Sleep habits and pattern in 1-14 years old children and relationship with video devices use and evening and night child activities

Association of digital media use with sleep habits in school children: A cross-sectional study

Background

The use of digital media (DM) is increasing among school-children, which can affect their sleep habits. The primary objective of this study was to evaluate the association of DM use with sleep habits in school-children.

Methods

It was a cross-sectional study of healthy school children. Sleep habits and DM use were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and SCREENS-Q, respectively. The Pearson correlation coefficient was used to establish the correlation between the two variables. Logistic regression analysis was performed to quantify the extent of association between variables. A p-value <0.05 was considered statistically significant.

Results

A total of 205 children were enrolled with a mean (SD) age of 7.1 (2.1) years. The mean (SD) sleep duration was 7.58 (0.80) hours. The mean (SD) CSHQ score was 50.6 (5.1). Use of DM was observed in 204 (99.5 %) children. On multivariate logistic regression analysis, DM use ≥2 h/day was significantly associated with higher CSHQ score (OR 1.28, 95%CI 1.18-1.40; p = 0.001). Sleep domains significantly affected by DM use ≥2 h/day were bedtime resistance (OR 1.55, 95 % CI 1.24-1.94; p < 0.001), sleep duration (OR 0.40, 95 % CI 0.28-0.58:p < 0.001), sleep anxiety (OR 1.69, 95%CI 1.40-2.04:p < 0.001), night awakening (OR 4.81 95 % CI 2.98-7.78:p < 0.001), parasomnias (OR 1.86, 95 % CI 1.45-2.38:p < 0.001), and daytime sleepiness (OR1.89,95 % CI 1.52-2.36: p < 0.001). DM use 30 min before bedtime was significantly associated with a higher CSHQ score (OR 1.32, 95 % CI 1.20-1.45; p < 0.001). In bivariate regression analysis, DM use ≥2 h/day was associated with poor academic performance (OR 2.36 95 % CI 1.28-4.35; p 0.006).

Conclusion

This study has shown that the average sleep duration in children was shorter than the recommended duration. DM use was common in school children and it has a significant association with sleep habits especially with use of ≥2 h/day and 30 mints before bedtime. It was also associated with poor academic performance. Public awareness on effect of DM use in school children is the need of the hour.

Children's nocturnal awakenings and sleep duration during the first two years of life in the NASCITA cohort study

PURPOSE

Previous studies have analyzed the characteristics and prevalence of sleep disturbances among Italian children. Less attention has been paid, however, to the factors involved in sleep disturbances in the first two years of life. The goals of the present study were, therefore: 1) to provide a developmental trajectory of Italian infants' night awakenings and duration during the first two years of life and 2) to analyze which factors affect night awakenings the most over time.

METHODS

Data for this study were collected in the NASCITA cohort. During the well-child visits conducted at 6, 12, and 24 months, pediatricians asked parents to report if the child had any sleep disturbances, especially frequent night awakenings. Univariate and multivariable analyses were performed to test the association between child and family variables and the likelihood of frequent awakenings.

RESULTS

2973 toddlers, out of 5054 initially enrolled newborns, were included in this study; 875 (29.4 %) of whom presented frequent awakenings in at least one visit (peak of prevalence of 19.8 % at 12 months). Bed-sharing (adjusted OR 2.53; 95%CI:2.05-3.12) and living in the northern Italy (aOR 2.25; 95%CI:1.80-2.81) were the variables more strongly associated with an increased likelihood of frequent awakenings in the binomial logistic regression, while sleeping alone was associated with a decreased chance (aOR 0.62; 95%CI 0.45-0.89). A short sleep duration (<11 h/day) was reported for 801 (26.9 %) at 12 months, for 743 (25.0 %) at 24 months of age; in 383 cases, the short sleep duration was reported at both time points. An association was observed between frequent awakenings at 12 or 24 months and short sleep duration (OR 1.23; 95%CI 1.05-1.44 -ꭓ2 6.25, p = 0.012).

CONCLUSIONS

The current study identified some early predictors of frequent awakenings during the first two years of life. Since optimal sleep practices in children are essential for their development, effective, early interventions must be defined and integrated into pediatric care practices.

Daytime Sleepiness from Preschool Children's and Parents' Perspectives: Is There a Difference?

This cross-sectional study investigated the level of daytime sleepiness and sleep-related behaviors in preschool children and compared their self-evaluations with the evaluations of their parents. It was conducted in Split-Dalmatian County, Croatia, among 196 preschool children aged 6-7 years seen at regular medical examinations, accompanied by their parents, using the Epworth sleepiness scale for children and parents/caregivers. Compared to their child's reports, parents tended to underestimate their child's sleepiness while sitting in a classroom at school (p = 0.001) and overestimate their child's sleepiness when lying down to rest or nap in the afternoon (p < 0.001). Boys were sleepier while sitting in a classroom at school during the morning than girls (p = 0.032). As much as 48.2% of preschool children had their own cellphones/tablets. Boys used video games (p < 0.001) and cellphones/tablets more than girls did (p = 0.064). Parental estimation of children playing video games at bedtime was lower than the child's report (p < 0.001). Children who had a TV in their bedroom reported more daytime sleepiness (p = 0.049), and those who played video games at bedtime went to sleep later during the weekend (p = 0.024). Also, children owning cellphone/tablets had longer sleep latency during the weekend compared to children not owning a cellphone (p = 0.015). This study confirmed that parents tend to underestimate children's habits of playing video games at bedtime and children's sleepiness during morning classes. Preschool children who use electronic devices at bedtime more frequently have prolonged sleep latency. These findings provide further evidence of the effects of electronic media devices on preschoolers' sleep patterns and daytime sleepiness.

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.

How does smartphone addiction affect the lives of adolescents socially and academically?: a systematic review study

Today, adolescents tend to accept smartphones more quickly than adults and spend more time with these devices since they are members of the first generation born and living in environments where smartphones and the internet are common. However, when they use smartphones excessively and become addicted to smartphones, this may cause them to suffer from various psychological, emotional, and physical health problems from an early age. Therefore, this study systematically examines the articles on smartphone addiction in adolescents. For this purpose, the related articles were screened using the Web of Science database and 188 studies by the search criteria were subjected to a systematic review. In this sense, methodological tendencies, variables and main findings of the studies included in the present study were examined. This study revealed that the quantitative research method was primarily used. The studies mainly investigated smartphone use, social relations, demographic characteristics, depression, personal characteristics, and sleep variables. Moreover, the studies were primarily conducted in China, and large sample groups were preferred. The factors that triggered the smartphone addiction of adolescents were family problems, and especially females were more addicted to smartphones than males. Moreover, smartphone addiction causes depressive symptoms, sleep problems, and decreased academic achievement in adolescents. Finally, various suggestions were presented based on the findings of this study.

