to add 60 minutes. What we're looking at doing is pulling it back in within that time frame. So you can work backwards that way. And the ways to check it out, you know, just going back to this idea is, is my child waking naturally or am I having to wake them up? A child who wakes naturally before the alarm after nine or more hours is probably getting enough, even if the guidelines suggest that they need 10 or 11. A child who has to be pulled out of sleep every morning is probably not. Child who falls asleep in the car on the sofa or within minutes that they're head touching the pillow is probably carrying a little bit of sleep debt. So that's the first thing, because then that helps us work backwards. Number two is protect the wind down window. Now, I know this is not always possible. We often have more than one child. We often have clubs, activities, just the general stresses of getting children to bed, but where we are able to, even if we can just carve this out of the weekend to try it, what you will find is if you can protect that time. If you really can reverse engineer and work out the timings, you'll find that what that does do is that that gives you back a lot of your evening and a lot of your daytime referring, soothing, and appeasing a dysregulated child because they're getting the sleep that they need. So ideally, work where you're at. So I'm saying ideally the hour before bed. If that is not possible, if that is genuinely not possible in your household, then work with where you're at and what you can do. But what we're trying to do is protect that time because what we're doing is we're setting the kind of the neurological conditions for falling asleep easily rather than fighting it for two hours. So what does wind down look like? Well, lights lower. So if you've got lights that you can dim in your house, do that. Avoidance of screens. Activity and voice levels lower. I know that's often easier said than done when we're asking them to come up for a bath or a shower for the umpteenth time. And ideally, we do want them to take some form of bath or shower because they're body, but the reason why that's helpful other than obviously cleaning our children, but their body temperature rises and then it drops afterwards. And that's what triggers the sleepiness. Then pajamas teeth, something calm, reading together, a short story, a quiet conversation, the same sequence in the same order every night, where possible because predictability is what makes it work, particularly for younger children who need to know what's coming next. Now for older children, negotiate the wind down activities, not the bedtime. So the bedtime stays in place, but we negotiate the wind down. So what helps you feel ready to sleep, reading is fine, gentle music is fine, scrolling social media is not. And the reason is the content, not just the light. And I've added that a little bit because they're very clever. As a lesson children, they'll come back with a, well, my phone has got this special thing that deals with the light, the blue light, and therefore it's fine. So it's actually about the content and having that quiet time. Social media is specifically designed to promote emotional responses, which is the neurological opposite of what settling the nervous system needs. So that's number two. Number three, light is the most powerful signal to the body clock. So melatonin production is suppressed by light. That's why we often talk about as blue light, specifically the blue light wave length emitted by screens, regardless of whether your adolescence tell you that their phone has, has covered that particular base. So there's not a screen time opinion. It's an endocrinology one. So bright light in the hour before bed tells the brain it is still daylight and delay, sleep, onset, sometimes by an hour or more. And actually you will find that quite often is the case with younger children when we're in those summer months. And it's really bright outside. The curtains are not quite managing to get rid of the light. Or even if we've got blackout curtains or blinds, our children have been playing in the daylight. And they haven't quite got their heads around because their body hasn't been given the cue that it's time to go to sleep. Now, here's some practical things that we can do. Warm low light in the hour before bed. Overhead lights off if we can, if we're in a position where we've got table lamps that we can use, screens off at least 60 minutes before your target sleep time. And in the morning, get natural light into their eyes as early as possible. And I know that this is going to be harder as we enter those dark winter months. But if we can, 10 minutes outside in the morning, we set the body clock forward, making earlier sleep onset more likely the following night. So you're not just having exposing them to light in the morning because you want to wake them up. But it's also really helpful for that recognition that this is now morning. And then there will be night time. It's one of the most effective and the most overlooked sleep interventions available. This sort of getting them into some daylight when they wake up. And for teenagers, really encourage and insist on phones being charged outside the bedroom because that can be the single most impactful habit change for adolescent sleep. They can have it on the landing outside their bedroom, just not in their bedroom. The phone in the bedroom is not just a screen issue. It is a light issue, a social notification issue, an anxiety issue. The teenager who charges outside the room has genuinely switched off. The one with the phone face down on the nightstand has not. All right, number four, consistency is the intervention. Most sleep strategies work. And the reason they appear not to work is that they are applied for three nights and then abandoned. Three nights of a new approach teaches a child that persistence pays off, yet that if they resist long enough, the rules change. The most important ingredient in any sleep intervention is doing the same thing every night until the new association is built. So what to expect? A new sleep association takes between one and three weeks of consistent application to become habitual. The first week is often harder, and that's often where we throw the towel in. It's harder than before you started quite often because there's a resistance, because the older association is actively, we're trying to extinguish the old association, and of course, our child is working harder to restore it. Night four or five is usually the peak difficulty, and night 10 is usually much easier. Stopping at night five, because it's getting worse, is stopping exactly at the wrong moment, because you've just got to get over that hump for it to get easier. And if your child has learnt to fall asleep with you present, the change can be gradual. Yeah, we don't need to kind of rip the bandaid off. We might sit on the bed until they sleep for a week, move to a chair by the door or on the floor by the door, then sit outside the door. Each stage we want to do that for long enough that the new arrangement feels normal before we move again, and slow enough to feel manageable and consistent enough to actually work. And number five, I have to cover this, of course, when you are at your wits end, if you have tried everything, and sleep is still genuinely problematic, three things are worth checking before concluding that there's nothing more to do. First, the environment, room temperature, and there's been lots of evidence to show that the temperature is really crucial. You don't have to become obsessive about this, but fundamentally, the bedroom should be probably cooler than you think it should be. They say between 16 and 18 degrees is optomorphic sleep, cooler than you the most parents expect. Blackout blinds, potentially consistent white noise or complete silence. These are worth revisiting even when you think that they are fine. That's the first thing. The second thing is about anxiety and worry. Children who are anxious at bedtime cannot settle because their threat detection system will not switch off. They're still hyper vigilant. If daytime anxiety is present, it will follow your bed, your child to bed. So addressing the worries directly, not just the sleep is often what shifts things. So that's the second thing to try. If you've tried your wits end and you've tried everything else, the third and worth trying tonight is a worry time. 10 minutes before the work while it down begins, invite your child to say or write everything that's on their mind, worries, unfinished thoughts, things left undone, write them down together, close the notebook, or write them on pieces of paper, post it through a shoe box, and say, like, we've put these away until tomorrow. you're physically getting it out of their head into a notebook or into a box and then you are then removing it. The act of moving the thoughts from inside their head to outside of it into something physical that can be closed, a book or a post-it letter box is neurologically useful. For children whose minds race at bedtime, that small shift is often enough. And if the problem is severe and persistent and you have literally tried everything even these last three, then have a conversation with your GP. Sleep disorders can be real in with some children and undiagnosed and perfectly treatable. You do not have to wait until you're running on empty yourself to ask for help. So I'm hoping that that was pretty comprehensive but of course there may well be some very specific questions you have about specific fine lens sleep problems that you have. So do email those in and we can answer them as a listener question, contact at Dr Maryhan. Now on Thursday I am going into one of the topics I am asked about most at this time of year and it is what to do when your child does not want to go into school. So why does it happen when to push and when to pause and what skills might your child be missing and what actually helps? Whatever your experience of this, Thursday's episode is for you so I will see you then. And that's all for today. Be as kind to yourself as you're trying to be to your children. You don't have to get it right every time and the fact that you are here learning and growing already says a lot. For more episodes and all the resources to support you head to DrMaryhan.com. I'm Dr Maryhan. Take good care of yourself and I'll see you on Thursday. [Music]