Toddler Screen Use Before Bed and Its Effect on Sleep and Attention

IF 24.7 1区医学 Q1 PEDIATRICS

JAMA Pediatrics Pub Date : 2024-10-21 DOI:10.1001/jamapediatrics.2024.3997

Hannah Pickard, Petrina Chu, Claire Essex, Emily J. Goddard, Katie Baulcombe, Ben Carter, Rachael Bedford, Tim J. Smith

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引用次数: 0

Abstract

ImportanceToddler 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.ObjectiveTo 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 ParticipantsThis 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 (&lt;37 weeks), and (3) current participation in another study.InterventionsFamilies 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 MeasuresFeasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures.ResultsA 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 RelevanceResults 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 RegistrationISRCTN.org Identifier: ISRCTN58249751

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幼儿睡前使用屏幕及其对睡眠和注意力的影响

重要性幼儿的屏幕时间与较差的睡眠质量和注意力差异有关。目标测试（1）对睡前一小时内有屏幕时间的幼儿（16-30 个月）进行为期 7 周的家长管理屏幕时间干预（PASTI）的可行性；（2）PASTI 对幼儿睡眠和注意力的影响。设计、地点和参与者这项评估者盲法、基于英国的随机临床试验于 2022 年 7 月至 2023 年 7 月间进行。这是一项单点研究，研究对象为幼儿年龄在 16 到 30 个月之间、居住在距离 Babylab 75 英里范围内、每周有 3 天或更多天在睡前一小时有 10 分钟或更多屏幕时间的家庭。排除标准为：(1) 遗传或神经系统疾病；(2) 早产（37 周）；(3) 正在参与其他研究。干预家庭被随机（1:1:1）分配到（1）PASTI：照顾者取消幼儿睡前一小时的屏幕时间，改用睡前盒子中的活动（如阅读、拼图）；（2）睡前盒子（仅 BB）：使用匹配的睡前活动，不提及屏幕时间；或（3）无干预（NI）：照常进行。主要结果和测量可行性结果：参与率、干预坚持率、保留率、家庭体验和评估可接受性。结果共筛选出 427 个家庭，164 个符合条件（38.4%），105 个家庭被随机分配（平均 [SD] 年龄为 23.7 [4.6] 个月；60 名男性 [57%]）。该试验是可行的，99% 的参与者（105 人中的 104 人）坚持了 PASTI，94% 的家庭（35 个家庭中的 33 个）坚持了 PASTI。PASTI 显示，家长报告的屏幕时间有所减少（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 对客观测量的睡眠效率有小幅至中幅改善（对比 NI：Cohen d = 0.27；95% CI，-0.11 至 0.66；对比仅 BB：与 NI 相比：Cohen d = 0.27；95% CI，-0.11 至 0.66；与仅 BB 相比：Cohen d = 0.56；95% CI，0.17 至 0.96），夜间觉醒（与 NI 相比：Cohen d = -0.28；95% CI，-0.67 至 0.12；与仅 BB 相比：Cohen d = -0.31）：Cohen d = -0.31; 95% CI, -0.71 to 0.10），以及白天睡眠减少（vs NI：Cohen d = -0.30; 95% CI, -0.74 to 0.13），但与仅使用呼吸机相比没有差异。PASTI对注意力的客观测量没有明显影响。与仅使用 BB 相比，PASTI 在家长报告的努力控制（Cohen d = -0.40；95% CI，-0.75 至 -0.05）和抑制控制（Cohen d = -0.48；95% CI，-0.77 至 -0.19）方面显示出差异，这是因为仅使用 BB 的得分增加了。在家长和儿科医生采用 PASTI 之前，还需要进行全面的确证试验：ISRCTN58249751

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来源期刊

JAMA Pediatrics PEDIATRICS-

CiteScore

31.60

自引率

1.90%

发文量

357

期刊介绍： JAMA Pediatrics, the oldest continuously published pediatric journal in the US since 1911, is an international peer-reviewed publication and a part of the JAMA Network. Published weekly online and in 12 issues annually, it garners over 8.4 million article views and downloads yearly. All research articles become freely accessible online after 12 months without any author fees, and through the WHO's HINARI program, the online version is accessible to institutions in developing countries. With a focus on advancing the health of infants, children, and adolescents, JAMA Pediatrics serves as a platform for discussing crucial issues and policies in child and adolescent health care. Leveraging the latest technology, it ensures timely access to information for its readers worldwide.