Change in screen time and overuse, and their association with psychological well-being among US-wide school-age children during the COVID-19 pandemic: analysis of the National Survey of Children's Health (NSCH) years 2018-21

BACKGROUND

Previous studies on screen use and children's mental health during the Coronavirus Disease 2019 (COVID-19) pandemic focused only on the timeframe during the pandemic, on children between narrow age ranges, only among a subset of children who have previously reported COVID-related severe family economic hardship or worries, or did not distinguish between instructive versus recreational device usage. Thus, in this study, we analyzed trends, specifically related to recreational screen use, and associations with psychological well-being (PWB) in the years before versus during the COVID-19 pandemic, among a wide range of school-aged children, widely across the nation.

METHODS

Using the National Survey of Children's Health (NSCH) years 2018-21, we analyzed a large random sample of school-aged children (6-17 years old) across the US (n = 88,823). We developed PWB issue scores (PWBIS) using self-reported measures relevant to this age group, and constructed regression models to assess the magnitude of the contribution of the pandemic on recreational screen use and PWB.

RESULTS

The prevalence of recreational screen overuse and PWBIS increased significantly during the pandemic, compared to prior years. We also detected a notable effect of the pandemic on increased PWBIS, as well as its interaction term finding that it strengthened the association between screen time and PWBIS (p < 0.01 across all regression models).

CONCLUSIONS

Accordingly, our results demonstrate the importance of the pandemic itself as an independent adverse factor and effect measure modifier for screen overuse and PWB more generally among all school-age children widely across the US. Our study used the most current data available, and future studies to evaluate whether these effects are persistent in the years after the pandemic are important.

Excessive use of electronic devices among children and adolescents is associated with musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life: a cross-sectional study

Objective

Electronic devices have become an indispensable part of our daily lives. The frequency and duration of device use in children and adolescents have increased drastically over the years and the study of its negative musculoskeletal, visual and psychosocial health impacts is necessary.

Materials and methods

This cross-sectional study aimed to evaluate the associations between electronic device use and the prevalence and severity of musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life in children and adolescents studying at primary and secondary schools. Data were collected through confidential online and paper-and-pencil questionnaires. Primary 4-5 and Secondary 1-4 students were recruited from 3 schools in Hong Kong. Demographics, frequency and duration of electronic device use, frequencies of musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life outcomes were measured.

Results

1,058 children and adolescents aged 9-17  years participated. Sixty-one percent and 78% of all students spent more than 2  h per day using electronic devices during school days and weekend/holidays, respectively. Extended electronic device use was associated with increased prevalence and severity of musculoskeletal symptoms (ρ's = 0.28-0.33, P's < 0.001), visual symptoms (ρ's = 0.33-0.35, P's < 0.001), and poorer device use-related psychosocial health (ρ's = 0.38-0.47, P's < 0.001). Secondary school students reported greater device use and severity of symptoms than primary school students.

Conclusion

Excessive electronic device use was associated with increased prevalence and severity of physical and psychosocial symptoms, and such use is more prevalent in adolescents when compared to the children. The findings have important health implications for children and adolescents, suggesting that early intervention is needed to reduce the risk of developing device use-related disorders.

Sleep habits and sleep disorders in Italian children and adolescents: a cross-sectional survey

STUDY OBJECTIVES

The aim was to describe sleep habits and epidemiology of the most common sleep disorders in Italian children and adolescents.

METHODS

This was a cross-sectional study in which parents of typically developing children and adolescents (1-18 years) completed an online survey available in Italy, gathering retrospective information focusing on sleep habits and disorders.

RESULTS

Respondents were 4,321 typically developing individuals (48.6% females). Most of our sample did not meet the age-specific National Sleep Foundation recommendations for total sleep duration (31.9% of toddlers, 71.5% of preschoolers, 61.6% of school-age children, and 41.3% of adolescents). Napping was described in 92.6% of toddlers and in 35.2% of preschoolers. Regarding geographical differences, children and adolescents of northern Italy showed more frequent earlier bedtimes and rise times than their peers of central and southern Italy. The most frequently reported sleep disorder in our sample was restless sleep (35.6%), followed by difficulties falling asleep (16.8%), > 2 night awakenings (9.9%), and bruxism (9.6%). Data also suggest that longer screen time is associated with later bedtimes on weekdays in all age groups.

CONCLUSIONS

The current study shows that Italian children are at risk of sleep disorders, particularly insufficient sleep, restless sleep, and difficulty falling asleep. The study also provides normative sleep data by age group in a large cohort of typically developing Italian children, emphasizing the importance of the developmentally, ecologically, and culturally based evaluation of sleep habits and disorders.

CITATION

Breda M, Belli A, Esposito D, et al. Sleep habits and sleep disorders in Italian children and adolescents: a cross-sectional survey. J Clin Sleep Med. 2023;19(4):659-672.

Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research

STUDY OBJECTIVES

This review aims to assess the association between socioeconomic status (SES) and sleep health in the general population and the mediating effects of lifestyle and mental and physical health in this relationship.

METHODS

Observational studies testing the independent association between objective or subjective SES indicators and behavioral/physiological or clinical sleep health variables in the general population were included. PubMed/MEDLINE was searched for reports published from January 1990 to December 2019. The direction of effect was used as the primary effect measure, testing the hypothesis that low SES is associated with poor sleep health outcomes. Results are presented in the form of direction effect plots and synthesized as binomial proportions.

RESULTS

Overall, 336 studies were identified. A high proportion of effects at the expected direction was noted for measures of sleep continuity (100% for sleep latency, 50-100% for awakenings, 66.7-100% for sleep efficiency), symptoms of disturbed sleep (75-94.1% for insomnia, 66.7-100% for sleep-disordered breathing, 60-100% for hypersomnia), and general sleep satisfaction (62.5-100%), while the effect on sleep duration was inconsistent and depended on the specific SES variable (92.3% for subjective SES, 31.7% for employment status). Lifestyle habits, chronic illnesses, and psychological factors were identified as key mediators of the SES-sleep relationship.

CONCLUSIONS

Unhealthy behaviors, increased stress levels, and limited access to health care in low-SES individuals may explain the SES-sleep health gradient. However, the cross-sectional design of most studies and the high heterogeneity in employed measures of SES and sleep limit the quality of evidence. Further research is warranted due to important implications for health issues and policy changes.

CITATION

Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med. 2023;19(3):605-620.

Children talking about their sleep: a cross-sectional survey of differences by ethnicity and socioeconomic status in Aotearoa New Zealand primary schools

STUDY OBJECTIVES

This study examined differences by ethnicity and socioeconomic status in attitudes to sleep and bedtime routine, as self-reported by children aged 7-9 years.

METHODS

Four groups of parent-child dyads were recruited: Māori participants from low- (n = 18) and high- (n = 17) decile schools and New Zealand European participants from low- (n = 18) and high- (n = 17) decile schools. Children completed a questionnaire about their sleep, a self-report of anxiety symptoms, and a semistructured interview.

