Health & Nutrition - Sweet dreams

Most of a child's brain development happens when they are asleep, particularly in the first two years of life, and adequate sleep is believed to support emotional, physical and mental development.

However, research by the British Nutrition Foundation found one in three primary school pupils got less than nine hours’ sleep a night, below the recommended level.

‘We get a huge amount of information about the need for exercise, or for healthy eating, but when it comes to sleep, we don't know a huge amount,’ says Ruth Silverman, neuro development pathway lead at Sussex Child and Adolescent Mental Health Services. ‘If we understand why it's important, it becomes easier to make changes to make it better.’

WHAT IS SLEEP?

Sleep supports bodies and minds to rest and repair. A protein hormone secreted by the pituitary gland called human growth hormone is released during deep sleep and helps children grow. Several factors affect its production, including nutrition, stress and exercise, but for young children the most important factor is sleep.

‘Sleep plays a crucial role in learning during the early years,’ explains Vicki Beevers, chief executive of The Sleep Charity. ‘Research shows that sleep directly impacts on happiness, emotional regulation, vocabulary acquisition and memory.

‘Children are negatively affected by a lack of sleep in many ways, including lowering of the immune system, increased daytime behaviour issues, inability to concentrate, poor growth and weight issues, to name just a few.’

Short sleep duration has also been found to be a risk factor for obesity, according to research by the University of Warwick (see Further information), and poor sleep in childhood has been linked to chronic sleep disorders and mental health problems later in life.

‘Studies show that if you’ve got a really good foundation for sleeping in the early years and primary school, it sets you up for a lifetime of better sleeping,’ Silverman says. ‘If we can role-model good sleep behaviours like we do with eating and exercise, maybe we’ll have better outcomes.’

SLEEP ROUTINES

Establishing a good routine is a key way to encourage good sleep. ‘Our bodies have an internal clock, or circadian rhythm,’ Beevers explains. ‘We need routine to keep our sleep on track.’

A hormone whose production is prompted by darkness, melatonin, helps synchronise our sleep-wake cycle with night and day, and regulate our circadian rhythm. It is a prime reason for avoiding screens before bed, as light can inhibit it.

Children are particularly sensitive to changes in their sleep routines. ‘We sleep in cycles and experience a number of partial wakings during the night,’ Beevers adds. ‘If conditions are consistent and we are able to resettle ourselves, these may not even be recalled, but many children wake fully because something has changed since they went to sleep – maybe a parent has left the room, a landing light has been switched off or a favourite toy has fallen out of bed.’

HOW MUCH SLEEP?

According to the NHS, newborns will sleep for between eight and 18 hours in a 24-hour period. As they grow, babies will quickly start to understand the difference between day and night, and by four months, they may be spending around twice as long sleeping at night as they do during the day.

Some babies aged between six months and a year will sleep for up to 12 hours at night, and after their first birthday they will sleep for around 12 to 15 hours in total.

Most two-year-olds will sleep for 11 to 12 hours at night, with one or two naps, while most children aged three or four will need about 12 hours’ sleep.

However, there are no hard and fast rules. ‘It is important to note that all children are individuals and the most important thing is to assess whether the child is suffering sleep deprivation rather than to try to chalk up hours,’ Beevers says. ‘What may be adequate for one child may not be sufficient for another.’

One of the main signs of sleep deprivation is hyperactivity, which can be misinterpreted as a child not being tired.

Reasons for sleep deprivation can include:

• inability to self-settle
• sleep associations that aren't in place throughout the night; for example, a light on, cuddly toy
• diet; for example, too much sugar or caffeine
• undiagnosed sleep disorders such as obstructive sleep apnoea
• other medical issues; for example, eczema
• teething
• sensory issues
• over-stimulating environment
• circadian rhythm issues; for example, lack of routine.
  
  

HOW TO HELP

Early years practitioners are ideal to support sleep routines, says Silverman. ‘They are in a really privileged position to be able to identify a child who might be overly tired, and, with children who are still having daytime sleep, to support parents with bedtime. They can ask about the routine at home and remodel it in the setting, and start supporting sleep the same way they would potty training; working together with parents,’ she says.

With a wide variety of approaches to sleep available, including gradual retreat, sleep training, rewards, or sleep diaries, it can be difficult for practitioners to know what to recommend.

Silverman invented the Sleep Game to encourage practitioners to discuss and learn about sleep and share experiences in a group, and is now developing an app.

‘It's really patchy, the training professionals receive on sleep,’ she explains. ‘Talking in a group helps consider different experiences and come up with different approaches. We suggest all different exercises to help children with physical development. Sleep should be the same. No one method is better than another; they should be tailored to a particular child and family.

