Does your child snore, mouth breathe, or seem “wired” instead of tired? Are they struggling with sleep—or is something bigger going on?

In this follow-up episode with sleep expert Dr. Shelby Harris, we dive deep into the connection between sleep, behavior, and diagnoses like ADHD. If you’ve ever felt unsure whether your child’s sleep issues are causing daytime struggles—or if the behavioral struggles are disrupting sleep—this episode is for you.

We cover:

• ???? How sleep deprivation can mimic ADHD symptoms

• ???? When to suspect sleep apnea—and what signs often get missed

• ???? Why mouth breathing in babies and toddlers isn’t “just cute”

• ????????‍♀️ The questions to ask before jumping to medication or a diagnosis

• ???? A balanced, science-based look at melatonin (when it can help—and when to pause)

• ????️ Real-life stories from Dr. Shelby and Dr. Mona’s parenting journeys

Plus: ???? How sleep quality impacts everything from emotional regulation to anxiety—and what to look out for at every age.

This episode is all about empowering you with information, not guilt. Because before we assume it’s “just behavior,” we need to explore what’s happening at night.

???? Tune in, take notes, and don’t be afraid to advocate for your child’s sleep. It just might be the missing piece.

Struggling with your child’s sleep? ⁠The Essential Guide to Children’s Sleep: a Tired Caregiver’s Workbook for Every Age and Stage⁠ offers expert tips and easy tools for every age and stage-so you (and your kid) can finally rest. 

Written by three psychologists (Drs. Roth, Shale and Harris) who are specialists in pediatric behavioral sleep medicine and child psychology, this book is packed with information to help anxious kids and tired parents learn the necessary tips and tricks to help everyone on the road to better sleep.

00;00;00;06 – 00;00;21;22

Dr. Mona

Hello, it’s Doctor Mona and you’re listening to the follow up. The only part of your Monday that won’t involve a tantrum. A sleep deprived sprint to the car. Or someone yelling, I’m not tired while obviously being tired. Today’s clip is from my conversation with Doctor Shelby Harris, a clinical psychologist, sleep expert, and one of the go to voices in behavioral sleep medicine.

 

00;00;21;24 – 00;00;48;05

Dr. Mona

If you’ve ever wondered whether your child’s behavior is a discipline issue or a sleep issue in disguise, this one’s for you. Because here’s the truth a tired child doesn’t always look tired. Sometimes they look hyper or emotional or like they’ve had three espressos and a bag of jellybeans. And while, yes, behavior matters. So to sleep. And we need to talk more about that connection, today’s follow up is an extremely important conversation surrounding sleep boundaries, ADHD, and sleep apnea.

 

00;00;48;07 – 00;01;09;05

Dr. Mona

I’m also excited to rerelease this episode with Doctor Shelby today, because she and her colleagues have a new book out, struggling with Your Child’s sleep? You are not alone, and thankfully, help is here. The Essential Guide to Children’s Sleep A tired Caregivers workbook for every age and stage, offers expert tips and easy to use tools for every age and stage, so you and your kid can finally rest.

 

00;01;09;09 – 00;01;31;12

Dr. Mona

And this isn’t just another sleep book, it’s a sanity saving roadmap written by three brilliant psychologist doctors Roth, Sheil and Harris. Yes, the same Doctor Harris you’re about to hear from. All of them are experts in pediatric behavioral sleep medicine and psychology. Whether you’re facing bedtime battles, early wake ups, or overtired chaos, this book is packed with practical, evidence based tips to help the whole family rest easier.

 

00;01;31;15 – 00;01;42;27

Dr. Mona

Now, let’s press play on today’s clip. And remember, sometimes the best parenting insight starts with a good night’s sleep.

 

00;01;42;29 – 00;01;49;07

Dr. Mona

Where would you kind of want to start with this? Like, what do people kind of have to look at when they’re looking at sleep as a whole for their child?

 

00;01;49;10 – 00;02;10;10

Dr. Shelby Harris

So I always first and foremost just think about age of the child, what’s considered quote unquote, normal sleep amounts, durations. And there’s a range, but not everyone falls in like the 11 to 13 hour range. You know, some people are outliers, but I always try to make sure that they’re consistent in general with their sleep hygiene. They’re not having a lot of sugar right before bed.

 

00;02;10;10 – 00;02;28;22

Dr. Shelby Harris

They’re having a consistent bedtime wake time. Now, if the child is sleeping through the night and they’re waking up early and tired, one of the big things that we see a lot of talking about, whether medicate or not, especially in ages like 4 to 6, 4 to 7, we see a lot of behavioral issues start to happen at this age range.

