Sleep, or the getting enough of sleep, is a problem.

Trouble falling asleep and staying asleep affects 15 to 25 percent of children and adolescents.

According to the website www.healthychildren.org not getting enough sleep often leads to some pretty difficult behaviors and health problems such as crankiness, trouble paying attention, high blood pressure, weight problems and obesity, headaches and depression. This is a problem frequently for the whole family.

The first recommended intervention for getting enough sleep is to establish a good bedtime routine. What the actual routine is can be unique to your family, but should happen about the same time each night. This helps the child understand that it is time to settle down and get ready to sleep. The most important rule is sleep routines need to be consistent. When starting a new sleep routine, it may take a while to get established. Be persistent, as routines are great for children — and well worth the time.

Sometimes there are other issues, which may cause sleep difficulties such as blue light. Blue light from TV’s, tablets, eReaders, LED lights, or smartphones have a short wavelength that affects the levels of melatonin. Blue light fools the brain into thinking it is daytime, so the body feels more alert when it should be feeling sleepy.

The American Academy of Pediatrics recommends that exposure to screen time should be avoided for at least one hour before going to bed. Using devices past bedtime, especially for violent video games or shows, can also interfere with sleep.

Melatonin is a natural, hormone-like substance produced by an area in the brain called the pineal gland. It is released naturally at night and tells the body it’s time to sleep. Melatonin is not a sleeping pill and should be used only when it has been discussed with your health care provider and the established bedtime routines are not working. Short time melatonin may help establish the bedtime routines, help after vacation, summer breaks or other interruptions of the routines. Teenagers have a very difficult time as their natural sleep cycles make it hard to fall asleep before 11 p.m., and melatonin may help.

Melatonin comes in a number of forms — liquids, gummies, chewables, capsules and tablets. There are no specific guidelines on melatonin dosing for children, and it can be confusing. Start with the lowest dose (0.5 mg or 1 mg) and give the dose 30 to 90 minutes before bedtime. Most children who do benefit from melatonin don’t need more than 3 to 6 mg of melatonin. It is important that the use of devices be stopped an hour before bedtime and remain off all night. It is also important that bedtime routines continue. Needless to say, a TV in the bedroom is not a good idea.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital. This column isn’t intended to replace the advice of your child’s physician.

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