To the editor:

I’m a pediatric emergency physician in the Hasbro Children’s Hospital Emergency Department. In my 20 years at Hasbro, the volume of depressed, anxious, and dysregulated kids has soared. It’s alarming, heartbreaking, and includes kids from Barrington.

I’ve tried to keep an open mind about SST change and was curious about the data that purportedly countered the AAPs recommendations. I was grateful the neonatologists included the link to the Cochrane Review in their LTE. From the Key Results section: “Later school starts were associated with an increase in school-night sleep for students based on the synthesis of two studies, and evidence from six other studies also supported the relationship between later school starts and increased sleep duration.” I think the claim last week that “no evidence for benefits of later school start times was found” was misleading.

The reviewers stated the studies were low quality. It’s true they were not randomized, double-blind, placebo controlled trials. Ideally, we’d randomly choose half the kids to start late, conceal from families which group they’re in, and have kids wear sleep monitoring devices. The impracticality of “high quality” SST studies shouldn’t make us discount the excellent work that’s being done.

The SST Cochrane reviewers were: a research coordinator, a research analyst assistant, a postdoctoral fellow, PhDs, librarians, graduate students, and a surgical resident. In contrast, the AAP’s sleep research team included three PhDs and 18 MDs with five MPHs, including a developmental pediatrician who’s published widely on pediatric sleep. This group’s thorough review of the literature was done within the context of their expertise in adolescent mental health.  

Both Cochrane and the AAP acknowledge that adolescent physiology shifts teens to a later sleep/wake cycle. Regarding school start times, they both came roughly to the same conclusion. “This systematic review on later school start times suggests several potential benefits for this intervention…” and “these studies support the presence of significant improvements in benchmarks of health and academic success”. Both agree that more studies will be helpful going forward.

No one is suggesting that changing start times will certainly help all the children. It’s safe to say it’s likely that some children will benefit. How much of a sacrifice are people willing to make to help some kids? To me, THAT is the question to ponder. What if it’s only 3 fewer kids who don’t contemplate suicide next year? One kid who doesn’t crash his car? Would that be worth the inconveniences many will be facing? My teen is up with the sun, but we’re being asked to take one for the team.

I propose we come together, support our amazing teachers, be creative about transportation, even offer to carpool with people whose votes didn’t align with ours. I’ve always admired rugby players who battle fiercely and after, enjoy a pint together.

It’s summer. I live in a beautiful town with great schools and passionate citizens who love their kids. I’m going to the beach to count my blessings. Hope to see you there!

Deirdre Fearon, MD, MA, MEd

Barrington

https://pediatrics.aappublications.org/content/134/3/642

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009467.pub2/full

https://www.tdsb.on.ca/Portals/research/docs/reports/ECCILateStart-Yr1InterimRpt.pdf