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Watching TV at bedtime is associated with worse sleep quality among toddlers, and in turn, future behavioral issues

PsyPost 8/2/2022 PsyPost
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A recent study has found that children who watch TV as part of their bedtime routine get less sleep, experience more sleep problems, and exhibit more attention problems and aggressive behavior six months later. The study, published in the journal Infant Behavior and Development, was conducted among a sample of mainly low-income and racial/ethnic minority families.

According to the field of sleep medicine, good sleep is critical for children’s health and early development. Bedtime routines can help children maintain healthy sleep habits, but evidence suggests that these routines often include the use of television. Screen use has been found to delay and shorten sleep — possibly by increasing arousal or suppressing melatonin through blue light emittance. TV watching has also been linked to behavioral issues in children, like aggression and attentional problems.

While the relationship between TV at bedtime and sleep quality has been extensively studied, study author Elizabeth B. Miller and her team saw a need to extend these findings. For one, the researchers wanted to explore the mechanism through which TV at bedtime influences children’s behavior, proposing a mediating effect of quality and duration of sleep.

“I was interested in this topic because of its focus on pediatric research in young children around screen time and other routines like sleep,” said Miller, an assistant professor of population health at NYU Grossman School of Medicine. “There has not been a lot of research in this area with very young children (age 0-3), and in our sample we examined this topic at 18 and 24 months. We further were interested in the mechanisms by which television at bedtime might impact sleep and behavior.”

The authors further opted to explore this hypothesis among a sample of low-income and racial/ethnic minority families to hone in on possible sociodemographic, psychosocial, and household predictors. Presumably, parents of lower socioeconomic status may be more likely to use TV at bedtime due to heightened family stress and/or limited time and money which can interfere with responsive parenting.

The researchers analyzed data from a wider study called the Smart Beginnings study, which was conducted among 403 low-income families from New York, NY and Pittsburgh, PA. The majority of families were from ethnic/racial minority backgrounds — 84% of the New York mothers were Latina and 81% of Pittsburgh mothers were Black/African American.

The mothers in the study completed surveys when their child was at 18 months and 24 months of age. At 18 months, the mothers indicated how often TV was used as part of their child’s bedtime routine, how many hours of sleep their child typically slept per night, and completed an assessment of their child’s sleep quality. At 24 months, the mothers completed two subscales of the Child Behavior Checklist that assessed children’s attention problems and aggressive behavior.

The survey results revealed that 52% of the sample used TV as part of the child’s bedtime routine. First-time mothers and mothers who were receiving public assistance were more likely to say they used TV at bedtime.

Mothers who used TV at bedtime tended to have children who slept fewer total hours, had more sleep problems, and exhibited more aggressive behavior and attention problems at age 2. Mediation analyses further revealed that sleep problems — but not sleep duration — mediated the relationship between TV at bedtime and children’s future attention problems and aggressive behavior. This suggests that lower sleep quality is partly responsible for the behavioral issues observed among children exposed to TV at bedtime.

“The key takeaway from our study is that although we had a lot of heterogeneity in our sample in terms of race/ethnicity, our findings underscore the universally harmful effects of television watching at bedtime for very young children,” Miller told PsyPost. “These harmful effects include decreases in total hours of nighttime sleep, increases in sleep problems (an indicator of sleep quality), and increases in externalizing behavior. Another key takeaway from this study is that we found sleep problems to be an explicit mechanism by which television watching at bedtime was associated with later behavior problems. That is, television watching disrupted sleep quality, which in turn led to more problem behavior.”

Miller and her team said the findings are consistent with evidence that screen time before bed is detrimental to children’s sleep quality and can negatively impact their behavior. The results support recommendations from organizations like the American Academy of Sleep Medicine (AASM), which emphasizes healthy nighttime routines and limited screen time before sleeping. Miller and her colleagues noted that it may be beneficial to screen for the use of media at bedtime when assessing children with reported sleep or behavior issues.

“The findings from this study lend support for the importance of structuring children’s nighttime routines to promote better child outcomes,” Miller said.

A limitation of the study was that sleep indicators were assessed by parent report, which may not be as accurate as objective sleep data. The researchers say that future studies should collect multiple reports of sleep behavior to help address this limitation.

“There are a couple of major caveats to this study, the most important of which is that this study is not causal. However, we performed several robustness checks to give credence to our findings,” Miller said.

“Future work can also examine how sleep and television habits change as children age and how such changes may contribute to later outcomes in early adolescence, another period of rapid hormonal change and brain development. Lastly, future research can also continue to examine if limits on TV in and of themselves are related to better child outcomes, or if it is a more indirect relationship, as possibly suggested in this study, in that households with these limits are likely to promote healthy sleep habits overall, which might be more influential than sleep duration per se on later child behavior. We are excited about these future possibilities!”

The study, “Predictors of television at bedtime and associations with toddler sleep and behavior in a medicaid-eligible, racial/ethnic minority sample”, was authored by Elizabeth B. Miller, Caitlin F. Canfield, Helena Wippick, Daniel S. Shaw, Pamela A. Morris, and Alan L. Mendelsohn.

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