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

Use of multimedia devices in pediatric age: risks or advantages? A survey in an Italian center

BACKGROUND

Nowadays children live in a digital world, exposed to relevant risks for their health and safety. The aim of this study is to investigate the use of multimedia devices in a sample of children and adolescents.

METHODS

The study was performed between November 2018 and June 2019 in a third-level University Hospital, recruiting children and adolescents during general or specialistic follow-up visits. Anonymous, age-specific, questionnaires were distributed to 500 children and adolescents and 370 parents.

RESULTS

Among children, 25 (17.1%) had their own mobile device, of which 84% Italian. The 54.1% of them uses multimedia devices half an hour/an hour per day and many of them (37.5% of Italian and 40% of foreign) use it without their parents' control. Most of adolescents had a mobile phone since the age of 10-12 years old. WhatsApp (Meta Inc., Cambridge, MA, USA) is the most used social network, followed by Instagram and Facebook. The use of multimedia devices was widespread between teenagers during classroom hours, meals and before sleeping and they are an important mean for cyberbullying. In addition, in the 29.9% of cases there is no correspondence between information given by parents and respective sons/daughters.

CONCLUSIONS

This study shows more risks than advantages derived from the use of multimedia devices in children and adolescents. Therefore, it is essential to educate them about their correct and responsible use.

Adherence to sleep recommendations is associated with higher satisfaction with life among Norwegian adolescents

BACKGROUND

Sleep plays a crucial role in the health and well-being of adolescents; however, inadequate sleep is frequently reported in numerous countries. This current paper aimed to describe sleep duration, factors impacting sleep, consequences of insufficient sleep and satisfaction with life in Norwegian adolescents, stratified by sex and by adherence to the 8-hour sleep recommendation, and to examine potential associations between adherence to the 8-hours sleep recommendation and satisfaction with life.

METHODS

This is a cross-sectional study using data from the Norwegian Ungdata Survey, collected in 2021. Adolescents from five Norwegian counties were included, comprising a total of 32,161 upper secondary school students. Study variables were collected through an electronic questionnaire administered during school hours and all data are anonymous. Descriptive data of sleep patterns are presented, and linear regressions were conducted adjusting for SES, perceived stress, physical activity level, over-the-counter analgesics use, grade level and screen time.

RESULTS

73% of adolescents did not adhere to the 8-hours of sleep recommendation per night, with similar results for girls and boys. 64% reported tiredness at school (minimum 1-2 days weekly) and 62% reported that screen time negatively affected their ability to sleep. 23% reported that gaming affected their sleep, with a higher prevalence in boys than girls. Satisfaction with life score was 7.0 ± 1.9 points (out of 10) for the total sample, with higher scores for boys (7.3 ± 1.8 points) than girls (6.9 ± 1.9 points). Regressions revealed a positive association with satisfaction with life (B = 0.31, 95% [0.15 to 0.48]) in adolescents adhering to sleep recommendation of 8h compared to the ones not adhering to the sleep recommendation.

CONCLUSIONS

Most Norwegian adolescents fail to adhere to the 8-hours of sleep recommendation and the majority feel tired at school or during activities. More than half of adolescents reported that screen time negatively affected their ability to sleep. Adhering to the sleep recommendation was associated with higher life satisfaction. Our findings highlight the importance of sufficient sleep in adolescents, while future research is needed to examine other sleep related measures on adolescents´ satisfaction with life.

Evaluation of the association between excessive screen use, sleep patterns and behavioral and cognitive aspects in preschool population. A systematic review

In this review, we analyzed the possible relationship between the excessive use of screens and sleep patterns, and how this may affect certain behavioral and cognitive factors in preschool children. The selection, extraction and synthesis of the data were conducted according to PRISMA guidelines. The search was carried out in the electronic databases Medline (PubMed), PsycINFO (American Psychological Association), Scopus and Web of Science (WOS). Of the 597 articles initially identified, 13 met the inclusion criteria. The risk of bias of the articles selected was evaluated using a specific scale created for this purpose. The results found indicate that excessive use of screens is associated with a negative impact on the duration and quality of sleep-in preschoolers, and this worsening of sleep in infancy is related with a greater probability of the appearance of internalizing and externalizing behavioral problems and certain cognitive problems. The results also suggest that sleep could play a mediating or moderating role as a bioregulatory system that attenuates or increases the onset of behavioral and cognitive difficulties in those children most exposed to digital devices.

An Examination of the Digital Parenting Profiles in Turkey

Internet use among children is increasing. This requires parents to develop digital parenting competencies as they are responsible for their children's well-being. In the current study the digital parenting self-efficacy perceptions of Turkish parents are examined with regard to the parental role, educational status, age, number of children, and Internet use experiences. Data were collected from a stratified sample of 7150 Turkish parents (i.e., only the mother or father in each family) from twenty-six provinces through the Digital Parenting Self-Efficacy Perception Scale. Descriptive statistics, comparison tests, and cluster analysis were used to analyze the data. The findings reveal that the participants' perceived digital parenting efficacy is high, and that perceptions change in terms of the parental role, educational status, age, number of children, and the Internet use experience.

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.

Unsupervised Screen Exposure and Poor Language Development: A Scoping Review to Assess Current Evidence and Suggest Priorities for Research

Screen exposure has both negative and positive effects on the level of language skills a child acquires. The purpose of this review is to address current literature on the possible relationship between unsupervised screen exposure and language development in children and to provide recommendations to caregivers regarding screen exposure of children, taking into consideration the possible effects. A scoping review was conducted using the PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online) database. A total of 590 articles were retrieved and considered for inclusion. Twenty-one articles were finally included and reviewed with an emphasis on language, communication, and executive skills as well as cognitive development. The negative effects of screen exposure for children outweigh the positive effects. The largest number of studies demonstrate that unsupervised screen exposure may negatively impact a child's language usage and cognitive and executive skills, disrupt playtime, and affect the quality of sleep. On the other hand, supervised screen use is associated with improved language skills. More evidence is needed on unsupervised exposure in children to new types of screens. As technology could play a significant role in schools in the future, additional research is required to create educational media for schoolchildren with specific guidelines.

"It helps and it doesn't help": maternal perspectives on how the use of smartphones and tablet computers influences parent-infant attachment

As families increase their use of mobile touch screen devices (smartphones and tablet computers), there is potential for this use to influence parent-child interactions required to form a secure attachment during infancy, and thus future child developmental outcomes. Thirty families of infants (aged 9-15 months) were interviewed to explore how parents and infants use these devices, and how device use influenced parents' thoughts, feelings and behaviours towards their infant and other family interactions. Two-thirds of infants were routinely involved in family video calls and one-third used devices for other purposes. Parent and/or child device use served to both enhance connection and increase distraction between parents and infants and between other family members. Mechanisms for these influences are discussed. The findings highlight a new opportunity for how hardware and software should be designed and used to maximise benefits and reduce detriments of device use to optimise parent-infant attachment and child development.Practitioner Summary: Many families with infants regularly use smartphones and tablet computers. This qualitative study found that how devices were used either enhanced or disrupted feelings of parent-infant attachment. Practitioners should be aware of the potential beneficial and detrimental impacts of device use among families given implications for attachment and future child development.

Childhood sleep: assessments, risk factors, and potential mechanisms

BACKGROUND

Sleep problem is a highly prevalent health issue among pediatric populations across the world. In this review, we aimed to identify risk factors contributing to sleep deficiency and poor sleep hygiene in children. Potential biological, psychosocial, and environmental mechanisms as well as research gaps in the literature are also discussed.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info. Both relevant data based and systematic reviews are included.

