In 2016, the task force recommended screening for depression in children and adolescents.

In a news release announcing its final recommendation for anxiety screening, the task force said, “Too many children and teens in the United States experience mental health conditions, including anxiety, depression, and suicidal thoughts or behaviors. There are several forms of anxiety, including generalized anxiety disorder and social anxiety, but all forms are characterized by excessive fear or worry. Depression, or major depressive disorder, is a condition that negatively affects how people feel, think, and act.”

For older children and teens, screening and follow-up care can reduce symptoms of depression and can improve, and potentially resolve, anxiety, the USPSTF said. However, there is very limited evidence on the benefits and harms of screening children younger than 8 for anxiety and younger than 12 for depression. And while suicide is tragically a leading cause of death for older children and teens, there continues to be limited evidence across all ages about screening for suicide risk in those who do not show signs or symptoms. This is an area where more research is critical.

“The Task Force cares deeply about the mental health of all children and adolescents. Unfortunately, there are key evidence gaps related to screening for anxiety and depression in younger children and screening for suicide risk in all youth,” Task Force member Lori Pbert, Ph.D., said in the task force news release. “We are calling for more research in these critical areas so we can provide healthcare professionals with evidence-based ways to keep their young patients healthy.”

Previous studies have demonstrated that insufficient sleep among youth can result in learning difficulties, impaired judgment and risk of adverse health behaviors. This newest study, published in a JAMA Pediatrics research letter on October 1, found an association between sleep duration and personal safety risk-taking actions.

Adolescents require 8-10 hours of sleep at night for optimal health, according to sleep experts, yet more than 70 percent of high school students get less than that.

“We found the odds of unsafe behavior by high school students increased significantly with fewer hours of sleep,” said lead author Mathew Weaver, PhD, research fellow, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital. “Personal risk-taking behaviors are common precursors to accidents and suicides, which are the leading causes of death among teens and have important implications for the health and safety of high school students nationally.”

Compared to students who reported sleeping eight hours at night, high school students who slept fewer than six hours were twice as likely to self-report using alcohol, tobacco, marijuana or other drugs, and driving after drinking alcohol. They were also nearly twice as likely to report carrying a weapon or being in a fight.

The strongest associations, researchers found, were related to mood and self- harm. Those who slept less than six hours were more than three times as likely to consider or attempt suicide, and four times as likely to attempt suicide, resulting in treatment. Only 30 percent of the students in the study reported averaging more than eight hours of sleep on school nights.

The Youth Risk Behavior Surveys are administered biannually by the U.S. Centers for Disease Control and Prevention (CDC) at public and private schools across the country. Researchers used data from 67,615 high school students collected between 2007 and 2015. Personal safety risk-taking behaviors were examined individually and as composite categories. All analyses were weighted to account for the complex survey design and controlled for age, sex, race, and year of survey in mathematical models to test the association between sleep duration and each outcome of interest.

“Insufficient sleep in youth raises multiple public health concerns, including mental health, substance abuse, and motor vehicle crashes,” said senior author Elizabeth Klerman, MD, PhD, director of the Analytic Modeling Unit, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital. “More research is needed to determine the specific relationships between sleep and personal safety risk-taking behaviors. We should support efforts to promote healthy sleep habits and decrease barriers to sufficient sleep in this vulnerable population.”

Whether your child is entering day care for the first time, going to middle school or heading off to college, University of Alabama at Birmingham physicians are answering some of the most commonly asked questions about immunizations, giving parents the proper resources and information needed to ensure that their child is up-to-date on all necessary vaccinations.

What is the benefit to vaccinating my child?

Vaccination is the most important way to protect your infant, child and teenager from harmful diseases, many of which are preventable and can be life-threatening. Vaccine-preventable diseases exist throughout the world and can cause outbreaks at any given time, even in our own country.