 

00;02;28;22 – 00;02;55;03

Dr. Shelby Harris

So there’s a sleepy child. This is the key is the sleepy child doesn’t always look sleepy. They don’t usually look. Maybe they look hyperactive. And so what happens is in some of these kids or a lot of these kids, they’re getting mislabeled as having behavioral issues and having potential ADHD or other outbursts, kind of behavioral issues. If I think the kid is actually sleeping well at night or sleeping enough at night, but it’s having a lot of behavioral issues.

 

00;02;55;05 – 00;03;18;14

Dr. Shelby Harris

First thing I’m always going to ask is, does your child snore? Do they have any pauses in their breathing consistently? Like not just when they have a cold or something. And if that’s happening, then I’m immediately going to send for a referral for a sleep evaluation, whether it be from the anti sleep center. Because what we see happen a lot of times, especially in like the 4 to 6 age range, is that their tonsils and adenoids begin to crowd their airway.

 

00;03;18;14 – 00;03;36;17

Dr. Shelby Harris

Their airway doesn’t grow as fast as a tonsils and adenoids do. And as a result, that crowded airway there’s more sleep disruption, more sleep apnea happens. And if we actually treat the sleep apnea, guess what happens? The behavioral issues tend to get better. Now that doesn’t mean you can’t have ADHD or behavioral issues as well as sleep apnea.

 

00;03;36;17 – 00;03;57;26

Dr. Shelby Harris

You can. But I think a lot of times were quick to diagnose a behavioral problem without seeing how the sleep is actually factoring in. So first and foremost, does your child snore any sort of pauses and breathing or anything like that using the bathroom a lot at night. That can be another symptom. Anything like that should make you immediately go for sleep evaluation.

 

00;03;57;28 – 00;04;01;14

Dr. Shelby Harris

Now the other thing we start to think about too is right. It’s like a little bit of chicken egg.

 

00;04;01;19 – 00;04;03;20

Dr. Mona

Is going to bring that up, right?

 

00;04;03;20 – 00;04;26;17

Dr. Shelby Harris

Yeah. So if we’re starting to talk about not like sweep limits, right. Or just not getting enough sleep or your child is needs to sleep with you or just won’t fall asleep until a certain time limit setting at that time, right? So your child’s stalling. So is there a lot of that going on that’s causing sleep deprivation, which can then lead to behavioral issues.

 

00;04;26;17 – 00;04;47;25

Dr. Shelby Harris

Right. So you want to try and treat whatever you can at night to get your child sleeping more. And then if that’s not working, is there actually a behavioral issue going on. So sometimes ADHD what we see a lot of times is there can be with ADHD kids, there can be trouble with falling asleep at night. Yeah. So I always try to work on the sleep first, trying to get them at least.

 

00;04;47;26 – 00;05;08;11

Dr. Shelby Harris

Even if you have to be there for sleep, try to get them on a better, just not sleep deprived anymore. And then you can slowly remove your presence and work with a practitioner if you need to to help you do that. But let’s try and get them enough sleep routinely. And if the quality and the quantity is okay, but they’re still having behavioral issues during the day, then you want to start thinking about what’s causing the behavioral issues because you’re losing sleep out.

 

00;05;08;13 – 00;05;27;15

Dr. Mona

You talked about the whole chicken and the egg, right? And the big thing is the ADHD component, right? Because it’s, you know, you’re like, okay, is the ADHD causing them not to be able to sleep? And then the cycle goes where they’re, you know, having more kind of ADHD type symptoms. Or is it that the lack of sleep is causing the behavioral symptoms?

 

00;05;27;15 – 00;05;46;03

Dr. Mona

You know, it’s a it’s a very hard diagnosis sometimes. And it is a lot of question asking like what’s going on in the one thing I you know, what we see in like under four. You know, we talked about like that 4 to 6 noisy mouth breathing. You know, it doesn’t mean it’s sleep apnea per se, but it could be something we want to intervene.

 

00;05;46;03 – 00;06;09;01

Dr. Mona

And it is kind of in that line of an airway issue. Right. So if you do see your infant that is like mouth breathing, noisy and just constantly mouth breathing past that, especially past that initial newborn phase, sometimes I do see it in the newborn, but I’m talking like a four month old. A five month old, like an infant toddler mouth is open all the time while they’re sleeping.

 

00;06;09;03 – 00;06;09;23

Dr. Shelby Harris

Yeah.