RESULTS

This paper summarizes many risk factors for childhood sleep problems, including biological (e.g., genetics, gender, age and puberty, prenatal factors, postnatal factors); nutritional (e.g., macronutrients, micronutrients, omega-3 fatty acids, obesity); environmental (e.g., heavy metals, noise, light, air pollution); interpersonal (e.g., family, exposure to violence, screen media use, physical injury); and community/socioeconomic variables (e.g., racial/ethnicity and cultural factors, neighborhood conditions and socioeconomic status, school factors, public health disasters/emergencies), to better understand the development of sleep problems in children.

CONCLUSIONS

Poor childhood sleep is a multifactorial issue affected by a wide range of prenatal and early-life biological, environmental, and psychosocial risk factors and contributors. A better understanding of these risk factors and their mechanisms is an important first step to develop future research and prevention programs focusing on pediatric sleep problems.

Problematic Social Media Use and Lifestyle Behaviors in Adolescents: Cross-Sectional Questionnaire Study

Background

The use of social media by adolescents has increased considerably in the past decade. With this increase in social media use in our daily lives, there has been a rapidly expanding awareness of the potential unhealthy lifestyle-related health effects arising from excessive, maladaptive, or addictive social media use.

Objective

This study aims to assess the association between adolescents' social media use and health-related behaviors.

Methods

We used a cross-sectional research approach and analyzed data from 96,919 adolescents at high schools throughout the Netherlands. A structured 43-item questionnaire was used to gather data on sociodemographics, dietary and lifestyle factors, and the degree of social media use based on the Compulsive Internet Use Scale. Logistic regression analyses were performed to assess the association between problematic social media use (PSMU) and lifestyle behaviors while adjusting for sociodemographic factors.

Results

Of the 96,919 included adolescents, 7.4% (n=7022) were identified as at risk for PSMU. Furthermore, logistic regression results showed that adolescents who are at risk for PSMU were more likely to report alcohol consumption and smoking while simultaneously having significantly lower levels of health-promoting behavior such as healthy eating habits (eating fruits, vegetables, and breakfast regularly) and physical activity.

Conclusions

This study confirms that adolescents at risk of PSMU were more likely to exhibit an unhealthy lifestyle. Being at risk for PSMU was a determinant of soft drug use, alcohol consumption, smoking, poor eating habits, and lower physical activity independent of the additional adjusted covariates including demographic variables and remaining lifestyle variables. Future research is needed to confirm this observation in an experimental setting.

Relationship between mental health, sleep status and screen time among university students during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

On 20 July 2021, after the outbreak of COVID-19 at Nanjing Lukou International Airport, several universities started closed management and online teaching. This had a large impact on students' daily life and study, which may lead to mental health problems. The purpose of this study is to study the effect of screen time on mental health status of university students and the possible mediating effect of sleep status.

METHODS

This was a cross-sectional study. A web-based questionnaire survey was employed that included demographic characteristics, sleep status and mental health status (depression, anxiety and loneliness). The Pittsburgh Sleep Quality Index scale was used to assess sleep status, while the Centre for Epidemiologic Studies Depression (CES-D) scale, Generalised Anxiety Disorder-7 (GAD-7) scale and Emotional versus Social Loneliness Scale (ESLS) were used to assess depression, anxiety and loneliness, respectively. Linear and logistic regression models were developed and adjusted for confounding factors, and finally the mediating effects were tested using the Karlson-Holm-Breen method.

RESULTS

Finally, 1070 valid questionnaires were included. Among these, 604 (56.45%) indicated depressive symptoms (CES-D score ≥16) and 902 (84.30%) indicated anxiety symptoms (GAD-7 score ≥10). The mean ESLS score (for loneliness) was 26.51±6.64. The relationship between screen time and depressive symptoms (OR 1.118, 95% CI 1.072 to 1.166) and anxiety symptoms (OR 1.079, 95% CI 1.023 to 1.138) remained significant after adjusting for confounding factors. Meanwhile, sleep status plays an intermediary role in screen time and mental health status (depression and anxiety) and accounts for 13.73% and 19.68% of the total effects, respectively. We did not find a significant association between screen time and loneliness.

CONCLUSION

During the outbreak of COVID-19, screen time is inevitably prolonged among university students. There is a relationship between mental health and screen time, and sleep status plays a mediating role.

More frequent naps are associated with lower cognitive development in a cohort of 8-38-month-old children, during the Covid-19 pandemic

Background

How often a child naps, during infancy, is believed to reflect both intrinsic factors, that is, the need of an immature brain to consolidate information soon after it is acquired, and environmental factors. Difficulty accounting for important environmental factors that interfere with a child's sleep needs (e.g., attending daycare) has clouded our ability to understand the role of intrinsic drivers of napping frequency.

Methods

Here we investigate sleep patterns in association with two measures of cognitive ability, vocabulary size, measured with the Oxford-Communicative Development Inventory (N = 298) and cognitive executive functions (EF), measured with the Early EF Questionnaire (N = 463), in a cohort of 8-38-month-olds. Importantly, because of the social distancing measures imposed during the Covid-19 Spring 2020 lockdown, in the UK, measures of sleep were taken when children did not access daycare settings.

Results

We find that children with more frequent but shorter naps than expected for their age had lower concurrent receptive vocabularies, lower cognitive EF and a slower increase in expressive vocabulary from spring to winter 2020, when age, sex, and SES were accounted for. The negative association between vocabulary and frequency of naps became stronger with age.

Conclusions

These findings suggest that the structure of daytime sleep is an indicator of cognitive development and highlight the importance of considering environmental perturbations and age when investigating developmental correlates of sleep.

Ground Rules for Preschooler Exposure to the Digital Environment: A Review of Studies

Background

The range of digital technologies that children use from an early age has expanded significantly. Most studies demonstrate that preschoolers now spend substantially longer on digital devices and start using them at a younger age. Finding a solution for this challenge has research merits and relevance, as the data on benefits and harm of early preschoolers' exposure to digital devices is contradictory. This poses a need to determine theoretically sound and practically validated criteria that could guide the duration and quality of children's exposure to the digital environment.

Objective

To review studies that contain recommendations on preschoolers' exposure to the digital environment, namely, exposure limits and evidence to justify the limitation of preschoolers' time on digital media.

Design

The analysis starts by identifying theoretical foundations that researchers use in their studies of children's behavior in the digital environment. This is followed by an overview of 40 studies that include research papers, official reports, and methodological recommendations made by healthcare and governmental organizations.

Results

The review identified the following ground rules for children's exposure to the digital environment: to provide for child's interaction with a digital device, to use educational applications that will develop skills appropriate to the child's age, to ensure mandatory supervision of children's engagement by an adult who limits the exposure according to child's age-related capabilities and creates conditions for active exploration of the real rather than a virtual world. Children's cognitive development suffers the most from passive intake of digital content.

Conclusion

The data herein can help to develop strategies to promote healthy and educational engagement of children with digital devices and media; however, the review highlights the insufficiency of psychophysiological research that would make it possible to practically validate the recommendations on the duration of preschoolers' exposure to the digital environment.

Parental Discontent with Infant Sleep During the First Two Years of Life

BACKGROUND

Problematic sleep in infants can have a high impact on families. We examined parental discontent with infant sleep in the first six months of life and parent-perceived problematic sleep during the second year of life.

