Daily touchscreen use in infants and toddlers is associated with reduced sleep and delayed sleep onset

Associations between daily screen time and sleep in a racially and socioeconomically diverse sample of US infants: a prospective cohort study

OBJECTIVE

To determine the associations between screen media use and sleep throughout infancy (3-12 months).

DESIGN

Prospective Nurture birth cohort.

SETTING

North Carolina, USA, 2013-2015.

PARTICIPANTS

Women enrolled in their second to third trimester, completed a phone interview after birth, and completed home visits at 3, 6, 9 and 12 months post partum.

PRIMARY AND SECONDARY OUTCOME MEASURES

Women reported the usual hours their infants slept during the day and night and their infants' usual use of five screen media activities at 3, 6, 9 and 12 months post partum. Adjusted mixed-effects regression analyses modelled the associations between infant screen time and sleep outcomes while disaggregating the between-infant and within-infant effects.

RESULTS

Among 558 mother-infant dyads, 374 (67.0%) infants were black and 304 (54.5%) households earned <$20 000 per year. Half (254, 50.2%) of the infants engaged with screens at 3 months of age, while 326 (72.9%) engaged at 12 months. The median value of the average daily screen time over the study period was 50 (IQR: 10-141) min. Infant screen time was inversely associated with night-time sleep duration only when considering between-infant effects (adjusted beta: -2.9; 95% CI -5.9 to 0.0; p=0.054 for log-transformed screen time). Effects were stronger for television+DVD viewing specifically (adjusted beta: -5.2; 95% CI -9.1 to -1.4; p<0.01 for log-transformed television+DVD time). For example, an infant who averaged 1 hour of television+DVD viewing over the study period slept, on average, 9.20 (95% CI 9.02 to 9.37) hours per night by 12 months compared with 9.60 (95% CI 9.41 to 9.80) hours per night for an infant with no screen time over the study period. There were no significant within-infant effects between screen time and night-time sleep, and screen time was not associated with daytime sleep or night-time awakenings.

CONCLUSIONS

Screen time during infancy was inversely associated with night-time sleep duration; however, causal associations remain uncertain.

TRIAL REGISTRATION NUMBER

NCT01788644.

Toddlers Using Tablets: They Engage, Play, and Learn

Although very young children have unprecedented access to touchscreen devices, there is limited research on how successfully they operate these devices for play and learning. For infants and toddlers, whose cognitive, fine motor, and executive functions are immature, several basic questions are significant: (1) Can they operate a tablet purposefully to achieve a goal? (2) Can they acquire operating skills and learn new information from commercially available apps? (3) Do individual differences in executive functioning predict success in using and learning from the apps? Accordingly, 31 2-year-olds (M = 30.82 month, SD = 2.70; 18 female) were compared with 29 3-year-olds (M = 40.92 month, SD = 4.82; 13 female) using two commercially available apps with different task and skill requirements: (1) a shape matching app performed across 3 days, and (2) a storybook app with performance compared to that on a matched paper storybook. Children also completed (3) the Minnesota Executive Functioning Scale. An adult provided minimal scaffolding throughout. The results showed: (1) toddlers could provide simple goal-directed touch gestures and the manual interactions needed to operate the tablet (2) after controlling for prior experience with shape matching, toddlers’ increased success and efficiency, made fewer errors, decreased completion times, and required less scaffolding across trials, (3) they recognized more story content from the e-book and were less distracted than from the paper book, (4) executive functioning contributed unique variance to the outcome measures on both apps, and (5) 3-year-olds outperformed 2-year-olds on all measures. The results are discussed in terms of the potential of interactive devices to support toddlers’ learning.

Sleep disorders reveal distress among children and adolescents during the Covid-19 first wave: results of a large web-based Italian survey

Background

Measures to contain the Covid-19 pandemic led to significant lifestyle changes for children and adolescents mainly related to the closure of schools and recreational activities, reduced social interaction, and increased family concerns.

Methods

A cross-sectional online survey of 78 questions investigating social determinants of health, mood changes, symptoms of anxiety, increase in sleep disorders and unusual repetitive movements was offered to parents living in Italy with children ≤18 years; including families of children with disabilities, autism spectrum disorders, chronic diseases, and specific learning disabilities. The survey was conducted on the Qualtrics platform 6 months after the beginning of the pandemic and distributed in hospitals and paediatricians’ waiting rooms as well as through social networks. The primary outcomes were the increase in sleep disorders among children and adolescents. Possible risk factors were investigated through multivariable regression.

Results

Six thousand two hundred ten volunteer parents responded to the questions concerning mood changes, sleep disorders and unusual repetitive movements, and were included in the present study. The majority were female (91.8%) and Italian (97.0%). 72.7% answered that their children had become more nervous, worried, or sad (80.2% in children with learning disabilities); 77.6% reported feelings of loneliness and 69.3% more difficulties in children falling asleep, 30.2% in staying asleep, and 18.7% an increase in nightmares and/or sleep terrors. Statistical analysis identified socioeconomic status, parent’s job loss, food insecurity, family attitude toward the pandemic, and children’s mood swing, feelings of loneliness, or missing outdoor activities, as major risk factors for sleep disorders.

Conclusion

The first Covid-19 lockdown impacted children’s and adolescents’ health through an increase in sleep disorders. In the following phases of the pandemic, this evidence may be useful to investigate and treat these disorders as well as make decisions about containment health policies concerning this age group.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-021-01083-8.