RESULTS

Most (77%) children reported liking to go to sleep (Māori, 88% vs New Zealand European, 65%; P = .053) and 28% reported trouble sleeping. Māori children were less likely to report fear of the dark and fighting about going to bed. Liking going to sleep was associated with less fear of the dark and of sleeping alone. Children from low-decile schools more often reported waking with pain and feeling sleepy (P = .022) and taking naps (P = .018) during the day. They also had more symptoms of anxiety. New Zealand European children more frequently reported using "screen time" (P = .02) or "reading a book" (P = .05). Children attending high-decile schools were more likely to read at bedtime (P = .01), whereas children attending low-decile schools were more likely to have "play time" (P = .02). Children were able to articulate what was a good night and bad night sleep.

CONCLUSIONS

These findings suggest that more adverse differences in sleep habits and attitudes in children are most likely to be related to socioeconomic status than to ethnicity.

CITATION

Elder D, Miller J, Douglas B, Stanley J, McDowall P, Campbell A. Children talking about their sleep: a cross-sectional survey of differences by ethnicity and socioeconomic status in Aotearoa New Zealand primary schools. J Clin Sleep Med. 2023;19(1):119-133.

Increased Screen Time as a Cause of Declining Physical, Psychological Health, and Sleep Patterns: A Literary Review

Dependency on digital devices resulting in an ever-increasing daily screen time has subsequently also been the cause of several adverse effects on physical and mental or psychological health. Constant exposure to devices like smartphones, personal computers, and television can severely affect mental health- increase stress and anxiety, for example, and cause various sleep issues in both children as well as adults. Risk factors for obesity and cardiovascular disorders, including hypertension, poor regulation of stress, low HDL cholesterol, and insulin resistance are among the physical health repercussions we see. The psychological health effects comprise suicidal tendencies and symptoms of depression which are associated with digital device dependency, screen-time-induced poor sleep quality, and content-influenced negativity. Oftentimes it can cause the induction of a state of hyper-arousal, increase stress hormones, desynchronize the body clock or the circadian cycle, alter brain chemistry and create a drag on mental energy and development. With a focus on brain development in children and detrimental effects in both adults and children, this research article goes on to explore the various aspects of screen addiction and excessive screen exposure.

Smartphone addiction and victimization predicts sleep problems and depression among children

BACKGROUND

In this study we examined the phenomena of smartphone addiction, online harassment, and school bullying/victimization to predict the prospective influence these could have on the onset and persistence of sleep problems and depression among children.

METHODS

Responses from 2155 fifth-grade children recruited from 30 primary schools in Taipei were assessed, and a follow-up was performed in the 6th grade. Self-administered questionnaires were collected for each year.

FINDINGS

Children who reported smartphone addictions, online harassment, and school bullying/victimization coupled with an increase in those factors were more likely to experience the onset and persistence of sleep problems. In addition, children who reported smartphone addiction, online harassment, school bullying/victimization, and poor sleep quality were more likely to experience the onset and persistence of depression.

IMPLICATIONS

School nurses or pediatric nurses should be able to assess children's Internet use and risks to understand potential influences on sleep quality and mental status and provide recommendations for children, parents and schools.

Timing of sedentary behaviour and access to sedentary activities in the bedroom and their association with sleep quality and duration in children and youth: a systematic review

BACKGROUND

The purpose of this study was to systematically review the relationship between the timing of sedentary behaviours and access to sedentary activities in the bedroom with sleep duration and quality in children and youth. A secondary purpose was to examine whether these relationships differ when comparing screen-based and non-screen-based sedentary activities.

METHODS

We searched four databases for peer-reviewed studies published between 1 January 2010 and 19 January 2021. Risk of bias assessment for each study and certainty of evidence were assessed using the GRADE framework.

RESULTS

We identified 44 eligible papers reporting data from 42 separate datasets and including 239 267 participants. Evening participation in screen-based sedentary behaviours and access to screen-based devices in the bedroom were associated with reduced sleep duration and quality. Daytime screen use was also associated with reduced sleep duration, although this was examined in relatively few studies. Whether performed during the day or night, non-screen-based sedentary behaviours were not consistently associated with sleep duration or quality. The quality of evidence was rated as low to very low for all outcomes.

CONCLUSION

In order to maximize sleep duration and quality, children and youth should be encouraged to minimize screen time in the evening and remove screens from bedrooms. (PROSPERO registration no.: CRD42020189082).

Lockdown impact on lifestyle and its association with oral parafunctional habits and bruxism in a Spanish adolescent population

AIM

To analyse the possible association between decreased physical and social activity and an increase in the use of mobile devices, internet, and social networks with increased anxiety and the appearance of oral parafunctions and bruxism for adolescents before and during COVID-19.

DESIGN

A total of 213 adolescents attended private clinics at two different times: before lockdown (T0) and after completion of total lockdown (T1). In T0 and T1, a clinical examination was carried out to assess dental wear (IA) and only in T1 were they given the self-report questionnaire which focuses on the periods before and during lockdown (self-reported bruxism, state anxiety, mobile phone and internet, social network use, physical and social activity, and questions on parafunctions).

RESULTS

There were a decrease in physical activity at T0-T1 and an increase in social media use, internet, state anxiety, and clinical and self-reported bruxism at T0-T1. There was a positive correlation between increased self-reported bruxism, increased social media use, mobile device use, and state anxiety.

CONCLUSIONS

There has been a change in adolescent lifestyle during lockdown with an increase in the prevalence of oral parafunctions and bruxism. In particular, the increase in the use of social networks at night and also in anxiety levels during lockdown were associated with of the increase in self-reported bruxism.

Associations between Sleep and Mental Health in Adolescents: Results from the UK Millennium Cohort Study

(1) Background: There is a growing interest in investigating the relationship between sleep and mental health development in adolescents. This study aims to further investigate this relationship by identifying the specific associations between several sleep problems in adolescents and several mental health areas, and the role of gender in these associations. (2) Methods: Data from the Millennium cohort survey containing 11,553 individuals at 13–14 years old was included. Nighttime sleep duration and bedtime during weekdays and weekends, night awakening frequency, and sleep onset latency were assessed using self-reported questionnaires. Affective symptom and emotional and behavioural problems were examined with self-reported questionnaires. (3) Results: Regression analyses and path analysis models suggested that frequent night awakening was associated with all the outcomes, and hyperactivity/inattention was the outcome that presented a higher number of significant associations with sleep patterns. Long sleep onset latency and late bedtime at school days were associated with higher risk of emotional and behavioural difficulties. Further, poor sleep seems to manifest more externally in males, while more internally in females. (4) Conclusions: Specific sleep problems should be considered when assessing mental health in adolescence, which would allow more targeted prevention and intervention strategies. Further, special attention should be given to gender differences when addressing sleep and mental health.

Child Sleep Problems Affect Mothers and Fathers Differently: How Infant and Young Child Sleep Affects Paternal and Maternal Sleep Quality, Emotion Regulation, and Sleep-Related Cognitions

PURPOSE

Problems in infant and young child sleep can represent a serious challenge to parental behavior of mother and father. However, most research about the effect of infant and young child sleep on parenting has focused on mothers. Therefore, the present study aimed to explore the perception and consequences of infant and young child sleep problems of both parents.

