Healthy Sleep Habits, Happy Child
69
My Opinion, #2
March 7, 2022

Found in age groups

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Introduction

A Healthy Child Needs a Healthy Brain, A Healthy Brain Needs Healthy Sleep

If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial. I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. This is a reference book. Read only the topic of interest to you.

Blog 69My Opinion, #2

My Opinion:

The most common cause of sleep problems in young children is a bedtime that is too late.

This is my opinion, based on my general clinical pediatric practice over 40 years, my many sleep consultations, my own research, and reviewing published scientific papers. Additionally, data shows that there is a long-standing trend towards later bedtimes that causes a decrease in total sleep duration. As more and more infants and children become short on sleep, they have more difficulties falling asleep and staying asleep. Here is the data:

What is an Early Bedtime?

Bedtimes have become later and later. This trend began a long time ago. Here are data showing bedtime (PM) by age:

Age    1974  1979 1986  2011-2015  
6 months 7:18 7:41  8:16 8:54
1 year 7:08 7:35 7:46 8:39
2 years 7:08 8:07 8:54

The trend towards later bedtimes means that the total sleep duration has decreased. Here are data showing total sleep duration (hours) by age:

Age    1979-1980 2004 2011-2015
1 year 13.8 13.4 12.8
2 years 12.8 11.9

Data specific for Spain shows the same trend towards decreased total sleep duration (hours) over time:

Age    1987 2011
2.5 years 10.7 10.3
6-9 years 9.9 9.5
10-14 years 9.3 8.9

As described in Blog Post 6, small differences in sleep duration can produce major consequences over time.

My published research, in 1982, shows that moving the bedtime to an earlier hour dramatically reduces the number of night wakings and the time interval between being put down to sleep and actually falling asleep (sleep latency). To accomplish the earlier bedtime, the parents woke her every morning at 7AM and did not permit afternoon naps. This tactic of ‘controlling the wake-up time’ has mostly been discussed in the adult literature in the context of ‘chronotherapy’, that is, resetting the circadian clock. Although this tactic is effective, it is not well known in pediatrics.  For example, my paper has been cited only once, in 1993.

In 1999, a study of children 2 to 5 years of age showed that the later bedtimes were associated with shorter night sleep duration. Less sleep at night was associated with behavior problems even when short night sleep is associated with longer and more frequent naps such that 24-hour sleep duration is normal.

In a 2020 study, objective measurements, using sleep actigraphs at 6, 15, and 24 weeks showed that “Infants who fell asleep earlier also slept longer at night. Keeping infants up later in hopes of them sleeping in longer may be counterproductive.”

A separate study in 2020, using objective measurements, found that at 3, 6, and 13 months, “that infants with later sleep times had less nighttime sleep.” They did not wake up later.

So, no matter your child’s age,  when you consider early bedtimes (Blog Posts 7 and 22) and use drowsy signs (Blog Post 9), don’t be shocked if your child goes to bed much earlier than your friends’ children. Their late bedtimes might be very common but being common is not the same as being healthy. Today, commonly occurring bedtimes might be too late, and unhealthy, for most children.

WHAT IS YOUR OPINION? HAVE YOU EVER TRIED AN EARLIER BEDTIME?

Comments

  1. Hi Dr. Weissbluth,
    Your book was a huge help when my 5 and 7 year old kids were babies. Now I have a nine week old, and he’s the hardest one yet. He’s the first that I’m able to nurse. He will not take a bottle or paci even though we have tried from the beginning. From two weeks on, he wouldn’t sleep for more than a minute, so we got Dr. Harvey Karp’s Snoo and that helped a lot. I am careful to put him to sleep within 1-2 hours of wakefulness. In the morning he goes down while awake for 1-2 naps in the moving Snoo, but after that he needs to be nursed to sleep. For weeks he would nurse all evening and all night long, and if I would stop he would fuss or scream. His weight is very good according to the pediatrician. He’s in the 55th percentile. When he turned 7 weeks he only nursed in the evenings for hours but then started sleeping five hours straight, usually from around 2am-7am. Then he got his 8 week vaccines and started nursing all night again. I am at a loss of what to do. The pediatrician said it’s okay if he cries a little, but I’m not sure what that means. Do I just wait this out until 12 weeks? My husband cannot help me with the baby because he’s taking care of the bigger ones. The bigger ones feel like I’m not with them at all and I feel horrible. Do you have any guidance for me? Please!
    Ariella

    1. What are the most common times that he falls asleep during the day and at night? How many times do you attend to him at night and is it just for feeding?

