Singapore, 12 November 2019 – Digital media have become an integral part of lifestyles in recent years, and the ubiquity of digital devices coupled with poor screen use habits can have a detrimental effect on the developmental and psychosocial well-being of children.
A new study by KK Women's and Children's Hospital (KKH), together with National University of Singapore, has found that first exposure earlier than 18 months of age to screen devices – such as smartphones, tablets, videogame consoles, television etc – and the presence of multiple screen devices in the bedroom are associated with elevated sleep disruption and emotional and behavioural difficulties (EBD) in preschool children with neurodevelopmental disorders (NDDs).
"Although this study was conducted in children with NDDs, the results from this study are applicable to the general population, and aligned with existing evidence from studies that have been done on typically developing children," said Dr Mae Wong, Senior Consultant, Department of Child Development, KKH, who led the study.
Conducted from 2015 to 2017, the study looked at 367 preschool children in Singapore aged two to five years old with NDDs such as autism, language delay, global developmental delay, and learning disorders. Using caregiver-reported information, the researchers explored the relationships between the children's screen use and sleep habits, and emotional and behavioural difficulties (EBD).
The study has been published in the Journal of Developmental & Behavioral Pediatrics. Key study findings are outlined below, with further details in Annex A:
To ascertain that the sleep problems and EBDs reported did not arise from the children's own NDDs, but were fully mediated by screen use, statistical analysis was used to control for levels of functional impairment.
"Despite controlling for this, there was still a clear association between first screen exposure earlier than 18 months of age and the presence of one or more screen devices in the bedroom, with sleep problems, poorer sleep quality and more EBDs. Furthermore, children who experienced both lifestyle factors had more sleep and EBD problems than those who experienced only one lifestyle factor," said Dr Wong.
Compared with typically developing children, children with NDDs are at overall higher risk for sleep problems, EBDs and poorer developmental outcomes.
"As this group of children also have more difficulties disengaging from screen use – possibly due to the attractive and repetitive nature of the screen content – increased screen use may possibly further exacerbate these problems," adds Dr Wong.
HOME AND FAMILY LIFESTYLE FACTORS
Earlier introduction to screen use may be related to:
RECOMMENDATIONS FOR PARENTS AND CAREGIVERS
Key KKH study findings on the impact of poor screen use habits on child sleep and emotional and behavioural function is as follows:
Screen time can negatively affect sleep quantity when it displaces sleep or activities related to good sleep hygiene. Even if the child is not directly using the digital device, the presence of the screen in the bedroom (background screen time) can also negatively affect sleep quality by disrupting sleep through physiological arousal, the brightness of the screen suppressing melatonin (a hormone that regulates the sleep/wake cycle) production, or delaying the child's normal sleep/wake cycle.
Problems associated with poor sleep quantity and quality include: difficulty falling asleep, difficulty with staying asleep throughout the night, nightmares, difficulty staying awake during the day, and unexplained decrease in daytime performance.
Sleep disturbances in children contribute to EBDs such as: problems of executive function (e.g., struggling to quickly retrieve or retain information to answer a question or complete a task, difficulty planning multi-step actions), hyperactivity, inattention, poor conduct, low mood and anxiety.
Extracts from the American Academy of Pediatrics (AAP) recommendations for screen use in children:
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