Quick Takes

📱 Screen Time Sleep Sabotage

90% of studies confirm what parents suspect: evening screen time disrupts children's sleep quality and duration. The fix is simple but requires discipline—remove devices from bedrooms and establish screen-free zones before bedtime. Adopt a different bedtime activity.

😰 The Loneliness Epidemic Fuels Depression

52% of teenagers report feeling lonely, and 40% of high schoolers feel depressed most days. What we should do now: Research shows targeted interventions—from school-based social skills programs to digital compassion apps—can effectively reduce loneliness and improve mental health.

🏥 Chronic Conditions Are Skyrocketing in Kids

Nearly 1 in 3 children (30.2%) now live with a chronic condition—up from 22.6% in 1999. While the causes are complex, families can take action with evidence-based approaches: addressing nutrient deficiencies, reducing environmental toxins, and supporting gut health.

🌙 Later School Start Times = Healthier, Smarter Kids

Aim for 8:30 AM for teens: When schools delay start times by just 40-70 minutes, students gain significant sleep, show improved academic performance, and experience less depression. It's a simple policy change with profound health benefits—yet many districts still resist implementation.

Part 2: Sleep, Mental Health Issues, and Chronic Medical Conditions in American Children

Last week we reviewed issues 1-4: infant mortality, firearm fatalities, obesity, and precocious puberty. We continue the overview of the Forrest et al. 2025 article on the health of American children this week with issues 5-7.

Issue 5: Sleep Problems

High prevalence: Up to 28.9% of children are affected.

Most common diagnoses: Obstructive sleep disordered breathing (oSDB), insomnia, parasomnias

Comorbidities: Chronic medical (atopic dermatitis, genetic syndromes), neurodevelopmental, or behavioral health conditions

Correlations:

• Socioeconomic and racial disparities: Sleep problems are more common in Medicaid-insured children and lower SES; White children are more likely to have any sleep diagnosis, Black/African American children more likely to have oSDB

• Rising pediatric obesity: Contributes to increased sleep-disordered breathing and obstructive sleep apnea

• Screen time: 90% of studies found adverse associations with sleep outcomes—more screen time is correlated with shortened duration and delayed timing

Individual/Family Action
1. Behavioral Sleep Interventions:

Randomized controlled trials have tested behavioral interventions, such as working one-on-one with families to teach effective sleep strategies versus providing educational materials. These interventions have demonstrated improvements in children's nighttime sleep duration and quality, with some also reporting reductions in BMI among children with overweight or obesity.

2. Sleep Extension Trials:

Sleep extension, especially when combined with dietary interventions, can increase weight loss, improve inflammation markers, and enhance self-regulation and cognitive performance in prepubescent children.

3. Mobile Health and Digital Interventions:

Recent sleep optimization trials use mobile health platforms to deliver sleep promotion interventions remotely, incorporating sleep trackers, digital guidance, caregiver incentives, and performance feedback.

4. Multidisciplinary Weight-Loss Programs:

Inpatient multidisciplinary programs for children with obesity have been shown to improve both sleep behaviors and psychological factors (such as anxiety, stress, and depression) over the course of treatment.

5. Address the Role of Schools

The American Academy of Sleep Medicine recommends middle and high schools start no earlier than 8:30 a.m. to align with adolescent circadian rhythms. Many districts now mandate later start times based on this evidence. Delaying start times by 40-70 minutes increases student sleep by 29-45 minutes on weeknights, with more students achieving sufficient sleep and less daytime sleepiness. These effects persist across diverse populations and remain stable two years post-implementation. Improved sleep correlates with modest but significant academic gains (higher grades, better engagement), enhanced attention, and fewer cognitive errors. Students report less sleepiness during homework and class. Later start times reduce depressive symptoms, irritability, fatigue, risk-taking behaviors, athletic injuries, and motor vehicle accidents. Teachers also report feeling less stressed and more rested. Earlier elementary start times (to accommodate secondary changes) minimally impact younger students' sleep, suggesting adolescents benefit most from delayed start times.