  2. His schedule is still very irregular… he usually falls asleep around 8/9am, then around 12/1pm, then around 3pm. After that he often takes 1-2 more naps. When he’s been very fussy he’s skipped those evening naps. The morning naps are sometimes longer, sometimes 2-3 hours. But sometimes in the morning he eats and sleeps every two hours, like 6, 8, and 10am. As the day goes on the naps get shorter, sometimes 1- 2 hours and sometimes 30 minutes.
    At night he was falling asleep between 1:00 and 3:00 a.m. after nursing for hours straight, then waking up at 6:00 or 7: 00am. But now he’ll just keep nursing sometimes again the entire night until 5:00 or 6:00 a.m. Last night he nursed from 11pm/12am until 3:30 a.m. and then woke up at 6:20 a.m.
    He usually nurses to sleep before his naps. After trying unsuccessfully twice to do that this last nap, I let him cry for 15 minutes and he fell asleep. Is that something I should try in the evening/ night? He is much fussier in the evening and night and I’m afraid it won’t work or that the crying will be much more intense.
    In the night my attendance to him is just for nursing and changing diapers and burping.. But that does go on for hours and hours. I don’t think he can be hungry for so long but I don’t know how to deal with the crying if I stop nursing him. And I don’t know how much to nurse him so that he’s not hungry.
    Thank you so so much!
    Ariella

    1. “For weeks he would nurse all evening and all night long, and if I would stop he would fuss or scream.” Children with colic often are like this and your narrative description.. Blog Posts 43 and 44 might clarify whether colic is or is not creating the stressful situation that you are dealing with. I suspect that this is so because you are an experienced mother and have tried carefully to help your baby sleep well. If you think that your baby might have colic, please read the section in my book on colic and how to prevent post-colic sleep problems. If you think that your baby does not have colic, then other sleep solutions might be appropriate now. Please let me know your thoughts.

  3. Dr. Weissbluth,
    I have a 12 week old who usually goes to bed at 8 pm. Based on her drowsy cues, I think she could go to sleep earlier (maybe 7) but it is still light out where we live and my husband believes this would throw her off. We could blackout her room but of course there would still be some natural light in the house and bathroom where she bathes as part of her nighttime routine. What are your thoughts? Can night sleep start when it’s still light?

    1. Please read, and have your husband read, Blog Posts 23 (How to motivate a parent) and 62 (I learned to stay on the schedule in order to avoid fighting with circadian rhythms.
      I concluded that I won’t win that fight, but my baby would lose!) to convince your husband that you have the correct viewpoint. Let me know how it goes.

  4. Thank you, Dr. Weissbluth. I just reread your section on colic (I’ve actually been reading it over and over these last few weeks) and the two blog posts you mentioned. Yes, I do believe my baby has colic. I got a confused, though, because he got a lot better at 7 weeks and started sleeping 5 hours in the night, only to regress a week later after his vaccines. Can that still be colic? Everything else seems to point to it.
    Based on your book, it seems I have to wait it out until 3-4 months, is that so? Is there anything I can do? I’m exhausted.
    The baby falls asleep on me while he’s nursing and I fall asleep too, sometimes, with him lying on top of me. It feels unsafe.
    Thank you again!
    Ariella

    1. Colic ends in 50% of children at about 2 months of age, 30% at 3 months, and 10-20% at 4 months. ” because he got a lot better at 7 weeks and started sleeping 5 hours in the night, only to regress a week later” suggests that colic was winding down around 7 weeks but because the brain wants an earlier bedtime around 6 weeks of age, he accumulated a sleep debt from a too late bedtime and over a week his sleep again worsened. Consider now a 5-day trial of any sleep solution you wish to prevent post-colic sleep problems, but definitely include a much earlier bedtime. Perhaps the two older children distracted you from implementing an appropriate early bedtime when he was younger. Let me know how it goes.

