This episode explores what healthy sleep looks like for children and how parents can recognize when something isn’t right. Experts from Stony Brook Children’s Hospital discuss common sleep concerns, warning signs, and when referrals to specialists such as pulmonologists or otolaryngologists are needed.
In this episode, you will learn about sleep studies, treatment options, and how poor sleep can affect behavior, weight and issues like bedwetting, as well as some key takeaways for families to support better sleep and overall well-being for children.
The Experts
- Catherine Kier, MD
- Pediatric Pulmonary Division Chief
- Stony Brook Children’s Hospital
- Mathew Ednick, DO
- Pediatric Pulmonary and Sleep Medicine
- Stony Brook Children’s Hospital
- Jaime P. Doody, MD
- Pediatric Otolaryngology, Department of Surgery
- Stony Brook Children’s Hospital
What You’ll Hear in This Episode
- 00:00 Opening and Introductions
- 2:18 What does good sleep look like for a child?
- 3:00 What should parents do if they have concerns about their child’s sleep?
- 3:20 What should parents watch out for when it comes to their child’s sleep?
- 4:11 When might a child be referred to a pulmonologist?
- 5:00 When might a child be referred to an otolaryngologist?
- 5:58 At what point is surgery considered?
- 7:10 What does a sleep study look like at Stony Brook?
- 9:00 Surgery for pediatric obstructive sleep apnea (OSA)
- 11:00 Non-surgical treatment options for children with sleep problems
- 12:34 Continuous Positive Airway Pressure (CPAP)
- 13:48 Healthy sleeping habits for children
- 15:14 Can side effects of poor sleep mimic behaviors of ADHD?
- 16:35 The connection between healthy weight and sleep
- 18:22 Bed wetting
- 19:18 Shaving v. removing tonsils
- 21:17 Recovery and follow-up after surgery
- 22:17 Key Takeaways
- 23:50 Closing Remarks
Full Podcast Transcript
00:00 Opening and Introductions
Description of Video Studio: News desk with Stony Brook Medicine logo on the front. A big screen is behind seated experts with the HEALTH Yeah! logo (red uppercase lettering with a microphone at the top of the “L”). Music plays as the announcer introduces the episode.
Announcer
Welcome to HEALTH Yeah!, where experts from Stony Brook Medicine come together to discuss topics ranging from the complex inner workings of an infectious disease to tips and tricks for staying safe and healthy all year long.
Catherine Kier, MD
Welcome to HEALTH Yeah!, where we break down the health topics that matter most to families. I’m Catherine Kier, Pediatric Pulmonology Division Chief, and today we’re shining a light on one of the most overlooked issues in pediatric health, children’s sleep.
Sleep plays a powerful role in behavior, learning, growth and emotional well being. Yet many families underestimate sleep problems or don’t recognize the signs when they appear. So joined by two of my colleagues, a wonderful combination – pediatric sleep specialist, Dr. Mathew Ednick and Dr. Jaime Doody, a doctor of laryngology.
Dr. Ednick, can you please introduce yourself?
Mathew Ednick, DO
Yes, thank you, Dr Kier. So my name is Matthew Ednick. I’m an attending physician here at Stony Brook. I work for the Children’s Hospital in the Division of Pediatric Pulmonary and Sleep Medicine, and I see a multitude of patients with respiratory concerns and issues like cough, wheezing, asthma, cystic fibrosis. But I also see a multitude of kids with multiple sleep disorders, including insomnia, sleep apnea, things like that.
Catherine Kier, MD
Thank you, Dr. Ednick. Dr. Doody?
Jaime P. Doody, MD
My name is Dr. Jaime Patrick Doody. I am a pediatric ear, nose and throat surgeon here at Stony Brook. I completed my training through the Royal College of Surgeons in Ireland before completing my fellowship in Boston Children’s Hospital. I worked in Chapel Hill and UNC for a while, and I’m here at Stony Brook for two years.
I treat the full gamut of pediatric ENT disease, such things as airway disorders, benign and malignant tumors of the head and neck area, but also pediatric sleep is also within my remit of treatment of patients here.
2:18 What Does Good Sleep Look Like for a Child?
Catherine Kier, MD
Fantastic. Happy to have both of you at Stony Brook and again here at the podcast. So let’s start the questions. We know that there’s a lot of concerns for parents about sleep. So Dr. Ednick, tell us about what good sleep would be for children.