METHODS

We used Sarphati Cohort data of 1471 children. During periodic youth health care visits in the first six months of life, professionals registered parental discontent with infant sleep. In the second year of life, parents filled out the Brief Infant Sleep Questionnaire (BISQ), from which we defined parent-perceived problematic sleep and BISQ-defined problematic sleep. We examined the association of parental discontent with infant sleep during the first six months with both BISQ-derived outcomes up to age two, using multivariable logistic regression analysis.

RESULTS

26% of parents were discontented with infant sleep during the first six months of life. During the second year of life, 27% of the parents perceived their child's sleep as problematic, and 9% of the infants had BISQ-defined problematic sleep. Early parental discontent with infant sleep was associated with parent-perceived problematic sleep [adjusted OR 2.50 (95% CI 1.91-3.28)], and BISQ-defined problematic sleep [adjusted OR 1.88 (1.11-3.17)].

CONCLUSIONS

Early registered parental discontent with infant sleep was a predictor of parent-perceived problematic sleep in early toddlerhood. Registering parental discontent during infancy might enable professionals to identify a group of infants at risk for later problematic sleep. We recommend screening and parental support for sleep difficulties in an early stage.

Predictors of screen exposure among infants under 2 years of age during the COVID-19 pandemic

Contradicting pediatric societies' recommendations, studies show that screen exposure begins at the first year of life for many children worldwide, with parental needs, educational purposes, and parental stress emerging as associated factors. However, the COVID-19 pandemic has likely worsened this scenario. This study aims to: 1) estimate the average daily screen exposure time for Brazilian infants aged 0-23 months during the COVID-19 pandemic based on caregiver report; 2) analyze the correlation between average exposure time, parental motivations for exposure, parental burnout levels and infant age; and 3) test the predictive role of parental motivations, burnout, and infant age on infant screen exposure. For this purpose, 139 parents (living in Brazil) answered online to questionnaires on infant screen exposure, parental motivations for exposure (four subscales: Parental Needs; Educational; Child's Desires/Family Routine; Behavioral Control), and parental burnout (Total score; four subscales: Emotional Exhaustion; Contrast; Feelings of Being Fed Up; Emotional Distancing). On average, infants were exposed to screens for 131 min/day. Higher scores on the four parental motivation subscales and higher parental burnout (specifically the Contrast subscale) correlated with longer exposure times. Furthermore, the motivation subscales Parental Needs and Child's Desires/family routine, the burnout subscale Contrast and infant age predicted greater screen exposure, while the burnout scale Feelings of Being Fed Up predicted less exposure. Our results suggest that infants in Brazil were exposed to substantial amounts of screen time during the pandemic. Interventions aiming to reduce screen time must consider parental motivations and parental burnout/mental health along with infant age.

Qualitative study of the association between psychosocial health and physical activity/sleep quality in toddlers

Physical activity and sleep are important factors of mental and physical health in children, with some reports indicating that their effects can persist into adulthood. However, there is limited research on the qualitative aspects of physical activity and sleep in preschool children, particularly in those aged < 3 years. Therefore, to elucidate the association between psychosocial health and physical activity/sleep in early childhood in terms of qualitative aspects, we conducted a retrospective cohort study in 2985 3-year-old children (37.2 ± 0.75 months) in Shanghai, China. An analysis using structural equation modeling indicated that current physical activity had a direct and moderate impact on current psychosocial health evaluated using the Strength and Difficulties Questionnaire. In particular, past physical activity had an indirect and mild effect on current psychosocial health via current physical activity in girls. However, regardless of sex, past sleep quality had slight impact on current psychosocial health, not only indirectly via current sleep quality, but also directly. These findings highlight the importance of considering the qualitative aspects of physical activity and sleep quality as significant factors influencing the current and future psychosocial health of children, even at a very early age (< 3 years).

Media in the Moment: An Observational Assessment of the Digital Media Context in Early Childhood

The majority of research on media use in the digital age during early childhood has consisted of parental reports or experimental lab research, however, little research has captured media use in the home. Thus, the purpose of the current study was to capture early childhood media use in the moment it occurs. Participants included 231 parent-child dyads (M child age = 41.17 months) who completed a one-week study. Parents were contacted multiple times per day via text. If children happened to be using media (or be in a room where media was present) when parents received the notification, parents were asked to take a 10-15 second video of their child. Most families submitted at least one video over the course of the week. These videos were coded in the current study using a coding scheme to capture the context around media use in early childhood (including the environment, child behavior, and media characteristics). Results revealed that children were most likely to view media on a television or tablet. Although most children were paying attention to media, about half were also physically active while consuming media. Another person was present in the majority of videos with children, most frequently siblings or peers. Most children showed a very flat and calm affect while viewing media. These findings were generally consistent across gender and family income. Overall, this study adds to the literature on children and media that uses other methods, but provides additional insight into the importance of the specific context during early childhood media use in the digital age.

Why Do Iranian Preschool-Aged Children Spend too Much Time in Front of Screens? A Preliminary Qualitative Study

There is evidence that Iranian preschool children are increasingly spending their time in front of screens (screen time: ST; time spent with any screen such as TVs, computers, tablets, smartphones, game consoles, or video games), but few studies have explored the possible causes of such an increase. Given this, the present study aimed to qualitatively explore determinants of excessive ST in Iranian children. To this end, parents of preschool children were interviewed, and their answers were qualitatively clustered to identify additional important factors. Key informant interviews were conducted with parents of preschool children in Tehran (Iran). A semi-structured interview was developed to assess child and family life, daily routine, family rules, family interactions, and home climate as possible contributing factors to ST. Parents' audiotaped statements were transcripted verbatim, coded, and clustered into main themes using thematic analysis with the MaxQda^® software. A total of 20 parents of children aged 2 to 7 were interviewed, and a total of 6 key themes and 28 subthemes were extracted from their interviews. The results of the analysis identified a broad range of both independent and interrelated factors leading to the development and maintenance of ST behaviors among preschool children. Our findings indicate that the central concept is the family. Considering screen-related behaviors, family life encompasses parental health literacy (e.g., parenting pattern, monitoring standards, thoughtful parenting), family psychological atmosphere (e.g., presence of parents, family norms, parent-parent and parent-child interaction, congruency/incongruency of parents with each other) and the digital structure of the home. The child's and parents' actions and characteristics can influence family interactions. A child's and parent's behavior is also influenced by social/cultural factors. Parents' behaviors and attitudes, family communications, and interactions contribute to healthy ST habits in children. It is not possible to examine the child's behavior without considering the family and the dominant environment, since the behavior of family members as a whole affects each family member. Given this, interventions should make parents aware of their role and responsibilities in reducing children's ST and consider the family system as a whole, and interventions also can benefit from considering the parental perceptions of children's behaviors.

What daily factors affect the sleep habits of Japanese toddlers?

STUDY OBJECTIVES

Good sleep, especially during early childhood, is important for development. In Japan, the mean nocturnal sleep duration of toddlers is < 10 hours, and even if toddlers slept for > 11 hours/day, as recommended by the National Sleep Foundation, some of them showed late bedtime and late wake-up time or took long naps. Therefore, we provisionally assumed the minimal sleep conditions for Japanese toddlers, named Nenne-criteria, such as bedtime before 10:00 pm, nocturnal sleep duration of ≥ 9 hours, and < 1 average time of awakening after sleep onset, and investigated the important factors for good sleep.

