Health & Well-Being: Obesity - Time for bed
Monday, June 11, 2018
With a recent study linking obesity to insufficient sleep, Meredith Jones Russell asks how practitioners and parents can ensure that children get enough rest day and night
With 14,787 of 629,359 Reception-aged children in England and Wales now classed as severely obese, worries about young people’s weight are ever-increasing. Now, research claims, children who get less than the recommended amount of sleep for their age are at higher risk of developing obesity.
Academics at the University of Warwick found that children who sleep less regularly gain more weight when they get older and are more likely to become overweight or obese.
The paper, published in the journal Sleep, followed 75,499 children aged from birth to 18 for an average period of three years. Their average sleep duration was assessed through a variety of methods, including questionnaires and wearable technology.
SLEEP STUDY
The recommended amounts of sleep were based on American National Sleep Foundation guidelines:
- infants (four to 11 months): 12 to 15 hours of sleep a night
- toddlers (one to two years old): 11 to 14 hours
- children in pre-school (three to five years): 10 to 13 hours
- school-aged children (six to 13 years): nine to 11 hours
- teenagers (14 to 17 years): eight to 10 hours of sleep a night
Risk of obesity
The study found that, overall, children are 58 per cent more likely to become overweight or obese if they get less than their recommended sleep. The biggest risk was to children aged between nine and 13, for whom sleeping less more than doubled the risk of becoming overweight. The increased risk of excess weight for other age groups was:
- 40 per cent for infants
- 57 per cent for children aged three to nine
- 30 per cent for teenagers
Strong links
Co-author Professor Francesco Cappuccio says, ‘Despite some variation between studies, there is a strikingly consistent overall prospective association between short sleep and obesity.’
Dr Michael Farquhar, consultant in sleep medicine at Evelina London Children’s Hospital and member of the Royal College of Paediatrics and Child Health (RCPCH), says this association is important.
‘A connection between sleep and obesity has been around for some time, but the difficulty was we didn’t know which came first,’ he says. ‘Historically, we have thought fat people got less sleep, due to issues like obstructive sleep apnoea, but this research builds up the evidence nicely to encourage us to think about it the other way round.’
CAUSES
There are a number of possible reasons for a lack of sleep leading to obesity, Vicki Dawson, chief executive of The Children’s Sleep Charity, explains. ‘A sleep-deprived child may be less motivated to exercise and may crave sugary snacks to keep on going,’ she says.
‘If a child has sleep issues, these usually impact on the parent’s sleep patterns too. A sleep-deprived parent may find it more difficult to provide healthier food choices and resort to processed meals or takeaways due to their exhaustion.’
Jenny Stephenson, senior specialist educational psychologist and sleep practitioner at Happy Sleepers, adds, ‘For the general population of children, there are several causal links between sleep and obesity, including hormonal changes, such as leptin and ghrelin imbalances, that increase hunger and calorie intake.’
Research has suggested as little as two or three nights of sleep restriction in young adults can have profound effects on these metabolic hormones. Ghrelin is an appetite-increasing hormone that increases the feeling of hunger before meals and decreases it afterwards, while leptin, secreted by fat cells, decreases hunger and stimulates energy expenditure. However, shorter sleep times have been found to increase ghrelin and decrease leptin, leading to lower energy expenditure and larger appetite.
HOW TO HELP
Interventions aiming to alter food consumption or increase physical activity have not yet resulted in significant long-term weight loss for children, with the World Health Organization estimating 41 million under-fives are overweight or obese. So could regulating sleep hold the key to tackling the problem?
Dr Farquhar says it is worth a try. ‘Fixing sleep won’t necessarily stop obesity, but sleep is one of many risk factors that is within everyone’s capability to help with. It will have a positive impact on other health issues, so there are plenty of reasons to encourage good sleep habits.
‘At the RCPCH, we see obesity and mental health as the great epidemics facing young people. Both of these could be helped by establishing the best possible sleep patterns from an early age.’
John Reilly, professor of physical activity and public health science at the University of Strathclyde, whose research has identified a link between short sleep duration (less than ten and a half hours) at age three and obesity at age seven, says establishing a routine for sleep can only improve children’s health.
He says, ‘There is a lot of evidence supporting a routine around bedtime, with an understanding that weekends and weekdays are often different. There is good evidence of the mental health and well-being benefits of consistent bedtimes and wake-up times.’
Ms Dawson adds, ‘The quality of sleep is important as well as the quantity. A child may be having an appropriate number of hours, but continuously disrupted sleep patterns may mean they remain tired. Parents often focus on bedtime and having a set time, but they also need to concentrate on a set wake-up time to support the body’s circadian rhythm. Consistency is of vital importance.’
Ms Stephenson points out disrupted sleep is particularly relevant when children are spending so much time in front of screens. Research by academics at Birkbeck, University of London and King’s College London has found 75 per cent of children aged between six months and three years use touchscreens on a daily basis.
‘We must tackle use of technology with babies and pre-schoolers,’ she says. ‘Studies have shown a significant association between touchscreen use and decreased night-time sleep. Every additional hour of tablet use was associated with 15.6 minutes less sleep.’