Mathew Ednick, DO
So good sleep varies amongst all kids, and not every kid fits in one box. The first thing we always talk about is the total amount of sleep, and like I said, that can certainly vary with child and with age. The rule of thumb, I like to think, is kids in that three to six year old range generally need anywhere between nine and 13 hours of sleep. Obviously, the younger they are, the more sleep they need. The older they are, the less sleep they need. But what’s always very important to discuss with families, parents as well as kids is proper sleep hygiene and consistent bedtime routines.
3:00 What Should Parents Do if They Have Concerns About Their Child’s Sleep?
Catherine Kier, MD
So when would parents start to have concerns about their kids’ sleep?
Mathew Ednick, DO
So parents can have concerns about their child’s sleep at any time, and if there’s any concern about their sleep, we certainly recommend that they speak to their pediatrician, who then can refer accordingly to a pediatric specialist.
3:20 What Should Parents Watch Out for When it Comes to Their Child’s Sleep?
Catherine Kier, MD
Can you tell us examples of what parents should watch out for?
Mathew Ednick, DO
Yeah, so there’s lots of things. One of the most common things we see is just trouble going to sleep, trouble falling asleep, and that falls under the umbrella of insomnia, but it could also be trouble staying asleep and different things that exist during the sleep, whether it’s snoring or any sort of breathing abnormality.
Are you concerned with how they look when they’re sleeping? Are they having what they would consider abnormal behaviors during sleep? Are they staying in bed? Are they getting up? Are they having trouble waking up in the morning, things like that are very important, especially in young kids who go to school, you know, are they able to function at a level that they should be during the day at school?
4:11 When Might a Child be Referred to a Pulmonologist?
Catherine Kier, MD
So when would parents or pediatricians refer to you?
Mathew Ednick, DO
Yeah. So we certainly get a lot of referrals from community providers as well as other providers in the hospital. The most common reason we see kids in the pediatric sleep center here is usually kids that snore and/or have big tonsils. With the snoring and with the big tonsils, like I said, we certainly get into more detail about the sleep, but that’s certainly one of the more common complaints.
But like I said, we definitely see lots of kids who have trouble falling asleep at night, trouble staying asleep at night, and if the parent has concerns about anything related to sleep, we are certainly happy to see those patients.
5:00 When Might a Child be Referred to an Otolaryngologist?
Catherine Kier, MD
Yeah, so I’ll turn to Dr. Doody. Dr. Ednick mentioned tonsils and adenoids. How do you see these patients? I know that we have partnerships and refer to you, but where are these patients coming from?
Jaime P. Doody, MD
So these patients are primarily coming from their pediatrician. As Matt alluded to, the history is common that they present with snoring and it’s usually of a significant amount to cause concern at home. And then the child presents to the pediatrician, and they perform an exam, and they see that they have large tonsils. They also might display other behaviors, such as open mouth posture when they’re sleeping, which could be indicative of adenoidal hypertrophy.
The adenoids are lymphoid tissue behind the nose, above the uvula or punching bag, and that can cause nasal obstruction and that can create snoring as well.
So patients present in a myriad of ways but it tends to be snoring is the most common one. And I do get them from pediatricians a lot.
5:58 At What Point is Surgery Considered?
Catherine Kier, MD
So parents become concerned about seeing you because they know their next step would be surgery. So tell us how you evaluate these kids, and when is surgery really a decision?
Jaime P. Doody, MD
I think in days gone by, I think surgery was performed kind of more blindly or empirically in patients that presented with these symptoms. But with the advent of technology and better understanding of sleep and the technologies behind sleep studies, I find that informs my decision making more and more, because oftentimes the clinical picture does not correlate with presenting symptoms and vice versa.
You know the classic image of a person with an increased body mass snoring heavily can have quite a low obstructive index, whereas a very low body weight child that’s quietly snoring can have a very high, so the sleep study is a key element of helping me make my decision, because not everyone needs surgery.
If we do the sleep study and we see that they have significant sleep apnea, then surgery is something that we can certainly discuss, and would be recommended by me.
7:10 What Does a Sleep Study Look Like at Stony Brook?
Catherine Kier, MD
So you mentioned sleep study. Dr. Ednik, what is sleep study?
Mathew Ednick, DO
Yeah, so a sleep study is a test that we do in our sleep lab where we assess patients, again in our case children, overnight.
Generally, what happens is they come with a parent to the sleep center. They usually get there around evening time, 7-7:30. They have their own room, separate beds in that room, but they have their own room, one for the parent, one for the patient.
