My Kids' Paediatric Endocrinologist Has Put His Foot Down About Sleeping Early

During a recent dietitian appointment for my youngest kiddo, while we were discussing food, calories and how to help him gain weight, the dietitian reminded us that sleep is also important for growth.

This means I need to think about more than just feeding my child more. I also need to make sure he sleeps earlier and has adequate hours of sleep, just like what his dietitian mentioned, and as reaffirmed by his paediatric endocrinologist, Prof. Dr Yazid at UMSC.

So naturally, this sent me down another research rabbit hole, because I wanted to understand why sleep was being treated as such an important part of his growth plan. Okay, I don't know how this happened, but I seem to have conveniently forgotten that kids grow during their sleep.

What does sleep actually have to do with children's growth?

As it turns out, quite a lot.

Growth hormone (GH) plays an important role in childhood growth, and its secretion is closely associated with sleep. Research has found that significant GH release occurs around the first period of slow-wave, or deep, sleep, particularly during the earlier part of the sleep period.

Source: Instagram

Research suggests that adequate, good-quality and regular sleep is important for children's health and development, and sleep is closely connected to the normal secretion of growth hormone. Children who get enough sleep at the correct timing tend to be able to grow taller.

For children aged 6 to 12, the American Academy of Sleep Medicine recommends between 9 and 12 hours of sleep per 24 hours, while teenagers aged 13 to 18 should generally get between 8 and 10 hours.

Guess what the timing is? 

Children should already be asleep no later than 10pm, preferably by 9pm.

Seriously?

But why wasn't this emphasised more?

Look, my kids have seen paediatricians throughout their childhood for general checkups, vaccinations, nutrition and growth charts, along with all the other things that parents normally discuss with their children's doctors.

Of course, we've also been told that children need enough sleep. I don't think there is a parent alive who doesn't know that children are supposed to sleep early.

But I now realise that there is a significant difference between being told, "Make sure he gets enough sleep," and being told, "Sleep needs to be part of how we manage his growth."

Those two statements would have landed very differently with me as a parent.

It was only when we started seeing a paediatric endocrinologist that I began to understand how seriously I should be treating sleep in the context of growth. Now that the dietitian has reinforced the same message, I find myself wondering why I didn't understand its importance much earlier.

How I wish somebody had made the connection much more explicit. If someone had told me years ago that when we assess a child's growth, we should be looking at nutrition, sleep and the overall growth pattern together, I would have treated bedtime very differently.

Anyway, turning bedtime into another reason to beat myself up isn't going to help anyone. What I can do is take what we know now and change what happens from here.

So Operation 'Sleep Earlier' Begins!

I'm realistic enough to know that announcing, "From tonight onwards, everybody goes to bed before 10pm!" is probably the fastest way to make the whole exercise fail.

Our bedtime has gradually crept later over the years, so I'm treating this as something we need to reset rather than something I can change overnight.

1. Move bedtime earlier gradually.

Instead of suddenly trying to shift bedtime by an hour, we can move it earlier in smaller increments. Even bringing bedtime forward by 15 minutes every few nights gives their bodies and our household routine some time to adjust.

The goal isn't to achieve the perfect bedtime immediately. It's to gradually make an earlier bedtime feel normal.

2. Work backwards from wake-up time.

This has been one of the more useful ways for me to think about it.

Instead of asking why my children need to sleep so ridiculously early, I can start with the time they need to wake up for school and work backwards according to how much sleep they need for their age.

Once I do the maths, bedtime becomes somehow less negotiable.

3. Start the bedtime routine well before bedtime.

I've also realised that saying "bedtime is 9pm" cannot mean that we start preparing for bed at 9pm.

BUT there is coming home from tuition or football, showering, packing school bags, finding things and, inevitably, remembering something important right before bedtime.

If I want them asleep earlier, the entire household needs to start slowing down earlier.

4. Screens need a bedtime too.

This is probably going to be one of the harder changes because "five more minutes" on a phone has a remarkable ability to become half an hour.

Rather than focusing only on what time the children get into bed, I think we need a clearer time when screens stop too. That gives them some time to wind down before they're expected to fall asleep.

5. Aim for consistency rather than perfection.

There will inevitably be late dinners, homework, football, family activities and weekends when everything goes completely off schedule.

I'm not trying to run a military camp where everybody must be unconscious at exactly 9.37 pm.

What I want is for an earlier bedtime to become our normal routine rather than something we attempt only when there is school the next morning.

Parenthood is not for the faint-hearted.

The more I learn about children's growth, the more I realise that there isn't one magic food, supplement or habit that determines how tall a child eventually becomes. Genetics matter, nutrition matters, overall health matters, hormones matter, and sleep is another part of that complicated picture.