‘We mustn't blame parents. What we can do is support them to change things to improve sleep, which often does mean going through rockier periods before things get better. That can be hard, because they will be losing sleep too. It's about having understanding, gentle, two-way communication, and working in partnership with parents.’

CASE STUDY: Wellies Nursery in Horncastle, Lincolnshire

Nursery owner Kathy Christie approached The Sleep Charity for support in 2015 as she had concerns about parents’ welfare.

‘Our practice was well defined from the get go,’ she says. ‘We have a non-stimulating sleep environment, recognise a child showing signs of being sleep-ready, and use gradual retreats; standing near children and slowly but surely moving away to give them the gift of self-settling without creating distress. That all seemed obviously good practice, you don't need a great deal of research for it.’

However, she acknowledges, this can be harder to implement as a parent. ‘Practitioners saw parents showing signs of sleep deprivation; abrupt, irritable, or crying. It's heart-breaking how upset or ill they can get, resigned to the idea this is just how it is to have a young child. There is a social understanding that children and sleep do not go hand in hand,’ Christie says.

‘A lot of conversations began with a family asking us not to let their child sleep during the day because they felt it impacted night-time sleep. There might be an element of truth to that, but we didn't feel it was a sensible approach. We don't want children to sleep when they are so physically exhausted they keel over.’

She adds, ‘Sometimes parents were trying to develop strategies for their child's negative behaviour, but sleep was causing the problems.’

Staff attended The Sleep Charity training, and cascaded what they had learned to colleagues and parents. The nursery now holds regular parents’ workshops, special parents’ evenings, and shares tips via social media.

Staff aim to approach every set of circumstances individually and non-judgementally. ‘Every set-up is different,’ says Christie. ‘For example, a lot of parents have their children in their bed. But there might be options to help.’ She says Covid added a challenge. ‘Everyone's routine went up the swanny. Even children who had been doing well were struggling.’

The nursery set up Zoom sessions with The Sleep Charity to keep parents on track and feeling supported.

Further information

• thesleepcharity.org.uk
• NHS: ‘Sleep problems in young children’, https://bit.ly/3zFg3dB and ‘Helping your baby to sleep’, https://bit.ly/3zHY2es
• Anna Freud Centre sleep advice, https://bit.ly/3zy0WlS
• University of Warwick research, https://bit.ly/3SwuyZD
  
  

Eating well

Dr Xanthi Maragdouaki, an Early Years Nutrition Partnership (EYNP) registered nutrition professional, considers advising parents on giving snacks to children

The structure of the nursery day with regular mealtimes and snack times can mean that early years practitioners do not get the same food demands as parents. So, how can you support parents when they are asked the question, ‘Can I have a snack please?’

Keep healthier snacks ready. If parents or carers have a healthy snack on standby, there is no preparation time and the healthier choice is always available. Crudités with cottage cheese or hummus, grapes, watermelon, cucumber and nectarines are all great seasonal options. More savoury snacks such as cheese cubes, homemade popcorn and wholemeal crackers can also be a starchier option. Also, don't hesitate to advise parents to offer snacks similar to those on your nursery's menus.

Avoid pre-packaged snacks, particularly ones high in salt and sugar. These snacks can become a habit for children, with the high sugar and salt content increasing their cravings for similar snacks and reducing satiety, while the packaging is also designed to make them more appealing to children. Nevertheless, some ready-to-eat snacks can be convenient when we lack time. In this circumstance, it is preferable to remove the packaging before offering them to children.

Do not say no to certain snacks! This may sound like contradictory advice, but if children do come across snacks that are considered ‘unhealthy’, parents should avoid always saying no, which can only make them more desirable. Nothing terrible will happen if they, once in while, get a snack that is not what you normally offer. Just avoid having such snacks always available, to avoid consuming or denying them too often.

Offer nutritious, satisfying meals. Ensure children get enough fibre and protein in their meals so they stay fuller for longer. I often advise nurseries to offer the food that is more likely to get rejected first, while the children are hungrier. It may also be worth serving starchy foods to children last to ensure their protein and fibre intake. If children are satisfied for longer, there is less chance that they will ask for snacks.

Involve children! Children love creating and cooking. Star-shaped fruits, ice lollies made from Greek yoghurt and berries, and skewers with halloumi and vegetables, offer easy and colourful choices to get children interested. It is also a great sensory experience that encourages acceptance of a greater variety of foods.

• If you would like to discuss any of the issues raised in this column or any other matter around early years nutrition, please contact Jonathan Lucas at hello@eynpartnership.org to arrange a conversation with one of the EYNP's registered nutrition professionals. For more information, see www.eynpartnership.org