Electronic Media Use and Sleep in School-aged Children and Adolescents a Review Free Pdf

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Electronic media use and sleep in children and adolescents in western countries: a systematic review

BMC Public Health volume 21, Commodity number:1598 (2021) Cite this article

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Abstract

Background

Sleep is essential for child and boyish wellness and well-being. There is an increasing interest in whether electronic media utilise affects children and young adolescents' sleep. Prior reviews have focused on a school-aged population. Moreover, it is crucial that inquiry continuously addresses the processes of technology and media use and the implication on sleep. This systematic review examines the evidence of electronic media utilise related to sleep among 0–fifteen-year-olds.

Methods

Searches were carried out in four databases (CINAHL, Web of Science, EMBASE, and Medline). Inclusion criteria included age ≤ xv years, and intervention, cohort, or cross-sectional studies from western countries. Methodological quality was rated using the Quality Assessment Tool for Quantitative Studies by two contained reviewers. Data was extracted using a standardized data extraction class. Synthesis was done past summarizing results beyond studies by age groups of 0–5, 6–12, and 13–xv years within four sleep domains: Bedtime and sleep onset; Sleep quality; Slumber duration; Daytime tiredness.

Results

The search identified ten,719 unique studies, of which 109 fulfilled inclusion and exclusion criteria and were assessed for methodological quality. In total, 49 studies were included in the review. The study designs were randomized controlled trials (due north = three), quasi-experimental studies (n = 2), prospective cohort studies (n = 15), and cross-sectional studies (north = 29). Evidence for an association betwixt electronic media use and slumber elapsing was identified, with stronger evidence for half dozen–15-years-olds than 0–v-year-olds. The evidence for a relationship between electronic media use and other sleep outcomes was more inconclusive. Notwithstanding, for half dozen–12-yr-old children, in that location was evidence for associations of electronic media use with delayed bedtime and poor slumber quality. For thirteen–15-year-olds, there was evidence for associations between screen fourth dimension and problems falling comatose, and between social media use and poor sleep quality.

Conclusions

Overall, electronic media employ was mostly associated with shorter sleep duration in children and adolescents. Studies with stronger research design and of higher quality are needed to draw solid conclusions about electronic media'due south touch on other slumber outcomes. Public awareness and interventions could be promoted near the potential negative impact on children's slumber of electronic media devices that are used excessively and close to bedtime.

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Background

Sleep has a major touch on the health and well-existence of children and adolescents. Slumber is vital for development and learning power, and insufficient sleep over an extended period can accept long-term physical and psychological health implications [1]. Physiological and psychological changes that sally in babyhood and youth may impact negatively on slumber, only poor sleep is arguably as well related to, or compounded past, external factors such equally early school starting time times, environmental conditions in the chamber (e.g. racket, high temperature or as well much light) and the availability of electronic media [one,two,3]. Over the last few decades, a major lifestyle change has happened due to the incorporation of electronic media device utilize into people's daily life. Electronic media has become a core part of young people's lives and children today are growing up surrounded by electronic media devices. Studies demonstrate that almost children, fifty-fifty as young equally four months of historic period, have experience with using electronic media devices, although electronic media consumption is largest amid older teenagers [4]. Media devices have become an integral role of children's evolution environment and a prevalent manner of communication among adolescents [5]. Although electronic media is widely accepted and accessible in the home environment, at that place is nonetheless just a limited understanding of how admission to and use of electronic media may impact the slumber patterns of children and adolescents.

Engineering is continuously evolving, and the way electronic media devices are used in everyday life may modify over fourth dimension. Although previous systematic reviews and meta-analyses have established a correlation between media use and sleep [6,7,8], it is crucial that research continuously addresses the processes of technology and media use and its implication on children and adolescents' sleep patterns. Therefore, reviews that include the newest types of electronic media devices and technological trends are needed. Moreover, previous reviews on this subject field focus mainly on an older paediatric target group, and there is express knowledge about the evidence of electronic media devices and the impact on sleep among pre-schoolers [9].