“The best way to treat diseases is to prevent them in the first place, and the diseases on the vaccine schedule are all preventable for the vast majority of our population,” said David Kimberlin, vice chair of UAB’s Department of Pediatrics, co-director of the Division of Pediatric Infectious Diseases, and also the American Academy of Pediatrics liaison to the CDC Advisory Committee on Immunization Practices. “The scientific evidence and public health statistics are comprehensive and compelling — properly scheduled and dosed vaccines are safe and effective, and they’re the reason we don’t see diseases like measles or whooping cough running rampant across our country.”

UAB’s Department of Pediatrics strongly supports the use of vaccines according to the schedule recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention.

Are vaccinations mandatory for my child to go to school? How do I know which vaccinations my child needs and when?

Depending on the state you live in, immunization requirements may vary, but all states and the District of Columbia agree that students must meet the minimum requirement for dosing each school year to attend public schools. In many states, including Alabama, state law requires an updated Certificate of Immunization be presented prior to entering any public school or child care center.

As of Aug. 22, 2014, all 50 states and D.C. require vaccinations for diphtheria, tetanus and pertussis, polio, measles, and rubella; 49 states and D.C. also require mumps vaccination; 48 states and D.C. require varicella (chickenpox) vaccination (Montana and Pennsylvania do not); and 45 states and D.C. require hepatitis B vaccination (Alabama, Maine, Montana, North Dakota and South Dakota do not) to enter kindergarten. Some states require Hib, PCV, flu and Hep A vaccines to enter kindergarten.

Are school vaccinations free?

“Vaccines are part of standard care for children and are covered by insurance,” said Rachael Lee, M.D., assistant professor in UAB’s Division of Infectious Diseases. As Lee notes, if you are in a position where you may not have access to health insurance, your state health department is a great resource. It can direct you to services which can offer low-cost and/or free immunizations, as well as provide other health and preventive-related resources to you and your child.

Where do I take my child to get their vaccinations?

You can take your child to their pediatrician to get their necessary vaccinations; but vaccinations are also available at local pharmacies, health centers and local health departments. Lee noted that, as a physician and a mother, she knows that it can be challenging for any parent to get their child to understand why getting a shot is important — a conversation that a pediatrician can also have when it is time for yearly immunizations.

“Vaccinating children can be hard; but I have found that, with my kids, by showing them my bandage and sore arm after getting the flu vaccine, I feel like they understand more about the importance of protecting ourselves from sickness, which turns into a great learning opportunity,” Lee said.

I’m entering college and/or postgraduate schooling. Are vaccinations required?

For students entering college or returning to a higher-education setting, there are specific vaccinations necessary for enrollment, so it is recommended that you check with your specific to see what immunizations are required. Life-threatening infections such as meningococcal disease occur more commonly in college-age people, and can be prevented through full vaccination.

What if my child has not been previously vaccinated? Is it too late to start?

If you have not vaccinated your children previously, it is important talk with your child’s pediatrician about getting caught up.

Stephen Russell, M.D., associate professor of internal medicine and pediatrics in UAB’s School of Medicine, says he has had parents who have previously rejected vaccinating their children change their mind. Whether it was because of their own further research, personally experiencing the devastation of one of these preventable diseases within their own family or through a friend’s family — or simply a change of heart — these parents have come to his UAB Medicine-Leeds clinic with one question: Now that we want to have our child vaccinated, what do we do?

“If parents who have previously not vaccinated their children decide they want to get the vaccines and get their children caught up, it can be done, and it can be done in one visit,” Russell said. “Many parents don’t know that the sooner a child is vaccinated, the more effective those vaccines will be. Pediatricians can quickly help families get back on the vaccine schedule in a safe and effective manner.”

The CDC has also developed a “catch-up” schedule that parents can work with their pediatrician to follow.

What if vaccinations are against my religious beliefs?

All major religions endorse vaccination, including Christianity, Judaism, Islam and Buddhism.  While most states offer medical and religious exemptions to vaccinations, and some states allow philosophical exemptions, the American Academy of Pediatrics views nonmedical exemptions to school-required immunizations as inappropriate for individual, public health and ethical reasons and advocates for their elimination. Both Kimberlin and Russell strongly encourage parents who have either rejected vaccinating their children or neglected to get vaccinations according to the CDC schedule to talk to their pediatricians now, and to make arrangements to get their children the vaccinations they need before the school year begins.

