BHIPP Bulletin

Volume 10, Issue 9

March 2025

This month's BHIPP Bulletin is a contribution from

Rheanna Platt, MD, Associate Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and BHIPP Consultant.

With the change in seasons can come changes in sleep. This newsletter will review the importance of sleep and describe strategies for promoting healthy sleep in youth. 



Problems with sleep can have a significant impact on the health and functioning of youth and their families. For example, in addition to physical health problems (e.g., obesity, reduced immune system functioning), sleep problems are associated with mood and anxiety symptoms, risk taking behaviors, cognitive and attentional difficulties, impaired school functioning, and suicidality.¹ It stands to reason, therefore, that promoting healthy sleep can have significant, broad impacts on child and family well-being.

Sleep requirements (the amount of sleep required to feel well-rested) vary by age. The American Academy of Pediatrics has endorsed the American Academy of Sleep Medicine recommendations on sleep duration, which are as follows:

• Ages 4-12 months: 12-16 hours (including naps)
• Ages 1-2 years: 11-14 hours (including naps)
• Ages 3-5 years: 10-13 hours (including naps)
• Age 6-12 years: 9-12 hours
• Age 13-18 years: 8-10 hours

Unfortunately, most youth do not meet these requirements. More than 50% of middle school and high school Youth Risk Behavior Survey respondents reported short sleep duration, below the recommended amounts.² 

In addition to educating patients and families about the importance of sleep and varying requirements by age, below are several tips for healthy sleep suggested by pediatric sleep experts.^1,3

• Ideally, bedtime and wake times should not vary significantly, with experts recommending that there not be more than 1 hour difference between bedtimes from one day to another, or from weekday to weekend.
• High-energy, stimulating activities (e.g., exercise) should be avoided for about 2 hours before bedtime. However, getting adequate exercise during the day can be helpful for promoting good sleep.
• Electronic media (e.g., TV, computer, smartphones) should be avoided for at least 1 hour prior to bedtime as these can be stimulating and interfere with sleep onset. It can be helpful to have devices left outside the bedroom at night. Additionally, reduce exposure to blue light at night; ensure that if devices are used, they are set to block blue light/night mode.
• A consistent, calming bedtime routine can be very helpful in providing ‘cues’ to the body that it is time to rest. A predictable routine during the day can also be beneficial. Starting this early can be helpful in setting a precedent for a bedtime routine as youth gain independence. The effects of having a bedtime routine can be felt relatively quickly- one study with young children found significant improvements within 3 nights of starting a routine.⁴
• Avoid caffeine entirely, if possible (or at the very least, avoid caffeine after 12pm as its half-life can be up to 7 hours).
• Heavy meals should be avoided 1-2 hours before bedtime, however a light, low-sugar snack before bedtime can be helpful in ensuring hunger does not interfere with sleep. This may be particularly important for patients who are on stimulants.
• If possible, avoid daytime naps for youth ages 6 and older, as this may interfere with nighttime sleep.
• If a child has nighttime awakenings that last longer than 15 minutes, the association of the bed with sleep may need to be reinforced. To accomplish this, it is recommended to have children get out of bed and do a quiet activity in dim light for 10-15 minutes prior to returning to bed.
• Consider using a white noise machine if there is significant ambient noise.
• Optimal sleep occurs when the bedroom temperature is ~60-67 degrees Fahrenheit.

Assessing Sleep in Pediatric Patients

There are a number of brief tools that can be used to assess child/adolescent sleep quality in primary care. A well-known tool is the BEARS Sleep Screening Tool. The BEARS acronym stands for: B=Bedtime Issues, E=Excessive Daytime Sleepiness, A=Night Awakenings, R=Regularity and Duration of Sleep, and S=Snoring. The tool also includes questions targeted for different age groups. To further assess sleep quality over time and understand potential problematic sleep patterns, a sleep diary is recommended.

Resources:

• Healthy Sleep in Children
• Practical Advice for Pediatric Sleep Concerns
• Sleep Tips for Your Family’s Mental Health
• How to Help Kids Who Have Trouble Sleeping
• Update on Melatonin Use in the Pediatric Population
• Behavioral Interventions for Sleep Concerns
• Pharmacological Interventions for Sleep Concerns

As always, if you have questions about the behavioral health needs of your patients, we encourage you to call the BHIPP consultation line at 

855-MD-BHIPP (632-4477), open 9am-5pm Monday-Friday, for resource/referral networking or consultation support.

We will keep you informed about all our services and training events through our website (www.mdbhipp.org) and monthly e-newsletters. Additionally, BHIPP is on LinkedIn and Facebook. We invite you to follow us there to stay up-to-date on upcoming training events, pediatric mental health research, and resources for providers, families and children.

BHIPP Announcements

Join the BHIPP ECHO Core Foundations Series Learning Collaborative!

Register for the BHIPP ECHO Core Foundations series! The next session will be held on March 27th from 12:00-1:00pm. Join our multidisciplinary team of child behavioral health experts every month between October 2024 and May 2025 for virtual case-based learning and didactic presentations. This series is great for providers who want to improve their knowledge of child mental health and develop foundational skills. Free CME and CEU credit is available for participation.

New BHIPP ECHO: Enhanced Behavioral Health Training for PMHNPs

Register for the new BHIPP PMHNP ECHO series! The next session will be held on April 1st from 11:00am-12:00pm. Join our multidisciplinary team of child behavioral health experts every month between November 2024 and April 2025 for virtual case-based learning and didactic presentations. This series is designed for Maryland Psychiatric-Mental Health Nurse Practitioners (PMHNPs) who want to deepen their knowledge of child and adolescent mental health. Free CEU credit is available for participation.

Register for the next BHIPP ECHO Beyond the Basics Session!

Register for the BHIPP ECHO Beyond the Basics series! The next session will be held on April 10th from 12:00-1:00pm. Join our multidisciplinary team of child behavioral health experts on the second Thursday of every month between October 2024 and May 2025 for virtual case-based learning and didactic presentations. This series is great for providers who have already participated in BHIPP ECHO, or who feel like they are experienced in treating behavioral health in their practice and are looking to explore advanced topics. Free CME and CEU credit is available for participation.

Sign up for the next BHIPP Webinar!

Register for an upcoming BHIPP Webinar on April 29th at 12:00pm! BHIPP Webinars are a series of interactive, web-based learning sessions that are a virtual space for pediatric primary care, emergency medicine, and behavioral health providers to connect, learn and share about strategies, practices and resources to promote mental health and resilience among children and families as well as providers. Free CME and CEU credit is available for participation.