We all recognize the physical symptoms of lack of sleep: frequent yawning, trouble waking up in the morning and difficulty staying awake during the day. If your child is experiencing these symptoms, he/she might not be getting the quality and amount of sleep needed.
In the long-term, lack of sleep can lead to:
An increase in stress, which can contribute to anxiety and depression
Low energy levels
Reduced immune system function (ie: getting sick more frequently)
Getting the proper amount of sleep is therefore extremely important, allowing your mind and body to rest and recover from the day’s activities.
So, how much sleep is optimal for your child?
The Canadian Pediatric Society recommends that children between the ages of 5-10 should be getting 10-12 hours of sleep on average.
How to get the recommended hours of sleep:
To ensure your child is getting the amount of sleep he/she needs, set a bedtime and establish a bedtime routine. This consistency can help your child physically and mentally unwind and ultimately, fall asleep faster and into a better sleep. The routine can include taking a bath, reading a book or listening to calm music.
Things that should be avoided before bedtime:
Playing with electronics and watching TV can stimulate the brain, thus making it harder to fall asleep.
Stimulants (such as drinks containing caffeine) should be avoided.
Engaging in exercise right before bed can also make it harder to fall asleep.
Note that if your child is repeatedly having trouble falling or staying asleep, it might be time to consult a family doctor.
Carol-Anne and Anne support the child’s transition back to his/her community school. Their goal is to help the school help the student. They do this by asking the school, “what is it we can do for you?”
Carol-Anne and Anne first get to know the children before they leave the Child Psychiatry Day Hospital program, by observing the children on the unit. As discharge approaches, the Child Psychiatry team identifies which children and families could benefit most from follow up care. If the family agrees, they are assigned to either Carol-Anne or Anne, who divide the cases based on the geographical location of the school. This isn’t just for convenience when doing school visits: each school functions differently and it takes times to learn the ways each school works and how the Transitional Care Team can best help.
The team works with school administrators and teachers to develop a child-specific plan for the student’s transition back to class. Carol-Anne’s message to the teachers and school administrators is they “keep the lines of communication open.” She encourages school staff to reach out frequently rather than wait until small problems escalate into big ones. She explains to the teachers, “you are our eyes, you are the most valuable part of our team. No matter how good it is or how bad it is… we’re here to see how we can support you.” The Transitional Care Team provides teachers with a “toolbox” of strategies and information that are specific to each child. They regularly visit the schools and observe the child in his/her classroom, checking up on how the child is managing now that they are attending school full-time, and trying to identify how the child responds to different situations. They keep an eye out for early signs that a child may be regressing. Carol-Anne and Anne represent continuity for the child. Carol-Anne elaborates that children recognize “someone from there [the child psychiatry unit at the Jewish Hospital] still knows what I’m doing and knows how I’m behaving… I have to be accountable… It creates the link, the kids feel that they’re still connected and supported and maintaining whatever they did learn [on the unit].”
In addressing the needs of both the children and the school personnel, Anne and Carol-Anne work to devise plans with small manageable steps that the child feels confident he or she can complete. For example, one senior elementary student was asked by his teacher to recall the difficulties he had over the course of a week. Sensing that this task was overwhelming for the student, Anne created a daily chart of each subject and throughout the day the child wrote down issues as they arose. At the end of the week, the team could easily identify and address difficulties the student was having.
It can also be difficult for children and parents to make the transition back to school as it is often the case that the family has a history of negative experiences with the school. Anne explains the student’s job is “to go back and show the teachers and students, that’s not who you are, you worked really hard to get to where you are now.” Children are often excited but nervous to return to their school. “They have been able to see themselves in a positive light for the first time in many years. Their family sees them differently. They don’t want to lose that,” explains Anne, and she tries to help them bring the new success they achieved in the Child Psychiatry program back to their school. When problems arise, Carol-Anne explains “we put a mirror up to the child” and remind him or her of the behaviors they are working to improve. Anne mentions a situation where a mother was going to remove her child from the school because she was upset with the administration. Anne was able to mediate in a meeting between the parent and school personnel, so that the child was able to stay in the school. “I think if we hadn’t been there, the outcome would have been very different.”