Screens across the pond: Findings from longitudinal screen time research in the US and UK

Digital media are increasingly pervasive in the lives of young children. This increase in the availability of digital media might have long-run implications for child development; however, it is too soon to definitively conclude the direction of effects. In part due to this lack of certainty, leading health organizations have chosen to make different recommendations to parents of young children: Many international health organizations (e.g., the American Academy of Pediatrics, World Health Organization) recommend very young children be limited to under one hour of screen time daily, whereas others (e.g., Royal College of Paediatrics and Child Health) have intentionally opted not to make recommendations about specific limits. These guidelines might contribute to parents in different countries making meaningfully different choices about children's use of digital media. Using a sample of N = 303 families recruited in Cambridgeshire, England and New York City prior to the birth of couples' first child, we explore predictors of digital media use across the first two years of life. Data were collected when children were 4, 14, and 24 months of age. Results of latent growth curve analyses show that generally, children spend more time engaging with digital media as they grow older; however, growth mixture models reveal most children fit into one of two classes: One group of children (High Media Users; 52.2 %) engages with a substantial amount of digital media, whereas the other (Low Media Users; 48.8 %) engages with relatively little. Children in the US were approximately 30 % more likely to be in the Low Media Users group and there were no differences in group membership on the basis of parents' psychosocial wellbeing. While these differences could be due to a number of factors, these findings may reflect the power of pediatric recommendations.

Correlates of Sleep Duration in Early Childhood: A Systematic Review

OBJECTIVE

This systematic review aimed to summarize correlates of sleep duration in children under 5 years of age.

METHODS

Six electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, SPORTDiscus, and Scopus) were searched from inception to May 2019. Observational studies and intervention studies reporting cross-sectional results from baseline data were considered. Data were extracted using a predesigned form and potential correlates were categorized following a sociological framework.

RESULTS

One-hundred and sixteen studies, representing 329,166 children, met the inclusion criteria, with a high risk of bias in 62 included studies. A total of 83 correlates of sleep duration were identified. Among the associations studied four or more times, correlates of nap duration were child's age and nighttime sleep onset/bedtime; correlates of nighttime sleep duration were household income, parent marital status, parental adiposity level, nighttime sleep duration at younger age, nighttime sleep onset/bedtime, nighttime sleep wakeup time, and frequency of current bedtime routine; correlate of total sleep duration was screen time.

CONCLUSIONS

Young children from low-income households, single families, or having overweight parents may be at risk for short sleep duration. Promoting healthy sleep duration from an early age appears essential. Effective practices may include encouraging an earlier bedtime, limiting screen time, and establishing a regular bedtime routine. The absence of consistent evidence in the psychological, cognitive, and emotional domain as well as the physical environmental domain warrants further research.

Sleep and screen exposure across the beginning of life: deciphering the links using big-data analytics

STUDY OBJECTIVES

Evidence for the association between screen time and insufficient sleep is bourgeoning, and recent findings suggest that these associations may be more pronounced in younger compared to older children, and for portable compared to non-portable devices. However, these effects have yet to be investigated within the beginning of life. Importantly, there are no data for the relationship between screen exposure and objectively measured infant sleep. This study examined the moderating role of age for both touchscreens' and television's relationship with sleep, using auto-videosomnography within a big-data sample of infants.

METHODS

The sleep of 1074 infants (46% girls) aged 0-18 months was objectively assessed using computer-vision technology in this cross-sectional study. Sleep was additionally reported by parents in an online survey, as was infant exposure to screens.

RESULTS

Age significantly moderated the relationship between daytime touchscreen exposure and sleep with a distinct pattern for younger infants, in which screen exposure was associated with decreased daytime sleep, but with a proposed compensatory increase in nighttime sleep consolidation. Compared to touchscreens, television exposure was less likely to be associated with sleep metrics, and age moderated this relationship only for daytime and 24-hour sleep duration.

CONCLUSIONS

In young infants, a daytime-nighttime sleep "trade-off" emerged, suggesting that the displacement of daytime sleep by screens may lead to greater accumulation of sleep homeostatic pressure, which in turn facilitates more consolidated nighttime sleep.

Parents and Mobile Devices, from Theory to Practice: Comparison between Perception and Attitudes to 0-5 Year Old Children's Use

Pediatrics associations recommend avoiding the use of mobile devices (MDs) in children aged 0–2 years and limiting them to one hour per day for children aged 3–5 years. This study aimed to explore public risk perception on MDs use by children aged 0–5 years and attitudes of parents to children’s use. Participants were recruited on a voluntary basis by social media using a self-administered survey. The study included 3115 participants, most of whom were parents of children aged under 5 years (n = 1901; 61%). Most of the respondents (74%) considered that MDs use could be harmful for children’s health. The awareness on a correct use did not always translate into avoiding MDs use as recommended, especially in parents of children aged 0–2 years. Half of the sample (54%) received or sought information on risks related to MDs use. The most consulted information sources were the web (78%), and pediatricians in only 22% of cases. Understanding the determinants of parents’ risk perception and behavior is necessary to design effective family-based interventions in order to guide parents to a moderate and more careful use of MDs by their children. To do so, public health actions must aim to strengthen awareness about conscious use of MDs.

Screen media use by Portuguese children in 2009 and 2016: a repeated cross-sectional study

BACKGROUND

Few studies have examined how access to mobile media is disrupting more traditional forms of media use.

AIM

To examine screen-time in 2009/10 and 2016/17 among children aged 3-6 years and assess potential socio-economic determinants of adherence to screen-time recommendations.

SUBJECTS AND METHODS

Two independent cross-sectional studies included 6874 Portuguese children. Screen-time (including television, computer, tablet, and smartphone) and proxy measures to calculate socioeconomic position (SEP) were parent-reported using a standardised questionnaire. Screen-time and adherence to screen-time recommendations were calculated for both periods. Determinants of excessive screen-time were identified using adjusted logistic regression models.

RESULTS

In 2009/10 screen-time averaged 107 min/day for pre-school children and 149 min/day for school-aged children. In 2016/17 values were 142 min/day and 173 min/day, respectively. Screen-time allocated to television was the highest, independently of children's age. In 2016/17, mobile media use was common among pre-school (37 min/day) and school-aged children (43 min/day). Exceeding the recommended screen-time was more prevalent in boys than girls (adjusted odds ratio (aOR) between 1.02 and 1.59) and in children whose parents had lower education levels or were unemployed (aOR between 1.00 and 2.23).

