Letters from Maine

Goodnight moon


I would be very surprised if you were unfamiliar with Goodnight Moon. Either you have read it to a child or had it read to you when you were child. The dark tones of its illustrations and the gentle meter of its prose have made it a favorite with parents and children as a key ingredient of an effective bedtime ritual. But, reading doesn’t always have the same soporific effect on everyone.

From an early age, reading has always made me sleepy. When I was home in time to read my children a story at bedtime, they would often have to yell downstairs to my wife, "Mom, he’s falling asleep again." She would come up and finish the story for me. Now that I am working much less in the office, I have more stamina in the evening but my preference for dry plot-less nonfiction makes it unlikely that I will stay awake for more than a half a dozen pages.

It took me a few years before I accepted the fact that, for some of my patients, reading was keeping them awake instead of helping them fall asleep. Now, I am careful to ask children and adolescents who are having trouble falling asleep what it is they are reading. Often, the boys are reading fantasy and science fiction that they find very stimulating. The girls, on the other hand, are reading books about interpersonal relationships, but they find them just as stimulating.

While I cringe when I hear myself say the words, I find that I am suggesting to some parents that they discourage their children from reading for the hour before lights-out. But obviously, reading at bedtime is on the endangered activity list. In a recent Pediatrics, I found an article titled "Presleep Activities and Time of Sleep Onset in Children."(Pediatrics 2013;131:276-82). These New Zealand and Australian investigators found that television was the most common activity and that screen time accounted for about one-third of the 90 minutes prior to sleep onset. They also observed that children "with later sleep onset had significantly greater engagement in screen time than [did] those with earlier sleep onset."

The explanations for this observation run from the obvious stimulating effect of the content being watched to the disruptive effect that blue light emitted by the screens may have on melatonin levels. I don’t think we need to dig any deeper into the mechanisms. My anecdotal observations certainly agree with those of these researchers. But now what?

When I suggest that parents remove the television from their child’s room, I am sometimes met with answer, "He doesn’t really watch it." I reply "Well, then that should make it easy." Next, silence and a blank expression on the parents’ faces. I don’t recall any parent saying, "Hey, good idea. I’ll take it out tonight." It appears that for many families a television in a bedroom is as critical as a bed and light. I can’t imagine that they think they will need a master electrician to do the job.

Rarely, when a child’s misbehavior has been absolutely terrible, I have been able to convince parents to disconnect or remove a television from a bedroom as consequence. However, I think they agree only because they view it as a temporary measure to be undone when the child’s behavior improves. The concept of a permanent extirpation is too much to accept.

I’m not sure how we can do a better job of keeping televisions out of bedrooms. You could argue that if we just wait televisions will be pushed out by tablets and smartphones. But, it wouldn’t hurt to start by replacing every poster about the food pyramid with one about the dangers of televisions in bedrooms.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine.

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