Evening Screen Time for Sleep Issues in Kids

Overseen By Jennifer Coon

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Baylor College of Medicine

Must not be taking: Melatonin, Steroids

Disqualifiers: Chronic medical condition, Sleep disorder, Cognitive impairment, Vision problems, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

180 Participants Needed

Trial Summary

What is the purpose of this trial?

To test the timing of evening tablet use on children's circadian phase and sleep (i.e., sleep onset and sleep duration) compared to no screen media use. To explore the effect of evening tablet use on children's inhibitory control and executive function.

Will I have to stop taking my current medications?

The trial requires that children not take any medications that affect sleep or circadian rhythms, such as melatonin or steroids.

What data supports the effectiveness of the treatment for reducing screen time and improving sleep in children?

Research shows that interventions to limit children's screen use can reduce screen time by about 33 minutes per day and increase sleep duration by about 11 minutes per day. These changes also help children go to bed earlier, especially on weekends. ^{1 2 3 4 5}

Is limiting evening screen time safe for children?

Research shows that reducing evening screen time in children is generally safe and can lead to improved sleep duration and earlier bedtimes. No significant safety concerns have been reported in studies evaluating interventions to limit screen use in children. ^{1 3 6 7 8}

How does the treatment of timed evening technology and digital media use differ from other treatments for sleep issues in kids?

This treatment is unique because it focuses on regulating the timing and amount of screen time in the evening, which has been shown to improve sleep duration and advance bedtime in children. Unlike other treatments that might involve medication or behavioral therapy, this approach directly addresses the impact of electronic media on sleep patterns. ^{1 3 6 9 10}

Eligibility Criteria

This study is for preschool-aged children (4 to just under 5 years old) and their parents in the Greater Houston area. Parents must be primary caregivers, comfortable with English, and have a child who uses or has access to an Android OS ≥5.0 or Apple iOS ≥14.0 tablet.

Inclusion Criteria

The child does not have to have access to a mobile device, but if they do, the primary device they use has to be an Android OS ≥5.0 either used only by the study child or shared with others, or an Apple iOS ≥14.0 that only the child uses

Parent and child must be fluent in English

Parent must be a biological parent or legal guardian who lives with the child ≥50% of the time and has a primary role of caring for the child

Exclusion Criteria

Child with blindness or significant vision problems that impacts both screen media use and sleep

My child has a condition or takes medication that affects their sleep or learning abilities.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Baseline

Children maintain a sleep schedule within 30 minutes +/- of their habitual bedtime

1 week

1 visit (in-person)

Intervention

Participants follow assigned screen media use conditions: no screen use or tablet use 1 or 2 hours before bed

2 weeks

1 visit (in-person) for dim light melatonin onset assessment

Follow-up

Participants are monitored for changes in sleep, circadian phase, and executive functioning

1 week

1 visit (in-person) for final assessments

Treatment Details

Interventions

• no technology and digital media use (screen media use)
• Timed evening technology and digital media use (tablet use)

Trial Overview The study examines how using tablets in the evening affects young children's sleep patterns and behavior compared to not using screen media at all. It looks into when kids fall asleep, how long they sleep, and their ability to control impulses.

Participant Groups

Group I: Group B: 1 hour of tablet use 2 hours before bed Experimental Treatment 1 Intervention

During week 1, children will maintain a sleep schedule within 30 minutes +/- of their habitual bedtime. This bedtime will be maintained throughout the 3 weeks of the study except on nights when dim light melatonin onset is assessed in the lab. During week 2, participants will be asked to reframe from screen use in the 3 hours before bedtime for 6 evenings. During week 3, participants will be exposed to 1 hour of tablet use (Standard bright setting), 2 hours before bedtime (and no screen use in the hour before bed) for 6 evenings.

Group II: Group A: 1 hour of tablet use in the hour before bed Experimental Treatment 1 Intervention

During week 1, children will maintain a sleep schedule within 30 minutes +/- of their habitual bedtime. This bedtime will be maintained throughout the 3 weeks of the study except on nights when dim light melatonin onset is assessed in the lab. During week 2, participants will be asked to reframe from screen use in the 3 hours before bed time for 6 evenings. During week 3, participants will be exposed to 1 hour of tablet use (Standard bright setting), 1 hour before bedtime for 6 evenings.

Group III: Control Condition Active Control 1 Intervention

During week 1, children will maintain a sleep schedule within 30 minutes +/- of their habitual bedtime. This bedtime will be maintained throughout the 3 weeks of the study except on nights when dim light melatonin onset is assessed in the lab. During week 2, participants will engage no screen use for the 3 hours before bedtime for 6 evenings. During week 3, participants will be asked to engage in no screen use in the 3 hours before bedtime for 6 evenings.

Who Is Running the Clinical Trial?

Baylor College of Medicine

Lead Sponsor

Trials

1,044

Recruited

6,031,000+

Northern Illinois University

Collaborator

Trials

9

Recruited

940+

William Marsh Rice University

Collaborator

Trials

50

Recruited

28,400+

University of Nevada, Reno

Collaborator

Trials

34

Recruited

20,200+

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Collaborator

Trials

2,103

Recruited

2,760,000+

Findings from Research

Interventions aimed at controlling screen use in children aged 2-14 years resulted in a mean reduction of screen time by about 33 minutes per day and an increase in sleep duration by approximately 11 minutes per day, based on a systematic review of 11 studies involving 4,656 children.