  5. Hi Dr Weissbluth,

    The baby has slept the last four nights! Thank G-d. I did as you suggested and put him to bed earlier with lights out, between 9:00 and 11:00 p.m. I didn’t even have to let him cry, just nursed him first. The first two nights I also gave him Tylenol as per the pediatrician, as he thought the baby might be still reacting from his shots from the week before when the sleeping problems all started again. I hadn’t been putting him to bed earlier because he showed no signs of drowsiness at night and was just fussy and demanding nursing. But so far now he has been sleeping 5-7 hours and then waking up once around 4 or 5am and going back to sleep. Thank you so, so much for all your help! I feel like I am finally coming out of this nightmare.

    One more question… I used to wake my other babies up by 7:00 a.m. to keep them on schedule. Right now this baby is waking up at 8:00 or 9:00 a.m. Am I supposed to start waking him up at 7:00? I feel like we are both catching up on so much lost sleep.
    Thank you again!!

    1. Your baby’s brain will want an even earlier bedtime soon, so continue to gradually move the bedtime earlier. This will automatically cause the wake-up time in the morning to move toward 7ish. If this gradual approach fails, then maybe go ahead and wake him to get naps around mid-morning and mid-day and a bedtime that is early. Let me know what you do.
      Sweet Dreams,
      Marc

  6. Dear Dr Weissbluth,

    I wanted to update you… I tried to move the bedtime earlier in the weeks after we were last in touch, but the baby insisted on nursing 4-6 hours in the evenings, and then he would sleep 7-8 hours straight at night. He would go to bed between 10pm and 12am and wakeup at 6am or 7am (which was so nice after barely sleeping those first few months!:)), so at least his wakeup time had shifted naturally to an earlier time.

    He is now 15 weeks (born a week early). This last week he started going to bed earlier, between 9pm and 10:30pm, though he started waking up again in the night just to eat, anywhere between 1am and 5am. He has a cold and I’m hoping that’s why he is waking again, but I guess regardless his bedtime is earlier, which is good. His evening nursing marathons got shorter and less intense, more like one session of 2-3 hours, with more breaks, right before bedtime.

    I know he probably should be going to bed even earlier, but if I put him down before his evening nursing marathon is over then he’ll scream, but when I let him do his thing then I know when he’s done, as he’ll suddenly stop and go to sleep, and then he sleeps well after that.

    His naps are still not scheduled or condensed, as he sleeps 45-60 minutes usually and occasionally 2 hours, but at least he still sleeps within 1-2 hours of wakefulness (besides for that one evening nursing marathon before bed).

    Thank you again so much for all your help and advice!!

    1. The effect of colic on night sleep is much less after 3-4 months. If you are comfortable with this, every few weeks, try a 4-5 day trial of a much earlier bedtime and a night-time sleep solution of your choice.

      The effect of colic on day sleep consolidation and regularity might last until 4-6 months of age. Your main challenge now is to do your best to keep him well rested during the day in the face of caring for two older children who might have scheduled activities. The better he sleeps during the day, the better he will sleep at night and vice versa.

      Congratulations on coping with colic. I think the worst is over. Please try to enlist as much help as you can for naps and night sleep. Please take breaks without guilt! Breaks for you are smart for the family, not selfish. Please give me a follow up.

      Sweet dreams,
      DrW.

  7. Dear Dr Weissbluth,

    I’m nervous to sleep train, but I know it’s probably the right thing to do… I will see how it goes.

    Yes, we make napping a top priority after reading your book! It definitely helps.

    Thank you so much for all the help and advice!! I will give a follow up.

  8. Hi there, my 8 week old ( born on due date). Is a pretty easy going baby minimal crying and naps/ sleeps decently. She can go down drowsy and about 50% of the time will fall asleep on her own. However sometimes she will start to cry, we have been reading your book and see you suggest letting them cry before sleep? Is this okay to do with an 8 week old? How long should we let this happen? Is it for naps and bedtime? She usually wakes up 1-2 times a night and has shown she can go 4-6 hours at night. Also her bedtime is still late 9-10 we have tried to move it earlier but she wakes up after an hour or two and treats it like a nap, how do we move bedtime earlier so she’ll treat it as nighttime? Thank you so much!

