A recent trial in the United Kingdom found that toddler screen time restriction before bedtime is feasible and has modest sleep benefits like improved sleep efficiency and fewer night awakenings compared to the toddlers who were exposed to screen time. The trial results were published in the journal JAMA Pediatrics.
Sleep is necessary for brain maturation and sleep disturbances can impact cognitive development in toddlers. Of late toddlers' exposure to screens has increased due to various reasons. Exposure to screens before bed can have a negative impact on the growing child. Research has linked it to abnormal sleep patterns, concentration issues, attention issues, and development in toddlers. Hence researchers from the United Kingdom have conducted a study to test 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 the impact of PASTI on toddlers’ sleep and attention.
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An assessor-blinded, single-site, randomized clinical trial was conducted between July 2022 and July 2023 by enrolling families with toddlers aged between 16 and 30 months were included except those with any genetic or neurological condition or premature birth or participating in any other study. Toddlers were given 10 minutes or more of screen time in the hour before bed on 3 or more days a week. Families were randomly divided into 3 groups (1:1:1) where caregivers removed toddler screen time an hour before bed and used activities from a bedtime box instead (eg, reading, puzzles). The second group where matched before-bed activities from the bedtime box were used with no mention of screen time and those without any interventions.
The feasibility of the trial was assessed by the participation rate, adherence, retention, family experiences, and acceptability of the participant families. Efficacy was assessed by screen use, actigraphy-measured sleep, and eye-tracking attention measures. However, larger trials are needed to confirm the effectiveness of the trial.
Findings:
Out of the 427 families that were screened, 164 were eligible (38.4%), and 105 families were randomized.
The trial was feasible as 99% of participants retained and 94% of families adhered to PASTI.
PASTI showed reductions in parent-reported screen time, small to medium improvements in objectively measured sleep efficiency, night awakenings, and reduced daytime sleep but no difference compared with BB only.
Regarding attention, PASTI did not show any observable effect on the objective measures of attention.
When compared to BB PASTI showed a difference in parent-reported effortful control and inhibitory control, due to an increase in BB-only scores.
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Thus, the study concluded that removing screen time before bed is feasible with potential benefits and can be a valuable tool for both parents and pediatricians.
Further reading: Pickard H, Chu P, Essex C, et al. Toddler Screen Use Before Bed and Its Effect on Sleep and Attention: A Randomized Clinical Trial. JAMA Pediatr. Published online October 21, 2024. doi:10.1001/jamapediatrics.2024.3997