And we have overnight sleep technologists that come in, and they basically hook up the kid with nothing that hurts. And I always make sure to tell the child that, and make sure to tell the parent that nothing hurts, but its sensors, generally on the head, the face and the body. And everything we’re doing overnight is to assess their sleep, is to assess their breathing during sleep, but we also assess other things.
We assess oxygen levels, we assess carbon dioxide levels, we look for any sort of abnormal limb movement behavior, and we again, in evaluating their sleep, we’re looking at their brain activity to see if there’s any abnormal abnormalities in their brain activity, we check basic EKG monitoring, which is heart monitoring. So we’re not just checking the breathing, which is usually the most common thing we’re checking for. We’re checking a whole host of other things and just jumping on what Dr. Doody was saying just before, no matter how much you complain or how many symptoms your child has prior to doing a sleep study, no one can with 100 percent certainty say you have sleep apnea or you do not have sleep apnea. You need a sleep study to show that you do or you don’t. That’s why that collaboration is important.
9:00 Surgery for Pediatric Obstructive Sleep Apnea (OSA)
Catherine Kier, MD
So tell us what the surgery is.
Jaime P. Doody, MD
Yep. So the first line surgery in otherwise well children that have obstructive sleep apnea, the recommendation is to perform adenotonsillar surgery.
Classically, it would be removal of the tonsils, tonsillectomy and removal of the adenoids, adenoidectomy. It’s a 30 to 45 minute procedure. It’s a full anesthetic. If a child is actually very well and their sleep apnea is on the kind of moderate or mild end of the spectrum, it can be safely performed as day surgery. If it’s more severe, the child has another comorbidity or illness, it would be performed as an overnight surgery. The recovery period is two weeks at home with very limited activity.
And the risks involved are, you know, you do have a sore throat. We can’t avoid that, but we do manage it very well with non-opioid analgesia, soft diet, because, you know, they’re sore back there, and eating Sun Chips would probably be a terrible idea. So we recommend soft, mushy things like overcooked mac and cheese, soups, stews, pudding, ice cream, you know, delicious things – lots of ice cream just to make it a little bit better.
And then the dreaded side effect, or sorry, complication, would be the small risk of bleeding. It’s approximately 3 percent with tonsillectomy, bleeding from the nose or mouth that can occur within the first 10 to 14 days after surgery. They do require to be reassessed by a medical professional. We usually recommend coming back to the emergency department, but 80 percent of these do spontaneously stop on their own without any further intervention. A small percentage of the overall people who have tonsillectomy do require a means or another procedure to stop the bleeding if it does continue. But overall, the bleeding rate is approximately 3 percent and of those, about 80 percent stop on their own with no intervention required.
11:00 Non-Surgical Treatment Options for Children with Sleep Problems
Catherine Kier, MD
That’s good to know. That addresses a lot of the concern and angst of patients.
Dr. Ednik, any other management for sleep problems in children?
Mathew Ednick, DO
Yeah, so especially in kids that have sleep apnea, that have big adenoids, that have big tonsils, the first line treatment is always going to be to send to Dr. Doody to talk about the tonsillectomy and the adenoidectomy.
For very mild kids, there are a few less invasive management therapies we can use. Sometimes we use a simple nasal steroid spray, which helps reduce any inflammation that might be in the nose or the back of the throat.
But the ultimate treatment, if there’s no surgical options, and it does require more definitive treatment than just a nasal spray would be what’s called CPAP. CPAP is continuous positive airway pressure. It’s usually the first line therapy in adults for sleep apnea, and people sometimes think of CPAP as the mask or the machine that is required when you sleep at night.
And again, it’s a mass that’s hooked up to a machine. And again, it’s continuous positive airway pressure. So it’s blowing a pressure of air to keep that upper airway open. It’s not oxygen, it’s simply a pressure that keeps that upper airway open.
And CPAP has been shown to be very effective in patients with sleep apnea. The biggest thing that concerns us as providers is often adherence or compliance with the CPAP, because CPAP is generally recommended and required during all sleep periods to treat the sleep apnea.
12:34 Continuous Positive Airway Pressure (CPAP)
Catherine Kier, MD
So what are the challenges and how do we support parents with a kid using the CPAP?
Mathew Ednick, DO
Yeah. So, like I said, especially in young kids, we explore all other treatment options before we go to the CPAP, but in terms of supporting both the child and the family, you know, we have to obviously encourage them that there’s no other treatment option and that CPAP is the best thing for long term health. Again, ensuring that they have a mask that fits them appropriately, a mask that fits them comfortably.