CONCLUSION

Screen-time was high among pre-school children, emphasising the need for earlier interventions, particularly among those from lower-SEP who had higher risk of exceeding the screen-time recommendations.

How Infant and Toddlers' Media Use Is Related to Sleeping Habits in Everyday Life in Italy

Background

Heavy media use has been linked to sleep problems in children, which may also extend to the infancy period. While international parent-advisory agencies, such as the American Academy of Pediatrics (2016), advise no screen time before 18 months, parents often do not follow this recommendation. Research on Italian infants’ early access to media is sparse, and only very few studies have investigated links with sleeping habits.

Method

To address this gap, we examined concurrent associations between parent-reported surveys of child technology use and sleeping patterns. The Italian version of the 60 item Comprehensive Assessment of Family Media Exposure (CAFE) Survey, developed as part of a larger international study, (Barr et al., 2020), the Brief Screening Questionnaire for Infant Sleep Problems (BISQ) Sadeh, 2004) were completed online by 264 Italian parents of 8- to 36-month-olds and a subset (n = 134) completed the Parenting Stress Index (PSI) Abidin, 1995) between April 2017 and April 2018.

Results

More devices located in the child’s room and the more time spent watching TV or using an iPad were associated with less hours of sleep at night. Furthermore, more time spent watching TV or using a smartphone, as well as the number of devices in the room was associated with going to sleep later at night. Instrumental media use was associated with less sleep.

Conclusion

Like other countries, Italian infants have high levels of exposure to media, and differences in media patterns were associated with sleep patterns. Cultural factors influence both instrumental reasons for media use and sleep practices. Further research should explore how media use may serve to regulate emotion as a function of both contextual factors and individual differences.

Electronic Media and Early Childhood: A Review

BACKGROUND

This review summarizes the state of knowledge of use of new media on the development in early childhood in 6 sections: descriptive utilization data, psychosocial and emotional development, cognition and language, motor development, nutrition and sleep, and influence of parental media consumption.

METHODS

The review is based on a literature search of this topic in peer-reviewed journals. We included 87 articles, books, and book chapters. The used literature data bases were ERIC, PsycARTICLES, PsycINFO and PSYNDEX.

RESULTS

Manifold studies describe in young children's utilization data the pervasive nature of digital exposure and impressive usage times and availability. They confirm adverse influences of electronic media use (television, video games) on children's emotional and behavioral problems and well-being, e. g. on physical activity, sleep and obesity. In general a positive effect in sense of knowledge transfer of age could be found for high quality educational media, however predominantly the impact of media use at younger age was negative.

CONCLUSIONS

High frequent media use in early childhood is likely to have a negative impact on psychosocial development, positive effects such as knowledge transfer may be seen beyond the age of 18 months. As parental media use is a strong predictor of child media habits, reducing parental media use and enhancing parent-child interactions might be important areas to address when trying to change the media behavior of young children. In view of the scarcity of studies for early childhood, it is advisable to use digital play and communication devices cautiously and restrictively in this vulnerable development phase.

Sleep and the General Behavior of Infants and Parents during the Closure of Schools as a Result of the COVID-19 Pandemic: Comparison with 2019 Data

This study compared cross-sectional data from online surveys describing the sleep behavior of infants and caregivers in March 2020 (the school closure period during the early stages of the COVID-19 pandemic; n = 295, 23.8 ± 3.8 months old) and March 2019 (before the pandemic; n = 2017, 24.2 ± 3.8 months old). In comparing those two points in time, no significant differences were found in wake-up times (2019: 7:19 ± 0:46 am vs. 2020: 7:18 ± 0:47 am, p = 0.289), bedtimes (21:01 ± 0:48 pm vs. 21:04 ± 0:53 pm, p = 0.144), or nocturnal sleep times (593.7 ± 43.9 min vs. 588.1 ± 50.3 min, p = 0.613). Regarding the caregivers, in 2020, wake-up times (2019: 6:46 ± 0:50 am vs. 2020: 6:39 ± 0:50 am, p = 0.017) and bedtimes (22:53 ± 1:17 pm vs. 22:42 ± 1:04 pm, p = 0.016) became significantly earlier compared to 2019. Among infants staying at home, total sleep time and percentage of outdoor play decreased significantly, and media use increased significantly in 2020. Lower levels of exercise and more frequent media viewing may have caused prolonged sleep latency in these children. The percentage of caregivers responding with "negative childcare feelings" was significantly higher in the group with less than three nursery school attendance days. Caregivers and infants staying at home are a high-risk group during the pandemic.

Prosocial television and prosocial toddlers: A multi-method, longitudinal investigation

How screen use might affect early childhood outcomes is an important question for parents, but existing research is patchy. In particular, screen time is often examined in relation to sleep and aggression, but much less is known about its links with prosocial behaviour. To address this gap, we conducted semi-structured observations and interviews / questionnaires with both mothers and fathers in a sample of 195 (predominantly affluent and educated) British families tracked across three time-points, when the first-born child was 14-, 24-, and 36-months old. We also applied an objective coding scheme to assess the relative frequency of prosocial behaviour in the programmes and films children were watching at age 24-months. While our results showed no overall associations between prosocial behaviour and either screen time or screen content, there were interaction effects. Specifically, children whose favourite programmes were slow-paced and rich in prosocial content were particularly likely to show developmental gains in sharing. We discuss these findings in terms of their implications for parents, researchers, and policy makers.

Sleep and Technology in Early Childhood

Research suggests that technology use is associated with poorer sleep outcomes among children less than 6 years of age. These associations are evident regardless of the type of technology studied, although evening exposure may have the greatest impact compared with technology use during other parts of the day. More work is needed, particularly given that technology use is relatively high among young children. Clinicians should assess patients' technology exposure, including before bedtime, to assess whether sleep issues stem from children's technology use. Moreover, clinicians should educate caregivers about the association between technology use and sleep problems among young children.