 

00;06;09;26 – 00;06;14;26

Dr. Mona

I would talk to your clinician about it because would you agree that that’s something that is kind of something that we want to monitor?

 

00;06;15;03 – 00;06;31;11

Dr. Shelby Harris

Yeah, 100%. And there’s like all these names and stuff that’ll go around on Instagram and online of like, oh, look at how cute this is. My child is like sitting with their like mouth open or watching TV and stuff. And I look at this okay, well that’s probably a sleep disorder issue or a mouth breathing issue that needs to get evaluated.

 

00;06;31;14 – 00;06;46;19

Dr. Shelby Harris

And the thing is, to a lot of people don’t think about this, but when they’re having their mouth open, a lot of times that can also change the way that their airway develops. It can change the way that their jaw develops, their face develops. So we really want to work on helping them to close the mouth for sure.

 

00;06;46;23 – 00;07;08;23

Dr. Shelby Harris

Right. To sleep at night. So all ages. That’s why I tried for so long. When people are quick to diagnose ADHD, I’m always like, does your child mouth listen to their pauses and everything? Just ask these questions first and then it can give you a lot of information. So for example, like my daughter, she’s eight now, but when she was 4 or 5 years old, because I’m on top of it, I know the literature.

 

00;07;08;23 – 00;07;28;29

Dr. Shelby Harris

She would not read aloud and she would snore a little bit at night. And so I took her to our and she was amazing in my area, and she found out that she had a large adenoids. Now, did we need to do surgery immediately? No. So we watched and wait. She actually used medication to help because she was congested a lot of the time and had allergies, and the medication helped to reduce the adenoids.

 

00;07;29;03 – 00;07;39;21

Dr. Shelby Harris

So we did that. And that was one other thing. And that helped with the mouth breathing and helped with her snoring at night. And I know that she didn’t have to have surgery. So there are definitely options, but you don’t want to ignore it. Not at all.

 

00;07;39;23 – 00;07;45;22

Dr. Mona

So she had mouth breathing and snoring or just the mouth. Yes. Yeah, but but and did it affect her behavior.

 

00;07;45;25 – 00;07;56;24

Dr. Shelby Harris

She not so much. It was interesting. It didn’t really affect your behavior. But I was definitely concerned about her sleep and quality of sleep at night. I still brought it up and she also had large adenoids.

 

00;07;56;27 – 00;08;04;25

Dr. Mona

When this happened with your daughter, was she sleeping in a separate room than you? Yes. So you just you would just hear it from outside the door, or you would just hear on the monitor or.

 

00;08;04;25 – 00;08;22;10

Dr. Shelby Harris

Something, while I would hear it on the monitor. When she was younger, it wasn’t so bad until she really hit that kind of four year old age. I noticed it, honestly, when we would, all have to speak together when we were traveling. So. Yes. Okay, we’re likely to share a room with my son, and he’s older and six years older.

 

00;08;22;10 – 00;08;27;12

Dr. Shelby Harris

You’d be like, wow, she was snoring at night. Yes. That’s what we picked up on it for sure.

 

00;08;27;15 – 00;08;29;17

Dr. Mona

Yeah, yeah, that’s a good thing.

 

00;08;29;19 – 00;08;38;22

Dr. Shelby Harris

She would sit in front of the TV with her mouth, which apparently I did as a kid, too, and then had to go to speech therapy for it, but she. So she’ll sit in front of the TV with their mouth wide open. Yeah. And just for you. Right.

 

00;08;38;22 – 00;08;54;27

Dr. Mona

So I think this is I mean, it obviously makes a lot of sense, especially with that open mouth breathing and not using the nose. I mean, the nose is there for a reason, right? We’re of breathtaking. Should be in through the nose, out through the mouth you know. And so I think it’s really an important area that you go often missed.

 

00;08;54;29 – 00;09;17;15

Dr. Mona

And yeah, especially in that infant toddler age group where I’m going to be honest, even pediatricians will dismiss it sometimes and say, okay, oh, that’s normal. But no, I, I agree with you. I have become very in tune with that because like I said, I think we often miss sleep issues and, you know, chalk it up to behavior or like even not sleeping can leave things like, you know, talking about anxiety too, right?

 

00;09;17;15 – 00;09;36;26

Dr. Mona

We know that sleep is very impactful. And again, it doesn’t mean you need to like your example of your daughter that you need to get your adenoids out tomorrow. But it is a important, you know, holistic approach, if you will, to sleep. And, you know, is there anything else you’d want to add that we may have missed upon in terms of the sleep apnea, ADHD and, you know, parenting with sleep?