There are many things about their growth that I cannot control, and perhaps that's the part of motherhood that makes me the most anxious. I can do all the right things and still have to accept that I cannot personally command their bodies to grow.

What I can do is make use of the information we have now.

I can work on his nutrition. I can add the extra oil. I can make his snacks more substantial. I can keep taking him to his appointments and keep monitoring his progress.

And I guess I can also occasionally be that mother who starts shouting across the house every night, "GO TO SLEEP! YOU NEED TO GROW!"

Haha.

Wish me all the best!

Oral Health Is Part of My Midlife Maintenance Now

By now, I have accepted that perimenopause has opinions about almost every part of my body.

Sleep? Affected.

Mood? Definitely affected.

Metabolism? Don't get me started.

Skin, hair, brain, joints? Apparently everybody gets a turn.

And now, my mouth has joined the conversation. Omg.

A Visit to the Dentist A Few Months Ago

A few months ago, I had an episode that sent me to the dentist. I blogged about it here: Apparently You Can Floss Religiously and STILL End Up at the Dentist 😭

Because of that episode, I discovered something I hadn't really thought about before: oral health can change during perimenopause and menopause.

Research has documented oral-health concerns during perimenopause and menopause, including dry mouth, gum and periodontal problems, oral discomfort and changes in the tissues of the mouth.

Hormonal changes, particularly changes in oestrogen, are thought to play a role, although of course not every dental problem in your 40s can be simply blamed on perimenopause.

This realisation has led me down the rabbit hole of oral probiotics, interdental brushes and toothpaste ingredients.

Welcome to midlife. Hehe.

The Product I Didn't Even Know Existed: Oral Probiotics

During that dental visit, I was given the usual treatment, but my dentist also recommended that I take BioGaia Prodentis for a month.

My first reaction was essentially: Har? There are probiotics for your mouth? Until then, probiotics lived firmly in the yoghurt-and-gut-health section of my brain.

BioGaia Prodentis contains the active strains of Limosilactobacillus reuteri Prodentis (a blend of L. reuteri DSM 17938 and L. reuteri ATCC PTA 5289).

Unlike swallowing a probiotic capsule, it comes as a lozenge that dissolves slowly in the mouth, so the bacteria are delivered directly into the oral cavity. BioGaia specifically developed the combination for oral health and gum support.

I have been taking BioGaia Prodentis for the past four months. And so far, my gums have been behaving themselves. I no longer have the bleeding or soreness I used to notice.

At the same time, I also started using an interdental brush properly.

I Changed My Toothpaste Too

As though oral probiotics weren't already enough of a departure from my old routine, about a month ago I switched toothpaste and started using Boostoral Restore+ n-HA Prebiotics Whitening Toothpaste.

Previously, toothpaste was… toothpaste. Now I read ingredient lists. Haha.

Boostoral caught my attention because its formulation is built around two things I hadn't previously looked for in toothpaste: nano-hydroxyapatite and oral prebiotics. The toothpaste also contains hydrated silica, while other ingredients in the range include things such as xylitol and tea tree extract.

Nano-hydroxyapatite, or n-HA, was particularly interesting. Hydroxyapatite is a mineral that naturally makes up much of tooth enamel. Boostoral uses a nano-sized form designed to interact more closely with the tooth surface and support remineralisation and the formation of a protective mineral layer.

Then there are the oral prebiotics, which are there to support the environment in which beneficial oral bacteria live.

So in a sense, I have somehow arrived at this situation:

Prodentis = probiotics

Boostoral = prebiotics

I have gone from buying whatever toothpaste seemed reasonable to apparently managing an ecosystem inside my mouth. Midlife is wild. Hahaha.

There is another reason Boostoral caught my attention that has absolutely nothing to do with microbiomes.

The branding is ridiculously eye-catching. Their packaging doesn't look like the traditional toothpaste packaging I've been staring at in supermarkets for decades. It looks almost like skincare.

And then there are the flavours. I started with Pink Guava, which sounds much more like something I should be drinking at a beach resort than brushing my teeth with. I've since bought Watermelon and Magic Mint. The one I actually wanted next, Lemonade Burst, is currently out of stock.

Looks like I've also started collecting toothpaste flavours now. I don't know when this became my life either. LOL.

And perhaps that matters more than it sounds. The best oral-care routine is still the one you actually keep doing.

Disclaimer: This is simply my personal experience with the products mentioned, not medical or dental advice. My oral-health routine also changed in several ways at the same time, so I can't attribute the improvements I've noticed to any single product. If you have persistent bleeding, swelling, pain or other changes in your gums or mouth, see a dentist rather than attempting to probiotic your way out of it. 😆

September Is Perimenopause Awareness Month

What Exactly Is Perimenopause?