METHODS

We analyzed cross-sectional data from online surveys describing the sleep-related behaviors of 2,124 toddlers and their caregivers. We compared the daily schedules that affect sleep between the Nenne-criteria-meet group and the not-meet group.

RESULTS

The Nenne-criteria-meet group showed better daytime behaviors than the not-meet group. Structural equation modeling on daily schedules revealed that, to increase sleep pressure at the appropriate time, it is important to restrict media viewing, play outdoors in the morning, have an early nap ending time, avoid hyperarousal-inducing behaviors before bedtime, maintain daily schedules regularly, and decrease social jetlag.

CONCLUSIONS

The Nenne-criteria are useful for screening Japanese toddlers who require intervention for sleep hygiene. To improve toddlers' sleep, it is important not only to guide the ideal bedtime but also to provide tips for improving daily schedules and to avoid suboptimal sleep-related behaviors.

CITATION

Murata E, Yoshizaki A, Fujisawa TX, Tachibana M, Taniike M, Mohri I. What daily factors affect the sleep habits of Japanese toddlers? J Clin Sleep Med. 2023;19(6):1089-1101.

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

COVID-19 transformed the family media environment and spurred research on the effects of screen media exposure and use on young children. This update of a 2017 CPS statement re-examines the potential benefits and risks of screen media in children younger than 5 years, with focus on developmental, psychosocial, and physical health. Four evidence-based principles-minimizing, mitigating, mindfully using, and modelling healthy use of screens-continue to guide children's early experience with a rapidly changing media landscape. Knowing how young children learn and develop informs best practice for health care providers and early years professionals (e.g., early childhood educators, child care providers). Anticipatory guidance should now include child and family screen use in (and beyond) pandemic conditions.

The Effects of COVID-19 Lockdown on the Sleep Quality of Children

INTRODUCTION

The COVID-19 lockdown has caused important changes in children's routines, especially in terms of nutrition, physical activity, screen time, social activity, and school time. Regarding these changes, recent studies show that the COVID-19 lockdown is associated with higher levels of anxiety and depression in children. The objective of this study was to assess changes in sleep quality in Spanish children during the lockdown decreed by the Spanish government between March and June 2020.

METHODOLOGY

We compared the BEAR (bedtime, excessive daytime sleepiness, awakening during the night, and regularity and duration of sleep) scores of 478 participants (median age = 7.5 years; 48% girls) in the SENDO project during the periods before, during, and after lockdown. The questionnaires were filled out by one of the parents. We used hierarchical models with two levels of clustering to account for the intra-cluster correlation between siblings. The interaction of time with a set of a priori selected variables was assessed by introducing the interaction term into the model and calculating the likelihood ratio test.

RESULTS

The mean scores in the BEAR questionnaire referred to the periods before, during, and after lockdown were 0.52 (sd 1.25), 1.43 (sd 1.99), and 1.07 (sd 1.55), respectively. These findings indicate a deterioration in sleep quality during the period of confinement. Parental level of education was found to be an effect modifier (p for interaction = 0.004). Children whose parents had higher education (university graduates or higher) showed a smaller worsening than those without.

CONCLUSION

Our study shows that the COVID-19 lockdown was associated with a significant worsening of sleep quality. Moreover, although the end of the lockdown brought about a slight improvement, mean scores on the BEAR scale remained significantly higher than before the lockdown, suggesting that the consequences for sleep quality could persist over time. This worsening was higher in children whose parents had lower educational degrees. Helping children maintain healthy sleeping habits despite the circumstances and providing early psychological support when needed is important to prevent negative psycho-physical symptoms due to lockdown that could persist over the years.

Development and Psychometric Properties of the Sleep Parenting Scale for Infants

Although infants' sleep behaviors are shaped by their interactions with parents at bedtime, few tools exist to capture parents' sleep parenting practices. This study developed a Sleep Parenting Scale for Infants (SPS-I) and aimed to (1) explore and validate its factorial structure, (2) examine its measurement invariance across mothers and fathers, and (3) investigate its reliability and concurrent and convergent validity. SPS-I was developed via a combination of items modified from existing scales and the development of novel items. Participants included 188 mothers and 152 mother-father dyads resulting in 340 mothers and 152 fathers; about half were non-Hispanic white. Mothers and fathers completed a 14-item SPS-I for their 12-month-old infant. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to explore and validate SPS-I's underlying structure. Multigroup CFA was used to examine measurement invariance across mothers and fathers. Reliability was examined using Cronbach's alpha. Concurrent validity was assessed using linear regressions examining associations between SPS-I factors and parent-reported infants nighttime sleep duration. Convergent validity was assessed using paired-sample t-tests to test whether the SPS-I subscale scores were similar between mothers and fathers in the same household. EFA and CFA confirmed a 3-factor, 12-item model: sleep routines, sleep autonomy, and screen media in the sleep environment. SPS-I was invariant across mothers and fathers and was reliable. Concurrent and convergent validity were established. SPS-I has good psychometric properties, supporting its use for characterizing sleep routines, sleep autonomy, and screen media in the sleep environment by mothers and fathers.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2002799 .

Screen use, sleep duration, daytime somnolence, and academic failure in school-aged adolescents

In this study, we examined the relationship between screen time use, sleep characteristics, daytime somnolence, and academic performance in school-aged adolescents. We surveyed 1,257 12- to 18-year-old adolescents attending 52 schools in urban or suburban areas of Argentina. We recorded the daily exposure to various screen-based activities, including video- and online-gaming, social media, TV or streaming. Screen time and device type in the hour before bedtime, sleep patterns during weekdays and weekends, somnolence (Pediatric Daytime Sleepiness Scale score), and grades in language and mathematics were also assessed. Structural Equation Modelling was used to identify a path connecting the latent variables. Results are expressed as standardized regression weights (srw). Missing data were present in 393 subjects, and thus the final sample consisted of 864 complete responses. Daytime somnolence (i.e., PDSS score ≥ 15) was observed in 614 participants (71%), and academic failure (i.e., grades < 7/10) in 352 of them (41%). Time spent using video gaming consoles was negatively associated with sleep duration (srw = -0.22, p<0.01) and positively connected with daytime somnolence (srw = 0.11, p<0.01). Use of mobile devices was associated with lower academic performance (srw = -0.11, p<0.01). Sleep duration was inversely related to daytime somnolence (srw = -0.27, p<0.01), which was in turn negatively associated with academic performance (srw = -0.18, p<0.05). Bedtime computer use did not influence any outcome. In summary, among adolescents, screen use adversely affected nighttime sleep, daytime somnolence, and academic performance. These findings call for the implementation of educational public campaigns aimed at promoting healthy sleep and reducing screen exposure among adolescents.

The status quo, contributors, consequences and models of digital overuse/problematic use in preschoolers: A scoping review

Digital devices play a critical role in preschoolers' learning and development. Despite the evidence that digital devices use may facilitate preschoolers' learning and development, their overuse/problematic use has become a global concern as the popularity and widespread use of digital devices. This scoping review aims to synthesize the empirical evidence to identify the status quo, influential factors, developmental outcomes, and models of overuse/problematic use in preschoolers. This search has identified 36 studies published in international peer-reviewed journals during 2001-2021, converging into four common topics: the current situation, the influential factors, the consequences, and the models. First, the average percentages of overuse and problematic use across the studies collected in this research were 48.34%, and 26.83%, separately. Second, two influential factors were identified: (1) children's characteristics and (2) parental and family factors. Third, early digital overuse/problematic use was found to have a negative impact on the following domains: (1) physical health, (2) psychosocial health, (3) problematic behaviors, and (4) cognitive development; Fourth, most relevant studies adopted general linear models, while few of them adopted experimental designs. Finally, the implications for future studies and practical improvements are also addressed.