Ultimately, Anne and Carol-Anne witness many success stories. School administrators frequently comment on the positive changes in the child’s behavior as a result of treatment in the Jewish General Day Hospital Program. The Transitional Care Team is able to see children transfer what they have learned to their schools. “Success is maintaining behavioral gains. There are varying degrees of success depending on what their needs are,” Carol-Anne explains. She recalls one student who was having a very difficult time, yet “even though things were not perfect, she gained a certain amount of self-actualization. She started to appreciate herself,” and that was a milestone for her.
Together Anne and Carol-Anne make a flexible team and a creative resource – a combination that they think contributes to their success.
I sat down with Jane Bourke, social worker and coordinator of the Transitional Care Team. Jane has been part of the team since 2006 and works with families whose children have been discharged from the child psychiatry units, while other members of the team work closely with the schools.
She says, “The goal of the team is to maintain the gains” children made in psychiatric treatment, after they have been discharged. Her team helps to achieve this with a flexible approach, which she describes as one of the strongest parts of the program. She explains, “We’ve structured the team so that we are available just about any hour. I’ve had families that have called me late in the evening… We aren’t an emergency service, but access to support in a more… practical way is necessary.”
This transition process is not without challenges. “Regression is often a normal experience,” Jane explains, “our role is to support that regression, whether it is minimal and needs just a little boost, or whether it’s actually a full regression.” Part of the way the Transitional Care Team can provide this support is by easy access to the psychiatric team at the Jewish General Hospital.
The biggest challenge for children are the changes that arise during the transition back to school. These may include social expectations and learning difficulties that surface when kids return to school. Another example is class size, “coming from a program here where the classroom is at most eight children [at the Day Hospital] going back to a classroom that is on average, 25 children” can be challenging. Part of this difficulty, is that “a teacher cannot be expected to see the cues in terms of early regression… Those little behaviors that will accelerate if not addressed.” These cues are what the childcare workers on the team look for when they observe in the schools.
Despite these challenges, the Transitional Care Team witnesses many successes. In particular, Jane recalls one boy with aggressive behavior who had serious difficulties at school and home. The team surpassed the usual 6 month contract and worked with this family for two years. Jane guesses the child “probably would have been suspended from school permanently had we not been there” and “he’s still in school. That is a success, because that is ultimately our goal, to make sure these children can graduate. And then, hopefully not accessing the [mental health care] system as often as maybe would have been needed had they not had earlier treatment.”
How can parents help with this transition? “Stay in touch” Jane says, “Our intention is to build a team around the child.”
Between social media, television, cell phones, and tablets, electronic media have become powerful forces in our children’s lives today. According to a national study conducted by the Kaiser Family Foundation in 2009, 8-10 year olds spend on average just under 8 hours per day exposed to media – a number which increases to almost 12 hours daily in the 11-14 year old age group. Despite this staggering statistic, this same study found that up to two thirds of children and teenagers have no rules regarding their media use.
It is therefore unsurprising that one of the most common questions our team hears from parents is: “how much time should my child spend in front of a screen?” To answer this question, we have summarized the recommendations put forth by the American Academy of Pediatrics:
Try to keep total screen time under 2 hours per day
Avoid screen exposure for children under the age of 2 years
Do not allow TV and internet-connected devices in your child’s room
Keep an eye on what media your child is using (social media, websites, etc)
Watch movies and shows with your child (this can be a good opportunity to talk about lessons and values we can learn from the media!)
Establish and enforce a reasonable plan for media use including curfews for mealtimes and bedtimes
Although modern media has been criticized for its sexually explicit imagery, negative portrayal of body image, and the ubiquity of violence, it is important to remember that the media can have positive effects, too. The media is a powerful tool both educationally and socially, and has helped spread prosocial messages and increase access to information- keep this in mind when coming up with reasonable restrictions on screen time!
Bullying is a critical issue for children and anyone involved in their care. As bullying spreads from the classrooms to social media, we are becoming increasingly aware of the consequences this can have on children’s well-being. What can we do as parents, teachers, children or others to help fight this problem?
Back to school is a stressful and exciting time for everyone involved. Managing this period as the parent or teacher of a child with mental health problems can be challenging, but here are some useful tips and guidelines.