And like I said, the most important thing with CPAP adherence is frequent follow ups and education. So kids and young adults that we start on CPAP, oftentimes, I’ll be seeing them on a pretty frequent basis, maybe every couple of weeks, every month, just to ensure that they’re adhering to the CPAP and we’re addressing all their concerns, making sure the pressure is heated and humidified, because that definitely is more comfortable to the patient when they’re receiving that pressure.
13:48 Healthy Sleeping Habits for Children
Catherine Kier, MD
That’s really good for parents to know.So let’s talk about sleep problems that aren’t related to snoring or sleep apnea, which are the more common things that we see.
How about healthy sleep habits? That’s, again, a good discussion for us.
Mathew Ednick, DO
Most importantly, especially at bedtime, is proper sleep hygiene, good and consistent bedtime routine. So what does that include? So any extracurricular activities, exercise, things like that, we definitely want to be done earlier in the evening. But once they kind of decide it’s getting closer to bedtime, proper sleep hygiene, so no stimulating activities for at least 30 to 60 minutes before, lots of times we like cooler environments, as opposed to too hot. Like I said, consistent routines each and every day, and most importantly, especially these days, is the avoidance of electronics for at least 30 to 60 minutes before they actually put their child to sleep.
And electronics, there’s a lot of electronics out there, so it’s not just the phone, but it’s the phone, it’s the computer, it’s the TV, it’s the tablet, it’s the watch, it’s the gaming system, it’s whatever you want it to be. We certainly recommend the avoidance of all those electronics at least 30 to 60 minutes before bedtime.
15:14 Can Side Effects of Poor Sleep Mimic Behaviors of ADHD?
Catherine Kier, MD
Yeah, that’s a very good point. So does poor sleep mimic ADHD, like a hyperactive kid?
Mathew Ednick, DO
Yeah? So I mean, you certainly know, we don’t just see the snoring kids in clinic, in the office, but we see plenty of kids that are either getting worked up for having a diagnosis of ADHD, Attention Deficit Hyperactivity Disorder, and the reason is because poor sleep, not good sleep, insufficient sleep, not enough sleep, can certainly present with behaviors that mimic ADHD.
And what’s most important in the kids that we’re seeing is they have to be able to get up for school, go to school, pay attention in school, stay focused. And when they don’t get good sleep at night, whether it’s due to sleep apnea, whether it’s due to sleep deprivation or not enough sleep at night, the kids are “overtired,” where they can have poor attention skills, poor focus, hyperactivity, things like that. And certainly, those things need to be addressed with the hopes that improving the sleep will improve the daytime activity, and then we could either minimize or potentially avoid a diagnosis of ADHD, which again, lends itself to over treatment with medications for ADHD, when in reality, it may be just be related to poor sleep habits.
16:35 The Connection Between Healthy Weight and Sleep
Catherine Kier, MD
Dr. Ednik, I have a question about healthy weight and sleep. So what is the connection between kids with increased body mass index, or are heavy, and sleep?
Mathew Ednick, DO
Yeah, so obesity obviously can affect your overall health, not just in kids, but adults as well. And patients who are obese or have an elevated body mass index certainly increases the likelihood of having obstructive sleep apnea, because again, it’s not just extra tissue in their belly and their arms and their legs, but certainly in the neck area and in the back of the throat as well.
So in patients we see, we always are recommending a healthy diet, regular exercise and things like that. And just along the lines of what Dr. Doody has been touching on in terms of surgical treatment for obstructive sleep apnea, patients with elevated BMI or obese, the curative rate of surgery is going to be less in a patient that’s obese, as compared to a child that’s not obese.
Catherine Kier, MD
Yeah, that’s really important for us to emphasize, because, as we mentioned, sleep affects not just behavior, but overall health.
Mathew Ednick, DO
Yeah, and just again, touching on obesity, sleep deprivation or not getting enough sleep, can certainly lend itself to gaining weight as well, because, again, it has to do with changes in hormone levels during the day. And again, if your child’s not getting good sleep, whether it’s due to sleep apnea or just poor sleep habits, they’re certainly at risk of gaining weight as well.
18:22 Bedwetting
Catherine Kier, MD
That’s a very important point. Thank you. I want to ask, what about bedwetting?
Mathew Ednick, DO
Yeah, so again, we see plenty of patients in our sleep center with bedwetting – fancy term is nocturnal enuresis. And quite surprising to lots of parents as well as kids, the upper limit of “normal” for kids to still have that concern can be up to seven years old. So if I see a kid that’s six or close to seven still with that issue, I try to tell the parents that it’s still normal.
