Early childhood screen use and sleep: Evaluating the strength of the evidence

Screen media use and its consequences for early development is a topic of ongoing discussion. In particular, the potential impact of screen media use on sleep has received increasing attention in recent research. However, the causal nature of this association in children under 5 years of age is unclear. This review draws on the decision rules proposed by Kraemer et al. (1997) to elucidate the relationship between potential risk factors and predefined outcomes. We evaluated empirical evidence of the association between screen exposure and different sleep parameters in infants and children from 0-to 5-years. We found ample correlational research and a few longitudinal studies that support the conclusion that screen exposure is a variable disruptive factor for sleep duration. Moreover, screen exposure was correlated with infants’ and young children’s sleep schedules. Although evidence of associations with sleep quality was generally less conclusive, three out of four randomized controlled studies demonstrated that screen media interventions targeting content, duration, or timing of screen exposure significantly reduced caregiver-reported or objectively measured sleep quality, preliminarily justifying the term causal disruptive factor. Based on our review, we encourage researchers to target screen exposure in experimental and intervention studies to reveal the causal effects on sleep duration and quality. We also advocate for more precise definitions and objective assessments of sleep behavior and screen exposure. A strong empirical base is required to inform far-reaching recommendations on early screen media use by bodies such as the World Health Organization. • Screen exposure's effect on sleep is debated, even in children aged 0–5 years • Causality must be explored due to sleep’s importance in early development • Evidence on screen exposure and sleep was evaluated using a risk factor framework • In 0–5-year-olds, causal evidence exists for sleep quality, not duration or schedule • Experimental studies were found to be notably underrepresented.