▸ ILimit sleep disrupters. Tell parents that caffeine should not be part of a child's diet, and remind them that some unlikely drinks, such as citrus-flavored sodas, can have high caffeine contents. Lobby parents and schools to limit the hours of extracurricular activities and to change early school start times. It may help to cite research on a Minneapolis school district that found grades markedly improved, tardiness and absenteeism greatly declined, and the graduation rate rose when school start times were delayed.
▸ Regularly ask patients and parents about sleep. Children's sleep problems too often go undetected and untreated. Since depression in particular can be related to sleep disturbances, both as a consequence and as a cause of inadequate sleep, “all children and teenagers who appear to be depressed must be queried about sleep,” Dr. Carskadon noted.