But again, lots of parents, especially once they have control of their bladder during the day, certainly want that at night. And bedwetting, as you can imagine, is related to potentially sleep disorder breathing or obstructive sleep apnea. So we certainly want to rule out sleep apnea in patients bedwetting, especially when they’re over seven years old.
19:18 Shaving v. Removing Tonsils
Catherine Kier, MD
Dr. Doody, I have a question about surgery. It’s a common question with parents, are they taking out the tonsils or are they shaving it? What’s the difference?
Jaime P. Doody, MD
It’s a very good question. So traditionally, we perform tonsillectomy and adenoidectomy. Adenoidectomy is just removal of the adenoids, which are a tissue up behind the nose with using a technique which involves cautery as well as suctioning.
But the question now people are asking is regarding tonsillectomy, which is actual removal of the tonsil tissue on block or on mass, versus tonsilotomy, which is removal of the bulk of the tissue or the shaving, as you put it.
There’s pluses and minuses for both. The pluses are in the short term, favor tonsilotomy. There seems to be less pain. Studies are showing smaller chances of the post operative bleeding in the first two weeks after surgery, and better patient satisfaction. The issue is that when you leave some tissue behind, in the case of tonsilotomy, there is the concern about tonsils regrowing. And what does that look like in the medium to long term?
There are some concerns in the literature that this can be associated with recurrence of sleep apnea, due to total regrowth of the tissue, but also things like tonsillitis later on in life, in the tonsillo, in the tonsil remnant, which can facilitate a second surgery, which can be quite difficult because a place that has been operated on before can be quite scarred down and reoperation on this site can actually be associated with more complications.
So yes, tonsillectomy and tonsilotomy are both being performed. Tonsilotomy is something that is becoming more en vogue, but we just need more evidence to really solidify it as the long term solution to the issue.
We offer both here at Stony Brook, but it depends on the patient, patient selection and what the needs of the patient are.
21:17 Recovery and Follow-Up After Surgery
Catherine Kier, MD
Thank you. Dr. Doody, when do you ask the patients to return to us after surgery?
Jaime P. Doody, MD
Yep. So the recovery from surgery, as I said, is two weeks at home. I see them back in clinic about six weeks post operatively, if the child had a severe obstructive sleep apnea and they require follow up in that regard, you have to wait at least three months before reattempting a sleep study to see what the residual breathing is like.
Children with milder sleep apneas that report symptom improvement, I don’t tend to follow up with them because they came to me with snoring, it was proven to be sleep apnea, and if they don’t have the symptoms anymore, it’s very safe to say that they’re doing well. But certainly the children with severe obstructive sleep apnea, they need a repeat sleep study, usually at least 12 weeks post operatively.
22:17 Key Takeaways
Catherine Kier, MD
Yeah, it’s so fascinating that within just these few minutes, we’re able to kind of give information to parents about sleep. So what I want to do before we end is just get key messages from each of you as far as this topic.
Mathew Ednick, DO
Sure, so I guess I’ll go first. Snoring is not normal. That’s the first off. Again, snoring may be snoring by itself, or snoring may be a symptom of sleep apnea, or other type of sleep related breathing disorder. So I certainly encourage parents, if they notice their kids snoring, to either talk to their pediatrician or call the sleep center directly.
And especially in young, developing kids, where they’re not just maturing physically and mentally, but improving in brain development as well. Sleep is very important, and we want to ensure the most optimal sleep these kids can get to, like I said, make sure they’re doing as well as they can in school. Make sure their overall health is as good as it can be.
Jaime P. Doody, MD
I think that children obstruct the sleep apnea, adenotonsillar surgery, it’s not the be all and end all, but in the correct patients, in the correctly stratified and identified patients, it can actually cure a lot of children with obstructive sleep apnea, and can be massively beneficial.
The surgery is safe. It’s not without its complications, because it’s surgery, but at the end of the day, we cure a lot of children that have these issues by just one procedure. And it’s very encouraging for parents and for myself to keep performing these procedures on these children to get the results that we get.
23:50 Closing Remarks
Catherine Kier, MD
That’s so fantastic. Thank you so much. Dr. Doody, Dr. Ednik. So I think that’s all the time we have today. And thank you to our experts for your time and expertise, and thank you to our viewers and listeners for tuning in. And if you found this conversation interesting, don’t forget to like and subscribe for more informative health related content. Thank you.
Announcer
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