Internet and Video Games: Causes of Behavioral Disorders in Children and Teenagers

Even though video games have been present among children for many years, children are using them more continuously and in an abusive and indiscriminate way nowadays because of the "technological boom". It is affecting the behavior of children and adolescents. This is the reason why we are carrying out this systematic review. The main objective of this article is to investigate literature that directly connects the continuous and undifferentiated use of video games with the emergence of behavioral disorders in children and young people. The PRISMA statement was followed in the process of this article. We used SCOPUS, Web of Science and PubMed as databases, moreover, we searched studies with a scoping review. The results indisputably supported six out of seven of our hypotheses. We find that the excessive use of video games causes addiction to technology, aggressive behaviors, sleep disorders, and poor school performance. In addition, it hinders social relationships and the development of emotional intelligence. To conclude, it is necessary to correctly use video games in particular, and technologies in general, adapting their content to children's age, as well as the amount of time that they dedicate to use them.

"Katerina gets mad": Infants' physiological and behavioral responses to co-viewing educational, self-regulatory media

A growing body of research has focused on the physiological impact of media on older children and adolescents. Less research has been focused on the potential physiological impact of media on infants and younger children, especially media designed to be age appropriate and educational in content. In this study, we examined respiratory sinus arrhythmia (RSA) in infants (N = 269, M_age  = 17.13 months) while they co-viewed an educational video clip that modeled emotion regulation and contrasted their physiological response to an unoccupied baseline and a frustration paradigm (arm-restraint). Given parent reports showing the calming effect of educational media viewing in young children, we anticipated that a similar pattern of calming would be observed physiologically in infants. Results showed that relative to baseline, most infants demonstrated an increase in RSA while co-viewing, suggesting greater parasympathetic (regulatory) activation consistent with behavioral calming. However, infants who demonstrated vagal withdrawal during co-viewing (decrease in RSA) were more likely to have parents who used a tablet to help infants go to sleep at night. Vagal withdrawal was also associated with increased levels of negative affect observed during the co-viewing task. Findings are discussed in relation to the contextual effect of co-viewing age-appropriate, educational media on children's physiological responses.

The influence of sleep patterns and screen time on the sleep needs of infants and toddlers: A cross-sectional study

PURPOSE

The purpose of this study was to examine the effects of screen time and sleep patterns on the sleep needs of infants and toddlers.

DESIGN AND METHODS

A descriptive cross-sectional data were collected from 304 parents of children aged 6 to 36 months old. The screen use of children and parents was assessed with seven questions and A Brief Infant Sleep Questionnaire (BISQ) was used to assess infant sleep.

RESULTS

The results of this study indicate that children's adherence to the recommended sleep standards is poor. The most important criteria that caused poor sleeping were the number of awakenings at night, the duration of sleeplessness at night and the minimum total sleep time of <9 h. The most frequently used screen type in all of the age groups and parents was TV, followed by smartphones. As the age of the children increased, the rate of all screen-type use also increased. Factors predicting sleep needs included bedtime, the PED usage of children, parents' watching TV and care of the children by the babysitter.

CONCLUSIONS

Sleep needs are associated with the sleep patterns and screen usage of the children and parents.

PRACTICE IMPLICATIONS

Given that screen usage behaviors are tracked from infancy to early childhood, these findings highlight the need for prevention and intervention efforts, as well as for education and policy measures, to limit screen use and exposure from an early age.

Effects of screen exposure on young children's cognitive development: A review

The past decade has witnessed a rapid increase in the use of screen media in families, and infants are exposed to screens at younger ages than ever before. The objective of this review is twofold: (1) to understand the correlates and demographic factors determining exposure to screens, including interactive screens, when available, and (2) to study the effects of watching screens and using touchscreens on cognitive development, during the first 3 years of life. We argue that the effects of screen viewing depend mostly on contextual aspects of the viewing rather than on the quantity of viewing. That context includes the behavior of adult caregivers during viewing, the watched content in relation to the child's age, the interactivity of the screen and whether the screen is in the background or not. Depending on the context, screen viewing can have positive, neutral or negative effects on infants' cognition.

AOASM Position Statement on Esports, Active Video Gaming, and the Role of the Sports Medicine Physician

ABSTRACT

Electronic sports, or esports, has a global audience of over 300 million fans and is increasing in popularity, resulting in projected revenue of over $1 billion by the end of this past year. The global pandemic of 2020 had little to no effect on these increasing numbers because athletes have been able to continue to engage in sports because of its electronic nature and fans have been able to follow them virtually. Esports has been recognized as an organized sport by the International Olympic Committee, the US National Collegiate Athletic Association, and several secondary school athletic associations within the United States. In addition, professional teams have been established in several major cities within the United States, Canada, Europe, and Australia. With the growth of esports, the necessity of incorporating esports medicine into the practice of sports medicine physicians has become paramount. Esports can be played on a monitor or screen and played using physical activity in what has become known as active video gaming. Within both of these platforms, there have emerged certain conditions unique to esports. There are also certain conditions seen in other sports applicable to esports athletes. This document will review the evaluation of the esports athlete, introduce conditions unique to these athletes and review common conditions seen in esports, discuss diagnostics used in the evaluation of esports athletes, introduce treatment options for conditions unique to esports and review those for commonly seen injuries in esports, discuss prevention of injuries in esports, and introduce a framework for the future development of esports medicine that can be introduced into the daily practice of the sports medicine physician.

An examination of bedtime media and excessive screen time by Canadian preschoolers during the COVID-19 pandemic

Background

Risky media use in terms of accumulating too much time in front of screens and usage before bedtime in early childhood is linked to developmental delays, reduced sleep quality, and unhealthy media use in later childhood and adulthood. For this reason, we examine patterns of media use in pre-school children and the extent to which child and family characteristics contribute to media use during the COVID-19 pandemic.

Methods

A cross-sectional study of digital media use by Canadian preschool-aged children (mean age = 3.45, N = 316) was conducted at the start of the COVID-19 pandemic between April and August of 2020. Parents completed a questionnaire and 24-h recall diary in the context of an ongoing study of child digital media use. From these responses we estimated hours of average daily screen time, screen time in the past 24 h, average daily mobile device use, and media use before bedtime. Parents also answered questions about their child (i.e., age, sex, temperament), family characteristics (parental mediation style, parental screen time, education, income), and contextual features of the pandemic (ex., remote work, shared childcare). Daycare closures were directly assessed using a government website.

Results

Our results indicate that 64% of preschoolers used more than 2 h of digital media hours/day on average during the pandemic. A majority (56%) of children were also exposed to media within the hour before bedtime. Logistic and multinomial regressions revealed that child age and temperament, restrictive parental mediation, as well as parent digital media use, education, satisfaction with the division of childcare, remote work, and number of siblings and family income were all correlates of risky digital media use by preschoolers.

Conclusions

Our results suggest widespread risky media use by preschoolers during the pandemic. Parenting practices that include using more restrictive mediation strategies may foster benefits in regulating young children’s screen time.