PARTICIPANTS AND METHODS

Participants were recruited via random sampling at, eg, kindergartens in North Rhine Westphalia. The sample includes data of heterosexual German-speaking couples with children without any medical or psychopathological problems. For this study, parents were asked to complete the test battery with regard to their youngest child. As sampling was via the kindergarten, the range of child age was 4-68 months. A survey assessed data of parents (N=196, 46% female). The test battery contained the following questionnaires: Children Sleep Habits Questionnaire (CSHQ), Pittsburgh Sleep Quality Index (PSQI), Self-Report Measure for the Assessment of Emotion Regulation Skills (SEK-27), and a German version of the Infant Sleep Vignettes Interpretation Scale (ISVIS). For the outcome variables of parental sleep as well as for parental emotional competence, the statistical tests of ANOVA were used, and for parental sleep-related cognitions with the grouping variables of infant and young child sleep as well as parental gender, a MANOVA was used. According to the analysis of group differences, the age of the child was also included additional to the grouping variable of parental gender and children's sleep.

RESULTS

Mothers and fathers in this sample were equally aware of their children's sleep problems and reported similar sleep quality and emotion regulation themselves (all p > 0.05). Mothers as well as fathers of children with sleep problems had lower parental sleep quality (F(1, 183) = 110.01, p < 0.001) and emotion regulation (F(1, 184) = 143.16, p < 0.001) compared to parents of children without sleep problems. In children under 26 months of age, the child's age seemed to have less negative impact on the father's sleep quality (F(1, 183) = 5.01, p < 0.001) and emotion regulation (F(1, 184) = 0.72, p < 0.05) than on the outcomes of the mother. With regard to sleep-related cognition, there were statistically significant effects of parental gender (F(2, 185) = 44.39, p < 0.001) and interaction effects of parental gender × child sleep problems observed (F(2, 185) = 31.91, p < 0.001).

CONCLUSION

The conclusion from this survey refers to the role of the father. According to the results, an association between paternal emotional competence, sleep quality as well as their sleep-related cognitions and infants and toddlers sleep behavior could be assumed in addition to and independent of the results of mothers. We would highlight the urgent need of inclusion of fathers in infant and developmental sleep research. In the context of sleep intervention, both parents should be provided with ongoing support to improve their sleep quality and competence in emotion regulation.

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.

Sleep habits and weight status in Brazilian children aged 4-6 years of age: the PREDI study

OBJECTIVES

To evaluate the association of sleep habits with the weight status of children aged 4-6 years.

METHODS

Data were obtained from the PREDI Study, a Brazilian birth cohort study. The current study was carried out in the homes of the participants during two follow-ups: 2016/17 and 2018. The participants were submitted to anthropometric assessment and demographic, socioeconomic and sleep data were obtained. The child's sleep habits were self-reported by the mother or caregiver on the day of the visit and included information on the following sleep habits during the past week: bedtime routine, rhythmicity, and separation affect determined with the Sleep Habits Inventory for Preschool Children and the Sleep Habits Inventory. Logistic regression and gamma-log regression analyses were used to examine the association of sleep habits with excess body weight of children in the two follow-ups according to sex.

RESULTS

Of the 217 and 185 children included in 2016/17 and 2018, respectively, 66 (30.6%) and 48 (25.9%) had a BMI >85th percentile at 4-6 years, respectively. The median rhythmicity score was higher in children with excess body weight (p = 0.05). Adjusted analysis showed that rhythmicity was associated with excess body weight of girls at ages 4-5 years (OR = 1.42, 95% CI: 1.09-1.86, p = 0.009) and 6 years (OR = 1.32, 95% CI: 1.06-1.65, p = 0.015), even after adjustment for other important covariates. Additionally, the sleep habit "separation affect" was inversely associated with the child's BMI in boys (β = -0.005, 95% CI: -0.010-0.000, p = 0.037).

CONCLUSIONS

In the present study, rhythmicity problems were associated with increased odds of girls aged 4-6 years having excess body weight. These results are important from a public health perspective since strategies aimed at preventing excess body weight in children need to consider the child's sleep quality as a potential risk factor, especially rhythmicity.

Daily energy expenditure through the human life course

Total daily energy expenditure ("total expenditure") reflects daily energy needs and is a critical variable in human health and physiology, but its trajectory over the life course is poorly studied. We analyzed a large, diverse database of total expenditure measured by the doubly labeled water method for males and females aged 8 days to 95 years. Total expenditure increased with fat-free mass in a power-law manner, with four distinct life stages. Fat-free mass-adjusted expenditure accelerates rapidly in neonates to ~50% above adult values at ~1 year; declines slowly to adult levels by ~20 years; remains stable in adulthood (20 to 60 years), even during pregnancy; then declines in older adults. These changes shed light on human development and aging and should help shape nutrition and health strategies across the life span.

Sleep Characteristics in the Italian Pediatric Population: A Systematic Review

OBJECTIVE

During childhood sleep duration, quality and patterns evolve and change greatly and relate strongly to healthy development. This systematic review aims to summarize the literature on sleep characteristics in the Italian pediatric population, adopting a cultural perspective.

METHOD

Pubmed, PsycINFO and Medline databases were systematically searched. Eligible studies had to: include Italian children and adolescents; report data for one or more sleep-related variables; be published in English or Italian.

RESULTS

Twenty-nine studies were selected including 18551 Italian children or adolescents. Studies were categorized by age group: infancy and toddlerhood (0-3 years); preschool and school age (3-12 years); adolescence (12-18 years) and mixed age groups. Overall, studies showed that the Italian pediatric population present shorter sleep duration and longer sleep onset latency compared to international recommendations. Furthermore, data indicate high prevalence of dysfunctional sleep habits, such as late bed-time (all age groups), involvement of parents during bed-time (infancy and toddlerhood), and high variability between sleep times on week-days vs. weekends (adolescence). Nevertheless, most studies lacked comprehensive data on sleep patterns, focusing instead on isolated variables.

CONCLUSION

These results suggest a strong trend among Italian children and adolescents towards unhealthy sleep patterns. Comprehensive data are still lacking and large studies evaluating a broad range of sleep characteristics in Italian pediatric populations are needed. Data strongly suggest that Italian Pediatric Primary Care should place higher focus on sleep problems and implement clinical protocols directed towards improving sleep patterns in children and adolescents.

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.

