Pediatricians take aim at school start times

Middle schools and high schools should start no earlier than 8:30 a.m. because insufficient sleep "represents one of the most common, important, and potentially remediable health risks in children, particularly in the adolescent population for whom chronic loss has increasingly become the norm," according to a policy statement from the American Academy of Pediatrics.

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Schools should start no earlier than 8:30 a.m, some pediatricians argue.

The academy strongly supports the efforts of school districts to optimize students’ sleep to improve physical and mental health, safety, academic performance, and quality of life, according to the statement published Aug. 25 in Pediatrics (2014 Aug. 26 [doi:10.1542/peds.2014-1697]).

The AAP also advocates that:

• Pediatricians educate adolescents and parents regarding the optimal sleep amount teenagers need to match physiologic sleep needs (8.5-9.5 hours).

• Health care professionals, especially those working in school-based clinics or those advising schools, be aware of adolescent sleep needs and educate parents, teenagers, educators, coaches, and others on the biologic and environmental factors that contribute to sleep deprivation in youths.

• Educational interventions for parents, adolescents, and the public on the risks of chronic sleep loss in adolescents be developed and disseminated.

• Pediatricians provide scientific information, evidence-based rationales, guidance, and support to educate school administrators, parent-teacher associations, and school boards about the benefits of later school start times as a potentially cost-effective countermeasure to adolescent sleep deprivation.

In a companion report, Dr. Judith Owens noted that "short sleep durations, coupled with evidence of daytime sleepiness (for example, increased self-reported sleepiness ratings, daytime napping, weekend oversleeping, and need for assistance in waking), as well as increased use of fatigue countermeasures (for example, excessive caffeine consumption), all indicate that adolescents are sleeping fewer hours than they need to. The clear consistent message is that middle and high school students are not getting enough sleep" (2014 Aug. 25 [doi:10.1542/peds.2014-1696]).

Dr. Owens of Children’s National Health System of Washington, D.C., is a member of the AAP Adolescent Sleep Working Group and Committee on Adolescence.

Factors that contribute to sleep deprivation in adolescents include smartphones/tablets/computers, early school start times, excessive caffeine intake, mental health issues such as anxiety and stress, chronic respiratory issues, and pain, as well as obesity-related sleep apnea. Sleep loss has been associated with depression, mood disturbance, and suicidal thoughts, as well as an increased risk for obesity, according to the report.

"Pediatricians have the opportunity to make significant inroads into addressing the health risk that sleep loss presents through screening and health education efforts," Dr. Owens said. "Many of the factors that have been shown to contribute significantly to the current ‘epidemic’ of insufficient sleep in teenagers ... are potentially modifiable and, as such, are important intervention points in anticipatory guidance in the clinical setting."

gtwachtman@frontlinemedcom.com