Video-Sharing Platform Viewing Among Preschool-Aged Children: Differences by Child Characteristics and Contextual Factors

Free video-sharing platforms such as YouTube are highly popular among young children but may contain low-quality and highly commercialized content. This study aimed to describe the prevalence, duration, and timing of objectively measured mobile YouTube viewing in preschool-aged children and test hypotheses about associations with child individual differences and contextual factors. We analyzed mobile sampling data from 349 English-speaking children aged 3-4.99 years whose parents completed surveys about child, parent, and household characteristics. We assessed whether the child ever viewed YouTube during the sampling week and calculated average daily duration in a subsample of 121 participants with their own mobile devices. We built multivariable logistic regression models to test correlates of mobile YouTube viewership and duration. Children were 3.82 years (SD 0.53), 74.6 percent white non-Hispanic; parents were mostly mothers (93.7 percent), 34.0 (SD 4.6) years, and 37.9 percent had less than a college degree. Mobile YouTube viewing (37.0 percent of children) was more likely in children who used Android devices, shared mobile devices with family members, were older, attended home-based childcare, or had parents with lower educational attainment. Median YouTube duration was 61.2 min/day, with longer durations in children whose parents had lower educational attainment. These results demonstrate that many young children use free video-sharing platforms on mobile devices for long durations, and this practice may be disproportionately higher in children from lower socioeconomic status. Longitudinal research is needed on video-sharing platform viewing and child outcomes.

Effects of Screen Viewing Time on Sleep Duration and Bedtime in Children Aged 1 and 3 Years: Japan Environment and Children's Study

This study aimed to clarify the effects of television/digital versatile disc (TV/DVD) viewing time and portable electronic device (PED) usage time on sleep duration and bedtime and the difference between the effects of TV/DVD and PED on sleep. The effect of TV/DVD viewing time or PED usage time on sleep duration and bedtime was analyzed using a multiple logistic regression analysis adjusted for covariates. A total of 74,525 participants were included in the analysis, using data from Japan Environment and Children’s Study. TV/DVD viewing was not associated with short sleep duration, but PED usage was associated with short sleep duration. In addition, the risk of short sleep duration increased as PED usage time increased. We also investigated the effects of sleep habits at age 1 year on sleep at age 3 years. This study showed that late bedtime at age 1 year posed a significant risk of late bedtime at age 3 years. In summary, particular caution should be paid to PED use from a child’s health perspective, and sleep habits should be focused on bedtime from the age of 1 year.

Effect of Screen Time on Physical and Mental Health and Eating Habits During COVID-19 Lockdown in Lebanon

OBJECTIVE

This study aimed to explore whether screen time and the screen type impacted various health aspects of children, including physical activity (PA), sleep quality, and eating habits. Additionally, we investigated whether children's eating behavior while using electronic devices affects their physical and mental health.

METHODS

We conducted an online survey asking for screen use (duration, type, and purpose), PA, eating habits, sleep problems, and level of depression. The participants were children between the ages of 3 and 7 years, and the survey was answered by the participants' parents from March 3 to March 20, 2021.

RESULTS

A screen time of ≥2 h in children was associated with various clinical characteristics, such as body mass index (BMI), sleep problems, depression, decreased PA, and unusual eating habits. Children's food eating behavior while using electronic devices was predicted by a total screen time ≥2 h, smartphone screen time ≥2 h, sleep problems, owning electronic devices, and eating unhealthy food.

CONCLUSION

There was an interplay among children's PAs, eating behaviors, depression, sleep problems, and screen time in this pandemic era. Therefore, guiding children on the correct use of electronic devices and helping them eat healthy are paramount during this COVID-19 pandemic.

Screen Media Overuse and Associated Physical, Cognitive, and Emotional/Behavioral Outcomes in Children and Adolescents: An Integrative Review

INTRODUCTION

Screen media overuse is seen as a public health concern because of its negative effects on child and adolescent health. This integrative literature review examines recent empirical evidence on the relationship between screen media overuse and physical, cognitive, and emotional/behavioral outcomes in children and adolescents.

METHODS

Empirical research of experimental design, observational studies, and systematic reviews from several data sources was reviewed and synthesized to form the basis of this integrative review.

RESULTS

Screen media overuse is associated with poor sleep quality, shorter sleep duration, greater likelihood for overweight/obesity, lower executive functioning, poorer academic performance, and increased internalizing and externalizing problems. Bidirectional associations may exist.

DISCUSSION

Findings support the importance of understanding the impact of screen media use on health and wellbeing. Generating screen time guidelines and developing effective prevention/intervention strategies are critical to mitigating screen media overuse and its adverse outcomes in children and families.

"Does your baby watch TV?": The associations between at-home TV watching and laboratory challenge cortisol are different for young infants and their mothers

This longitudinal study examined associations between at-home TV watching and the biological stress response (cortisol) during a laboratory infant cognitive challenge task in 240 3- and 5-month infants and their mothers. Cortisol levels were lower in mothers of 5-month-old infants whose infants were exposed to TV at home, compared to mothers of infants that were not TV-exposed. Cortisol patterns were different across three laboratory sampling intervals for 3-month-old infants as a function of TV watching, revealing a sharp increase in laboratory cortisol only for infants who were exposed to TV at home. In contrast, there was no effect of TV exposure in 5-month-old infants' cortisol. Infant temperament and demographic measures were included as control variables in regression models to predict maternal and infant cortisol. At 3 months, for the T3 cortisol sampling interval, and at 5 months across all three sampling intervals, maternal cortisol levels were significantly predicted by infant TV exposure after accounting for variance due to these control variables. Our findings show the strong influence of the infant TV-exposure factor in the biological stress response of mothers of young infants, and suggest that infant TV exposure may influence self-regulation in 3-month-old infants.

Not all babies are in the same boat: Exploring the effects of socioeconomic status, parental attitudes, and activities during the 2020 COVID-19 pandemic on early Executive Functions

Early executive functions (EFs) lay the foundations for academic and social outcomes. In this parent‐report study of 575 UK‐based 8‐ to 36 month olds (218 followed longitudinally), we investigate how variation in the home environment before and during the 2020 pandemic relates to infants’ emerging EFs. Parent‐infant enriching activities were positively associated with infant Cognitive Executive Function (CEF) (encompassing inhibitory control, working memory, cognitive flexibility). During the most‐restrictive UK lockdown—but not subsequently—socioeconomic status (SES) was positively associated with levels of parent‐infant enriching activities. Parents who regard fostering early learning, affection, and attachment as important were more likely to engage in parent‐infant enriching activities, yet there was no significant pathway from parental attitudes or SES to CEF via activities. Infant screen use was negatively associated with CEF and Regulation. Screen use fully mediated the effect of SES on CEF, and partially mediated the effect of SES on regulation. Parental attitudes toward early learning, affection, and attachment did not significantly influence screen use. These results indicate that although parental attitudes influence the development of early EFs, interventions targeting attitudes as a means of increasing enriching activities, and thus EF are likely to be less effective than reducing barriers to engaging in enriching activities.