The aim of this study was to systematically review the literature on the impact of using electronic media on slumber in children and adolescents. The population was pre-schoolhouse children, school-age children up to 12-years-old and young adolescents up to 15 years old. The exposure was access to and use of electronic media devices, and the outcomes were bedtime and sleep onset, sleep quality during dark, sleep elapsing and daytime tiredness. The intention was to inform policy and practice and to highlight what further research is needed on this topic.

Methods

A narrative method was applied to synthesis the data on the association between electronic media use and sleep amongst children and adolescents.

Eligibility criteria

Nosotros included studies which fulfilled the following eligibility criteria: (1) Assessed the associations between the utilise of or access to electronic media devices and slumber, i.e. delayed bedtime, sleep onset latency, sleep quality during dark-fourth dimension, slumber duration and daytime tiredness; (2) Published in English language between January i, 2009 and Baronial 31, 2019; (three) From western countries; (4) Examined children and adolescents between 0 and 15.9 years of age without any diagnoses/diseases. Electronic media devices were defined as mobile phones, televisions, touchscreens/tablets, computers, or video game consoles. The exclusion criteria were apps intended to treat sleep disorders, or problems (e.thou., slumber apnoea), and studies examining electromagnetic radiation.

Information sources and search strategy

The PICo model was used to generate the search strategy, and the search strategy was divided into three search blocks: P (Patient / Trouble / Population), I (Miracle of interest), and Co (Context). The population was children and adolescents aged 0–15; the field of interest was electronic media devices, and the context was before sleep (bedtime and sleep onset), during sleep (sleep quality during night), and afterwards slumber (sleep duration and daytime tiredness). Nosotros performed a systematic search in four databases: CINAHL, EMBASE, Spider web of Science, and Medline based on keywords (subject area headings/MeSH terms) and free text searches (title, keywords, text). The search terms and syntax included relevant synonyms for the search terms adolescents/children (e.chiliad. minor, teenager), electronic media devices (e.g. cell telephone, screen), and sleep (due east.k. sleep latency, bedtime routine) (meet Supplementary eTable 1 for the full search in each database). In addition, we included previous reviews to identify relevant studies.

Study selection; screening, quality assessment, and data extraction

Title and abstracts identified were screened for eligibility, and full texts of potentially eligible articles were read and assessed by two reviewers (LL and INS) independently. Discordance regarding inclusion was resolved through discussion. Two reviewers (LL and SA) independently assessed the methodological quality of the included quantitative studies. To ensure consistency in the quality assessments, meetings were held on an ongoing basis, focusing on inter-rater reliability. The methodological quality of the quantitative articles was assessed using the Effective Public Wellness Practise Project (EPHPP) assessment tool [ten], based on the post-obit five components: selection bias, written report design, confounders, data collection methods, and withdrawal/dropouts. The EPHPP covers any quantitative study design, it is developed for utilize within public health and has been found to accept psychometric properties as skilful as the Cochrane adventure-of-bias tool. Each study was rated as loftier, moderate, or low quality. Low-quality studies were excluded to ensure moderate evidence. Nosotros extracted the information using a standardized information extraction grade. Information technology included country of study, age, sex, study design, sleep outcomes, exposure (electronic media device measures) and reported associations. Synthesis was washed by summarizing results and conclusions beyond studies grouped by age groups of 0–five.9 years, six–12.9 years, and 13–15.9 years within 4 sleep domains: Bedtime and slumber onset; Slumber quality; Sleep duration; Daytime tiredness. If a study included data on ages overlapping the defined age categories, nosotros used the hateful age to classify the written report to an historic period category. A few studies (n = two) included a large age bridge. Withal, these studies had performed analyses past subgroups of age corresponding to our categories.