While the findings suggest that reducing screen time may lead to small improvements in sleep duration, the evidence is not strong enough to confirm a direct causal relationship due to methodological limitations and variability among the studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis. Martin, KB., Bednarz, JM., Aromataris, EC.[2021]

The pilot study involving 29 children aged 9 to 12 years showed that using an electronic TV time monitor for 6 weeks led to a decrease in television watching by an average of 4.2 hours per week, although this change was not statistically significant compared to the control group.

Participant retention was high at 93%, and families found the monitors moderately acceptable, reporting benefits like increased awareness of TV viewing habits, though some drawbacks included disruptions to family routines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of electronic time monitors on children's television watching: pilot trial of a home-based intervention. Ni Mhurchu, C., Roberts, V., Maddison, R., et al.[2018]

Bedtime use of electronic devices among 234 children aged 8 to 17 years significantly reduces both sleep quantity and quality, highlighting the negative impact of technology on sleep health.

There is a notable association between bedtime technology use and elevated body mass index (BMI), suggesting that excessive screen time may contribute to weight issues in children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bedtime Use of Technology and Associated Sleep Problems in Children. Fuller, C., Lehman, E., Hicks, S., et al.[2020]

Approximately one-third of Italian children aged 1-14 years do not meet recommended sleep durations, with the percentage dropping to 50% among teenagers, highlighting a significant public health concern.

The study identified modifiable risk factors for poor sleep, such as the use of video devices before bedtime and having a TV in the bedroom, suggesting that addressing these factors could improve sleep quality in children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sleep habits and pattern in 1-14 years old children and relationship with video devices use and evening and night child activities. Brambilla, P., Giussani, M., Pasinato, A., et al.[2022]

About 67% of pediatric cancer survivors reported using digital media before bedtime, which is similar to usage rates in their siblings and healthy control children, indicating that BDM is common across these groups.

The study found trends suggesting that bedtime digital media use is linked to less sleep and increased fatigue in all children, highlighting the need for clinicians to promote healthy media use and sleep habits in pediatric oncology settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bedtime digital media use, sleep and fatigue among survivors of childhood cancer, their siblings and healthy control sibling pairs. Merz, EL., Russell, KB., Sell, H., et al.[2023]

The review identified 36 studies examining the impact of electronic media on sleep in school-aged children and adolescents, highlighting that media use is consistently linked to delayed bedtimes and shorter total sleep duration.

A proposed model of how electronic media affects sleep is discussed, suggesting pathways for future research to explore these relationships further.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electronic media use and sleep in school-aged children and adolescents: A review. Cain, N., Gradisar, M.[2022]

A study of 3,398 grade 5 children in Alberta, Canada, found that access to and night-time use of electronic entertainment and communication devices (EECDs) is linked to shorter sleep duration and higher body weight.

The research suggests that limiting EECDs in children's bedrooms could help improve sleep quality and reduce the risk of childhood obesity, supporting existing recommendations from the American Academy of Pediatrics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Availability and night-time use of electronic entertainment and communication devices are associated with short sleep duration and obesity among Canadian children. Chahal, H., Fung, C., Kuhle, S., et al.[2017]

Adolescents who used multiple forms of technology at night and consumed caffeine reported significantly less sleep, with those getting 8 to 10 hours of sleep having lower multitasking indices compared to those who slept less.

Caffeine consumption was 76% higher among teenagers who reported falling asleep during school, indicating a link between high caffeine intake, technology use, and daytime sleepiness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adolescents living the 24/7 lifestyle: effects of caffeine and technology on sleep duration and daytime functioning. Calamaro, CJ., Mason, TB., Ratcliffe, SJ.[2022]

A study of 3427 Australian children found that sleep duration and media use (like screen time) influence each other, with increased media use at age 4 leading to shorter sleep at age 6, and vice versa.

These bidirectional relationships were affected by socioeconomic status, highlighting the importance of addressing both sleep and media habits to improve children's health and well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bidirectional relationships between sleep duration and screen time in early childhood. Magee, CA., Lee, JK., Vella, SA.[2015]

Children aged 4-8 who used three or more media devices, excluding TV/DVDs, were more likely to have delayed bedtimes, indicating a link between excessive device use and sleep disruption.

Smartphone use, even for just 0.1-1 hour per day, was associated with delayed bedtimes, particularly when used for gaming, highlighting the need for families to limit screen time to promote better sleep in young children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between Media Use and Bedtime Delays in Young Children: An Adjunct Study of the Japan Environment and Children's Study. Yamamoto, M., Mezawa, H., Sakurai, K., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Effect of electronic time monitors on children's television watching: pilot trial of a home-based intervention. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Bedtime Use of Technology and Associated Sleep Problems in Children. [2020]

4. England pubmed.ncbi.nlm.nih.gov

Sleep habits and pattern in 1-14 years old children and relationship with video devices use and evening and night child activities. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Bedtime digital media use, sleep and fatigue among survivors of childhood cancer, their siblings and healthy control sibling pairs. [2023]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Electronic media use and sleep in school-aged children and adolescents: A review. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Availability and night-time use of electronic entertainment and communication devices are associated with short sleep duration and obesity among Canadian children. [2017]

8. United States pubmed.ncbi.nlm.nih.gov

Adolescents living the 24/7 lifestyle: effects of caffeine and technology on sleep duration and daytime functioning. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Bidirectional relationships between sleep duration and screen time in early childhood. [2015]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Association between Media Use and Bedtime Delays in Young Children: An Adjunct Study of the Japan Environment and Children's Study. [2022]