Summary: A world-first trial shows that eliminating screen time in the hour before bed significantly improves toddlers’ sleep quality. The study involved 105 families and found that toddlers who replaced screen time with calming, non-screen activities slept more efficiently and woke up less during the night.
Parents in the intervention group successfully reduced screen time, and all families completed the 7-week trial. These findings offer practical evidence to support pediatric guidance on limiting screen time before bed for better sleep in early childhood.
Key Facts:
- Removing screen time before bed improves toddler sleep efficiency.
- Toddlers had fewer night awakenings after replacing screens with calming activities.
- The study is the first randomized controlled trial supporting this sleep strategy.
Source: University of Bath
A world-first randomised controlled trial (RCT) of toddler screen time shows that removing screen time in the hour before bed improves the quality of toddler sleep.
It is widely recognised that poor sleep in early childhood is linked to negative outcomes such as health problems, developmental difficulties, and behavioural issues.
The Bedtime Boost study, funded by the Nuffield Foundation is the first RCT supporting paediatric guidance to limit toddler screen time before bed.
Researchers from University of Bath, University of the Arts London (UAL), Birkbeck, Queen Mary University of London, and King’s College London recruited families with 16- to 30-month-old toddlers from across London.
One hundred and five families who already used screens with their child before bed were randomly allocated to either the intervention – parents were asked to remove all screen time in the hour before bed and use a Bedtime Box containing non-screen-based activities instead (e.g. calming play, reading or puzzles) over a 7-week period; or to control conditions, with matched activities but no mention of screen time. Toddler sleep was recorded before and after the intervention using a wearable motion tracker.
Parents in the intervention group were able to successfully remove toddlers’ screen time before bed, and toddlers’ sleep quality improved, with more efficient nighttime sleep and fewer night awakenings.
Professor Rachael Bedford, who oversaw the research at the University of Bath and is now Head of the Queen Mary Child Development Lab and co-lead on the project said:
“We worked closely with parents and early years practitioners to ensure the Bedtime Boost intervention was low-cost and easy to implement.
“Results suggest the trial was highly feasible for parents, with all of the intervention families completing the trial. However, further work is needed to understand how the varied ways in which families use screen media may influence these effects.”
Study lead Professor Tim Smith, UAL Creative Computing Institute, said:
“Previous correlational studies have shown that the more screen time toddlers have, the worse they sleep. But it was not possible to know if the screen use was causing sleep problems or vice versa.
“The Bedtime Boost study provides the first preliminary evidence that removing toddler screen use before bed may lead to better sleep. Further work is required to replicate these effects in a larger number of families.”
The intervention was co-created with families and early-years experts, including representatives from the Early Years Alliance, National Childbirth Trust, The Sleep Charity, and children’s centre staff, to ensure the intervention was as inclusive as possible.
About this sleep and neurodevelopment research news
Author: Chris Melvin
Source: University of Bath
Contact: Chris Melvin – University of Bath
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Toddler Screen Use Before Bed and Its Effect on Sleep and Attention A Randomized Clinical Trial” by Rachael Bedford et al. JAMA Pediatrics
Abstract
Toddler Screen Use Before Bed and Its Effect on Sleep and Attention A Randomized Clinical Trial
Importance
Toddler screen time has been associated with poorer sleep and differences in attention. Understanding the causal impact of screen time on early development is of the highest importance.
Objective
To test (1) the feasibility of the 7-week parent-administered screen time intervention (PASTI) in toddlers (aged 16-30 months) who have screen time in the hour before bed and (2) the impact of PASTI on toddlers’ sleep and attention.
Design, Setting, and Participants
This assessor-blinded, UK-based randomized clinical trial was conducted between July 2022 and July 2023. This was a single-site study that enrolled families with a toddler aged between 16 and 30 months, living within 75 miles of the Babylab, and with 10 minutes or more of screen time in the hour before bed on 3 or more days a week. Exclusion criteria were (1) a genetic or neurological condition, (2) premature birth (<37 weeks), and (3) current participation in another study.
Interventions
Families were randomized (1:1:1) to (1) PASTI: caregivers removed toddler screen time in the hour before bed and used activities from a bedtime box instead (eg, reading, puzzles); (2) bedtime box (BB only): used matched before-bed activities, with no mention of screen time; or (3) no intervention (NI): continued as usual.
Main Outcomes and Measures
Feasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures.
Results
A total of 427 families were screened, 164 were eligible (38.4%), and 105 families were randomized (mean [SD] age, 23.7 [4.6] months; 60 male [57%]). The trial was feasible, with 99% participant (104 of 105) retention and 94% of families (33 of 35) adhering to PASTI. PASTI showed reductions in parent-reported screen time (vs NI: Cohen d = −0.96; 95% CI, −1.32 to −0.60; vs BB only: Cohen d = −0.65; 95% CI, −1.03 to −0.27). PASTI showed small to medium improvements in objectively measured sleep efficiency (vs NI: Cohen d = 0.27; 95% CI, −0.11 to 0.66; vs BB only: Cohen d = 0.56; 95% CI, 0.17-0.96), night awakenings (vs NI: Cohen d = −0.28; 95% CI, −0.67 to 0.12; vs BB only: Cohen d = −0.31; 95% CI, −0.71 to 0.10), and reduced daytime sleep (vs NI: Cohen d = −0.30; 95% CI, −0.74 to 0.13) but no difference compared with BB only.
There was no observable effect of PASTI on objective measures of attention. Compared with BB only, PASTI showed a difference on parent-reported effortful control (Cohen d = −0.40; 95% CI, −0.75 to −0.05) and inhibitory control (Cohen d = −0.48; 95% CI, −0.77 to −0.19), due to an increase in BB-only scores.
Conclusions and Relevance
Results of this randomized clinical trial show that, supporting pediatric recommendations, removing screen time before toddler bedtime was feasible and showed modest preliminary beneficial effects on sleep. A future full confirmatory trial is needed before PASTI’s adoption by parents and pediatricians.
Trial Registration
ISRCTN.org Identifier: ISRCTN58249751