Sleep Through Toddlerhood: The Distinct Roles of Overall Media Use and Use of Media to Regulate Child Distress

OBJECTIVE

Excessive media exposure has been associated with various sleep disturbances in early childhood. However, previous research mostly addressed the overall amount of media use while neglecting the role of media use practices. The purpose of this study was to examine whether media use practices (specifically, maternal use of media to regulate child distress) and overall media use predict distinct aspects of children's sleep. We hypothesized that frequent maternal use of media to regulate child distress will predict difficulties in sleep regulation, whereas higher child screen time will predict lower sleep duration.

METHODS

One-hundred fifty-one mothers (predominantly from the United Kingdom) completed anonymous online questionnaires via the Prolific platform that assessed child sleep latency and duration, use of media to regulate child distress, overall child screen time, and demographic covariates at 2 time points: 22 months (T1) and 26 months (T2) of children's age.

RESULTS

Maternal use of media to regulate child distress at T1 (but not screen time) predicted longer sleep latency at T2. Conversely, screen time (but not media to regulate distress) at T1 predicted shorter sleep duration at T2. These results were obtained while controlling for multiple covariates and sleep and media use at both time points.

CONCLUSION

Findings suggest that media use practices and overall use have differential effects on sleep. Specifically, the use of media-based regulation strategies may interfere with the development of children's ability to self-soothe and regulate arousal in contexts that require the use of regulatory skills, such as transition to sleep.

Screen Time and Executive Function in Toddlerhood: A Longitudinal Study

Technology is pervasive in homes with young children. Emerging evidence that electronic screen-based media use has adverse effects on executive functions may help explain negative relations between media use and early academic skills. However, longitudinal investigations are needed to test this idea. In a sample of 193 British toddlers tracked from age 2 to 3 years, we test concurrent and predictive relations between screen use and children’s executive function. We find no concurrent association between screen use and executive function; however, screen time at age 2 is negatively associated with the development of executive functions in toddlerhood from age 2 to 3, controlling for a range of covariates including verbal ability. Implications for parenting, education, and pediatric recommendations are discussed.

Parental decision-making: infant engagement with smartphones

Smartphones have become a ubiquitous part of life, and as a result, many children are engaging with smartphones beginning in infancy. Little is known regarding the thought processes used by parents in deciding when and how to allow their infants to engage with smartphones. Using a sample of twelve parents with infants younger than one year, this qualitative study examines parental smartphone use, their perspectives regarding use by their young children, and what sources informed their decision-making about allowing their infants to use a smartphone. Results found that the smartphone has become such a common part of everyday life that choices to use a smartphone around, and with, infants has become one that is nearly automatic. These research data showed that most parents are largely unaware of guidelines for childhood screen time provided by the American Academy of Pediatrics and the World Health Organization. Given our current knowledge that smartphone use can have a significant impact on the cognitive development of young children, this topic is an important area of future research.

The Effect of a Screen Protector on Blue Light Intensity Emitted from Different Hand-held Devices

PURPOSE:

In response to growing concern about the effect of blue light on ocular tissue, companies have created mobile device screen protectors to block blue light. This project evaluates one of these screen protectors' ability to reduce blue light intensity.

METHODS:

The intensity of light at 450 nm from an iPhone 8, iPhone X, and iPad was measured in a dark room. The averages of three measurements were taken with and without the screen protector at different distances, settings of brightness, and Apple's night shift (NS) mode. Results were analyzed using paired t-tests.

RESULTS:

At 33 cm, 100% brightness, and 0% NS, the screen protector decreased intensity by 43.9%, 32.3%, and 34.9% for the iPhone 8, iPhone X, and iPad, respectively. At 33 cm and 100% brightness, increasing NS mode from 0% to 100% decreased intensity by 81.2%, 84.2%, and 86.5%. At 33 cm without NS, decreasing the brightness from 100% to 0% decreased intensity by 99.5%, 99.8%, and 97.8%.

CONCLUSIONS:

The screen protector decreased the intensity at 450 nm for every setting other than those at 0% brightness. Decreasing brightness and applying NS mode were more effective in reducing blue light. More research is needed to determine the benefits of decreasing blue light exposure from electronic devices.

The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review

Evidence suggests that excessive screen time in early childhood is related to children's physical and mental health. This study aimed to review the relationships between screen media use and several health indicators in infants, toddlers, and preschoolers. A systematic search was conducted by two independent reviewers on PubMed, Web of Science, Embase, and Cochrane Library to identify the eligible studies, with an end date of 13 August 2019. Included studies (published in English) were peer-reviewed and met the determinate population (children aged 0-7 years with screen media exposure and related health outcomes). The AHRQ, NOS, and the Cochrane Handbook were used to evaluate the cross-sectional study, cohort study, and RCT, respectively. A meta-analysis and narrative syntheses were employed separately. Eighty studies (23 studies for meta-analysis) met the inclusion criteria for the systematic review. Strong evidence of the meta-analysis suggested that excessive screen time was associated with overweight/obesity and shorter sleep duration among toddlers and preschoolers. Excessive screen use was associated with various health indicators in physical, behavioral, and psychosocial aspects. Better-quality research on newer media devices, on various kinds of contents in young children, and on dose-response relationships between excessive screen use and health indicators are needed to update recommendations of screen use.