😴

Issue 6: Mental Health Crisis

Of all the concerns, this one is the most stark and pressing. According to the JAMA article, 40% of 9-12 graders report feeling depressed most days. This is based on the CDC’s Youth Risk Behavior Survey recent data. The YRBS is an authoritative, reliable source. The apparent contributing factor to this appalling statistic is that young people feel desperately lonely, with 52% of teenagers reporting feeling lonely (Forrest et al, 2025).

While loneliness is not the only cause of depression, we know that reducing loneliness is associated with improvements in depressive symptoms, anxiety, and emotional regulation.

In case anyone thinks this is just teens exaggerating their feelings, the suicide rate is also rising. In preteens it has been rising by 8% annually since 2008. In 10-24 year olds, it has increased by 56% over the last decade, with Black youth experiencing a 78% increase. In.10.years. That is stunning. Thousands of children die every year of suicide. In a 2021 study, 13.3% of female and 6.6% of male high school students reported a suicide attempt in the past year.

There are many successful interventions to reduce loneliness:

• A 2020 meta-analysis of 39 studies (25 RCTs) found that youth loneliness can be reduced via interventions, including both group-based and individual approaches.

• School-based interventions focusing on social and emotional skills, friendship-building, and conflict resolution have demonstrated reductions in loneliness among adolescents in randomized controlled trials.

• Digital interventions, such as the +Connect smartphone app, and brief group-based resilience training (RT) programs have shown significant reductions in loneliness in young adults and adolescents, with effects maintained at follow-up.

• Resilience Training (RT): A 4-session, group-based behavioral intervention for young adults (aged 18–25) led to significant reductions in loneliness scores compared to a waitlist control in a randomized trial.

• Compassion-based and positive psychology digital interventions: Both in-person and digital interventions targeting emotion regulation, self-compassion, and social skills have reduced loneliness and, in some cases, depressive symptoms in youth.

• School-based programs: Universal interventions delivered in schools, teaching social skills, emotional regulation, and conflict resolution, have been shown to reduce loneliness and improve academic outcomes.

What Research Reveals:

• Strong association with sleep disorders and psychiatric conditions

• Environmental factors: Screen time, irregular sleep routines, environmental exposures

Individual/Family Actions

From a functional medicine standpoint, mood disorders are related to inflammation in general. This includes issues such as loneliness and stress-related pressures, but also unsuitable food, food intolerances, glucose regulation and pre-diabetes, nutrient deficiencies and insufficiencies, toxins, and chronic infections. Also lack of exercise and lack of purpose.

Individual families can address some of the above.

• Interventions to mitigate stress and improve mood (I have several interventions listed in my book including the simple exercise (“What Went Well Today and Why?”) that reduces depression for 6 months.

• Inflammatory food can include sugar, which dovetails with glucose regulation issues; of course also processed foods.

• Mood improves with exercise: the ideal amount of walking to reduce depression in 1 hour daily; dancing is even more impactful.

• Heavy metals have been associated with mood issues. Lead, mercury, cadmium, and arsenic are all associations. Odds ratios can be quite high, such as doubling of risk with high serum cadmium. Avoidance rather than chelation would be the first priority in relation to heavy metals.

• Oral contraceptives can lead to depression and that possibility should be kept in mind.

• Deficiencies in omega-3s, vitamin D, B vitamins, iron, B12, zinc, copper, glucose regulation issues, exercise, stress reduction and simple approaches for amenable children and parents. My book has several. We have plans for a workbook!

• Of course address sleep and obesity which also correlate with mood disorders, setting up a dark ping-pong situation with each problem (depression, poor sleep, obesity) worsening the other two.

• Infections, especially those with microbes known to persist, such as Herpes and Borrelia (Lyme Disease bacteria) are believed to raise the risk for mood disorders. A study in Denmark showing a 60% raised risk of later mood disorders in people who were hospitalized for infection suggests that either each infection leaves a lasting mark (or maybe the treatment for the infection, the antibiotics, leave the gut biome impoverished). The latter is actionable.

Issue 7: Rising Diagnosed Conditions

Several conditions have been rising including leukemia and brain tumors (these have been increasing steadily for several decades), and more steeply, autoimmune diseases (including Type 1 diabetes and diseases that are hard to over or underdiagnose), migraines and headaches, allergies and asthma.