Results

A total of 446 full texts were reviewed, of which 338 were excluded (Fig. 1). Nosotros identified 7 qualitative studies of which three studies received high- or moderate-quality assessments. These studies focused on factors (eastward.thousand. the office of parents) that facilitate the accessibility and acceptability of electronic media employ in relation to sleep, and non on how electronic media use might affect sleep in children and adolescents. The results from the qualitative studies volition be reported in a split up paper given the focus on quantitative studies in this systematic review.. In total, 52 quantitative studies were not included considering they received a low-quality assessment rating as a upshot of a range of methodological issues: weakness in report design, a small percentage of responses, not controlling for confounders, and not reporting validity and reliability of measures used. Of the 49 included quantitative studies, iv studies received a high-quality cess rating, and 45 studies received a moderate-quality cess rating. Of the included studies, eighteen were conducted in North America (USA and Canada) [eleven,12,13,14,15,xvi,17,eighteen,nineteen,20,21,22,23,24,25,26,27,28], 23 in Europe (England, Finland, Sweden, Holland, Switzerland, French republic, Italy, Kingdom of spain, and Federal republic of germany) [29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,l,51], five in Australia and New Zealand [52,53,54,55,56], and 3 studies combined several western countries [57,58,59]. There were three randomized controlled trials (RCTs) [27, 28, l], two quasi-experimental studies [26, 51], 15 prospective cohort studies [12, 16, 19, 24, 30, 32, 35, 37, twoscore, 42, 45, 47, 48, 52, 55], and 29 cross-exclusive studies [11, 13,14,fifteen, 17, 18, 20,21,22,23, 25, 29, 31, 33, 34, 36, 38, 39, 41, 43, 44, 46, 49, 53, 54, 56,57,58,59] (see Table 1 for chacteristics of the included studies). The majority of the included studies adjusted for all or well-nigh of the post-obit confounders: ethnicity, historic period/class, sex, and socioeconomic status (due east.g., parental education and/or parental occupation). Some studies likewise included health factors such as BMI, psychological symptoms, and concrete activities. Detailed descriptions of study blueprint and results are available in Supplementary eTables two–iv, and references on excluded studies in Supplementary eTable 5.

Fig. 1

Menses chart of the review process

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Tabular array 1 Study characteristics of the 49 included studies in the systematic review

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Electronic media use amongst children aged 0–five

Table 2 summarizes the results of the 13 studies [11,12,thirteen,xiv,15, 27, 29,thirty,31,32, 52, 56, 57] included for 0–5-year-olds.

Tabular array ii Summary of studies and their findings on the relationship between electronic media devices and sleep outcomes among 0–5-year-olds

Full size tabular array

Bedtime and sleep onset

5 studies analysed the association betwixt electronic media utilize and late bedtime and/or slumber onset [xi, 13, 14, 29, 52]. Three studies examined tablet use and found an association of tablet utilise (both general and at bedtime) with delayed bedtime or sleep onset latency [11, thirteen, 14]. There were two studies on television viewing earlier bedtime and both found an clan with delayed bedtime or slumber onset latency [11, xiii]. 2 studies estimated the association between mobile phone utilize and delayed bedtime or slumber onset latency with one finding a positive association for the use of mobile phones at night-time [14] and one finding no clan [xi]. The association between gaming and delayed bedtime or slumber onset latency was examined in three studies [11, 13, fourteen] with 1 study reporting an association [thirteen]. Ane longitudinal report examined screen time in two-year-olds and found a positive association with sleep onset latency in 5-year-olds [52]. No evidence was found for an association between computer/Internet apply and delayed bedtime/sleep onset [11, 13, 14]. One study found an clan between the presence of a television in the bedroom and delayed bedtimes on weekdays, simply not on weekends [13].

Sleep quality

There was no evidence for television viewing or use of touchscreens [29], while there was inconsistent bear witness for general screen time utilize [fifteen, 52, 56] on night awakenings or slumber disturbances. An intervention study showed that promotion of prosocial content on electronic media reduced sleep problems [27].

Sleep duration

Regarding sleep elapsing, three studies showed that overall screen fourth dimension was associated with shorter sleep duration [15, 52, 57], and six studies showed this concerning tv viewing [eleven,12,13, 30,31,32] and three studies concerning use of touch screen or tablet [11, 14, 29]. Lack of association was found for the apply of mobile phones [eleven, 14], video gaming [11, xiii, fourteen] and computers or Net [11, 13, 14]. Inconsistent evidence was found for the presence of electronic media devices in the bedroom [12, thirteen]; for ethnic minority children, television in the bedroom among 4-year-olds was associated with 32 fewer minutes of slumber per day at historic period 7 [12].