Physical and Sedentary Activities and Childhood Overweight/Obesity: A Cross-Sectional Study among First-Year Children of Primary Schools in Modena, Italy

Children obesity is a serious public health issue. This study aimed to investigate physical/sedentary activities of first-year primary schools children in Modena, and their association with overweight/obesity and dietary habits of children and family characteristics to identify the risk factors for unhealthy lifestyles. Child physical/sedentary activities were gathered through an anonymous questionnaire administered to parents, as well as family characteristics and weight/height of child and parents. Logistic regression models, eventually adjusted for parents' sociodemographic characteristics, were used to analyze data. Questionnaires were delivered by 660 families (74.2%), of which 72 without anthropometric data were excluded. Three out of four children spent in physical activities less than 7 h/week, while 63.9% dedicated to sedentary activities two or more hours/day. From multivariate analysis, the habit significantly affecting children's overweight/obesity was spending time on tablets/Personal Computers/mobile phones/videogames. Higher parental education level resulted in a protective factor for implementing unhealthy lifestyles in terms of time dedicated to physical/sedentary activities. Our results suggest the need of interventions to increase time for physical activity and to promote a responsible use of digital media involving the entire families to reach all parents regardless of their education and nationality with a possible relapse on other family members.

Pediatric sleep health: It matters, and so does how we define it

In 2014, Buysse published a novel definition of sleep health, raising awareness for the importance of this construct for individuals, populations, clinical care, and research. However, the original definition focused on adults, with the recommendation that it should be adapted for children and adolescents. As children live within a complex and dynamic system, and may not always have control over their own sleep, this theoretical review will examine and apply Buysse's five dimensions of sleep health within the context of pediatrics. In addition, using examples from the pediatric sleep literature we introduce a modified definition that takes into consideration the influence of the socio-ecological system within which children live, and the sleep-related behaviors that are critical in supporting or hindering sleep health. Finally, we discuss how the proposed theoretical framework, Peds B-SATED, can be applied to clinical practice, research, and training in the field of pediatric sleep.

The possible effects of maternal electronic media device usage during pregnancy on children's sleep patterns

Objective

In recent years, there has been increasing scientific evidence about potential health risks caused by electromagnetic fields because of electronic media devices. Therefore, this study aimed to examine the possible association between electronic media device usage during pregnancy and sleep patterns in children and the possible role of electronic media device presence in the sleeping environment on children's sleep disturbances.

Material and Methods

The study was carried out with 400 healthy children aged between 1 month and 5 years whose parents agreed to complete the questionnaire form. The questionnaire form consisted of questions about the history of prenatal and postnatal electromagnetic field exposure caused by electronic media devices and the presence of sleep disturbances in children. Data were analyzed with SPSS for Windows program. P-values <0.05 were considered statistically significant.

Results

Sleep problems were more prevalent in children whose mothers lived near a base station during pregnancy (p<0.05). Sleep disorders were more frequent and sleep duration was shorter in children whose mothers used electronic devices (television, computer, mobile phone, wi-fi, microwave oven) during pregnancy (p<0.05). Sleep problems were also more common in children with electronic media devices in the sleeping environment during the night (p<0.05). Sleep disturbances were not associated with maternal consumption of tobacco or alcohol or history of disease during pregnancy (p>0.05).

Conclusion

Our results highlight that exposure to electromagnetic fields caused by electronic media devices during the prenatal or postnatal period could be associated with sleep patterns in childhood. Considering the widespread use of electronic media devices, it may be an important public health problem given the long-term consequences of sleep disorders in childhood.

Socioeconomic status and sleep disturbances among pediatric population: a continental systematic review of empirical research

To this day, no consensus has been established on the definition and the conceptualization of the socioeconomic status (SES), since all the available studies on the relation between SES and health did not use the same conceptual framework and operationalization to assess SES. While literature reported that SES markers (such as income, social support networks, education, employment or occupation) influence the health of populations by shaping living conditions; empirical research does not tell us which SES markers affect more strongly the sleep components of the individuals, as well as which sleep disorders (SD) are affected and how. Even though several original studies have tried to assess how changes in socioeconomic status of parents may affect the psychosocial environment and mental health of an individual directly or through his community, no systematic reviews on the influence of SES on children's sleep are available. This systematic review make an update on the different measures of SES and sleep disturbances used for pediatric population across the different regions of the world. Recommendations for a future standardization of SES measures is proposed, for a better understanding of its influence on sleep disturbances.

The Associations Between Media Use, Midpoint of Sleep, and Sleep Quality in German Preschoolers: A Mediation Analysis Based on the Ulm SPATZ Health Study

INTRODUCTION

The relation of electronic media use with sleep quality among preschoolers is a matter of ongoing debate. Longitudinal data are scarce and do not account for sleeping schedules.

METHODS

We used the German Children's Sleep Habits Questionnaire to measure parent-reported child's sleep quality; its score is computed by the sum of 34 items defined by a 1-3 level Likert scale (score ranging 34-102), with higher values representing lower sleep quality. A causal mediation analysis of these relations using data from the Ulm SPATZ Health Study in Germany was conducted. Repeated data on electronic media use, book reading, sleep quality, sleep duration, and midpoint of sleep were prospectively collected yearly from ages 4 to 6 years (n=563) during parent's working days and free days.

RESULTS

We observed negative correlations of sleep quality with sleep duration and midpoint of sleep at ages 4-5 (R=-0.21 to -0.10), which attenuated with age 6 years. Sleep duration and midpoint of sleep were strongly positively correlated at all ages (R=0.55-0.95). We observed significant negative associations between total electronic media use and TV/DVD watching, while book reading did neither affect the sleep quality score nor sleep duration or midpoint of sleep. We found little evidence for an indirect negative effect of media use on sleep quality via sleep duration or midpoint of sleep, indicating that media use acts independently on sleep duration, midpoint of sleep, and sleep quality. Non-statistically significant associations of sleep duration and midpoint of sleep on sleep quality indicate that these are independent aspects of sleep adequacy. Evidence for this was stronger during free days.

CONCLUSION

Media use acted on sleep quality through a direct effect in a prospective fashion. Thus, we conclude that electronic media use increases the risk for sleep impairments in German preschoolers, while book reading seems to be a safe and healthy alternative.

Tratamento multicomponente para insônia infantil e seus efeitos nos padrões, hábitos e rotinas de sono

Problemas de sono são frequentes na infância e estão associados a problemas de comportamento. O estabelecimento de rotinas pré-sono é recomendado para pais de crianças. Nenhum estudo brasileiro investigou os hábitos e rotinas de crianças que apresentam problemas de sono. Os objetivos deste estudo foram investigar os hábitos e rotinas de crianças com problemas de sono e verificar se a educação parental sobre o sono da criança levou a mudanças nos padrões de sono e de rotina. Participaram 57 crianças com problemas comportamentais relacionados ao sono e suas mães. As mães receberam orientações sobre o sono das crianças e estabelecimento de rotinas pré-sono. Os dados foram avaliados através de medidas parentais. Nossos resultados apontaram que crianças com problemas de sono apresentam em sua maioria, hábitos e rotinas inadequadas antes de dormir e que a modificação destes levam a melhora do sono. Espera-se que este trabalho possa estimular a produção de pesquisas nacionais sobre o tema, servindo como incentivo para o desenvolvimento de medidas preventivas e interventivas para os problemas de sono na infância.

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.

Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth

BACKGROUND

Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0-17 years) and present, explain, substantiate, and discuss the final Consensus Statement.

METHODS

The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan.

RESULTS

Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit.

