adolescents

What Parents Need to Know About Sleep in Children

Author/s: 
Cynthia-Mae M Hunt, Lindsay A Thompson

Half of all children have sleep issues at some point during childhood.

When a child does not sleep well, the entire family feels the impact. Sleep supports growth and development and prevents other illnesses. Poor sleep can lead to daytime irritability, trouble focusing, behavioral issues, and learning difficulties. Poor sleep is also associated with long-term problems, such as obesity, breathing problems, and heart problems.

Childhood sleep problems fall into 4 main categories. The most common is behavioral insomnia. This happens when a child has trouble falling or staying asleep, often because they need a specific habit or aid (like rocking or feeding) to settle. Without this help, they struggle to soothe themselves to sleep.

A second category is parasomnias, which are sleep disturbances like night terrors, sleepwalking, and teeth grinding. Night terrors are sudden episodes in which a child screams or appears panicked early in the night. While frightening to witness, the child is unaware of the episode and will have no memory of it. These are usually harmless and temporary.

A third category is bed-wetting, which is also common up to around age 7 years and is usually normal. If it continues regularly after that, discuss with a health care professional to rule out underlying issues or find strategies to help.

Sleep apnea is the final category and is a more serious condition involving repeated pauses in breathing during sleep. Sleep apnea can be caused by enlarged tonsils or excess weight. Children may snore loudly, gasp, or appear restless at night. This disrupted sleep can affect their mood, behavior, and ability to learn. Some children may need overnight sleep studies to diagnose sleep apnea and provide interventions to decrease lifetime illness.

Speak to your child’s pediatrician if you have concerns. Note if your child snores loudly 3 or more nights per week, especially if they gasp or choke during sleep. Excessive daytime sleepiness, frequent headaches or stomachaches, or sleep consistently lasting less than the recommended amount (less than 9 hours for school-aged children) are also signs that your child may have a more serious sleep condition.

All sleep problems need attention. The best way to support better sleep is to create consistent routines that support sleep, known as good sleep hygiene. Keep the same bedtime and waking time every day, including weekends. Establish a calm wind-down routine (like a bath or quiet reading) for 20 to 45 minutes before bed. Turn off all screens and end exciting activities at least 1 hour before bedtime, and make sure the bedroom is cool, dark, and quiet without televisions and screens. Pay attention to both nighttime signs (like snoring or waking) and daytime behaviors (like crankiness, trouble concentrating, or hyperactivity). For children who have trouble falling asleep on their own, put them to bed when they are drowsy but still awake so they learn how to independently fall asleep. They will need this skill every time they wake up in the middle of the night, which could happen 2 to 3 times. With consistency, many sleep issues improve, helping your child rest well at night and feel their best during the day.

Diagnosis and management of depression in adolescents

Author/s: 
Daphne J Korczak, Clara Westwell-Roper, Roberto Sassi

KEY POINTS
Depression is common among adolescents in Canada and has the potential to negatively affect long-term function and quality of life; despite this, in most affected adolescents depression remains undetected and untreated.

Management requires a multimodal approach, including risk assessment, psychoeducation, psychotherapeutic and pharmacologic treatment, and interventions to address contributing factors.

Support from child and adolescent psychiatrists may be required in the case of diagnostic uncertainty and complex presentations, as well as for patients who do not respond to first-line treatments.

Obesity in Adolescents: A Review

Author/s: 
Aaron S Kelly, Sarah C Armstrong, Marc P Michalsky, Claudia K Fox

Importance: Obesity affects approximately 21% of US adolescents and is associated with insulin resistance, hypertension, dyslipidemia, sleep disorders, depression, and musculoskeletal problems. Obesity during adolescence has also been associated with an increased risk of mortality from cardiovascular disease and type 2 diabetes in adulthood.

Observations: Obesity in adolescents aged 12 to younger than 18 years is commonly defined as a body mass index (BMI) at the 95th or greater age- and sex-adjusted percentile. Comprehensive treatment in adolescents includes lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Lifestyle modification therapy, which includes dietary, physical activity, and behavioral counseling, is first-line treatment; as monotherapy, lifestyle modification requires more than 26 contact hours over 1 year to elicit approximately 3% mean BMI reduction. Newer antiobesity medications, such as liraglutide, semaglutide, and phentermine/topiramate, in combination with lifestyle modification therapy, can reduce mean BMI by approximately 5% to 17% at 1 year of treatment. Adverse effects vary, but severe adverse events from these newer antiobesity medications are rare. Surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy) for severe adolescent obesity (BMI ≥120% of the 95th percentile) reduces mean BMI by approximately 30% at 1 year. Minor and major perioperative complications, such as reoperation and hospital readmission for dehydration, are experienced by approximately 15% and 8% of patients, respectively. Determining the long-term durability of all obesity treatments warrants future research.

Conclusions and relevance: The prevalence of adolescent obesity is approximately 21% in the US. Treatment options for adolescents with obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. Intensive lifestyle modification therapy reduces BMI by approximately 3% while pharmacotherapy added to lifestyle modification therapy can attain BMI reductions ranging from 5% to 17%. Surgery is the most effective intervention for adolescents with severe obesity and has been shown to achieve BMI reduction of approximately 30%.

