Pickard Hannah, Chu Petrina, Essex Claire, Goddard Emily J, Baulcombe Katie, Carter Ben, Bedford Rachael, Smith Tim J
Centre for Brain and Cognitive Development, Birkbeck, University of London, London, United Kingdom.
Department of Biostatistics and Health Informatics, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.
JAMA Pediatr. 2024 Dec 1;178(12):1270-1279. doi: 10.1001/jamapediatrics.2024.3997.
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.
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.
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.
Feasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures.
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.
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.
ISRCTN.org Identifier: ISRCTN58249751.
幼儿的屏幕使用时间与较差的睡眠及注意力差异有关。了解屏幕使用时间对早期发育的因果影响至关重要。
测试（1）针对睡前一小时有屏幕使用时间的16至30个月幼儿，为期7周的家长管理屏幕使用时间干预措施（PASTI）的可行性，以及（2）PASTI对幼儿睡眠和注意力的影响。
设计、地点和参与者：这项评估者设盲的、基于英国的随机临床试验于2022年7月至2023年7月进行。这是一项单中心研究，纳入了居住在Babylab方圆75英里内、家中有一名16至30个月幼儿且每周至少3天睡前一小时屏幕使用时间达10分钟或更长时间的家庭。排除标准为：（1）患有遗传或神经疾病；（2）早产（<37周）；（3）目前正在参与另一项研究。
家庭被随机分为（1:1:1）三组：（1）PASTI组：照顾者在睡前一小时去除幼儿的屏幕使用时间，改为使用睡前盒子中的活动（如阅读、拼图）；（2）仅睡前盒子组（BB only）：使用匹配的睡前活动，不提屏幕使用时间；（3）无干预组（NI）：照常进行。
可行性结局：参与率、干预依从性、留存率、家庭体验和评估可接受性。有效性结局：屏幕使用情况、通过活动记录仪测量的睡眠情况以及眼动追踪注意力测量指标。
共筛查了427个家庭，164个家庭符合条件（38.4%），105个家庭被随机分组（平均[标准差]年龄为23.7[4.6]个月；60名男性[57%]）。该试验可行，99%的参与者（105名中的104名）留存，94%的家庭（35个中的33个）坚持PASTI。PASTI组家长报告的屏幕使用时间减少（与NI组相比：Cohen d = -0.96；95%置信区间，-1.32至-0.60；与仅BB组相比：Cohen d = -0.65；95%置信区间，-1.03至-0.27）。PASTI组在客观测量的睡眠效率方面有小到中等程度的改善（与NI组相比：Cohen d = 0.27；95%置信区间，-0.11至0.66；与仅BB组相比：Cohen d = 0.56；95%置信区间，0.17 - 0.96），夜间觉醒次数减少（与NI组相比：Cohen d = -0.28；95%置信区间，-0.67至0.12；与仅BB组相比：Cohen d = -0.31；95%置信区间，-0.71至0.10），白天睡眠时间减少（与NI组相比：Cohen d = -0.30；95%置信区间，-0.74至0.13），但与仅BB组相比无差异。PASTI对注意力的客观测量指标没有明显影响。与仅BB组相比，PASTI组在家长报告的努力控制（Cohen d = -0.40；95%置信区间，-0.75至-0.05）和抑制控制（Cohen d = -0.48；95%置信区间，-0.77至-0.19）方面存在差异，这是由于仅BB组的得分有所增加。
这项随机临床试验的结果表明，遵循儿科建议，在幼儿睡前去除屏幕使用时间是可行的，并且对睡眠有适度的初步有益影响。在家长和儿科医生采用PASTI之前，需要进行未来的全面验证性试验。
ISRCTN.org标识符：ISRCTN58249751
