Sleep and Heart Health in Children and Teens

As parents know, kids’ schedules can quickly become jam-packed with activities like after-school sports, social events, and homework—not to mention scrolling social media and learning the latest viral dances on TikTok. Getting enough sleep may be low on the priority list.

Research from Elsie Taveras, MD, MPH, a Mass General Brigham pediatrician, shows that getting enough sleep is crucial for preventing chronic conditions like heart disease, and that children from racial minority or low-income households are particularly at risk. Dr. Taveras is the chief community health and health equity officer at Mass General Brigham and the executive director of the Kraft Center for Community Health at Massachusetts General Hospital.

“Sleep health is something we need to pay attention to, and that we counsel teenagers and their families about,” Dr. Taveras says.

In this article, she discusses her research, shares tips for families to ensure their children get enough sleep, and highlights efforts at Mass General Brigham to ensure that all communities have access to the care they need.

Research on sleep habits in kids

How much sleep do children need? Good sleep depends on both duration, or the length of time someone is asleep, as well as sleep quality, or how many times someone wakes up in the middle of the night. Ideally, children and adults should be sleeping for longer durations, without waking up during the night. The American Academy of Sleep Medicine recommends that children 6 to 12 years old should get 9 to 12 hours of sleep each night, and teenagers 12 to 18 years old should sleep 8 to 10 hours a night.

Dr. Taveras’ research team has published research in the journal Pediatrics showing the impact that sleep has on children’s health. They have followed and studied a group of children and adolescents for several years, allowing them to track their health over time. They have collected data on things like body mass index, cholesterol levels, and blood sugar. “We’ve found that shorter sleep duration and lower sleep quality in children and adolescents are associated with higher risk of obesity and heart disease. These are substantial effects that can impact children’s health for years to come,” Dr. Taveras says.

Not all children were affected equally. “We also found that racial/ethnic minority children and children living in low-income households are more likely to have worse sleep quality, and are at higher risk for these chronic diseases,” Dr. Taveras explains. “We’ve been very interested in the connection that socioeconomic status, race, ethnicity, and potentially even racism, have on sleep quality. This is a heightened risk that we need to pay attention to and be careful that we counsel teenagers and their families about.”

Establishing healthy sleep habits

How can parents help improve their childrens’ quality of sleep? “For younger children, my best advice is to have a very consistent bedtime routine, because that’s something we have more control over at this stage,” says Dr. Taveras. “With my own patients, we talk about the routine of ‘bath, book, and bed,’ and putting kids to bed at roughly the same time each night." Having a set bedtime routine serves as a cue to children that it’s time to go to sleep, and can help establish healthy sleep habits later in life.

With teenagers who are more independent and have devices like tablets and smart phones, it’s important that parents try to negotiate with them and support good sleep habits when it comes to screen time. “Teenagers can be a little more challenging, but there’s still some room for parents to intervene,” Dr. Taveras says. “We recommend talking to them about not drinking caffeinated drinks in the evening, and getting screens out of the bedroom at night, including disabling notifications so they’re not woken up by alerts or texts.”

Dr. Taveras describes the sleep deprivation she sees in teenagers as a form of social jet lag. “Teenagers’ schedules often don’t allow extra sleep to happen. They have an early, fixed school start time, and then social, academic, and athletic activities affecting when they go to sleep. They’re under more stress. There’s growing realization that extended periods of social jet lag can have negative effects on the heart health of teenagers,” she explains.

While families can work with their own kids directly, there are potential policy improvements that could help on a larger scale. “Nationally, we’re trying to revisit school start times. Later start times would be more friendly to teenagers’ natural sleep rhythms,” Dr. Taveras says.

Addressing health equity

Improving access to health care for minority and low-income patients is a priority for Dr. Taveras and her team, both on an individual level with her own patients, and on a broader, system-wide level through her work with Mass General Brigham’s United Against Racism initiative.

“The most important thing we can do with all of our patients is provide them with what we call social risk-informed care and counselling. We get to know a person’s social context and risk factors, like family history, housing insecurity, food insecurity, and diet quality. This means that for a patient with hypertension, we connect that person not only with the medication they need, but with a community health worker that can help them find more resources to improve their nutrition and help provide other social supports as needed,” says Dr. Taveras.

She cites the example of one patient who lives in a housing development where there was a neon light outside their child’s bedroom window for safety reasons. “This meant the room wasn’t dark enough, and it was affecting their child’s sleep. In that case, we worked closely with the family to think about room darkening shades,” she says. 

Another important element of increasing access to health care is meeting patients where they are. “We are working in underserved communities, bringing health care, treatment, and screening with our Community Care Vans,” says Dr. Taveras. “We are trying to improve health outcomes through community-based clinical services, patient education and health coaching. We are making sure care is provided in multiple languages, and connecting patients with digital tools and virtual care to bring the care directly to them.”