Interventions for High Body Mass Index in Children and Adolescents: US Preventive Services Task Force Recommendation Statement

Author/s: 
Wanda K Nicholson, US Preventive Services Task Force, Michael Silverstein, John B Wong, David Chelmow, Tumaini Rucker Coker, Esa M Davis, Katrina E Donahue

Importance: Approximately 19.7% of children and adolescents aged 2 to 19 years in the US have a body mass index (BMI) at or above the 95th percentile for age and sex, based on Centers for Disease Control and Prevention growth charts from 2000. The prevalence of high BMI increases with age and is higher among Hispanic/Latino, Native American/Alaska Native, and non-Hispanic Black children and adolescents and children from lower-income families.

Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the evidence on interventions (behavioral counseling and pharmacotherapy) for weight loss or weight management in children and adolescents that can be provided in or referred from a primary care setting.

Population: Children and adolescents 6 years or older.

Evidence assessment: The USPSTF concludes with moderate certainty that providing or referring children and adolescents 6 years or older with a high BMI to comprehensive, intensive behavioral interventions has a moderate net benefit.

Recommendation: The USPSTF recommends that clinicians provide or refer children and adolescents 6 years or older with a high BMI (≥95th percentile for age and sex) to comprehensive, intensive behavioral interventions. (B recommendation).

Marijuana and Youth: The Impact of Marijuana Use on Teen Health and Wellbeing

National Cannabis Awareness Month is observed in April to increase awareness and education about marijuana. While scientists are still learning about the risks and benefits of using marijuana, we know that marijuana use can harm a teen’s health and wellbeing.

NIAAA for Middle School

Underage drinking is a significant public health problem in the United States.

This webpage contains interactive activities to help parents, caregivers, and teachers introduce and reinforce key messages about peer pressure, resistance skills, and other important topics related to underage drinking.

These engaging activities are designed for middle schoolers ages 11 to 13. They can be used at home, in classrooms, or in after-school programs.

The content is based on a curriculum for grades 6–8 developed by the University of Michigan. The curriculum was created for the Alcohol Misuse Prevention Study (AMPS), a large-scale project supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

One goal of AMPS was to give students a clearer picture about alcohol use among their peers. Many middle schoolers tend to overestimate how much other students their age really drink. When they learn more accurate information, some of the pressure to drink can subside. Other goals of AMPS were to help students learn skills to resist pressure to drink and to give them reasons not to drink. This site incorporates AMPS goals in these and other features.

This website contains three sections focused on different aspects of alcohol, peer pressure, and resistance skills, followed by a resource list in section 4. The first three sections contain an overview, handouts, and role-playing exercises. The overviews provide background information to help you prepare to discuss alcohol and peer pressure with middle schoolers. The handouts are designed to be given to middle schoolers. The role-playing exercises are designed to be led by an adult and consist of two parts—a guide for the adult leader and a script for the middle schooler to read aloud.

Diagnosis and management of depression in adolescents

Author/s: 
Korczak, D. J., Westwell-Roper, C., Sassi, R.

Depression is common among adolescents in Canada and has the potential to negatively affect long-term function and quality of life; despite this, in most affected adolescents depression remains undetected and untreated.

Management requires a multimodal approach, including risk assessment, psychoeducation, psychotherapeutic and pharmacologic treatment, and interventions to address contributing factors.

Support from child and adolescent psychiatrists may be required in the case of diagnostic uncertainty and complex presentations, as well as for patients who do not respond to first-line treatments.

Dynamics of Naturally-Acquired Immunity Against SARS-CoV-2 in Children and Adolescents

Author/s: 
Patalon, T., Saciuk, Y., Perez, G., Peretz, A., Ben-Tov, A., Gazit, S.

Background
To evaluate the duration of protection against reinfection conferred by a previous SARS-CoV-2 infection in children and adolescents.
Methods
We applied two complementary approaches: a matched test-negative, case-control design and a retrospective cohort design. 458,959 unvaccinated individuals aged 5-18 years were included. Analyses focused on July 1 to December 13, 2021, a period of Delta variant dominance in Israel. We evaluated three SARS-CoV-2-related outcomes: documented PCR confirmed infection or reinfection, symptomatic infection or reinfection, and SARS-CoV-2-related hospitalization or death.
Findings
Overall, children and adolescents who were previously infected acquired durable protection against reinfection with SARS-CoV-2 for at least 18 months. Importantly, no SARS-CoV-2-related deaths were recorded in either the SARS-CoV-2 naïve group or the previously infected group. Effectiveness of naturally-acquired immunity against a recurrent infection reached 89.2% (95% CI: 84.7%-92.4%) three to six months after first infection, mildly declining to 82.5% (95% CI, 79.1%-85.3%) 9-12 months after infection, with a slight non-significant waning trend up to 18 months after infection. Additionally, we found that ages 5-11 years exhibited no significant waning of naturally acquired protection throughout the outcome period, whereas waning protection in the 12-18 year-old age group was more prominent, but still mild.
Interpretation
Children and adolescents who were previously infected with SARS-CoV-2 remain protected to a high degree for 18 months. Further research is needed to examine naturally-acquired immunity against Omicron and newer emerging variants.

Screening for Depression and Suicide Risk in Children and Adolescents

Author/s: 
Jin, Jill

Depression is a leading cause of disability in the US. Children and adolescents with depression typically have functional impairments in their performance at school or work as well as in their interactions with their families and peers. Depression can also negatively affect the developmental trajectories of affected youth. Major depressive disorder (MDD) in children and adolescents is strongly associated with recurrent depression in adulthood; other mental disorders; and increased risk for suicidal ideation, suicide attempts, and suicide completion. Suicide is the second-leading cause of death among youth aged 10 to 19 years. Psychiatric disorders and previous suicide attempts increase suicide risk.

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