Daytime slumber elapsing

Three studies found associations between goggle box viewing and longer naps [11, xiii, 29], while inconsistent evidence was found for the utilise of mobile phones [xi, xiv] and touch screen or tablet [11, fourteen, 29]. No prove was found for gaming, figurer or internet use, and the presence of electronic media devices in the bedroom [11, 13, 14].

Electronic media utilise among children anile 6–12

Table three summarizes the results for the xv studies [fifteen,sixteen,17,xviii,19,20,21, 28, thirty, 33,34,35,36,37, 53] included for the age range 6–12.

Table 3 Summary of studies and their findings on the relationship between electronic media devices and sleep outcomes amongst 6–12-year-olds

Full size tabular array

Bedtime and sleep onset

Six studies analysed the association between electronic media use and late bedtime and/or slumber onset [xviii, 33, 35,36,37, 53]. Five of the studies found an association. Some studies only found an clan when stratified by specific variables such as weekends/weekdays. For example, Mireku et al. (2019) showed that use of screen-based media device in the terminal hour earlier bedtime was associated with i.44 times the odds of delayed sleep onset on weekends, simply no association was establish on weekdays [36]. Two studies assessed the association between video gaming and slumber onset [18, 33]. Arora et al. (2014) showed that high frequency of gaming at bedtime was associated with a vi.two min prolonged sleep onset on weekdays [33]. Falbe et al. (2015) reported that each hour per day of gaming was associated with a ix.viii min later bedtime [18]. Two studies constitute that electronic media in the sleeping room, including mobile phones, televisions, and computers, were associated with later bedtimes [18, 37]. Ane of the studies, nonetheless, only found a meaning clan among boys, not girls [37]. One study did not discover that electronic media devices in the bedroom was associated with sleep latency and problem falling asleep [33].

Slumber quality

Vi of eight studies institute a positive association betwixt the utilise of electronic media, including full screen fourth dimension and bedtime use of television set and mobile phone, and night-time awakenings/slumber disturbances [xv, 33, 35, 53] or poor sleep quality [20, 36]. For instance, Mireku et al. (2019) establish that using mobile phone or watching television in the dark was associated with restless slumber, waking up at night, and waking early in the morning [36].

Sleep elapsing

A full of 15 studies were identified, examining the clan betwixt electronic media apply and slumber duration among half-dozen–12-year-olds [fifteen,xvi,17,eighteen,19,20,21, 28, 30, 33,34,35,36,37, 53]. The studies found use of mobile phone [17, 33, 35, 36], social media [33], and computer or idiot box [17, eighteen, 21, xxx, 33, 36, 37] associated with brusque slumber duration. Six studies examined the association between electronic media in the bedchamber and slumber duration [17, 18, 28, 33, 34, 37]. Among these studies, iii found an association. Chahal et al. (2012) showed a dose-response clan, where children who had admission to more than electronic media in their bedroom slept less [17]. Falbe et al. (2015) found that children who slept shut to a small screen (e.g., mobile phone) reported 21 min less slumber compared to children who did not [18].

Daytime tiredness

Two studies examined mobile telephone use and daytime tiredness [35, 53]. Redmayne et al. (2013) found that children disturbed by their mobile phone at night at least once a week were iii.5 times more likely to feel daytime tiredness than children who were non disturbed by their mobile telephone at night [53]. Huss et al. (2015) did non find an association [35].

Electronic media use among children anile 13–fifteen

Tabular array iv summarizes the results of the 24 studies [15, 22,23,24,25,26, 38,39,40,41,42,43,44,45,46,47,48,49,fifty,51, 54, 55, 58, 59] included in the age range xiii–15.

