TABLE 18-1 -- Normal Developmental Changes in Children's Sleep AGE AVERAGE SLEEP ADDITIONAL SLEEP DISORDERS CATEGORY SLEEP

PATTERNS VARIABLES DURATION IMPACTING (24 HR) ON SLEEP Newborn (0 1620 hr 3 mo) 14 hr sleep periods followed by 12 hr awake periods Amount daytime sleep = amount nighttime sleep Prematurity:few differences in sleep development Birth trauma associated with sleep disruption Breastfed:shorter sleep periods Infant (312 mo) 1415 hr total at 4 mo; 1314 hr total at 6 mo (11 hr/night; 3 hr in 2 naps/day) Sleep periods 34 hr first 3 mo; 68 hr periods at 46 mo; day/night differentiation develops at 6 wk to 3 mo Self-smoothing skills develop starting at 3 mo; may signal night wakings (crying) to parents Sleep onset association disorder/night wakings Rhythmic movement disorders (head banging, body rocking) Colic Apnea of infancy

Nap for 24 hr/day at 912 mo

7080% settle (sleep through the night) at 9 mo

Settling and night wakings influenced by parenting, feeding practices Co-sleeping common

Toddler (13 yr)

1214 hr total Nap 1.5

Night wakings often resume

Nighttime fears develop; transitional objects, bedtime

Sleep onset association disorder

AGE AVERAGE CATEGORY SLEEP DURATION (24 HR) 3.5 hr (1 nap/day) Preschool (3 1112 yr 6 yr) Napping declines; most stop by age 5 yr

SLEEP PATTERNS

ADDITIONAL VARIABLES IMPACTING ON SLEEP routines important

SLEEP DISORDERS

Limit-setting sleep disorder/bedtime resistance

Night waking in about 20%

Napping patterns Limit-setting sleep influenced by disorder parental, school Sleepwalking practices

Sleep problems may become chronic Middle 10 hr childhood (6 12 hr) Low levels of daytime sleepiness Increased discrepancy between amount of sleep on school vs non-school nights

Sleep terrors Obstructive sleep apnea

School and Nightmares behavior problems may be related to sleep Anxiety-related sleep problems onset delay

Stressful events Insufficient sleep affect sleep; poor sleep affects coping skills Adolescence (>12 yr) 9 hr ideal; 7 hr Often irregular; actual influence of lifestyle; later bedtimes/earlier rise times Phase delay at puberty; daytime alertness decreases at midpuberty Insufficient sleep Delayed sleep phase Narcolepsy Restless legs syndrome/periodic limb movement disorder

TABLE 14-1 -- Growth and Caloric Requirements APPROXIMA APPROXIM TE ATE DAILY MONTHLY GROWTH WEIGHT WEIGHT IN LENGTH AGE GAIN (g) GAIN (cm/mo) 03 mo 30 36 mo 20 69 mo 15 912 mo 13 yr 12 8 2 lb 1.25 lb 1 lb 13 oz 8 oz 3.5 2.0 1.5 1.2 1.0

GROWTH IN HEAD CIRCUMFERE NCE (cm/mo) 2.00 1.00 0.50 0.50 0.25

RECOMMENDE D DAILY ALLOWANCE (Kcal/kg/day) 115 110 100 100 100

46 yr 6 6 oz 3 cm/yr 1 cm/yr 90100 Adapted from National Research Council, Food and Nutrition Board: Recommended Daily Allowances. Washington, DC, National Academy of Sciences, 1989; Frank D, Silva M, Needlman R: Failure to thrive: Myth and method. Contemp Pediatr 1993;10:114. TABLE 14-2 -- Formulas for Approximate Average Height and Weight of Normal Infants and Children WEIGHT KILOGRAMS (POUNDS) At birth 312 mo 16 yr 712 yr At birth At 1 yr 212 yr 3.25 (Age(mo)+9)/2 (age(yr)x7-5)/2 50 75 (7) (age [mo] + 11) (age [yr] 7 + 5) (20) (30)

Age (yr) 2 + 8 (age [yr] 5 + 17)

HEIGHT CENTIMETERS (INCHES)

age (yr) 6 + 77 (age [yr] 2 + 30)