CONCLUSION

Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders.

Association of Maternal Depression and Anxiety Symptoms with Sleep Duration in Children at Preschool Age

OBJECTIVES

To evaluate the effect of maternal depression and anxiety symptoms on daily sleep duration in 4-5-year-old children.

METHODS

Data were obtained from the PREDI Study, a larger cohort study conducted in Brazil. The current study is a cross-sectional study carried out in the homes of the participants between July 2016 and August 2017. The participants were submitted to anthropometric assessment and demographic, socioeconomic and psychological data were obtained. Total sleep time was self-reported by the women and classified as ≥ 10 or < 10 h of sleep/day. Maternal depression and anxiety symptoms were assessed using the Beck Depression Inventory and Beck Anxiety Inventory, respectively.

RESULTS

Of the 216 children included in the study, 77.3% and 22.7% had ≥ 10 and < 10 h of sleep/day, respectively. Regarding the women, 20.0% and 19.5% had moderate/severe depression and anxiety symptoms, respectively. Moderate/severe symptoms of maternal depression were associated with < 10 h of sleep/day (p = 0.034). Unadjusted analysis showed that children whose mothers had moderate/severe depression symptoms were significantly more likely to sleep < 10 h/day at 4-5 years of age than those whose mothers had minimal/mild depression symptoms (OR 2.38, p = 0.037). This association continued to be significant and increased to an OR of 3.99 (p = 0.006) after adjusting for potential confounders.

CONCLUSIONS FOR PRACTICE

Our study showed that sleeping less than 10 h/day at preschool age was associated with moderate/severe maternal depression symptoms. These results are important from a public health perspective since strategies designed to treat depression in women with school-age children may help improve their child's sleep quality and, consequently, his cognitive performance and related behavioral and emotional problems in the future.

Application of latent class analysis in assessing the awareness, attitude, practice and satisfaction of paediatricians on sleep disorder management in children in Italy

AIM

To identify subgroups regarding paediatricians' awareness, attitude, practice and satisfaction about management of Sleep-Disordered Breathing (SDB) in Italy using Latent Class Analysis (LCA).

METHODS

A cross-sectional study was conducted on a large sample of Italian paediatricians. Using a self-administered questionnaire, the study collected information on 420 Paediatric Hospital Paediatricians (PHPs) and 594 Family Care Paediatricians (FCPs). LCA was used to discover underlying response patterns, thus allowing identification of respondent groups with similar awareness, attitude, practice and satisfaction. A logistic regression model was used to investigate which independent variables influenced latent class membership. Analyses were performed using R 3.5.2 software. A p-value<0.05 was considered statistically significant.

RESULTS

Two classes were identified: Class 1 (n = 368, 36.29%) "Untrained and poorly satisfied" and Class 2 (n = 646, 63.71%) "Trained and satisfied." Involving paediatric pneumologists or otorhinolaryngologists in clinical practice was associated with an increased probability of Class 2 membership (OR = 5.88, 95%CI [2.94-13.19]; OR = 15.95, 95% CI [10.92-23.81] respectively). Examining more than 20 children with SDB during the last month decreased the probability of Class 2 membership (OR = 0.29, 95% CI [0.14-0.61]). FCPs showed a higher probability of Class 2 membership than PHPs (OR = 4.64, 95% CI [3.31-6.55]).

CONCLUSIONS

These findings suggest that the LCA approach can provide important information on how education and training could be tailored for different subgroups of paediatricians. In Italy standardized educational interventions improving paediatricians' screening of SDB are needed in order to guarantee efficient management of children with SDB and reduce the burden of disease.

Lower physical activity is associated with daytime sleepiness in children aged 9-12 years

This study clarified the prevalence of daytime sleepiness in fourth-, fifth-, and sixth-grade children and examined the association between physical activity (PA) and daytime sleepiness in children aged 9-12 years. This cross-sectional study included 314 children (mean age ± standard deviation: 10.5 ± 1.0 years; male: 52.9%) enrolled in two public elementary schools in Kobe, Japan. PA was assessed using the Physical Activity Questionnaire for Older Children. The outcome was self-reported daytime sleepiness. The prevalence of daytime sleepiness in fourth-, fifth-, and sixth-grade children were 10.8%, 25.2%, and 28.6%, respectively. In univariate analysis, subjects with reported daytime sleepiness had lower PA levels than those without daytime sleepiness (odds ratio (OR) = .67; 95% confidence interval (CI) = .47-.95). Multiple logistic regression analysis demonstrated that lower PA was significantly associated with daytime sleepiness after adjusting for multiple confounders (OR = .54; 95% CI = .37-.81). The prevalence of daytime sleepiness in fifth and sixth grades was higher than fourth grade. Furthermore, this study clarified the significant association between PA and daytime sleepiness and suggested that PA could be one of the factors to prevent daytime sleepiness in children aged 9-12 years.

What does sleep hygiene have to offer children's sleep problems?

Sleep hygiene practices have been described extensively in the literature. There is considerably less clarity about relationships between particular elements of sleep hygiene and particular sleep outcomes, and which intervention approaches using sleep hygiene principles are effective. In this review, we describe themes extracted from a systematic review of the sleep hygiene literature. We systematically searched Psycinfo, CINAHL, Cochrane, Ovid Medline, Embase, and Web of Science Search Engines up to August, 2017. We included all studies that associated sleep hygiene (behaviors adjacent to bedtime and during the night) with sleep duration and/or sleep onset latency and/or night waking or that used sleep-hygiene based interventions to improve sleep duration and/or sleep onset latency and/or night waking (n = 44). We organized our findings into themes by age group, sleep hygiene factors, and interventions. We provide evidence-based recommendations about areas of sleep hygiene that have significant empirical support and those that require urgent attention.

Transitions in smartphone addiction proneness among children: The effect of gender and use patterns

OBJECTIVES

This study assessed the incidence of transitions in smartphone addiction proneness (SAP) among children and examined the effects of gender, use patterns (social networking sites (SNSs) use and smartphone gaming) and depression on smartphone addiction transitions.

METHODS

A representative sample of 2,155 children from Taipei completed longitudinal surveys in both 2015 (5th grade) and 2016 (6th grade). Latent transition analysis (LTA) was used to characterize transitions in SAP and to examine the effects of gender, use patterns and depression on SAP transitions.

RESULTS

LTA identified four latent statuses of SAP: about half of the children were in non-SAP status, one-fifth were in tolerance status, one-sixth were in withdrawal status, and one-seventh were in high-SAP status. Both boys and girls had a higher prevalence of high-SAP and tolerance in 6th grade than in 5th grade, whereas in both grades boys had a higher prevalence of high-SAP and withdrawal, and girls had a higher prevalence of non-SAP and tolerance. Controlling for parents' education, family structure, and household income, higher use of SNSs by children, increasing use of mobile gaming and higher levels of depression were individually associated with increased odds of being in one of the three SAP statuses other than non-SAP. When all three covariates were jointly entered into the model, usage of SNSs and depression remained significant predictors.