Beyond Screen Time: A Synergistic Approach to a More Comprehensive Assessment of Family Media Exposure During Early Childhood

Digital media availability has surged over the past decade. Because of a lack of comprehensive measurement tools, this rapid growth in access to digital media is accompanied by a scarcity of research examining the family media context and sociocognitive outcomes. There is also little cross-cultural research in families with young children. Modern media are mobile, interactive, and often short in duration, making them difficult to remember when caregivers respond to surveys about media use. The Comprehensive Assessment of Family Media Exposure (CAFE) Consortium has developed a novel tool to measure household media use through a web-based questionnaire, time-use diary, and passive-sensing app installed on family mobile devices. The goal of developing a comprehensive assessment of family media exposure was to take into account the contextual factors of media use and improve upon the limitations of existing self-report measures, while creating a consistent, scalable, and cost-effective tool. The CAFE tool captures the content and context of early media exposure and addresses the limitations of prior media measurement approaches. Preliminary data collected using this measure have been integrated into a shared visualization platform. In this perspective article, we take a tools-of-the-trade approach (Oakes, 2010) to describe four challenges associated with measuring household media exposure in families with young children: measuring attitudes and practices; capturing content and context; measuring short bursts of mobile device usage; and integrating data to capture the complexity of household media usage. We illustrate how each of these challenges can be addressed with preliminary data collected with the CAFE tool and visualized on our dashboard. We conclude with future directions including plans to test reliability, validity, and generalizability of these measures.

A preliminary investigation assessing the basic digital capabilities of minimally verbal children on the autism spectrum with intellectual disability

Purpose

Children with Autism Spectrum Disorder (ASD) can demonstrate a preference for using digital technologies which can represent a relative strength within the autism community. Such a strength would have implications for digitally mediated interventions and support for autism. However, research to date has not developed a methodology for assessing the capabilities of minimally verbal children on the autism spectrum with intellectual disability (ID) to use digital technology.

Design/methodology/approach

Six minimally verbal children with ASD and ID undertook an accessible assessment that identified what capabilities for interacting with a digital tablet device they could and could not demonstrate. Twelve brief assessments were demonstrated, including turning on the device, adjusting the volume, operating the camera, touching, tilting and rotating the screen.

Findings

Participants could be assessed on their digital capabilities. In this study, participants could largely touch and swipe the screen effectively and leave the app, but could not tilt and rotate the screen nor turn on the digital tablet device.

Research limitations/implications

While the numbers were small, the findings indicate that the digital capabilities of this group can usefully be assessed. Future research can use such assessments to highlight how intervention effectiveness and support can be enhanced by matching the digital capacities of minimally verbal children with ASD and ID to technological support. This is a preliminary study and a greater understanding of children’s prior experiences with technology will better inform how and which digital capabilities develop.

Originality/value

This is the first study to assess a range of basic capabilities for using digital tablet devices in minimally verbal children with ASD and ID.

Beyond Screen Time: A Synergistic Approach to a More Comprehensive Assessment of Family Media Exposure During Early Childhood

Digital media availability has surged over the past decade. Because of a lack of comprehensive measurement tools, this rapid growth in access to digital media is accompanied by a scarcity of research examining the family media context and sociocognitive outcomes. There is also little cross-cultural research in families with young children. Modern media are mobile, interactive, and often short in duration, making them difficult to remember when caregivers respond to surveys about media use. The Comprehensive Assessment of Family Media Exposure (CAFE) Consortium has developed a novel tool to measure household media use through a web-based questionnaire, time-use diary, and passive-sensing app installed on family mobile devices. The goal of developing a comprehensive assessment of family media exposure was to take into account the contextual factors of media use and improve upon the limitations of existing self-report measures, while creating a consistent, scalable, and cost-effective tool. The CAFE tool captures the content and context of early media exposure and addresses the limitations of prior media measurement approaches. Preliminary data collected using this measure have been integrated into a shared visualization platform. In this perspective article, we take a tools-of-the-trade approach (Oakes, 2010) to describe four challenges associated with measuring household media exposure in families with young children: measuring attitudes and practices; capturing content and context; measuring short bursts of mobile device usage; and integrating data to capture the complexity of household media usage. We illustrate how each of these challenges can be addressed with preliminary data collected with the CAFE tool and visualized on our dashboard. We conclude with future directions including plans to test reliability, validity, and generalizability of these measures.

Excessive Screen Media Use in Preschoolers Is Associated with Poor Motor Skills

Excessive screen media use exposure is a robust childhood predictor of sedentary behavior. The association between excessive exposure to sedentary behaviors (e.g., screen media use) and motor skills and how this association differs across sociodemographic strata is an important knowledge gap that needs to be addressed. The study aims to investigate the association of motor skills and screen media use in preschool children, taking into account sociodemographic variables, physical activity, and sleep profile. A cross-sectional survey of 926 children from 27 preschools was performed. The main outcome was defined as motor skills assessed using the general motor quotient (GMQ). Independent variables included sociodemographic variables, screen media use, screen habits, physical activity, and sleep duration. Logistic regression models were used to estimate the associations between the children's motor skills and each exposure factor. More than 55 percent of the children ate while watching television and 28 percent spent a long time watching television, playing video games, or using a computer, tablet, or cell phone. Excessive screen media use increased the risk of a low GMQ by 72 percent and inactivity in children increased the odds by 90 percent; sleep duration at night decreased the odds of a low GMQ by 51 percent and daytime sleep decreased the odds by 33 percent. Excessive screen media use has been associated with poor motor skills and increased physical inactivity in children, especially among those with prolonged exposure. Our findings can alert parents to the consequences of excessive screen media use and can motivate policymakers to encourage sports and other health-promotion strategies.

Sex differences in the relationship between social media use, short sleep duration, and body mass index among adolescents

OBJECTIVES

The main objectives of this study were to (1) determine whether sex moderates the association between social media use and body mass index (BMI) and (2) assess whether sleep duration mediates the association between social media use and BMI.

DESIGN

A cross-sectional province-wide and school-based survey of 7^th to 12^th graders (mean age: 15.1 years).

PARTICIPANTS

The sample consisted of 4,991 students from the 2015 cycle of the Ontario Student Drug Use and Health Survey (Canada).

MEASUREMENTS

Participants self-reported time spent using social media, total screen time, physical activity, sleep duration, and body weight and height. Multiple linear regression analyses were used to examine the association between social media use and BMI z-scores. Given that the sex by social media use interaction term was significant, analyses were stratified by sex.