    1. Individualized advice for your family depends on many variables. My suggestion is to read the following topics on my Blog and tell me which variables are most salient to consider.
      1. Drowsy signs (Blog Posts 9 and 83)
      2. Parents (Blog Post 17 and 18)
      3. Sleep training (Blog Posts 57 and 67)
      4. Make Bedtime earlier (Blog Post 74)
      5. Bedtime routines (Blog Posts 10 and 87)
      Parents’ reports
      #1. Graduated extinction and extinction (by age of child)
      #2. Early bedtimes (by age of child)

      Please let me know your thoughts.
      Sweet Dreams,
      Marc

  9. Hello Dr. Weissbluth,

    I have read your book numerous times and have employed your methodology successfully for my first 2 children. I wish I had used your methods and advice for my first child sooner. He was a horrible sleeper and finally, around the 15/16 month mark, the pediatrician recommended reading your book. Within 3 nights, our son was sleeping better. For my second son, we employed your methods and strategies early and he has been such a great sleeper. There are hiccups along the way but for the most part, both have been good sleepers. My 3rd child has been a challenge. We were unable to employ your methods earlier on with her. We needed more help with our daughter (grandparents helped to take care of her but refused to listen to us) and unfortunately, that meant inconsistency. My parents (grandparents) have now left and our daughter is 17 months now. We employed your methods and it’s been well over a week now. Unfortunately, we are not having the same success as with our first 2. She will still take about 15 minutes to soothe herself to sleep. Like clockwork, she will wake up around 1:30 am. It
    Takes anywhere from 30 to 45 minutes for her to soothe herself to sleep. She will then sleep again until around 5:30 a.m. at that point, it is off and on until around 7:30, which is when our 2 boys wake up. Do you have any suggestions?

    1. Is it possible that your 3rd child at 17months has been chronically a little short on sleep and/or fragmented sleep?
      What is her current nap pattern?
      How does she behave and feel around 4-5pm?
      Please describe a typical bedtime and bedtime routine and 1:30am routine.
      Is your husband available early in the evening and on week-ends to help?

  10. Dear Dr Weissbluth,

    I wanted to give you an update, but was embarrassed because the baby’s sleeping had been not great at all and I’m still scared to sleep train. He is now 6 months. To be fair, we had been moving a lot this summer while we did work on our house, and then he got sick a few times, and each time any of those events happened he didn’t sleep well for about a week.

    We finally moved back home two weeks ago, and he finally fell into a routine. He still goes to bed late, around 9/10pm, and then he wakes up between 12am and 2am and then again around 4/5am. He has 3 naps a day, and the first two are often long. His last, short nap is around 4/5pm, and if I try to hold him out to skip it, he’ll just take it at 7pm and go to bed later.

    Our focus with this baby is to keep him as well rested as we can. People comment that he is such a happy, calm baby, and they can’t believe he is the same child as the screaming baby he was the first 3 months.

    Two issues I have now are that the first time he wakes up at night, he eats and then goes back to sleep pretty quickly. He’s usually still sleeping mostly. I usually fall asleep while he’s nursing and put him back an hour later. Then the second time he wakes up, he seems very uncomfortable after he eats and has so many burps and spits up. Once he gets all the burps out, he goes back to sleep happily, but that can take two hours sometimes. I wonder if that’s because we are both sleeping the first wakeup and he eats for too long. He also has a lot of burps/reflux throughout the day, though.

    He also seems to want to go to bed at night earlier but wakes up with burps and can’t stay asleep until he gets them all out.

    The other issue is that he still sleeps in the Snoo, which is a bassinet that has a swaddle attached to keep him from rolling over. If his arms are unswaddled, he wakes himself up by hitting his head. He sleeps much better and much longer while swaddled. Right now he doesn’t roll over, but he is outgrowing the bassinet and then I will be unable to swaddle him any longer, as it will be unsafe.

    I really appreciate all the help, kind words, and advice you have given throughout these difficult few months.