Temporal trends in frequency, type and severity of myopia and associations with key environmental risk factors in the UK: Findings from the UK Biobank Study

This study investigated temporal trends in the epidemiology of primary myopia and associations with key environmental risk factors in a UK population. Data were collected at recruitment (non-cycloplegic autorefraction, year of birth, sex, ethnicity, highest educational attainment, reason and age of first wearing glasses and history of eye disease) from 107,442 UK Biobank study participants aged 40 to 69 years, born between 1939 and 1970. Myopia was defined as mean spherical equivalent (MSE) ≤-1 dioptre (D). Temporal changes in myopia frequency by birth cohort (5-year bands using date of birth) and associations with environmental factors were analysed, distinguishing both type (childhood-onset, <18 years versus adult-onset) and severity (three categories: low -1.00 to -2.99D, moderate -3.00 to -5.99D or high ≥-6.00D). Overall myopia frequency increased from 20.0% in the oldest cohort (births 1939-1944) to 29.2% in the youngest (1965-1970), reflecting a relatively higher increase in frequency of adult-onset and low myopia. Childhood-onset myopia peaked in participants born in 1950-54, adult-onset myopia peaked in the cohort born a decade later. The distribution of MSE only shifted for childhood-onset myopia (median: -3.8 [IQR -2.4, -5.4] to -4.4 [IQR -3.0, -6.2]). The magnitude of the association between higher educational attainment (proxy for educational intensity) and myopia overall increased over time (adjusted Odds Ratio (OR) 2.7 [2.5, 2.9] in the oldest versus 4.2 [3.3, 5.2] in the youngest cohort), being substantially greater for childhood-onset myopia (OR 3.3 [2.8, 4.0] to 8.0 [4.2, 13]). Without delineating childhood-onset from adult-onset myopia, important temporal trends would have been obscured. The differential impact of educational experience/intensity on both childhood-onset and high myopia, amplified over time, suggests a cohort effect in gene-environment interaction with potential for increasing myopia frequency if increasing childhood educational intensity is unchecked. However, historical plateauing of myopia frequency does suggest some potential for effective intervention.

Relationships between screen viewing and sleep quality for infants and toddlers in China: A cross-sectional study

AIM

Currently young children have more opportunity to access all kinds of media, while their sleep duration has been steadily decreasing. However, little is known about the relationships between screen viewing and sleep quality, and the reasons of screen viewing for children under three years old in China. This study aimed to describe the relationships between screen viewing and sleep quality of infants and toddlers in mainland China.

METHODS

A cross-sectional study was conducted. Eight hundred twenty-seven children were recruited at a health care unit from a university affiliated hospital in China, and the questionnaires were completed by their parents. An extended Brief Infant Sleep Questionnaire and a Screen Viewing Questionnaire were used to collect information on children's sleep quality and screen viewing. Multivariate linear regression models were used to assess the relationships between screen viewing and sleep quality among infants and toddlers, adjusted for sociodemographic variables.

RESULTS

Of the 827 children, 26.9% of the infants and 61.4% of the toddlers did not comply with the World Health Organization (WHO) guideline on screen time. Even after adjusting for the sociodemographic covariates for both infants and toddlers, negative relationships between screen time and total sleep time (P < 0.001), and screen time and nighttime sleep (P < 0.001) existed. TV viewing time was negatively related to infants' total sleep time (β = -0.15, P < 0.001) and toddlers' nighttime sleep (β = -0.1, P < 0.05). Smartphone viewing time was negatively related to toddlers' total sleep time (β = -0.12, P < 0.05) and daytime sleep (β = -0.22, P < 0.05). Parents who offered screen media for children when they needed to do house chores were more likely to report that their children had less total sleep time (β = -0.1, P < 0.05) and shorter longest sleep episode (β = -0.1, P < 0.05).

CONCLUSION

The majority of toddlers did not meet the WHO guidelines on screen time in China. Screen time was negatively related to total sleep time and nighttime sleep among infants and toddlers. Practical strategies, such as education programs on children's screen viewing, more outdoor exercises and indoor parent-child activities, providing other educational materials instead of screening, early sleep, restricted use of TVs and smartphones, and screen co-viewing, are needed to improve young children's sleep quality and promote their development.

Child’s Play in the Context of Digital Transformation: Cultural-Historical Perspective (Part One)

The article is devoted to the peculiarities of preschoolers’ play within the Information Society. It studies the types of technologies used by preschoolers in the process of play (video games, educational apps, smart and digital toys). It also provides an overview of the existing empirical research, proving that contemporary play represents a specific type of play activity, where physical and digital objects interact in real time. The article discusses different approaches to the analysis of digital play in the context of Cultural-Historical Theory (M. Fleer, N.N. Veresov, N.E. Veraksa). It also focuses on the key differences between technical behaviors and digital play activity. The authors stress the need of transition transition from contrasting traditional play and play, mediated by technologies, to the analysis of digital play as a complex system of child-child and child-adult communities that construct the socio-cultural context of the child’s everyday life.

Usage time of touch screens in relation to visual-motor integration and the quality of life in preschooler children

Objectives

This study aims to examine the usage of touch screen time in relation to the visual-motor integration and the quality-of-life in preschool children. Additionally, we compare the difference between children who practiced sports and attended nursery with those who did not attend such activities.

Methods

This study includes a convenience sample of 100 preschool children aged between three and five years. The Peabody Developmental Motor Scale is used to assess visual-motor integration and the Arabic version of the Paediatric Quality of Life Inventory™ generic scale to assess the quality of life (QoL).

Results

The Pearson correlation coefficient equation reveals a negative significant correlation (p = 0.0001) between touch screen usage time and visual-motor integration (r = −0.37), physical (r = −0.38), psychosocial (r =−−0.55) and the QoL total score (r = −−0.48). Children who practiced sports showed lower visual-motor integration and higher QoL scores than those who did not. Children who attended nursery showed higher visual-motor integration and lower QoL scores than those who were not given the chance to attend these activities.

Conclusion

Based on the results of the current study, it can be concluded that increased touch screen usage time was found to adversely affect visual-motor integration and the QoL in preschool children. Practicing sports and attending nursery influence the visual-motor integration and the QoL.

Infant diurnal cortisol predicts sleep

The sleep-wake system is immature at birth and develops in parallel with the hypothalamic-pituitary-adrenal axis, a biological stress system of which the end product is cortisol. Perturbations in one system during infancy can maladaptively influence the maturation of the other system, leading to lasting sleep and cortisol system dysregulation and heightening the risk of enduring health problems. To better understand the early interplay between these systems, we examined whether actigraphy-derived measures of night-time sleep duration and onset were associated with cumulative exposure to cortisol, indexed by hair cortisol concentration, in 12-month-old children. Overall, early sleep onset predicted lower hair cortisol above and beyond sleep duration, family income and chaos experienced at home. Furthermore, both sleep and cortisol levels vary day to day, and temporal dependencies between daily sleep and cortisol regulation are not well understood. Thus, we assessed how the sleep characteristics on a particular evening related to salivary cortisol levels the following day and how daytime and evening cortisol related to the sleep characteristics on the same night. Lower total exposure to cortisol on a particular day was related to longer night-time sleep duration the same night, but not sleep onset. Lower salivary cortisol levels on a given evening related to earlier sleep onset the same night, but not to night-time sleep duration. Sleep duration and onset on a given night were unrelated to total cortisol exposure the following day. Findings suggest that in early development, the day-to-day relation between sleep and cortisol is not bidirectional, but more driven by diurnal cortisol.