 

00;09;37;00 – 00;09;53;07

Dr. Shelby Harris

I think when it comes to the app or the ADHD stuff as well. Is that right? If you’ve done whatever you can to help your child sleep, even if you have to be there with them and they still can’t fall asleep easily, they’re needing a lot of like it feels like it’s taking a lot of effort to help them sleep.

 

00;09;53;09 – 00;10;14;07

Dr. Shelby Harris

If you know that there’s ADHD going on that has been diagnosed. What we do see is sometimes when we were talking about melatonin at the beginning, right? Sometimes there is a role for melatonin, melatonin having more of a role with kids who have autism and kids who have ADHD. So then it’s really if you’ve tried the behavioral stuff and it just is not working or not working well enough, right?

 

00;10;14;13 – 00;10;34;21

Dr. Shelby Harris

The goal is to get them sleeping. And like I said, we always continue behavioral first. But sometimes there is a issue with some of these kids where we do need to use melatonin so that when we think about using the smallest dose possible. All right, I can’t tell you how many kids I have or taking five ten milligrams just because it’s in a gummy form.

 

00;10;34;21 – 00;10;50;15

Dr. Shelby Harris

That’s way too much. So we’re talking like a milligram, half a milligram. If you have melatonin, taking it a half hour to an hour before bed to help with that doesn’t mean they’re gonna have to be on it long term, but sometimes it can help to settle the sleep a little bit more and then help with the behavioral issues during the day.

 

00;10;50;15 – 00;10;53;11

Dr. Shelby Harris

So it’s definitely something to consider with your doctor’s approval.

 

00;10;53;18 – 00;11;16;13

Dr. Mona

And as a physician, I could not agree more because what I see, like I said at the beginning, is that I often see parents, even on my social media, like in stories saying, hey, my child’s sleeping, I want to give him melatonin. And like I said, I’m not against it because I have in those exact examples, I have a good amount of children who have ADHD and autism who need it, and it’s fine, but we’ve made that diagnosis.

 

00;11;16;13 – 00;11;38;12

Dr. Mona

We’ve worked on other things sleep hygiene. We’ve worked on the fact that we’ve excluded things like sleep apnea. Had that diagnosis of Aids for autism. And that’s the underlying message, is that we’ve done our due diligence and not just medicated and potentially masks an underlying other condition that we could treat. And so that’s a huge thing that I see as well.

 

00;11;38;14 – 00;11;40;01

Dr. Shelby Harris

Exactly. There you go.

 

00;11;40;04 – 00;11;56;06

Dr. Mona

Oh man. So this is great I love this because like I mentioned, I think a lot of times parents put a lot of guilt on themselves. Like, you know, the topic was about, you know, is am I just not doing enough? Like, am I not strict enough with boundaries? But there is a reality that sometimes there is something medical going on.

 

00;11;56;06 – 00;12;18;26

Dr. Mona

And so the mouth breathing, the snoring, the knots, the noisiness like. And I want to be clear, because I have talked about this on my social, that newborns are noisy, there’s no denying that a newborn under the age of, I would say 12 weeks is noisy, but it should get better. Like it should not be that they’re always noisy, they’re always making these sounds like it should improve and we should see sleep start to stretch a little bit.

 

00;12;18;26 – 00;12;25;05

Dr. Mona

And if you’re not and they’re noisy and they’re making these snoring sounds, oh, we gotta evaluate. Yeah.

 

00;12;25;08 – 00;12;43;00

Dr. Shelby Harris

Sleep is the bedrock with which everything else is built on, so don’t ignore it. And if you think something is off and someone’s telling you, I don’t worry about it, it’s fine. Keep getting another opinion. Yeah. You don’t. Don’t just ignore it. If you notice something’s off.

 

00;12;43;02 – 00;13;04;12

Dr. Mona

And that’s your follow up. Just a small dose of the real relatable and eye opening conversations we love to have here. If you smiled, nodded, or had an moment, go ahead and download, follow and share this episode with a friend. Let’s grow this village together for more everyday parenting wins and real talk. Hang out with us on Instagram at the PedsDocTalk podcast.

 

00;13;04;19 – 00;13;20;02

Dr. Mona

Want more? Dive into the full episode and more at PedsDocTalk.com. Because parenting is better with support. And remember, consistency is key. Humor is medicine and follow ups are everything. I’m Doctor Mona. See you next time for your next dose.