CONCLUSION

Both boys and girls tended to transition to tolerance or high-SAP statuses, while children's depression and their usage of SNSs increased the risk of smartphone addiction.

The Association of Physical Activity and Sedentary Behaviors with Upper Respiratory Tract Infections and Sleep Duration in Preschool Children-Study Protocol

Currently, there is no consensus regarding the benefits of physical activity in terms of upper respiratory tract infections (URTIs) among different age groups of children. The number of school students avoiding physical education is on the rise. Children of all ages spend more time on sedentary behavior, eat less nutritious food and spend less time sleeping. All of these concomitant aspects adversely affect the immune system. A coexisting problem of a growing society is a large number of URTIs which is the main reason for general practitioner intervention. The aim of this study is to determine whether there is a correlation between the frequency of respiratory tract infections and the level of physical exercise in a cohort of pre-school children. This will be a cross-sectional, short-term study conducted on a single study population. We aim to recruit four-, to seven-year-old children who will be receiving activity monitoring devices for 24 h a day for 40 days. Daily step count, mean intensity of physical exercise and sleep duration will be measured. Simultaneously, their parents will receive a series of 60 questionnaires, one questionnaire per day, for the daily assessment of upper respiratory infection (URI) symptoms. Our study conducted on a cohort of healthy pre-school children using uniform tools, aims to scientifically establish and quantify the relationship between physical activity and health outcomes over a specified period of time.

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.

"From the moment I wake up I will use it…every day, very hour": a qualitative study on the patterns of adolescents' mobile touch screen device use from adolescent and parent perspectives

BACKGROUND

The use of mobile touch screen devices, e.g. smartphones and tablet computers, has become increasingly prevalent among adolescents. However, little is known about how adolescents use these devices and potential influences on their use. Hence, this qualitative study explored adolescents' perceptions on their patterns of use and factors influencing use, and perceptions and concerns from parents.

METHODS

Semi-structured interviews were conducted with adolescents (n = 36; 11 to 18 years) and their parents/caregivers (n = 28) in Singapore recruited to represent males and females across a range of ages from different socioeconomic groups. Prompts covered weekday and weekend use patterns, types of activities, perspectives on amount of use, parental control measures and concerns. Interviews were recorded and transcribed. Transcripts were coded and thematic analysis was carried out.

RESULTS

Smartphone was the most common mobile device owned and used by many of the adolescents, while only some used a tablet. Many adolescents and their parents felt that adolescents' MTSD use was high, frequent and ubiquitous, with frequent checking of device and multitasking during use. Reported influences of use included functional, personal and external influences. Some of the influences were irresistibility of mobile devices, lack of self-control, entertainment or relaxation value, and high use by peers, family and for schoolwork that contributed to high use, or school/parental control measures and lack of internet availability that limited use. Most adolescents were generally unconcerned about their use and perceived their usage as appropriate, while most parents expressed several concerns about their adolescents' use and perceived their usage as excessive.

CONCLUSIONS

This study has provided rich insights into the patterns and influences of contemporary mobile device use by adolescents. Mobile device use has become an integral part of adolescents' daily routines, and was affected by several functional, personal and external influences which either facilitated or limited their use. There also seemed to be a strong inclination for adolescents to frequently check and use their mobile devices. There is an urgent need to understand the implications of these common adolescent behaviours to inform advice for wise mobile device use by adolescents.

Advances in pediatrics in 2017: current practices and challenges in allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology from the perspective of Italian Journal of Pediatrics

This review provides an overview of a remarkable number of significant studies in pediatrics that have been published over the past year in the Italian Journal of Pediatrics. We have selected information from papers presented in the Journal that deal with allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology. The relevant epidemiologic findings, and developments in prevention, diagnosis and treatment of the last year have been discussed and placed in context. We think that advances achieved in 2017 will help readers to make the future of patients better.

Study Protocol of Sleep Education Tool for Children: Serious Game "Perfect Bedroom: Learn to Sleep Well"

Promoting a healthy sleep is a big challenge and becomes a strategic priority in public health, due to the severe consequences on children's development and risk to psychiatric diseases. Interventions that promote healthy sleep, such as those that focus on the dissemination of behavioral and environmental recommendations of sleep hygiene with children, are presented as an alternative. Serious game design offers wide-reaching domains in health applications and is increasing in popularity, particularly with children and teens because of it's potential to engage and motivate players differently from other interventions. This study aims to evaluate effects of serious game on sleep hygiene recommendations "Perfect Bedroom: learn to sleep well," on sleep habits and sleep parameters of healthy children. This is an experimental, prospective and quantitative study. We will randomize children in experimental (n = 88) and no intervention groups (n = 88). The experiment has four stages (pre-intervention, intervention, post-intervention, and follow-up), which will count with participation of children and their parents/guardians. In the evaluation stages, the guardians will answer questionnaires and scales to assess sociodemographic and health data, sleep habits and sleep pattern of their child. The children themselves will answer the following: a scale to assess sleepiness levels, a questionnaire to evaluate the serious game and the game itself, will characterize their bedroom and the activities they perform before sleep, with strategies developed by researches. Intervention with experimental group conducted with the serious game "Perfect Bedroom" will happen twice a week, for 3 weeks in a row, resulting in six sessions of 50 min each. Inferential analysis will be conducted for comparisons between groups and intragroups to measure effect of intervention in primary outcomes (sleep habits) and secondary outcomes (sleep parameters). We expect that the intervention with this game can provide valuable evidence to a new approach in promoting healthy sleep habits, with applications in clinical, educational, and familiar settings, which could diminish future health issues and risk at psychiatric diseases, decreasing the social burden of treatments for these conditions in children.

Proportion of infants meeting the Australian 24-hour Movement Guidelines for the Early Years: data from the Melbourne InFANT Program

BACKGROUND

Little information is available on the movement behaviours of infants, despite evidence that these are important for development. The release of new Australian 24-hour Movement Guidelines provides an opportunity to document the current state of movement behaviours in infants relative to these guidelines. The aim of this study was to report the prevalence of 4 month old Australian infants meeting the 24-hour Movement Guidelines, individually, and in combination, and to describe associations with individual characteristics.

METHODS

Maternal report baseline data from the Melbourne Infant Feeding, Activity and Nutrition Trial Program were used to determine prevalence of infants meeting physical activity (30 min of tummy time per day), sedentary behaviour (no more than 1 h at a time kept restrained; zero screen time), and sleep guidelines (14-17 h for 0-3 month olds or 12-16 h for 4-11 month olds). Prevalence of infants meeting combined guidelines was also described. The odds of meeting guidelines based on infant and family characteristics was determined.

RESULTS

Data are reported for 455 infants with a mean age of 3.6 months (SD = 1.0). The proportion of infants meeting each of the guidelines was 29.7% for tummy time, 56.9% for kept restrained, 27.9% for screen time, 58.7% for sleep and 3.5% for the combined guidelines (i.e. meeting all four guidelines). A significantly higher proportion of girls than boys met the screen time guideline (32.5% versus 24.0%, p = 0.04) and the combined guidelines (5.7% versus 1.6%, p = 0.01). Few associations were observed between infant and family characteristics and proportion of infants meeting individual guidelines.