    1. I know that there are many variables influencing your baby’s sleep. Please focus on two main issues:
      1. The bedtime is too late.
      2. When you fall asleep nursing your baby, there is the potential for harm to come to you or your baby.
      Please consider a Community Sleep Consultant (Blog Post 27) to help you help your child sleep well. The failure to move the bedtime earlier and his dependency on the Snoo guarantee future major sleep problems. To correct your unhealthy sleep deprivation and to protect your baby’s neurodevelopment, now is the time to make major changes. Please let me know how it goes.
      Sweet Dreams, DrW

  11. Dear Dr Weissbluth,
    Ok, thank you again for your advice. We built the crib today and will try to make some serious changes over the weekend and next week. I will also consider a sleep consultant.
    Hopefully I can update you soon with good news.
    Thank you!!
    Ariella

  12. Hello Dr. Weissbluth,

    Thank you for your response! My husband helps a lot on the evenings and weekends. It is just the 2 of us and both of us are working professionals. We rely on daycare for help during the day now.

    I do think she is either chronically short on sleep or has fragmented sleep.

    At daycare, she naps anywhere from 45 minutes to 2.5 hours. It’s usually around the 1-1.5 hour mark. The daycare turns off the lights, plays music, and then pats the children on the back until they fall asleep. On the weekends, we try for 2 naps but she is slowly going to 1 nap. Getting her to nap is a bit of a challenge.

    Around 4-5 pm, she is fine. She plays and is very happy.

    Ideally, I would like to get her to sleep earlier. Our first was in bed around 7 pm. When our second was born, it was harder to do that and bed times ranged from 7:30-8:00. Now that we have 3 (oldest just turned 5, middle just turned 3, and youngest at 17 months), bedtime is usually around 8:00 – 9:00. She is usually asleep around 8:10 with the boys falling asleep on their own between 8:30-9:00 (sometimes later if they fall asleep on the way home and develop a second wind).

    The typical bedtime routine is dinner, bath, short story, then bed. I have weaned her so that she does not nurse to sleep. After the story, I say goodnight and she waves goodnight to her brothers. I then take her to her crib and she snuggles against me and then I place her in the crib. I say goodnight and close the door. She then whines and cries but does fall asleep.

    At 1:30 am, she wakes up. She will whine and cry for about 30-45 minutes. I have not gone in to her room. She will fall asleep again but I am surprised that she is still doing this.

    For the past 2 nights, I have tried for an earlier bedtime for her but it was not successful. In fact, it took her longer to fall asleep and in the end, she ended up falling asleep at around 8:10 to 8:30. I think a significant factor is that her 2 older brothers are up still and she can hear them playing or taking a bath. We try telling them to be quieter but they are toddlers still so that has limited success. In an ideal world, I would love for all 3 to go to bed earlier.

    Regards,
    Christina

    1. Your daughter is usually asleep around 8:10pm. What time do you you usually enter your home after picking up your daughter from daycare? What time does her usual bedtime routine begin? How long does her bedtime routine last? After you leave the room, how long does she whine and cry before falling asleep? What time was the new earlier bedtime for the past 2 nights? Please describe how she sleeps day and night on week-ends.

      What is the time in the late afternoon or early evening when all 5 are you together? What time do all of you usually sit down together for dinner?

  13. Hello Dr. Weissbluth,

    We usually get home between 5:00 and 5:30 (depending on traffic) and that’s for all 5 of us. Dinner starts anywhere between 6:00-6:30 (sometimes at 6:45) depending on if we have dinner prepared already or are making dinner. We take turns with making dinner. Ideally, we like to have dinner at 6 but honestly, it sometimes takes a while to get her brothers to stop playing and sit at the table with us. Bath is right after that and is usually around the 7:15 to 7:30 mark. I guess the bath is part of the bedtime routine and lasts about 5-10 minutes. Then the drying her off, diaper, PJs, and sleep sack is about another 5 minutes. Story is less than 5 minutes. Snuggles and placing her in the crib is also less than 5 minutes. After I leave the room, she whines and cries less than 15 minute minutes. The first night was the worst and each subsequent night was about 15 minutes or less.

    The last 2 nights (and tonight so this is the 3rd night), I tried for an earlier bedtime so we made a concerted effort to have dinner early and start bath early. I basically gave her a bath earlier than her brothers and did bedtime routine a bit earlier than her brothers. Last night, she was in her crib around 7:30 but it took her a lot longer to go to bed and she ended up falling asleep later than her usual time of 8:10 (I think because she could hear her brothers). However, last night, she did not wake up at 1:30 a.m. and woke up a bit later, whined for less than 30 minutes and then, slept all the way until about 7:30 a.m. Today, it was the same thing and I knew she was tired. Even though we pushed things earlier, she fell asleep at 8:03 (a few minutes earlier than her normal 8:10).