RESULTS

After adjusting for age, ethnic background, subjective socioeconomic status, frequency of breakfast consumption, and physical activity, heavy social media use (>2 hours/day) was associated with higher BMI z-scores among males (β=0.323, 95% CI: 0.094; 0.551) than among females (β=0.036, 95% CI: -0.292; 0.364). This association remained significant after further adjusting for total screen time. Results also showed that sleep duration mediates the association between social media use and BMI z-scores among men.

CONCLUSION

Our results showed that short sleep duration is a concurrent mediator of the relationship between social media use and BMI z-scores among males. Reducing time spent using social media may be a good behavioral target to promote adequate sleep duration, which is considered as a component in childhood obesity prevention efforts.

The Impact of Internet and Videogaming Addiction on Adolescent Vision: A Review of the Literature

During the past decade, vision problems that were attributed to the use of electronic screens have gradually shifted from being a workplace health issue to a wider public health issue. “Computer vision syndrome” originally related to the few professionals exposed to long hours of work in front of a computer screen. The widespread use of digital screens in devices used throughout the day have led to the emergence of “digital eye strain” as a new clinical syndrome that affects every individual who spends a large period of time fixated on multiple screens, for work or leisure. A new subcategory, “video game vision” has been proposed to specifically address vision issues related to large periods of continuous use of screen enabled devices in order to play video games. With gaming disorder being included in the next version of the WHO classification of diseases (ICD-11), it is becoming increasingly important to have a clear idea of the impact of this disorder in general health and functioning. At the same time, a number of research studies have reported positive impact of videogame playing on the players vision. This article reviews the latest research studies on the impact of digital screen enabled devices on adolescent vision in light of the increasing reports of internet addiction and gaming disorder while referencing positive findings of videogaming on vision in order to provide a balanced approach and assist with classification, diagnosis and treatment, while providing directions for future research.

Potential determinants during 'the first 1000 days of life' of sleep problems in school-aged children

STUDY OBJECTIVES

Early life determinants of sleep problems are mostly unknown. The first 1000 days of life (ie, the time between conception and a child's second birthday) is a period where the foundations for optimum health, growth and neurodevelopment are established. The aim of this explorative study is to identify potential early life determinants of sleep problems at age 7-8 years.

METHODS

Data from the Amsterdam Born Children and their Development cohort study (n = 2746) were analyzed. Sleep problems at age 7-8 years were reported by the caregiver in the 'Child Sleep Habits Questionnaire'. A higher total score indicates more sleep problems. After multiple imputation (n = 20), we studied multivariable associations between all potential determinants and sleep problems using regression analysis.

RESULTS

A higher pre-pregnancy body mass index (BMI) was associated with more sleep problems at age 7-8 years [β 0.12 (95% CI 0.05, 0.18)]. Children of mothers with symptoms of anxiety during pregnancy [β 0.06 (95% CI 0.03, 0.09)] and infancy period [β 0.04 (95% CI 0.00, 0.07)] had more sleep problems. Children of mothers drinking ≥1 glass of alcohol a day around 14 weeks of gestation had a 2 points higher sleep problem score [β 2.55 (95% CI 0.21, 4.89)] and children of mothers smoking ≥1 cigarette per day in that period had a one point higher score [β 1.07 (95% CI 0.10, 2.03)]. Infants with relative weight loss (delta BMI-SD) had a higher sleep problem score during childhood [β -0.32 (95%CI -0.60, -0.04)].

CONCLUSIONS

We identified several potential determinants during pregnancy and infancy associated with childhood sleeping problems. We encourage further research into these and other potential determinants to replicate results and to identify underlying mechanisms.

Manual Dexterity is not Related to Media Viewing but is Related to Perceptual Bias in School-Age Children

Although the media can have both negative and positive effects on children’s cognitive and motor functions, its influence on their perceptual bias and manual dexterity is unclear. Thus, we investigated the association between media viewing time, media preference level, perceptual bias, and manual dexterity in 100 school-aged children. Questionnaires completed by children and their parents were used to ascertain media viewing time and preference levels. Perceptual bias and manual dexterity were measured using the visual-tactile temporal order judgment task and Movement Assessment Battery for Children—2nd edition, respectively. There were significant positive correlations between age and media viewing time and between media viewing time and media preference level. There was also a significant negative correlation between visual bias and manual dexterity. Hierarchical multiple regression analysis revealed that increasing visual bias was a significant predictor of decreasing manual dexterity. Further, children with low manual dexterity showed significant visual bias compared to those with high manual dexterity, when matched for age and gender. The present results demonstrated that, in school-aged children, although viewing media was not associated with perceptual bias and manual dexterity, there was a significant association between perceptual bias and manual dexterity.

Shedding light on a potential hazard: Dental light-curing units

BACKGROUND

Dental light-curing units (LCUs) are powerful sources of blue light that can cause soft-tissue burns and ocular damage. Although most ophthalmic research on the hazards of blue light pertains to low levels from personal electronic devices, computer monitors, and light-emitting diode light sources, the amount of blue light emitted from dental LCUs is much greater and may pose a "blue light hazard."

METHODS

The authors explain the potential risks of using dental LCUs, identify the agencies that provide guidelines designed to protect all workers from excessive exposure to blue light, discuss the selection of appropriate eye protection, and provide clinical tips to ensure eye safety when using LCUs.