“It’s difficult for me to understand fully why someone would reject a medical miracle for their child, and that’s what vaccines are,” Kimberlin said. “The very success of the vaccination program is probably a big part of why we as physicians face these obstacles today, because parents don’t see measles, polio and rubella the way they did 30, 40, 50 and 60 years ago. So, they don’t have the perspective that their mothers, grandmothers and great-grandmothers had when it was common to lose a child to one of these now-preventable diseases.”

How can I pull my or my child’s immunization records?

According to the CDC, there are a few places to look to find immunization records. They recommend starting with the following agencies or organizations, as they should have a copy of their records on file:

Your child’s pediatrician or public health clinic

Your child’s state health department

Your child’s school or day care center

Your child’s college, should they be of adult age

How can I protect my children from HPV-related cancers, and when should I get them vaccinated?

According to Isabel Scarinci, Ph.D., professor in the UAB Division of Preventive Medicine and associate director for Globalization and Cancer at the UAB Comprehensive Cancer Center, more than 31,000 people will be diagnosed with human papillomavirus (HPV)-related cancer this year. Many of these cancers occur in both men and women and could be prevented by the HPV vaccine.

“The good news is that we now have a vaccine that has been proven to be effective against the HPV virus and that could eliminate multiple HPV-related cancers,” Scarinci said.

The Center for Disease Prevention and Control recommends the HPV vaccine for boys and girls between 11 and 12 years of age but they can start as early as 9 years of age. If they are between 9 and 14, they only need two shots six-months apart. If they are older than 14, then three shots are required.

“Teens who did not get the vaccine or did not get all doses when they were younger should get it now,” Scarinci said. “I cannot underscore enough that boys also need to get the vaccine because approximately 40 percent of HPV-related cancers occur among men.”

The research, led by a Massachusetts General Hospital for Children (MGHfC) physician, was published in the journal Pediatrics.

“While many studies have associated shorter sleep duration with increased obesity levels in children, few have examined effects on other risk factors – such as blood pressure, blood lipids and glucose metabolism – or examined associations of sleep quality with these outcomes,” said Elsie Taveras, MD, MPH, chief of the MGHfC Division of General Academic Pediatrics and senior author of the Pediatrics paper.

“An additional strength of our study is that we relied on an objective measurement of sleep, in contrast to subjective reports from parents or children that may be less accurate, and that it is also one of the first to focus on early adolescence – a developmental period with dramatic biological changes in sleep, a high incidence of inadequate sleep and the emergence of cardiovascular risk factors.”

According to a news release from Massachusetts General, the study is the latest report out of Project Viva, a long-term study based at Harvard Pilgrim Health Care Institute of more than 2,000 women and their children who enrolled between 1999 and 2002. Study participants have been followed on a regular basis over the past two decades, with periodic reporting of factors related to the children’s development and their physical and mental health. Taveras has led several Project Viva studies examining aspects of sleep – including its impact on body fat and obesity in children and how sleep duration is affected by television viewing.

The current study reports results from 829 now-adolescent study participants who, along with an in-person study visit, had both their nighttime sleep and daily physical activity measured over 7 to 10 days by actigraphy, which records physical motion by a device worn on the wrist. The participants, who averaged around 13 years old, also completed written sleep logs. In addition to sleep duration – the amount of time spent asleep during the night – actigraphy also measured sleep efficiency: the percentage of time during the overnight sleep period actually spent asleep, an indication of the quality and continuity of sleep.

Results showed that the average sleep duration for all participants was 441 minutes or 7.35 hours per day; only 2.2 percent met or exceeded the recommended average sleep duration for their age group – 9 hours per day for ages 11 to 13 and eight hours per day for those 14 to 17. Sleep duration of fewer than seven hours was found in 31 percent of participants, and more than 58 percent had sleep efficiency less than the 85 percent that is considered sufficient for adults.