    On weekends, I try for 2 naps. She wakes up between 7:00 a.m. to 7:30 a.m. Then around the 9:00/9:30 mark, I try to get her to nap and if unsuccessful, then I try again around 11:30 a.m./noon (which is when her daycare has nap times). If she does take a morning nap, then I try for a mid-afternoon nap around 1:00/1:30/2:00. Her naps range anywhere from 1 hour to 2 hours. Night routines on the weekend are basically the same times as the weekday routine.

    1. CONGRATULATIONS! You have accomplished a lot in just a few days.
      Before: ” Like clockwork, she will wake up around 1:30 am.” “Takes anywhere from 30 to 45 minutes for her to soothe herself to sleep.”
      Now: ” last night, she did not wake up at 1:30 a.m. and woke up a bit later, whined for less than 30 minutes and then, slept all the way until about 7:30 a.m” “After I leave the room, she whines and cries less than 15 minute minutes.”

      Please stay the course! As described on my Blog, just a few minutes per night of extra sleep will make a huge difference over time. Here are my suggestions which may, or may not, be compatible with your life-style:
      Because of her age, try for one mid-day nap on weekends and a super early bedtime based on drowsy signs (the time will vary because of variability of the nap and physical activities); even as early as 5:30pm.
      Brainstorm with your husband on how to make an early dinner easier to accomplish. Perhaps make a plan to prepare week-day dinners ahead of time. Maybe this will be a fun week-end family activity to do a lot of menu-making, prep, cooking, and storing!

      Going forward, it will take weeks to repay her chronic sleep deprivation debt. Please be patient. But once this is accomplished, she will be able to comfortably tolerated occasionally staying up much later for exceptional events (a few times per month) and possibly skipping a week-end nap (perhaps add on a super early bedtime).
      How do you and your husband feel about what you have been through these past few days?
      Sweet Dreams,
      DrW.

  14. Hello Dr. Weissbluth,

    Thank you. That night was the anomaly unfortunately. The subsequent night where she went to bed a bit earlier at 8:03 was rough. She woke up at 1:30 am again and then proceeded to wake up and cry throughout the night. Last night, I was able to get her into her crib at 7:08 but she did not go to sleep right away and fell asleep around 8:40. She then woke up at 4:00 am and did not go back to sleep. We will continue to try and incorporate what you have suggested.

    Regards,
    Christina

  15. Hi Dr Weissbluth,
    We’ve made a little progress, the baby is out of the Snoo and his arms are not swaddled anymore. He naps in his crib. My question is, his naps before when he was in the Snoo seemed consolidated for at least a month or so. Now that his arms are not swaddled, his naps are usually 45 minutes, sometimes 1 hour, which is less. My oldest baby had colic as well, and she did not start consolidating her naps until after 8 months. This baby is 6 months. Is it possible that he needs more time to consolidate now that he is in a regular sleeping environment? Or the fact that he had consolidated already in the Snoo means that he doesn’t?
    Thank you!
    Ariella

    1. In my nap study, at 6 months of age, I divided infants into 5 groups based on the total duration of their naps. The briefest nap group, 1-2.5 hours, had a mean nap duration of 2.3 hours per day. I suspect that infants who had colic were overrepresented in this group.

      At 9 months of age, the mean daily duration of naps in the other 4 groups decreased, but those infants who had been in the briefest group now had longer naps (2.7 hours per day)!

      This observation supports your suspicion based on your first child that it takes longer for naps to develop in post-colic infants. This has been my experience also.

      So please be optimistic that naps will improve. However, sometimes, an older sibling distracts a parent from observing drowsy signs in their baby or an older child has too many late scheduled activities with the result that the baby’s bedtime is too often too late or the baby experiences skipped naps because of the older siblings scheduled daytime activities. The result is a baby that continues to struggle with day sleep, night sleep, or both.

      Please give me a progress report.

      Sweet dreams,
      DrW.

  16. Dear Dr Weissbluth,

    Thank you for your reply!

    Ok, we will continue to make his sleep a priority and be optimistic that the naps will consolidate.

    Thank you again!

    Ariella

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