Table 4 Summary of studies and their findings on the relationship between electronic media devices and slumber outcomes amidst 13–xv-year-olds

Full size tabular array

Bedtime and sleep onset

Eleven studies investigated the relationship betwixt electronic media use and delayed bedtime and slumber onset [23, 24, 40, 43, 45, 46, 48,49,fifty,51, 59]. Ix of these studies showed a positive association [23, 40, 43, 45, 46, 48, 49, 51, 59]. High electronic media use was associated with problems falling asleep/later sleep onset [23, 40, 45, 46, 51, 59], delayed bedtime [43, 46, 49] and bedtime problems [45] The study past Poulain et al. (2019) showed a positive clan for high utilise of computer or Cyberspace (three–4 h/day or more) and more bedtime problems at 12-month follow-upward, while no clan was establish for television viewing or mobile phone utilise [45]. Two studies found an association between social media use and delayed sleep onset [46, 48]. Van der Schuur et al. (2019) found that social media stress was longitudinally related to sleep onset latency among girls, but not boys [48]. Scott et al. (2019) institute a dose-response relationship between social media use and late sleep onset, where a higher use of social media was associated with college odds of late sleep onset [46].

Slumber quality

9 studies assessed the clan between electronic media apply and sleep quality, including restless slumber, night-time awakenings, and insomnia complaints [15, forty, 41, 44,45,46, l, 54, 55] and seven of these studies institute a positive association [15, xl, 41, 44, 46, 54, 55]. Three of these studies examined social media utilise [46, 54, 55]. In that location were indications that a big amount of time on social media or problematic utilize of social media had an impact on sleep quality [46, 54, 55]. Problematic utilize of social media was measured by whether the adolescents preferred spending time on social media rather than engaging in social activities or used social media to feel practiced most themselves.

Sleep duration

The relationship between electronic media utilize and slumber duration was examined in 13 studies [xv, 22,23,24,25,26, 38, 39, 42, l, 51, 58, 59]. Mazzer et al. (2018), who examined 8th- and ninth-class students over a year, found that of electronic media use was associated with short sleep duration [42]. Regarding different types of electronic media, it appears that computers [22, 24, 38, 58], mobile phones [22, 24, 38], and video games [22, 38] afflicted sleep duration. Brunetti et al. (2016), for example, found that computer use doubled the odds of a curt night's sleep, while talking on a mobile phone tripled the odds of a curt night's sleep [22]. In contrast, Tavernier et al. (2017) constitute that talking on the phone increased the sleep elapsing, whereas texting reduced the sleep duration. In this report, social media utilise was not related to slumber duration, whereas Twenge et al. (2017) plant an association between social media and curt sleep duration. Ii studies investigated the presence of electronic media in the bedroom and sleep duration. There were indications that a calculator, only not a television or gaming console, in the bedroom negatively afflicted sleep duration [23, 39].

Daytime tiredness

Eight studies examined the association between electronic media use and daytime tiredness, and plant mixed results [22, 23, 40, 45, 47,48,49,l]. Poulain et al. (2019) showed that high figurer or Cyberspace use, merely not television and mobile telephone use, resulted in more than daytime tiredness [45]. Brunetti et al. (2016) found that estimator use and time spent talking on the mobile telephone were associated with more daytime sleepiness while no associations were found for videogame time and television use [22]. I study that examined social media showed that using social media was non in itself associated with daytime tiredness, just adverse emotional reactions arising from social media (i.e. social media stress) was related to daytime tiredness among girls [48].

Discussion

This systematic review summarizes results from 49 epidemiological studies on associations betwixt electronic media apply and slumber in 0–15-year-old children and adolescents. Across historic period groups, we found consequent evidence that media utilize was associated with short sleep duration. The evidence for a human relationship betwixt electronic media use and other sleep outcomes was less stiff.

For the youngest children (i.e. preschool children), television watching, and tablet device use were associated with difficulties in falling comatose and less sleep duration. Moreover, heavier boob tube use was associated with increased daytime napping, which suggests poorer sleep consolidation and less mature sleep patterns [threescore]. There was no or insufficient evidence for an association of video game, mobile phone, estimator, and the presence of an electronic media device in the bedroom with poor sleep outcomes among 0–v-year-olds.

