Screen Time Removal Before Bed Can Improve Sleep in Toddlers

TOPLINE:

Taking screens away from toddlers an hour before bedtime resulted in slight improvements in sleep; however, this intervention did not have a significant impact on attention measures.

METHODOLOGY:

• The randomized clinical trial aimed to evaluate the feasibility and efficacy of a 7-week, parent-administered screen time intervention (PASTI) in toddlers aged 16-30 months who watched TV, a tablet, or a smartphone in the hour before bed.
• Overall, 105 families with a toddler (mean age, 23.7 months; 57% boys) who had 10 or more minutes of screen time in the hour before bed on 3 or more days a week were randomly assigned to one of three groups: PASTI, activities from a bedtime box only, or no intervention.
• Parents in the PASTI group were asked to remove screens for their toddlers before bed and use alternative activities such as puzzles or books; those in the bedtime box–only group received similar activities without any instructions about screen time removal.
• Outcome measures included screen use duration in the hour before bed, measured using a bedtime activity diary, actigraphy-measured sleep outcomes, and eye-tracking attention measures.

TAKEAWAY:

• Parent-reported screen time in the hour before bed was significantly shorter in the PASTI group than in the no intervention (Cohen d, −0.96; 95% CI, −1.32 to −0.60) or bedtime box–only (Cohen d, −0.65; 95% CI, −1.03 to −0.27) groups.
• Adherence to the PASTI intervention was high, with most (94%) families reporting no screen time in the hour before bed on 60% or more of daily screen time questionnaires.
• Participants in the PASTI group achieved higher sleep efficiency than those in the bedtime box–only group (Cohen d, 0.56; 95% CI, 0.17-0.96); they also experienced modest but nonsignificant improvements in sleep efficiency when compared with the no intervention group.
• No significant effect of the PASTI intervention was found on objective measures of attention.

IN PRACTICE:

“The take-home message for caregivers and clinicians is that evening screen time directly impairs toddlers’ sleep health, and there is something that families can do about it,” authors from the University of Oregon, Eugene, Oregon, and Stony Brook University, Stony Brook, New York, wrote in an accompanying editorial.

“Some families, particularly those reporting toddler sleep problems, may benefit from a more flexible and collaborative ‘harm reduction’ approach in which evening screen time is moved earlier in the bedtime routine or gradually reduced, in addition to other behavioral sleep strategies,” they added.

SOURCE:

This study was led by Hannah Pickard, PhD, from the Centre for Brain and Cognitive Development, Birkbeck, University of London, London, England. It was published online on October 21, 2024, in JAMA Pediatrics.

LIMITATIONS:

This study relied on parent-reported measures of screen time use, which may have been subject to reporting bias. Parents in the intervention group may have been more likely to underreport their child’s screen time due to the instructions provided as a part of the intervention. This study was also underpowered for an efficacy study.

DISCLOSURES:

The study was supported by the Nuffield Foundation, the National Institute for Health and Care Research Maudsley Biomedical Research Centre and other sources. No conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.