The prevalence of children (ages 5–17) with a chronic condition or functional limitation in the US increased from 22.6% in 1999/2000 to 30.2% in 2017/2018. Leading contributors to this increase include asthma and mental/behavioral health conditions (Wisk et al, 2025).

What Research Reveals:

Causes may be different for the different diagnoses, but in many cases, problems with the gut microbiome and deficient nutrients, problematic food choices, lack of exercise, poor sleep, and mental health are playing a significant role.

We also should not discount our recent and ongoing pandemic with SARS-COV2, a virus that infects blood vessels (in addition to the upper respiratory tract) including in the brain and all possible organs, and persists in the GI tract and elsewhere, and is known to trigger extreme fatigue, autoimmunity, gastrointestinal disorders, depression, etc.

Public health interventions

Re COVID-19: it is exacting a terrible cost. The increase in mental as well as physical illness in children will leave a long-lasting impact. It is heartbreaking that there hasn’t been a strong push to improve air quality, especially in schools, where the safety of children should be a critical priority. Better air quality would benefit everyone, including those suffering from other issues like asthma and allergies and improve the learning environment.

Individual/Family Action

• Address common nutrient deficiencies: Omega-3s, vitamin D, B vitamins, sometimes iron, B12, zinc, copper, glucose regulation issues and gut health

• Food, exercise, sleep, stress reduction, a family purpose. (What is this family about? Consider developing a family mission statement. Purpose improves emotional reactivity and correlates with better health and a more satisfying life.)

• Antibiotics lead to autoimmunity: the relationship is linear; avoid whenever possible; always discuss their necessity with your prescriber.

 Universal Environmental Toxin Reduction Strategies

• Advocate for stringent environmental health protections
  I often hear even my colleagues downplay California’s Prop 65 and other environmental restrictions like the California Environmental Quality Act (CEQA). They have downsides but trouble is that the alternative is worse. It’s almost impossible at this point for us to go overboard reducing toxins in the environment. While CEQA may interfere with housing, is the only solution really to weaken it? It’s an important way that activists were able to push back on excessive pesticide use. The guidelines from EPA are too lax.

High-Risk Foods to Limit: Be Persistent

• Canned foods and beverages: all metal cans are lined with plastic except Eden Foods and canned fruit, and this leaches into your food or drink, especially if carbonated or acidic; the lid of a glass bottle can be a problem too.

• Fast food and ready-to-eat meals

• Charred/grilled foods

• To go containers, pizza boxes, are lined with PFOAs and PFASs, also known harmful

Lower-Risk Options: Find Your Favorites

• Follow websites like Mamavation, Moms Across America

• Choose fresh, seasonal produce

• Choose and store foods in glass containers

• Choose looseleaf tea vs. tea bags

• Drink tap water (ideally filtered) vs. bottled

Food Preparation and Storage: Some of the changes are easy

• Don't microwave plastic containers

• Use glass for hot foods

• Use cast iron and avoid fancy nonstick (unfortunately has a habit of turning out to be toxic after all)

• Ensure proper kitchen ventilation with vent hood

• Ceramic dishes can also have problems; glass is really best

• Avoid putting plastic in the dishwasher

Conclusion

Multiple complex factors drive declining child health. The unfavorable comparison with other OECD countries suggests that aspects of the very structure of US society are involved in multiple ways in driving disease. But it’s a crisis for which we have many good public health solutions. The most logical next step would be to call for a “Children’s Health Moonshot.” There are 73 million children under age 18 in the US at last census. Massive investment in their health and well-being would benefit us all. Who will be our doctors, teachers, legislators, and engineers of the future?

In the meantime, families may want to make use of evidence-based tools available now. Research supports targeted nutritional interventions and environmental toxin reduction as meaningful steps families can take while remembering that child health is a concern that would be addressed vigorously at a higher societal level in any society where there is basic concern and care for the vulnerable.

* OECD is the Organization for Economic Co-operation and Development, a forum of 38 nations that describe themselves as committed to democracy and the market economy. It includes most developed nations (https://en.wikipedia.org/wiki/OECD)

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