For 6–12-year-old children, use of electronic media (television, video game console, mobile phone, computer, screen time) in general and at bedtime and their presence in the bedroom was associated with later bedtimes and shorter slumber duration. Additionally, we establish evidence for an association of bedtime television and mobile phone use as well as full screen time with sleep disturbances and awakening at nighttime. Similar results take been reported in a previous systematic review examining the clan between portable screen-based media device access or use in the bedchamber and less sleep [61]. Our results support the hypothesis that evening exposure to bright light from screens may disturb the sleep-wake cycle and suppresses the melatonin production [vii, 62]. Other mechanisms through which media use may interfere with sleep onset and sleep problems are fourth dimension replacement (i.e. fourth dimension spent on the screens at night displaces time spent sleeping) or the psychological stimulation from the media content [63].

For xiii–fifteen-year-olds, there was evidence for a positive association of total screen fourth dimension and employ of figurer and mobile phone with less sleep. Moreover, the included studies indicated that screen time was associated with problems falling asleep, and social media use was associated with poor slumber quality. Telly watching was least likely to be associated with poor slumber outcomes. Thus, for this historic period group our study supports that more interactive forms of electronic media with increases in physiological arousal [64] may have greater touch on on sleep than more passive forms [7, 65]. Our results are in line with a systematic review [66] including an older age group (15–24-year-olds) that suggests that adolescents often use electronic devices for social media, and this may explain the human relationship between use of electronic media device and poor slumber.

Five of the included studies investigated subgroup outcome or effect modification, i.e. whether an observed clan differed depending on characteristics of the study sample. Four studies performed gender-specific analyses [39, 40, 48, 49] and one study examined ethnicity [12]. The studies institute that the association betwixt electronic media use and sleep may depend on gender and ethnicity. For example, a report from U.s. constitute that sleeping accommodation Goggle box was associated with less slumber for ethnic minority children but not among white non-Hispanic children [12]. Future studies of properly powered subgroup analysis should further investigate whether the association between media use and slumber in children and boyish is differentially impacted past factors such equally age and ethnicity [67]. Moreover, how does parenting style, values, and socioeconomic status of the family contribute to the affect of electronic media on slumber. Improvements in sociocultural and contextual understanding would elucidate the clan between media use and sleep in childhood and adolescence [68].

Limitations and future directions

We noted several limitations in the studies included in this review. Firstly, most of the study designs were cross-exclusive which precluded causal inferences and limit the conclusions of this review because it is non possible to uncover the direction of relationships between electronic media and slumber. Some children and adolescents may experience bedtime procrastination (i.e. going to bed later than intended despite the absence of external reasons) [69] and utilise electronic media as an activity earlier sleep. Others may use electronic media to help them get to sleep [70] or because of tiredness [42]. Such reciprocal associations are confirmed by some of the included studies [42, 45]. Prospective studies with measurements at multiple time points are needed to identify how and when use of electronic media impact on sleep in babyhood and youth. Secondly, both cocky-reported and parent-reported information may be discipline to dubiety. For example, adolescents tend to over-report their slumber duration compared with objective measurements such as actigraphy or diary methods [71], and parents tend to report amend sleep for adolescents compared with both self-reported and objective measurements [72]. Thirdly, the included studies were measuring media apply and sleep outcomes differently (eastward.one thousand., overall screen time exposure versus bedtime use). Due to the substantial heterogeneity in measurements of media and slumber as well as in effect size mensurate, it was difficult to summarize the results, estimate the magnitude of the associations and provide articulate conclusions. Nonetheless, nosotros have rigorously outlined the associations between electronic media and each sleep outcome which enables comprehensive results; withal, there were several insufficiencies. The studies among 6–12-year-olds lacked measurements of sleepiness during daytime; a gene that may have serious consequences on schoolwork and leisure activities. In the age group of 13–15-yr-olds, there was a lack of studies measuring the electronic media apply at bedtime or during the dark. This is an of import surface area to examine considering parental monitoring and parent-set bedtimes decline significantly from early to late years of adolescence [73] which might imply an increase in the use of electronic media devices at bedtime.

