Brief CommunicationMedia consumption and sleep quality in early childhood: results from the Ulm SPATZ Health Study
Introduction
Systematic reviews have documented the association between electronic media use and poor sleep quality and inadequate sleep quantity in school-age children [1], [2], [3]. Yet, media use is increasingly becoming common in preschoolers, starting before three years of age [4], [5]. While several studies have already documented the effects of screen time on sleep duration in this age group [6], [7], [8], [9], [10], investigations into sleep quality are scarce and mainly cross-sectional [11], [12], [13], [14], [15], [16].
One longitudinal observational study conducted within the framework of a birth cohort study initiated in 1996 was confined to the evaluation of the effects of >2 h of television viewing daily and the ‘sleep problems’ subscale of the Child Behavior Checklist [12]. Another more recent longitudinal study demonstrated the effects of a healthy media-use intervention altering media content on children's sleep problems measured by the Children's Sleep Habits Questionnaire in a randomized controlled trial [17]. All of the remaining previous cross-sectional studies were limited by investigating sleep across broader age ranges or in older preschoolers, which may have blurred the early effects and ideal time for intervention [11], [13], [14], [15], [16].
In a preliminary cross-sectional analysis, the current study investigated the association between media consumption, considering electronic media and books, with overall sleep quality at the age of three years. Moreover, it used longitudinal data by investigating the association between media consumption at three years of age with worsening sleep problems between the ages of 2–3 years.
Section snippets
Methods
The Ulm SPATZ Health Study cohort contained 1006 live newborns of 970 mothers (49% of 1999 eligible families) recruited from the general population shortly after delivery at the University Medical Center Ulm, Southern Germany, from April 2012 to May 2013 [18]. Exclusion criteria were outpatient delivery, maternal age <18 years, transfer of the newborn or mother to intensive care immediately after delivery, or insufficient German language skills. The Ethics Board of Ulm University approved the
Results
Data on CSHQ and media consumption at age three years were available for 530 children. While all but one family had electronic media devices in the household, nine children owned a device such as a mobile phone or tablet PC themselves, and three other children had a TV in their bedroom. Watching TV or DVD was common, with screen time up to 1 h/day for 58.4% and >1 h/day for 13.7% of the children. Computer gaming and other computer or internet use was markedly less frequent and contributed less
Discussion
The current study was the first larger-scale study to comprehensively investigate the effects of electronic media consumption and book reading on all CSHQ items in three-year-olds. Electronic media consumption had a moderate dose and prevalence in the current setting. However, the preliminary results indicated alarming associations with overall sleep quality and worsening indicators of bedtime resistance, sleep anxiety, and daytime sleepiness.
The reported effects may have partly been driven by
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This research received intramural funding of the Medical Faculty of Ulm University.
References (22)
- et al.
Electronic media use and sleep in school-aged children and adolescents: a review
Sleep Med
(2010) - et al.
Screen time and sleep among school-aged children and adolescents: a systematic literature review
Sleep Med Rev
(2015) Impact of television on the quality of sleep in preschool children
Sleep Med
(2016)- et al.
Developmental aspects of sleep hygiene: findings from the 2004 National Sleep Foundation Sleep in America Poll
Sleep Med
(2009) - et al.
Epidemiological study of sleep habits among four-and-a-half-year-old children in Japan
Sleep Med
(2012) - et al.
Impact of television on the quality of sleep in preschool children
Sleep Med
(2016) - et al.
Changes in children's sleep domains between 2 and 3 years of age: the Ulm SPATZ Health Study
Sleep Med
(2017) - et al.
Association between portable screen-based media device access or use and sleep outcomes: a systematic review and meta-analysis
JAMA Pediatr
(2016) - et al.
Exposure and use of mobile media devices by young children
Pediatrics
(2015) - et al.
Television viewing, bedroom television, and sleep duration from infancy to mid-childhood
Pediatrics
(2014)
Hours of television viewing and sleep duration in children: a multicenter birth cohort study
JAMA Pediatr
Cited by (29)
Sleep and Technology in Early Childhood
2024, Psychiatric Clinics of North AmericaMedia literacy and digital citizenship
2023, Encyclopedia of Child and Adolescent Health, First EditionRelationship between screen time and sleep among Finnish preschool children: results from the DAGIS study
2021, Sleep MedicineCitation Excerpt :Sufficient sleep and healthy sleep habits are crucial for healthy growth and development, especially in the early years [6]. Studies have shown associations between increased screen time and poor sleep outcomes, such as sleep disturbances [3,26] and irregular sleep habits in children under school age [2,12]. Previous studies have investigated whether screen time affects sleep by reducing sleep duration (a sleep displacement process) or by shifting both bedtimes and wake-up times later, resulting in a delayed circadian rhythm (a sleep time shifting process).
Sleep and Technology in Early Childhood
2021, Child and Adolescent Psychiatric Clinics of North AmericaCitation Excerpt :In addition, children who experienced increases in television exposure (from <1.5 hours per day to >1.5 hours per day of exposure) experienced reduced sleep duration over time. Likewise, Genuneit and colleagues28 found that electronic media use at age 2 predicted worse sleep outcomes by age 3, as measured by the Children’s Sleep Habits Questionnaire. Using an even longer time period, Cespedes and colleagues13 found that television viewing during infancy was related to shorter sleep durations concurrently and into middle childhood.
Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and meta-analysis
2020, Sleep Medicine ReviewsCitation Excerpt :Included articles were published between 2007 and 2019 and conducted in North America (n = 10) [17,19,27,28,30–35]; Europe (n = 7) [36–42]; Asia (n = 8) [29,43–49]; Australasia (n = 5) [19,20,50–52]; and one article included participants from multiple countries [53]. One article reported an experimental design (RCT; [36]), seven were longitudinal [19,30,38,41,47,50,51] (of which four also analyzed data cross-sectionally [30,47,50,51]) and 23 were cross-sectional [17,18,20,27–29,31–35,37,39,40,42–46,48,49,52,53]. Eleven articles examined the association between physical activity and sleep [19,20,31,33,36,40,44,45,49,51,52], five articles examine the association between sedentary time and sleep [20,27,31,36,49] and 23 articles examined the association between screen time and sleep [17,18,28–30,32,34,35,37–43,45–48,50–53].
“My stuffed animals help me”: the importance, barriers, and strategies for adequate sleep behaviors of school-age children and parents
2019, Sleep HealthCitation Excerpt :Media consumption and screen time have been widely reported to have an inverse relationship on duration of sleep. Media consumption during early childhood has been associated not only with decreased sleep duration54 and sleep quality but also with increased bedtime resistance and sleep anxiety.55,56 Additionally, Kim et al observed that spending 2 or more hours daily of leisure time using the Internet was linked with insufficient sleep duration (ie, 6 or fewer hours of sleep per night) in youth.57