Both shorter sleep duration and lower sleep efficiency were associated with increased levels of overall and abdominal fat deposition – associations that persisted after adjustments for physical activity, television viewing and consumption of fast foods or sweetened beverages. Longer sleep duration and higher efficiency were associated with reductions in cardiometabolic risk – based on factors such as smaller waist circumference, lower systolic blood pressure and higher HDL cholesterol levels. Most of those associations also persisted after adjusting for the factors noted above.

“Sleep quantity and quality are pillars of health alongside diet and physical activity,” said lead and corresponding author Elizabeth Cespedes Feliciano, ScD, ScM, formerly at the Harvard Chan School of Public Health and now with the Kaiser Permanente Northern California Division of Research. “Pediatricians should be aware that poor sleep quality – frequent awakenings and not just insufficient duration of sleep – is associated with increased cardiometabolic risk. While several trials have tried to extend the duration of sleep, few have targeted sleep efficiency and other aspects of sleep quality. We know that exercise improves sleep efficiency in adults and that screen time decreases it in children, so preventive measures should target those and other factors such as stress, noise and caffeine consumption.”

A professor of Pediatrics at Harvard Medical School, Taveras adds, “Sleep has many dimensions beyond its quantity and quality that may influence cardiometabolic health, including the relationship of sleep timing to other daily activities and whether an individual’s circadian clock, the internal sleep/wake schedule, is synchronized with the rhythms of social activities. Those may be particularly important in adolescents – who may have high academic demands or naturally prefer to be active in the evening but need to get up early for school – and will be a focus of our upcoming research.”

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In a study funded by the National Institutes of Health, the University of Delaware’s School of Nursing assistant professor ‘s Xiaopeng Ji and principal investigator Jianghong Liu (University of Pennsylvania) turned to the Chinese classroom for comparison. With participants from schools in Jintan, Ji measured midday napping, nighttime sleep duration and sleep quality, and performance on multiple neurocognitive tasks.

Neurocognitive functioning is essential for learning, emotion and behavior control.

The study’s findings suggest an association between habitual midday napping and neurocognitive function.

“Daytime napping is quite controversial in the United States,” Ji said. “In China, time for napping is built into the post-lunch schedule for many adults in work settings and students at schools.”

According to a news release from the University of Delaware, Ji has studied the circadian rhythm of sleep (a person’s 24-hour cycle). A developmental change takes place in circadian rhythm during adolescence; teenagers’ rhythm shifts one to two hours later than the preadolescent period.

“This phase delay is biologically driven in adolescents,” Ji said. “Think about that in a school schedule. Teenagers have to get up early for school. And, with this phase delay of going to bed later, they are at-risk for chronic sleep deprivation.”

Ji explained that these adolescents may experience impaired neurocognitive function, which makes paying attention in school even more difficult. Memory and reasoning ability also suffer.

A circadian dip occurs daily from 12 to 2 p.m. During that period, adolescents are more likely to fall asleep. In a U.S. school, a student does not have a formal opportunity to do so.

“Throughout childhood, U.S. kids experience decreases in napping tendencies. Kids are trained to remove their midday napping behavior,” said Ji.

There is a great deal of literature on adults and sleep, but that’s not the case for adolescents. And since the American school schedule was a barrier to finding more information about the link between midday napping and neurocognitive function, researchers used Chinese data in the study.

Ji investigated two dimensions of nap behavior — frequency and duration.

The conclusion: Routine nappers, who napped five to seven days in a week, had sustained attention, better nonverbal reasoning ability and spatial memory.

As for how long a nap should be, Ji concluded that the best length is between 30 and 60 minutes. Participants who slept between 30 to 60 minutes produced better accuracy in attention tasks as well as faster speed.

The researchers were surprised to find a positive relationship between midday napping and nighttime sleep. Habitual nappers (who napped more often) tended to have a better nighttime sleep, they found.

“That’s different than the findings in the United States, where napping may serve as a function to replace sleep lost from the previous night. Consequently, that may interfere with the following night’s sleep,” Ji said. “In China, a midday nap is considered a healthy lifestyle. Routine nappers are more likely to experience healthy nighttime sleep. So routine nappers are essentially trained to sleep well and sleep more at night.”

Ji said that further studies might help influence public policy in the U.S.