This review was limited to include studies published in English and study populations from Western countries. The latter brand us able to generalize to Western countries simply limits the generalizability of our findings to non-Western countries. The reason for the inclusion criteria was that traditions, values, conditions and environments for slumber practices and attitudes may differ between Western and non-Western countries [74], inhibiting results to inform policy and practice.

Despite these limitations, we note several strengths of this study in addressing the association betwixt electronic media device utilize and sleep in children and adolescents. Get-go, the studies represented a relatively short period of time which ensured that the definition of electronic media devices remained stable. Secondly, nosotros excluded studies of low quality. Thirdly, we included a broad age grouping; children and adolescents from 0 to fifteen. This broadens our agreement of how the use of electronic media devices may impact slumber in different age groups in a childhood development perspective. Yet, comprehensive equity reviews on e.one thousand. socio-economical background in the study population and mechanisms would provide a more than thorough understanding of the associations. But a few qualitative studies were identified. This leaves a large gap in understanding the complexities of electronic media device use and slumber human relationship in children and adolescents.

Implications for policy and practice

At the policy level, data and more than public awareness could be promoted about the potential negative impact on children's sleep of electronic media, if used excessively and immediately before bedtime. In full general, this could include renewed awareness and promotion of advisable slumber hygiene, but likewise more attention to the potential adverse furnishings of the seemingly unavoidable increase in the employ of electronic media in the everyday life. At the practice level, professionals and caretakers of children and adolescents should have a heightened awareness on sleep and encourage bedtime routines including calming activities without use of electronic media and remove all electronic media from the bedroom [75]. Given the stiff allure of electronic media on almost children, interventions should include both structural measures to guide children's electronic media habits and private measures focusing on e.g. information near the potential impact of electronic media devices and how to develop healthy media habits.

Conclusions

This systematic review of 49 studies found consistent evidence that use of electronic devices is associated with shorter slumber duration in children and adolescents. The clan betwixt electronic media use and other sleep outcomes was more inconclusive. Moreover, the show for association betwixt electronic media and sleep was stronger for half-dozen–15-years-olds than 0–five-year-olds.

Availability of information and materials

All data generated or analyzed during this study are included in this commodity (and its supplementary files).

Abbreviations

Due north:

Number

RCT:

Randomized controlled trial

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Acknowledgements

We would like to thank all the authors of the primary studies included in this systematic review.

Funding

No specific funding was received for this article; even so, nosotros gratefully acknowledge the support of the The Danish Health Authority. The content is solely the responsibleness of the authors. The Danish Health Authority was not involved in designing the study, collecting, analyzing or interpreting data, in writing manuscript, or in the conclusion to submit the manuscript for publication.

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1. National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455, Copenhagen, Kingdom of denmark

   Lisbeth Lund, Ida Nielsen Sølvhøj, Dina Danielsen & Susan Andersen

Contributions

Affiliation: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Contributions: LL and SA designed the written report. LL and ISN conducted the database searches and extracted information. LL, ISN and SA did the initial analysis and DD supervised data analysis. LL and SA wrote the starting time draft, and ISN and DD critically revised the starting time draft. All authors have read, reviewed, and canonical the final manuscript.

Corresponding writer

Correspondence to Susan Andersen.

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Supplementary Information

Additional file 1: Tabular array S1

: Search terms and syntax. Table S2: Characteristics and detailed results of included studies amidst 0–5-year-quondam children. Table S3: Characteristics and detailed results of included studies among half-dozen–12-twelvemonth-quondam children. Table S4: Characteristics and detailed results of included studies amongst thirteen–15-twelvemonth-old children. Table S5: References on excluded studies.

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Lund, Fifty., Sølvhøj, I.N., Danielsen, D. et al. Electronic media apply and sleep in children and adolescents in western countries: a systematic review. BMC Public Health 21, 1598 (2021). https://doi.org/x.1186/s12889-021-11640-9

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• Received: 05 January 2021

• Accepted: eighteen August 2021

• Published: 30 September 2021

• DOI : https://doi.org/ten.1186/s12889-021-11640-nine

Keywords

• Systematic review
• Kid
• Adolescent
• Telecommunication
• Sleep

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