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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to understand how the timing of evening tablet use affects young children's sleep patterns and mental skills, such as focus and self-control. It will compare different timings of tablet use before bedtime to determine their impact on when children fall asleep and how well they sleep. The trial involves three groups: one uses a tablet one hour before bed, another uses it two hours before bed, and the last group avoids screens in the evening (no technology or digital media use). Preschool-aged children living in Greater Houston who do not have chronic medical conditions or take sleep-affecting medication are suitable candidates for this study. As an unphased trial, this study offers a unique opportunity to contribute to understanding how evening screen time affects children's sleep and development.

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 prior data suggests that this protocol is safe for children?

Research shows that using screens before bed can affect children's sleep. Many studies have found that evening screen time links to less overall sleep, poorer sleep quality, and daytime fatigue. One study found that 90% of research articles reported negative effects on sleep when kids used screens. These effects include taking longer to fall asleep, waking up more during the night, and feeling anxious about sleep.

Another study examined kids aged 4 to 11 and found that more screen time correlated with waking up more at night and increased sleep anxiety. In short, using screens in the evening might disrupt sleep, but it's not harmful like a drug. Instead, it can disrupt sleep patterns, affecting how well kids perform during the day. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how the timing of evening screen time affects children's sleep, which is a fresh approach compared to traditional methods like behavioral therapies or medication. The trial examines if using a tablet one or two hours before bedtime impacts sleep differently, while also comparing it to no screen exposure in the hours leading up to bedtime. By understanding these effects, researchers aim to develop more effective, non-invasive strategies for managing sleep issues in kids, potentially leading to better sleep hygiene practices that don't rely on medication.

What evidence suggests that this trial's treatments could be effective for sleep issues in kids?

Research has shown that using screens before bed can affect children's sleep. About 90% of studies have found that screen time delays bedtime and reduces total sleep time. Specifically, using screens right before bed is linked to less sleep, poorer sleep quality, and daytime tiredness. This trial will compare different timings of screen use. Group A will use tablets for 1 hour in the hour before bed, while Group B will use tablets for 1 hour, 2 hours before bed. The control condition involves no screen use in the 3 hours before bedtime. Studies also indicate that children and teens who use electronic devices generally sleep less. This suggests that the timing of screen use could be important for improving sleep. ^{3 6 7 8 9}

Are You a Good Fit for This Trial?

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

Parent and child must be fluent in English

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 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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11581737/

Toddler Screen Use Before Bed and Its Effect on Sleep and ... Our findings support current pediatric guidance to avoid screen time in the hour before toddler bedtime, and our study has several strengths.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5839336/

Youth screen media habits and sleep - PubMed Central - NIH 90% of included studies found an association between screen media use and delayed bedtime and/or decreased total sleep time.

3. sleephealthjournal.org sleephealthjournal.org/article/S2352-7218(24)00090-1/fulltext

The impact of screen use on sleep health across the lifespan The current evidence suggested that overall screen use and the content of presleep screen use impaired the sleep health of children, but there ...

4. sciencedirect.com sciencedirect.com/science/article/pii/S1389945724003186

Associations between bedtime media use and sleep ... Use of screen media, particularly before bedtime or after getting in bed, has been linked to less total sleep time, poor sleep quality, and daytime sleepiness [ ...

5. bmcpublichealth.biomedcentral.com bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11640-9

Electronic media use and sleep in children and adolescents in ... Overall, electronic media use was generally associated with shorter sleep duration in children and adolescents.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11280700/

Screen time and sleep in children - PMC The authors found 90% of published studies reported statistically significant adverse associations between screen use and at least 1 sleep outcome. Notably, ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5669315/

Bedtime Use of Technology and Associated Sleep ... A study of children ages 4 to 11 found that increased screen time was associated with increased sleep anxiety, increased night waking, and ...

8. sleepfoundation.org sleepfoundation.org/bedroom-environment/technology-in-the-bedroom

Technology in the Bedroom A technology-free bedroom can enhance sleep by preventing multiple problems associated with using electronic devices at night.

9. longevity-protocols.com longevity-protocols.com/en/knowledge-base/interventions/negative/screen-use-before-bed/

Screen use before bed Shortened and reduced sleep quality: Most studies confirm that evening screen use leads to shorter sleep, delayed sleep onset, more frequent awakenings, and ...