ImportanceToddler 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.ObjectiveTo 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 ParticipantsThis 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.InterventionsFamilies 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 MeasuresFeasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures.ResultsA 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 RelevanceResults 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 RegistrationISRCTN.org Identifier: ISRCTN58249751

中文翻译：

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幼儿睡前使用筛查网及其对睡眠和注意力的影响


重要性幼儿屏幕时间与睡眠不佳和注意力差异有关。了解屏幕时间对早期发展的因果影响至关重要。目的检验 （1） 在睡前一小时内有屏幕时间的幼儿 （16-30 个月） 进行为期 7 周的父母管理屏幕时间干预 （PASTI） 的可行性，以及 （2） PASTI 对幼儿睡眠和注意力的影响。设计、设置和参与者这项评估员设盲、总部位于英国的随机临床试验于 2022 年 7 月至 2023 年 7 月期间进行。这是一项单中心研究，招募了有 16 至 30 个月幼儿的家庭，居住在 Babylab 75 英里范围内，并且每周 3 天或更多天睡前一小时有 10 分钟或更长时间的屏幕时间。排除标准是 （1） 遗传或神经系统疾病，（2） 早产 （<37 周），以及 （3） 目前参与另一项研究。干预措施 家庭被随机分配 （1：1：1） 至 （1） PASTI：看护人在睡前一小时取消了幼儿的屏幕时间，并使用睡前盒中的活动（例如，阅读、拼图）;（2） 睡前盒（仅限 BB）：使用匹配的睡前活动，不提及屏幕时间;或 （3） 无干预 （NI）：照常继续。主要结局和措施可行性结局：参与率、干预依从性、保留率、家庭经历和评估可接受性。疗效结果：屏幕使用、活动记录仪测量的睡眠和眼动追踪注意力测量。结果共筛选了 427 个家庭，其中 164 个符合条件 （38.4%），105 个家庭被随机分组 （平均 [SD] 年龄，23.7 [4.6] 个月;60 名男性 [57%]）。 该试验是可行的，99% 的参与者 （105 人中的 104 人） 保留，94% 的家庭 （35 人中的 33 人） 坚持 PASTI。PASTI 显示父母报告的屏幕时间减少（与 NI：Cohen d = -0.96;95% CI，-1.32 至 -0.60;仅与 BB：Cohen d = -0.65;95% CI，-1.03 至 -0.27）。PASTI 显示客观测量的睡眠效率（与 NI：Cohen d = 0.27;95% CI，-0.11 至 0.66;仅与 BB：Cohen d = 0.56;95% CI，0.17-0.96）、夜醒（与 NI：Cohen d = -0.28;95% CI，-0.67 至 0.12;与 BB 相比：Cohen d = -0.31;95% CI，-0.71 至 0.10）和日间睡眠减少（与 NI： 科恩 d = −0.30;95% CI，-0.74 至 0.13），但与仅 BB 相比无差异。PASTI 对客观注意力测量没有可观察到的影响。与仅 BB 相比，PASTI 在父母报告的费力控制（Cohen d = -0.40;95% CI，-0.75 至 -0.05）和抑制控制（Cohen d = -0.48;95% CI，-0.77 至 -0.19）方面显示出差异，因为仅 BB 评分增加。结论和相关性这项随机临床试验的结果表明，支持儿科建议，在幼儿就寝前取消屏幕时间是可行的，并且对睡眠显示出适度的初步有益影响。在父母和儿科医生采用 PASTI 之前，需要进行未来的全面验证试验。试用注册ISRCTN。org 标识符：ISRCTN58249751