If there's one thing I've realised from learning more about this stage of life, it's this: many women enter perimenopause without really knowing what to expect.

We know that menopause is when menstruation stops. This is the simplest explanation.

But perimenopause, the transition phase before menopause, can last up to 8 to 10 years before menopause actually occurs.

During perimenopause, which Dr Mary Claire Haver describes as the Zone of Chaos, hormones such as estrogen, progesterone and testosterone become increasingly unpredictable, and the effects can show up in ways that don't immediately seem hormonal at all: brain fog, anxiety, poor sleep, mood changes, joint aches, palpitations, changes in body composition and many more.

Which is why, so many women in their 40s seem to describe similar experiences:

"Maybe I'm just stressed."

"Maybe I'm just getting old already lah."

"Why don't I feel like myself anymore?"

And then you finally start connecting the dots.

Discovering the Perimenopause Rollercoaster

My Blog Posts

I thought estrogen was just a reproductive hormone. Here's what I learnt about estrogen's role in brain fog, mood, sleep and other perimenopause changes.

Why do anxiety, irritability, and poor sleep feel different in perimenopause? Here's what I learnt about progesterone and feeling less steady in midlife.

Feeling flat, less motivated or low in energy? Here's what I learnt about testosterone in women and how it may affect drive, strength, and midlife.

Aha. No wonder lah!

Perimenopause Deserves More Conversations

Awareness matters because recognising that these changes could be related to perimenopause gives us more context. It helps us ask better questions, seek appropriate support and have more informed conversations about what is happening to our bodies.

If you're wondering whether some of the changes you’ve been experiencing could be related to perimenopause, you can also reach out to Menopause Asia.

It is a digital platform that connects women with independently licensed doctors, reliable information and practical midlife health resources, with the aim of making menopause support easier to access and navigate. Menopause Asia itself is not a healthcare provider; medical consultations are provided independently by licensed healthcare professionals.

Sometimes, knowing what might be happening is already a very useful first step.

So this September, maybe tell another woman what you've learnt too.

Because the more openly we talk about perimenopause, the less likely someone else is to spend years thinking: "What on earth is wrong with me?"

❤️ Share this with a woman who might need her own Aha, No Wonder Lah moment.

Adding Oil to Everything Is Now Part of My Parenting Strategy

I came home from a dietitian appointment recently with a new parenting strategy:

Add oil to lunch, dinner, and whatever food my child will happily eat.

So apparently, when you're trying to help a child gain weight, sometimes the answer isn't eat more. It's figuring out how to make what they're already eating work a little harder.

I just realised this is one of those parenting things I never thought I'd know need to put into practice.

For the past few months, we've been working with a dietitian to help our youngest kiddo with his growth. He's always been on the smaller side, so we're trying to help him gain weight steadily and, hopefully, support his height growth along the way.

The good news from our latest appointment is that he has gained some weight.

Although not a drastic increase, it was enough for the dietitian to mention that whatever we're doing, keep doing it.

So next, we add oil.

One of the things I've learnt is that helping a child gain weight doesn't necessarily mean piling more food onto his plate.

Because if your child already doesn't eat very much, staring at an even bigger mountain of food isn't exactly going to inspire him.

Instead, we're learning to increase the calorie density of the food he's already eating.

Hence: oil (e.g., olive oil, butter).

And we're also encouraged to add things like fried shallots, fried garlic, and fried ikan bilis to his meals; basically foods that add more oil, protein, and calories without significantly increasing the amount of food he has to finish.

Vegetables require a different strategy.

This is another thing I liked from the dietitian.

Instead of constantly introducing vegetables as a separate 'you must eat this because it's good for you' item, we can introduce them through something he already likes.

He loves tom yum, for example.

So rather than saying, "Here is a new veggie. Eat it." It can be, "Here's your tom yum. There's a nice veggie in it." 😂

He's already started accepting a few vegetables, so the idea now is to keep those consistent while slowly expanding the selection.

Sleep is not for the weak.

This one is probably going to be harder than adding oil.

The dietitian also reminded us that nutrition is only one part of growth; sleep matters too.

So we're now working towards an earlier and more consistent bedtime, which means my child's growth plan involves not only what happens at the dining table, but also what time he needs to be in bed.

Wish me luck!

Small progress is still progress.

I think that's probably my biggest takeaway from these appointments.

When you're watching a child's growth over time, progress doesn't always look dramatic. Sometimes it's simply seeing that the gap on the growth chart has become a little smaller.

And for now, that's enough to make me happy.

We have another few months before the next check-in, so the plan is pretty simple:

• Keep doing what seems to be working.
• Keep making his snacks more substantial.
• Keep introducing food, including veggies, without turning every meal into a battle.
• Get him to bed earlier.
• And of course, add oil to his food.

Wish me luck!