Abstract
Importance: Toddler 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.
Objective: To test 1) the feasibility of our seven-week Parent-Administered Screen Time Intervention (PASTI) in toddlers (16-30 months) who have screen time in the hour before bed; 2) the impact of PASTI on toddlers’ sleep and attention.
Design: This assessor-blinded, UK-based randomised controlled trial was conducted between July 2022 and July 2023.
Setting: Single-site study.
Participants: 427 families were screened, 164 were eligible (38.4%; 16-30 months; ≥ 10 minutes screen time on ≥ 3 days/week) and 105 families were randomised (60 male, mean age=23.70 months).
Intervention: Families were randomised (1:1:1) to 1) PASTI: caregivers removed toddler screen time in the hour before bed and used activities from a Bedtime Box instead (e.g. reading, puzzles); 2) Bedtime Box (BB-only): used matched pre-bed activities, with no mention of screen time; or 3) No Intervention (NI): continued as usual.
Main Outcomes and Measures: Feasibility outcomes: participation rate, intervention adherence, retention, family experiences and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep and eye-tracking attention measures.
Results: The trial was feasible, with 99% retention and 94% of families adhering to PASTI. PASTI showed reductions in parent-reported screen time (versus NI: Cohen’s d=-.96 [95% CI: -1.32, -.60]; BB-only d=-.65 [-1.03, -.27]). PASTI showed small-to-medium improvements in objectively-measured sleep efficiency (versus NI d=.27 [-.11, .66]; BB-only d=.56 [.17, .96]), night awakenings (versus NI d=-.28 [-.67, .12]; BB-only d=-.31 [-.71, .10]) and reduced day-time sleep (versus NI: d=-.30 [-.74, .13]; but no difference compared to BB-only). There was no observable effect of PASTI on objective measures of attention. Compared to BB-only, PASTI showed a difference on parent-reported effortful control (d=-.40 [-.75, -.05]) and inhibitory control (d=-.48 [-.77, -.19]), due to an increase in BB-only scores.
Conclusions and Relevance: 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 prior to PASTI’s adoption by parents and pediatricians.
Objective: To test 1) the feasibility of our seven-week Parent-Administered Screen Time Intervention (PASTI) in toddlers (16-30 months) who have screen time in the hour before bed; 2) the impact of PASTI on toddlers’ sleep and attention.
Design: This assessor-blinded, UK-based randomised controlled trial was conducted between July 2022 and July 2023.
Setting: Single-site study.
Participants: 427 families were screened, 164 were eligible (38.4%; 16-30 months; ≥ 10 minutes screen time on ≥ 3 days/week) and 105 families were randomised (60 male, mean age=23.70 months).
Intervention: Families were randomised (1:1:1) to 1) PASTI: caregivers removed toddler screen time in the hour before bed and used activities from a Bedtime Box instead (e.g. reading, puzzles); 2) Bedtime Box (BB-only): used matched pre-bed activities, with no mention of screen time; or 3) No Intervention (NI): continued as usual.
Main Outcomes and Measures: Feasibility outcomes: participation rate, intervention adherence, retention, family experiences and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep and eye-tracking attention measures.
Results: The trial was feasible, with 99% retention and 94% of families adhering to PASTI. PASTI showed reductions in parent-reported screen time (versus NI: Cohen’s d=-.96 [95% CI: -1.32, -.60]; BB-only d=-.65 [-1.03, -.27]). PASTI showed small-to-medium improvements in objectively-measured sleep efficiency (versus NI d=.27 [-.11, .66]; BB-only d=.56 [.17, .96]), night awakenings (versus NI d=-.28 [-.67, .12]; BB-only d=-.31 [-.71, .10]) and reduced day-time sleep (versus NI: d=-.30 [-.74, .13]; but no difference compared to BB-only). There was no observable effect of PASTI on objective measures of attention. Compared to BB-only, PASTI showed a difference on parent-reported effortful control (d=-.40 [-.75, -.05]) and inhibitory control (d=-.48 [-.77, -.19]), due to an increase in BB-only scores.
Conclusions and Relevance: 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 prior to PASTI’s adoption by parents and pediatricians.
| Original language | English |
|---|---|
| Journal | JAMA Pediatrics |
| DOIs | |
| Publication status | Published - 21 Oct 2024 |