RESULTS

While current literature and regulatory standards regarding the safety of blue light is primarily based on animal studies, sufficient evidence exists to suggest that appropriate precautions should be taken when using dental curing lights. The authors found it difficult to find on the U.S. Food and Drug Administration database which curing lights had been cleared for use in the United States or Europe and could find no database that listed which brands of eyewear designed to protect against the blue light has been cleared for use. The authors conclude that more research is needed on the cumulative exposure to blue light in humans. Manufacturers of curing lights, government and regulatory agencies, employers, and dental personnel should collaborate to determine ocular risks from blue light exist in the dental setting, and recommend appropriate eye protection. Guidance on selection and proper use of eye protection should be readily accessible.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The Centers for Disease Control and Prevention Guidelines for Infection Control in the Dental Health-Care Setting-2003 and the Occupational Safety and Health Administration Bloodborne Pathogen Standard do not include safety recommendations or regulations that are directly related to blue light exposure. However, there are additional Occupational Safety and Health Administration regulations that require employers to protect their employees from potentially injurious light radiation. Unfortunately, it is not readily evident that these regulations apply to the excessive exposure to blue light. Consequently employers and dental personnel may be unaware that these Occupational Safety and Health Administration regulations exist.

Sleep and new media usage in toddlers

Several studies over the years have demonstrated the association between lack of sleep in children and certain physical, psychological, and behavioral disorders. The aim of this study was to disentangle the association between new screen-based electronic devices and sleep problems in toddlers, adjusting for other covariates already known to be associated with sleep quality. We conducted a cross-sectional study with the aid of a national sample of 1117 toddlers. Parents reported children's sleeping habits such as total sleep time and sleep onset latency, recreational activities, bedtime routines, and temperament. An ordered logistic regression was run to assess the associations between new media exposure and two sleep outcomes (total sleep time and sleep onset latency). Everyday use of a tablet or smartphone raised the odds of a shorter total sleep time (OR 1.95 [1.00-3.79], p < 0.05) and a longer sleep onset latency (OR 2.44 [1.26-4.73] p < 0.05) irrespective of other factors, such as temperament (restlessness, sociability), or traditional screen exposure (watching TV or playing videogames).Conclusion: New media usage is a factor associated in toddlers with sleeping fewer hours and taking longer to fall asleep, irrespective of other confounding factors. What is known • Studies have found an association between sleep behavior and the use of computers and video games in early childhood. • The blue light emitted from TV screens suppresses endogenous melatonin. What is new • The study found an association between daily new media (tablet and smartphone) usage and sleep quality in toddlers • New media usage exposes toddlers to the risk of fewer hours of sleep and taking longer to fall asleep, irrespective of other factors.

Mobile Media Device Use is Associated with Expressive Language Delay in 18-Month-Old Children

OBJECTIVE

The objective was to examine the association between mobile media device use and communication delays in 18-month-old children.

METHODS

A cross-sectional study was conducted from September 2011 and December 2015 within the TARGet Kids! primary care research network. Children were included if parents reported their child's mobile media device use and completed a validated questionnaire for communication delay at the 18-month well child visit. Mobile media device use was measured using a parent-reported survey instrument. Daily mobile media device use was calculated as a weighted average of typical weekday and weekend day mobile media device use. Two communication outcomes were investigated: (1) expressive speech delay and (2) other communication delays, as measured by the Infant Toddler Checklist.

RESULTS

The study sample included 893 children (mean age 18.7 months, 54.1% male). Most parents reported 0 minutes per day of mobile media device use in their children (n = 693, 77.6%). Among children whose parents reported any mobile media device use (n = 200, 22.4%), the median daily mobile media device use was 15.7 minutes (range 1.4-300). The prevalence of parent-reported expressive speech delay was 6.6%, and the prevalence of other parent-reported communication delays was 8.8%. For children who used a mobile media device, each additional 30-minute increase in daily mobile media device use was associated with increased odds of parent-reported expressive speech delay (ORa = 2.33, 95% confidence interval, 1.25-4.82). No relationship was observed between mobile media device use and other parent-reported communication delays.

CONCLUSION

Our study demonstrated a significant association between mobile media device use and parent-reported expressive speech delay in 18-month-old children.

Correlates of nocturnal sleep duration, nocturnal sleep variability, and nocturnal sleep problems in toddlers: results from the GET UP! Study

OBJECTIVE

To explore the correlates of nocturnal sleep duration, nocturnal sleep variability, and nocturnal sleep problems in a sample of Australian toddlers.

METHODS

Participants were 173 toddlers (average age 19.7 ± 4.1 months) from the GET UP!

STUDY

Nocturnal sleep duration, nocturnal sleep variability, nap(s) and physical activity were measured using 24-h accelerometry (Actigraph GT3X+) over seven consecutive days. Nocturnal sleep problems were assessed using the Tayside Children's Sleep Questionnaire. Screen time was reported by the parents. Logistic regression models were used to examine the associations between potential correlates (ie, age, sex, socio-economic status, weight status, physical activity, screen time, nap(s), bedtimes, and wake-up times) and nocturnal sleep characteristics.

RESULTS

Older children were more likely to have greater sleep variability (OR: 1.97; 95% CI: 1.08-3.61). Less physical activity (OR: 2.38; 95% CI: 1.27-4.45), shorter nap(s) (OR: 2.42, 95% CI: 1.29-4.55), and later wake-up times (OR: 4.42; 95% CI: 2.32-8.42) were associated with higher odds of having longer nocturnal sleep duration. Late bedtimes were associated with shorter nocturnal sleep duration (OR: 0.09; 95% CI: 0.04-0.18) and with greater nocturnal sleep variability (OR: 1.97; 95% CI: 1.06-3.68). None of the potential correlates were associated with nocturnal sleep problems.

CONCLUSION

The present study identifies several correlates of nocturnal sleep duration (total physical activity, nap(s), bedtime, and wake-up time) and nocturnal sleep variability (age and bedtime), whereas no correlates were identified for nocturnal sleep problems. The association between late bedtimes and shorter nocturnal sleep duration and greater nocturnal variability suggests that these may be modifiable targets for future sleep interventions in early childhood.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12616000471482, 11/04/2016, retrospectively registered.

Snoring and breathing pauses during sleep: interview survey of a United Kingdom population sample reveals a significant increase in the rates of sleep apnoea and obesity over the last 20 years - data from the UK sleep survey

STUDY OBJECTIVES

(1) To determine the prevalence of snoring, breathing pauses during sleep and obstructive sleep apnoea syndrome in the United Kingdom (UK) and determine the relation between these events and obesity and other sociodemographic variables. (2) To compare and integrate this data with published UK population data.

