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Toddler Screen Use Before Bed and Its Effect on Sleep and Attention: A Randomized Clinical Trial
Hannah Pickard1, Petrina Chu2,3, Claire Essex1
1Centre for Brain and Cognitive Development, Birkbeck, University of London, London, United Kingdom.
Insights
Reducing toddler screen time before bed is feasible and improves sleep. This parent-administered screen time intervention (PASTI) shows preliminary benefits for sleep, but further research is needed.
Area of Science:
- Pediatric sleep science
- Developmental psychology
- Clinical trial methodology
Background:
- Toddler screen time is linked to sleep disturbances and attention issues.
- Understanding the causal relationship between screen time and early development is crucial.
- Existing research highlights the need for interventions to mitigate negative effects.
Purpose of the Study:
- To assess the feasibility of a 7-week parent-administered screen time intervention (PASTI) for toddlers (16-30 months).
- To evaluate the impact of PASTI on toddler sleep and attention.
- To provide evidence supporting pediatric recommendations on screen time.
Main Methods:
- A UK-based, assessor-blinded, randomized clinical trial involving 105 families with toddlers (16-30 months).
- Families were randomized to: PASTI (screen time removal, bedtime box activities), bedtime box (BB) only, or no intervention (NI).
- Feasibility assessed via participation, adherence, and retention; efficacy measured by screen use, actigraphy (sleep), and eye-tracking (attention).
Main Results:
- The PASTI intervention was feasible with high retention (99%) and adherence (94%).
- PASTI significantly reduced parent-reported toddler screen time.
- Modest improvements were observed in sleep efficiency and reduced night awakenings; no significant effects on attention were found.
Conclusions:
- Removing screen time before toddler bedtime is feasible and shows preliminary benefits for sleep.
- The parent-administered screen time intervention (PASTI) supports pediatric recommendations.
- A larger confirmatory trial is necessary to validate these findings before widespread adoption.
Importance:
Toddler screen time has been associated with poorer sleep and differences in attention. Understanding the causal impact of screen time on early development is of the highest importance.
Objective:
To test (1) the feasibility of the 7-week parent-administered screen time intervention (PASTI) in toddlers (aged 16-30 months) who have screen time in the hour before bed and (2) the impact of PASTI on toddlers' sleep and attention.
Design, Setting, And Participants:
This assessor-blinded, UK-based randomized clinical trial was conducted between July 2022 and July 2023. This was a single-site study that enrolled families with a toddler aged between 16 and 30 months, living within 75 miles of the Babylab, and with 10 minutes or more of screen time in the hour before bed on 3 or more days a week. Exclusion criteria were (1) a genetic or neurological condition, (2) premature birth (<37 weeks), and (3) current participation in another study.
Interventions:
Families were randomized (1:1:1) to (1) PASTI: caregivers removed toddler screen time in the hour before bed and used activities from a bedtime box instead (eg, reading, puzzles); (2) bedtime box (BB only): used matched before-bed activities, with no mention of screen time; or (3) no intervention (NI): continued as usual.
Main Outcomes And Measures:
Feasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures.
Results:
A total of 427 families were screened, 164 were eligible (38.4%), and 105 families were randomized (mean [SD] age, 23.7 [4.6] months; 60 male [57%]). The trial was feasible, with 99% participant (104 of 105) retention and 94% of families (33 of 35) adhering to PASTI. PASTI showed reductions in parent-reported screen time (vs NI: Cohen d = -0.96; 95% CI, -1.32 to -0.60; vs BB only: Cohen d = -0.65; 95% CI, -1.03 to -0.27). PASTI showed small to medium improvements in objectively measured sleep efficiency (vs NI: Cohen d = 0.27; 95% CI, -0.11 to 0.66; vs BB only: Cohen d = 0.56; 95% CI, 0.17-0.96), night awakenings (vs NI: Cohen d = -0.28; 95% CI, -0.67 to 0.12; vs BB only: Cohen d = -0.31; 95% CI, -0.71 to 0.10), and reduced daytime sleep (vs NI: Cohen d = -0.30; 95% CI, -0.74 to 0.13) but no difference compared with BB only. There was no observable effect of PASTI on objective measures of attention. Compared with BB only, PASTI showed a difference on parent-reported effortful control (Cohen d = -0.40; 95% CI, -0.75 to -0.05) and inhibitory control (Cohen d = -0.48; 95% CI, -0.77 to -0.19), due to an increase in BB-only scores.
Conclusions And Relevance:
Results of this randomized clinical trial show that, supporting pediatric recommendations, removing screen time before toddler bedtime was feasible and showed modest preliminary beneficial effects on sleep. A future full confirmatory trial is needed before PASTI's adoption by parents and pediatricians.
Trial Registration:
ISRCTN.org Identifier: ISRCTN58249751.
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