CONCLUSIONS

Very few infants met all of the guidelines contained in the new Australian 24-hour Movement Guidelines suggesting there is much room for improvement in movement behaviours from early life. Fewer infants met the tummy time and screen time guidelines hence these appear to be the behaviours requiring most attention. Parents and others providing care to infants require support and strategies to assist them in adhering to the guidelines to ensure optimal health and development for the youngest in our population.

Meeting new Canadian 24-Hour Movement Guidelines for the Early Years and associations with adiposity among toddlers living in Edmonton, Canada

BACKGROUND

Canada has recently released guidelines that include toddler-specific recommendations for physical activity, screen-based sedentary behaviour, and sleep. This study examined the proportions of toddlers meeting the new Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) and associations with body mass index (BMI) z-scores in a sample from Edmonton, Canada.

METHODS

Participants included 151 toddlers (aged 19.0 ± 1.9 months) for whom there was complete objectively measured physical activity data from the Parents' Role in Establishing healthy Physical activity and Sedentary behaviour habits (PREPS) project. Toddlers' physical activity was measured using ActiGraph wGT3X-BT monitors. Toddlers' screen time and sleep were measured using the PREPS questionnaire. Toddlers' height and weight were objectively measured by public health nurses and BMI z-scores were calculated using World Health Organization growth standards. Meeting the overall 24-Hour Movement Guidelines was defined as: ≥180 min/day of total physical activity, including ≥1 min/day of moderate- to vigorous-intensity physical activity; no screen time per day (for those aged 12-23 months) or ≤1 h/day of screen time per day (ages 24-35 months); and 11-14 h of sleep per 24-h period. Frequency analyses and linear regression models were conducted.

RESULTS

Only 11.9% of toddlers met the overall 24-Hour Movement Guidelines, but this finding was largely driven by screen time. The majority of toddlers met the individual physical activity (99.3%) and sleep (82.1%) recommendations, while only 15.2% of toddlers met the screen time recommendation. No associations were observed between meeting specific and general combinations of recommendations within the guidelines and BMI z-scores.

CONCLUSIONS

Most toddlers in this sample were meeting physical activity and sleep recommendations but were engaging in more screen time than recommended. Consequently, only a small proportion of toddlers met the overall guidelines. Based on the findings of this study, identifying modifiable correlates of screen time to inform appropriate strategies to reduce screen time appears key for increasing the proportion of toddlers meeting the 24-Hour Movement Guidelines for the Early Years. Future research should examine the associations between meeting the new guidelines and other health indicators. Furthermore, future high-quality studies examining dose-response relationships between movement behaviours and health indicators are needed to inform guideline updates.

Different healthy habits between northern and southern Spanish school children

AIM

Healthy habits are influenced by several factors such as geographical location. The aims of this study were to describe and compare healthy habits within two populations of sixth-grade primary school children (aged 11-12 years) from northern and southern Spain.

SUBJECTS AND METHODS

A cross-sectional study using two representative samples of school children was conducted. Participants came from Logroño (n = 329) in the north and Granada (n = 284) in the south of Spain. Socio-demographic and anthropometric variables, adherence to the Mediterranean diet, aerobic fitness, and healthy lifestyles were recorded.

RESULTS

Boys reported a higher level of physical activity and aerobic fitness than girls (p = 0.000). Southern school children reported significantly higher adherence to the Mediterranean diet (♀: p = 0.041; ♂: p = 0.008), lower aerobic fitness (♀: p = 0.000; ♂: p = 0.042) and hours of nightly sleep (♀: p = 0.008, ♂: p = 0.007) than northern school children. Southern boys also reported lower levels of physical activity (p = 0.013). There were slight or moderate correlations among all habits measured (physical activity, diet, screen and sleep time). Additionally, the physical activity level was inversely related to weight status. Overweight and obese northern boys reported less physical activity than healthy-weight northern boys (p = 0.020) and overweight and obese southern girls reported less physical activity than healthy-weight southern girls (p = 0.024).

CONCLUSIONS

Results showed differences in physical activity, eating and sleep habits, and aerobic fitness according to geographical location. The relationships found among lifestyle habits indicate the need for health promotion interventions nationally and considering the differences discussed here.

Sleep behaviors in children with different frequencies of parental-reported sleep bruxism

OBJECTIVE

Knowledge on the relationship between sleep bruxism (SB) and sleep behaviors in children is still fragmental, especially when socioeconomic factors are concerned. To assess sleep behaviors in children with different frequencies of proxy-reported SB.

METHODS

Parents of 1475 Colombian children, aged 9.8±1.6years, belonging to 3 different social layers, filled out a questionnaire on their childreńs sleep (Childreńs Sleep Habits Questionnaire [CSHQ]). Differences in sleep behaviors were assessed for the total sample and the three socioeconomic layers, using one-way ANOVA and Bonferroni post-hoc tests or Kruskal-Wallis and Dunn's post-hoc tests, based on the normality of outcome variables.

RESULTS

Most sleep patterns and daytime sleepiness were similar for children with different frequencies of proxy-reported SB, without differences among socioeconomic layers, whilst sleep disorders and parasomnias increased with the frequency of proxy-reported SB, independently on the socioeconomic layer (Bonferroni post-hoc<0.001). The association between sleep-related habits and the frequency of proxy-reported SB was different for each socioeconomic layer.

CONCLUSION

Among the various sleep behaviors under investigation, some sleep disorders and parasomnias seem to be associated with parental-reported SB in children. The influence of socioeconomic conditions on sleep behaviors seems not relevant. Based on these results, more specific studies on the association between different sleep behaviors are needed.

CLINICAL SIGNIFICANCE

Sleep behaviors, sociodemographic and socioeconomic features are correlated with SB in adults. However, in children, good evidence about this topic is lacking. This article give information to help clinicians evaluating sleep behaviors, sociodemographic and socioeconomic characteristics, when assessing sleep bruxism, based on evidence.

Impact of different recommendations on adequacy rate for sleep duration in children

A huge amount of literature in the last decades showed that sleep is essential for children’s health and well-being and that short sleep duration is associated with several negative health outcomes. Many developmental phases in infancy and childhood are in strict relationship with an healthy sleep.

In the last years some specific recommendations made for how much sleep children need have been published. The empirical evidences for contemporary sleep recommendations has changed and the new recommendations are clearly different from the previous ones and reflect clearly the changes in the sleep need of the children and adolescents in the last decades although seem still to be largely unfitting for preadolescence and adolescence.

If sleep is to be treated as a therapeutic intervention, then consensus guidelines, statements, and evidence-based best-practice documents are needed to underpin sleep recommendations for children.

Sleep recommendations for children play an important role for public policies and interventions, and to advertise parents and children of the negative consequences of sleep deprivation/reduction.