COURSES
The authors of the University of Warwick paper recommend the use of educational programmes to help children maximise sleep. The Open College Network London offers Levels 3 and 4 sleep training courses for practitioners working with babies, children and young people.
The Children’s Sleep Charity also provides sleep courses for practitioners and, alongside PACEY, has developed resources.
Ms Dawson says, ‘We are becoming more aware of the impact of sleep deprivation, and the link now to obesity. Sleep issues in children still do not receive the attention that they deserve. Sleep is of vital importance for children’s well-being, yet all too often professionals have not received any evidence-based sleep training to share with families. Providing families with support is important, as they often feel isolated when dealing with sleep issues.’
Professor of lifecourse epidemiology at University College London, Yvonne Kelly, agrees intervention is vital. ‘It’s never too late. If children have a poor routine, you can look for pinch points.
‘We know as adults if we have a bad night’s sleep, it impacts on how we feel. For children, you can just multiply that up. But it is never too late for us, and I would strongly suggest it is never too late for children or young people either.’
SLEEP TIPS
By Jenny Stephenson at Happy Sleepers
Have a basic understanding of children’s sleep, what is normal and how these patterns change over time, in order to have realistic expectations and appreciate how common lots of sleep behaviours are.
Promote a healthy relationship with sleep – we can influence children’s feelings about sleep through our words, tone of voice and our own sleep habits. Talk about sleep, how ‘clever’ it is and why people need to sleep. Choose some picture books to aid discussion.
Create a routine and stick to it – consistency goes a long way and is all the more important if a child has difficulties. Having a predictable, calm and familiar routine helps children feel safe and have an expectation that they are moving towards sleep. Keep the same sequence of events that signpost what is going to happen next.
Take a step back – reflect on your own thoughts, feelings and behaviours. They can be powerful in influencing children’s sleep, and changing them can bring about a shift in sleep behaviour. Consider your own emotional state and take steps to manage your stress and fatigue if needed.
CASE STUDY
Great Wood Farm Early Years Centre, Lincolnshire
Great Wood Farm Early Years Centre in Grantham, Lincolnshire, introduced outdoor sleeping for the setting’s under-twos in April. A sleep hut has been constructed on the farm site where the nursery is based.
The benefits of sleeping outside have been evident from the start, says manager Kate Robinson. ‘Children sleep better and often longer outside. It is relaxing for them, with calming sounds and the wind rustling through the leaves. If it’s colder we wrap them up warm. They’re breathing good-quality air, unlike in a stuffy sleep room, and the sound of other children waking up and crying dissipates and doesn’t disturb them as much as it might inside.’
The amount of sleep that each child has at Great Wood Farm depends on their age, but is usually between one and four hours. ‘When they have slept well, it is noticeable how much happier and more refreshed the children are, and ready to play,’ Ms Robinson says.
Two members of staff went on the Sleep Tight: Train the Trainer courses run by the Children’s Sleep Charity, and now hold sleep workshops for parents.
‘It’s fundamental to educate the parents. Without knowledge, understanding and support, it isn’t easy. There can be many challenges along the way and we can’t expect everyone to be able to get it right on their own. We want to reassure them and work on strategies to help children sleep through the night,’ says Ms Robinson. ‘It’s about giving them the confidence to do it themselves.
‘We share information from the Sleep Council and talk through all the health and safety elements so none of them have any qualms.
‘As a result, parents have been really on board. Every single one has elected to have their child sleep outside, and they say children are actually sleeping better at home. Cutting down on sleep in the day doesn’t necessarily mean children will sleep better in the evening. They can get overtired and overstimulated, which leads to restlessness, but if they are well-rested in the day, that feeds into their night-time routine.’
MORE INFORMATION
https://sleepfoundation.org/sleep-topics/children-and-sleep
www.thechildrenssleepcharity.org.uk
‘All about…sleep’ by Dr Natasha Kirkham is at: www.nurseryworld.co.uk
BOOK CORNER
Goodnight Moon by Margaret Wise Brown
A little bunny tucked up in bed says goodnight to all the familiar things in the room, one by one, in this rhyming bedtime story.
Russell the Sheep by Rob Scotton
All the other sheep are falling asleep, but Russell is still wide awake. He tries sleeping in different locations or near other animals, but nothing works. Can counting help?
Can’t You Sleep, Little Bear? by Martin Waddell
Little Bear can’t get to sleep because he is afraid of the dark. Big Bear brings him lanterns but nothing can comfort Little Bear, until he sees the moon and stars and learns the dark is nothing to be scared of.
Peace at Last by Jill Murphy
Mr Bear is very tired, but with Mrs Bear’s snoring, the clock ticking and the tap dripping, he just can’t seem to get to sleep.
I Am Not Sleepy and I Will Not Go To Bed
by Lauren Child
Night owl Lola never gets tired. She prefers to stay up colouring, wriggling, bouncing and chattering. How can her patient big brother, Charlie, convince her it’s time for bed?
I’m Not Sleepy! by Jonathan Allen
Morning has come, and that means bedtime for a very tired Baby Owl, but he is determined to stay awake.
