Jan. 9, 2025 – Many 4-year-olds spend this prime year of early childhood perfecting the arts of picky eating, skipping naps, waking up before the adults do, and indulging in the digital babysitter.
But new research suggests a specific relationship between screen time, sleep, and behavior problems that parents of young children should know about.
Researchers in China found that greater screen time is linked to greater sleep problems among preschoolers. The two things are also linked to an increased risk of hyperactive behavior, attention issues, and emotional problems, which may lead children to seek to use screens even more. Ultimately, the researchers concluded, this can become a cycle.
“More screen time is linked to a greater chance of experiencing hyperactive and inattentive behaviors, such as being fidgety and unable to stay still, along with emotional issues like often complaining about not feeling well physically, having headaches or stomachaches,” said researcher Shujin Zhou, PhD, a postdoctoral fellow at the Institute of Early Childhood Education at Shanghai Normal University in China. “Additionally, we observed that extended screen time results in poorer sleep quality for children, with symptoms like trouble falling asleep at night, shorter sleep periods, and being more likely to wake up during sleep.”
Screen use should be limited to an hour or less per day for children ages 2 to 5 years old, according to the American Academy of Pediatrics, which acknowledges that well-designed educational programs like Sesame Street can aid development of social, language, and reading skills.
Prior research has linked screen time with a higher risk of attention and hyperactivity problems in children. It’s also well established that screens affect sleep in people of all ages.
But don’t be too hard on yourself if you’re using screens with your young child, said child psychologist Miller Shivers, PhD, an infant and early childhood clinical psychologist at the Ann & Robert H. Lurie Children's Hospital of Chicago. The key is limits, and just as this latest study suggests, a focus on quality sleep may be more of a priority than counting every second that the digital babysitter is on duty.
“If you're using it just for the fact of ‘I've got to cook dinner, so let them just be entertained,’ that's fine,” said Shivers, who is also an assistant professor of psychiatry and behavioral health at Northwestern University’s Feinberg School of Medicine. “Also, we know that if you’re a parent of little kids who have behavioral problems, you tend to use more screen time, right? Because you just need a break sometimes.”
What the New Study Shows
For this latest study, researchers in China analyzed survey data from 571 mothers of children ages 3 to 6 years old living in Shanghai, China. About two-thirds of them were the sole children in their household. The moms reported their children’s screen time, and they also rated 25 statements as not true, somewhat true, or certainly true about their child. Some of the strengths and difficulties measured included:
- Being considerate of other people’s feelings
- Being restless, overactive, or not being able to stay still for long
- Losing their temper often
- Generally being well-behaved and usually doing what adults request
- Having a good attention span, seeing work through to the end
The mothers also reported on sleep measures that are regularly used by child health experts, such as how often a child naps, wakes at night, gets up and switches beds, or wakes up very early.
Not only did the researchers report a relationship between screen time and sleep problems, and between sleep and attention and hyperactivity problems; the team’s analysis also suggested that sleep quality plays a key role.
“In these relationships, sleep quality serves as a partial mediator between screen time and hyperactive attention problems and emotional symptoms,” Zhou said in an email to WebMD. “That means screen time first affects sleep quality, which then further impacts the child's hyperactivity and emotions.”
That doesn’t prove, though, that poor sleep causes these problems, cautioned Shivers, who was not involved in the research. She noted that the study couldn’t determine what happened first – poor sleep or behavior problems.
“Kids with behavioral problems, especially early emerging ADHD or autism, they don't sleep well,” she said. “And kids with just general behavioral problems, their sleep is not great – maybe they're just defiant and you can't get them in bed. So is it the screen time or is it that they're not sleeping great that’s exacerbating their behavioral problems?”
“Some little kids look hyperactive when they haven't slept great,” Shivers added.
Ultimately, this latest study serves as a great moment for parents and caregivers to take stock of children’s screen time limits as well as the family’s approach to sleep.
Tips for Parents
Start with examining your child’s sleep routine. Screens should be off an hour or two before bed, and definitely not stored in a child’s room.
“If kids are kind of sneaking screen time during bedtime, or they're pushing bedtime later and later because they're having trouble relinquishing screens, that might be part of that feedback loop that I'd be interested in,” said child psychologist Matt Edelstein, PsyD, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University’s School of Medicine.
If your child knows there are structured and enforced limits for screen time use in your house, it will make things easier.
“We want it to be available only sometimes. But many families don't operate that way, and what that ends up looking like is that kids are on screens for eight to 10 hours a day, and I'm talking about kids 3, 4, and 5 years old,” said Edelstein, who also directs a clinic at the Kennedy Krieger Institute in Baltimore that helps children and their parents work through issues like tantrums, aggression, not following directions, poor sleep, and anxiety.
Parents worried that their child may have behavior problems can check the signs on a new app that Shivers and a team from Lurie Children’s Hospital developed called Little Lessons. The app covers attention, hyperactivity, tantrums, defiance, physical aggression, and anxiety, among other topics, and helps parents identify symptoms, learn about possible causes, and offers tips to manage the issues.
When making sleep routine or screen limit changes, it’s important to stay consistent and persevere with the new normal for 10 days to two weeks, Shivers advised.
One recent randomized clinical trial in which parents of toddlers who changed their screen-time-before-bed habits and instead used a “bedtime box” of activities for seven weeks showed small to medium improvements in some measures, such as time falling asleep and night awakenings. There weren’t any significant impacts on children’s attention.
As for the potentially self-sustaining cycle of poor sleep, screen time, and behavior problems, Edelstein said this latest study is yet another reminder of the enormous influence we have as parents and caregivers.
“This study confirms that a child's environment is incredibly important to their development,” he said. “The things that we do with our child and the things that we have our child interact with – whether intentionally or unintentionally – have really big impacts on how our child develops.”