Effects of Touchscreen Media Use on Toddlers' Sleep: Insights from Longtime ECG Monitoring

Wearable biomedical sensor technology enables reliable monitoring of physiological data, even in very young children. The purpose of the present study was to develop algorithms for gaining valid physiological indicators of sleep quality in toddlers, using data from an undisturbing and easy-to-use wearable device. The study further reports the application of this technique to the investigation of potential impacts of early touchscreen media use. Toddlers' touchscreen media use is of strong interest for parents, educators, and researchers. Mostly, negative effects of media use are assumed, among them, disturbances of sleep and impairments of learning and development. In 55 toddlers (32 girls, 23 boys; 27.4 ± 4.9 months; range: 16-37 months), ECG monitoring was conducted for a period of 30 (±3) h. Parents were asked about their children's touchscreen media use and they rated their children's sleep quality. The use of touchscreen media predicted the physiologically determined quality of sleep but not parent-reported sleep quality (such as sleep onset latency). Greater heart rate differences between restless sleep phases and restful sleep indicated poorer nighttime recovery in children with more frequent use of touchscreen media. The study demonstrates that the expert analysis of the ECG during sleep is a potent tool for the estimation of sleep quality in toddlers.

The negative effects of new screens on the cognitive functions of young children require new recommendations

Television studies have shown that some negative effects of screens could depend on exposure time, but more importantly on the characteristics of the child, the type of content viewed, and the context in which it is viewed. Studies on newer screens show that these factors are still valid but new ones now play a negative role: portable screens increase the duration of exposure and lowered the age at which exposure begins. More worryingly, new screen persuasive designs and dark patterns largely used incite more frequent use, attracting the attention of children and parents, resultantly interfering deeply in parent/child relationships. In this text we suggest that current academic recommendations have to be more broadly shared but also that new recommendations are needed: especially to advise parents not to let their screen interactions compete with real interactions with their child which are the core of learnings (especially language) and emotional regulations but also of their security.

Associations among average parental educational attainment, maternal stress, and infant screen exposure at 6 months of age

Evidence suggests that increased use of screens early in life may have negative developmental consequences for children. However, little is known concerning parental factors that predict initial screen exposure in infancy. The primary goal of this study was to examine whether parental educational attainment and maternal stress were associated with infant screen exposure by 6 months of age. A diverse sample of mothers (N = 93) was recruited prenatally. In a follow-up visit when the infants were six months of age (N = 82), we examined factors that may be associated with initial infant exposure to screens. First, mothers reported whether they had already exposed their infants to screens. Thereafter, those mothers who reported already having exposed their infants to screens were further queried to determine the extent of infant screen use. Results demonstrated that among infants exposed to screens, mothers reported an average of nearly 3 h of daily screen use. Average parental educational attainment, but not maternal stress, was significantly associated with initial infant exposure. Of those families who endorsed screen exposure by 6 months, 70 % reported a screen in the room where the child sleeps, nearly half reported using screens to help calm the infant, and about a third reported using a screen at least sometimes during meals, when going to sleep, and while waiting. Parental education around infant screen use behaviors may be important to help promote child development and outcomes.

Electronic media use and sleep in children and adolescents in western countries: a systematic review

Background

Sleep is essential for child and adolescent health and well-being. There is an increasing interest in whether electronic media use affects children and young adolescents’ sleep. Prior reviews have focused on a school-aged population. Moreover, it is crucial that research continuously addresses the processes of technology and media use and the implication on sleep. This systematic review examines the evidence of electronic media use related to sleep among 0–15-year-olds.

Methods

Searches were carried out in four databases (CINAHL, Web of Science, EMBASE, and Medline). Inclusion criteria included age ≤ 15 years, and intervention, cohort, or cross-sectional studies from western countries. Methodological quality was rated using the Quality Assessment Tool for Quantitative Studies by two independent reviewers. Data was extracted using a standardized data extraction form. Synthesis was done by summarizing results across studies by age groups of 0–5, 6–12, and 13–15 years within four sleep domains: Bedtime and sleep onset; Sleep quality; Sleep duration; Daytime tiredness.

Results

The search identified 10,719 unique studies, of which 109 fulfilled inclusion and exclusion criteria and were assessed for methodological quality. In total, 49 studies were included in the review. The study designs were randomized controlled trials (n = 3), quasi-experimental studies (n = 2), prospective cohort studies (n = 15), and cross-sectional studies (n = 29). Evidence for an association between electronic media use and sleep duration was identified, with stronger evidence for 6–15-years-olds than 0–5-year-olds. The evidence for a relationship between electronic media use and other sleep outcomes was more inconclusive. However, for 6–12-year-old children, there was evidence for associations of electronic media use with delayed bedtime and poor sleep quality. For 13–15-year-olds, there was evidence for associations between screen time and problems falling asleep, and between social media use and poor sleep quality.

Conclusions

Overall, electronic media use was generally associated with shorter sleep duration in children and adolescents. Studies with stronger research design and of higher quality are needed to draw solid conclusions about electronic media’s impact on other sleep outcomes. Public awareness and interventions could be promoted about the potential negative impact on children’s sleep of electronic media devices that are used excessively and close to bedtime.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11640-9.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

COVID-19 babies: auto-videosomnography and parent reports of infant sleep, screen time, and parent well-being in 2019 vs 2020

OBJECTIVE

The COVID-19 pandemic has profoundly impacted families, yet studies on its effects on infants and their parents have thus far been sparse and based mostly on retrospective parent reporting. This study aimed to prospectively evaluate the impact of COVID-19 living conditions on infant and parent sleep, as well as infant screen exposure, parent daytime sleepiness, and parent depression levels, using multi-method assessment.

METHODS

Infant and parent data collected in 2020 were compared with a matched cohort collected in 2019. The total sample included 1518 US infants aged 1-18 months (M = 8.5, SD = 4.6; 54% boys). Auto-videosomnography metrics were obtained from the 14-day period prior to survey completion (number of analyzed nights: M = 12.11 SD = 2.66 in the 2019 cohort; and M = 11.91 SD = 2.41 in the 2020 cohort). Parents completed online questionnaires regarding their infant's sleep and screen exposure, as well as their own sleep quality, daytime sleepiness, and depression levels.

RESULTS

Compared to 2019, infants in 2020 slept ∼40 min more per night on average, as indicated by auto-videosomnography. Infants additionally had earlier sleep timing, and increased parent-reported sleep-onset latency and nocturnal wakefulness. Infant screen time rose by 18.3 min per day for older infants, but remained stable for younger infants. Parents reported lower daytime sleepiness and higher depression symptomology during 2020, whereas no change was apparent in their sleep quality ratings.

CONCLUSIONS

Restricted living conditions during COVID-19 in the USA led to increased infant screen exposure and parental depression, but also to increased infant sleep duration and reduced parent sleepiness. Future research is needed to examine the mechanistic pathways through which COVID-19 impacted on infant and parent well-being.

Brain health consequences of digital technology use

Emerging scientific evidence indicates that frequent digital technology use has a significant impact—both negative and positive—on brain function and behavior. Potential harmful effects of extensive screen time and technology use include heightened attention-deficit symptoms, impaired emotional and social intelligence, technology addiction, social isolation, impaired brain development, and disrupted sleep. However, various apps, videogames, and other online tools may benefit brain health. Functional imaging scans show that internet-naive older adults who learn to search online show significant increases in brain neural activity during simulated internet searches. Certain computer programs and videogames may improve memory, multitasking skills, fluid intelligence, and other cognitive abilities. Some apps and digital tools offer mental health interventions providing self-management, monitoring, skills training, and other interventions that may improve mood and behavior. Additional research on the positive and negative brain health effects of technology is needed to elucidate mechanisms and underlying causal relationships.