METHODS

A total of 664 women and 575 men aged 18-100 years who formed a representative sample of the non-institutionalised UK population participated in an online interview survey directed by a previously validated computerised system.

RESULTS

Overall, 38% of men and 30.4% of women report that they snore at night. Furthermore, 8.7% of men and 5.6% of women state that they stop breathing at night. Comparing our data to published data from the 1990s, this study observes a highly significant increase in the rates of reported breathing pauses during sleep (sleep apnoea) in the UK over the last 20 years (p < 0.0001). In addition, we observe a highly significant increase in the prevalence of obesity (BMI>30) in the UK population between 1994 and 2015 (p < 0.0001). Integration of our data with NHS and public health England data on obesity confirms this increase.

CONCLUSIONS

Our data demonstrate a significant increase in the rates of reported breathing pauses during sleep (sleep apnoea) and obesity in the UK over the last 20 years. Sociodemographic and behavioural changes have likely contributed to this. Moreover, our data also suggests that sleep disordered breathing (SDB) is widely underdiagnosed in the UK.

Children's Environmental Health in the Digital Era: Understanding Early Screen Exposure as a Preventable Risk Factor for Obesity and Sleep Disorders

The quantity, accessibility and focus on child-targeted programming has exponentially increased since it entered American households in the early 1900s. It may have started with the television (TV), but technology has evolved and now fits in our pockets; as of 2017, 95% of American families own a smartphone. Availability and child-tailored content has subsequently led to a decrease in the age at initial screen exposure. The negative effects that accompany the current culture of early screen exposure are extensive and need to be considered as technology continues to enter the home and inundate social interactions. Increased levels of early screen exposure have been associated with decreased cognitive abilities, decreased growth, addictive behavior, poor school performance, poor sleep patterns, and increased levels of obesity. Research on the adverse effects of early screen exposure is mounting, but further epidemiological studies are still needed to inform prevention and regulation policies.

Media and Young Minds: Comparing State Screen Media Use Regulations for Children Under 24 Months of Age in Early Care and Education to a National Standard

Introduction Excessive screen media use has been associated with a number of negative health outcomes in young children, including increased risk for obesity and comparatively lagging cognitive development. The purpose of this study was to assess state licensing regulations restricting screen media use for children under 24 months old in early care and education (ECE) and to compare regulations to a national standard. Methods We reviewed screen media use regulations for all US states for child care centers ("centers") and family child care homes ("homes") and compared these regulations to a national standard discouraging screen media use in children under 24 months of age. We assessed associations between state geographic region and year of last update with the presence of regulations consistent with the standard. In centers, 24 states had regulations limiting screen media use for children under 24 months of age and 19 states had regulations limiting screen media use in homes. Results More states in the South and fewer states in the Midwest had regulations limiting screen media use. The association between geographic region and regulations was not significant for centers (p = 0.06), but was for homes (p = 0.04). The year of last update (within the past 5 years versus older than 5 years) was not associated with regulations for centers (p = 0.18) or homes (p = 0.90). Discussion Many states lacked screen media use regulations for ECE. States should consider adding screen media use restrictions for children under 24 months based on current research data and current recommendations in future regulations updates.

The potential influence of LED lighting on mental illness

OBJECTIVES

Two recent scientific breakthroughs may alter the treatment of mental illness, as discussed in this narrative review. The first was the invention of white light-emitting diodes (LEDs), which enabled an ongoing, rapid transition to energy-efficient LEDs for lighting, and the use of LEDs to backlight digital devices. The second was the discovery of melanopsin-expressing photosensitive retinal ganglion cells, which detect environmental irradiance and mediate non-image forming (NIF) functions including circadian entrainment, melatonin secretion, alertness, sleep regulation and the pupillary light reflex. These two breakthroughs are interrelated because unlike conventional lighting, white LEDs have a dominant spectral wavelength in the blue light range, near the peak sensitivity for the melanopsin system.

METHODS

Pertinent articles were identified.

RESULTS

Blue light exposure may suppress melatonin, increase alertness, and interfere with sleep in young, healthy volunteers and in animals. Areas of concern in mental illness include the influence of blue light on sleep, other circadian-mediated symptoms, prescribed treatments that target the circadian system, measurement using digital apps and devices, and adolescent sensitivity to blue light.

CONCLUSIONS

While knowledge in both fields is expanding rapidly, future developments must address the potential impact of blue light on NIF functions for healthy individuals and those with mental illness.

Le temps d’écran et les jeunes enfants : promouvoir la santé et le développement dans un monde numérique

Le paysage numérique évolue plus rapidement que les recherches traitant des effets des médias sur écran sur le développement, l’apprentissage et la vie familiale des jeunes enfants. Le présent document de principes porte sur les bienfaits et les risques potentiels de ces médias chez les enfants de moins de cinq ans. Il s’attarde sur la santé développementale, psychosociale et physique. Les conseils fondés sur des données probantes en vue d’optimiser et de soutenir les pratiques des jeunes enfants à l’égard des médias reposent sur quatre principes : limiter le temps d’écran, en atténuer les effets négatifs, être attentif à l’utilisation des écrans et donner l’exemple d’habitudes positives. Les connaissances sur l’apprentissage et le développement des jeunes enfants éclairent les dispensateurs de soins quant aux stratégies en matière de pratiques exemplaires.

Screen time and young children: Promoting health and development in a digital world

The digital landscape is evolving more quickly than research on the effects of screen media on the development, learning and family life of young children. This statement examines the potential benefits and risks of screen media in children younger than 5 years, focusing on developmental, psychosocial and physical health. Evidence-based guidance to optimize and support children's early media experiences involves four principles: minimizing, mitigating, mindfully using and modelling healthy use of screens. Knowing how young children learn and develop informs best practice strategies for health care providers.