Article Text

Original research
Associations between daily screen time and sleep in a racially and socioeconomically diverse sample of US infants: a prospective cohort study
  1. Jennifer A Emond1,2,
  2. A James O'Malley1,3,
  3. Brian Neelon4,
  4. Richard M Kravitz5,
  5. Truls Ostbye6,
  6. Sara E Benjamin-Neelon7
  1. 1Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
  2. 2Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
  3. 3The Dartmouth Institute, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
  4. 4Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  5. 5Division of Pediatric Pulmonary and Sleep Medicine, Duke University Medical Center, Durham, North Carolina, USA
  6. 6Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
  7. 7Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Jennifer A Emond; Jennifer.A.Emond{at}


Objective To determine the associations between screen media use and sleep throughout infancy (3–12 months).

Design Prospective Nurture birth cohort.

Setting North Carolina, USA, 2013–2015.

Participants Women enrolled in their second to third trimester, completed a phone interview after birth, and completed home visits at 3, 6, 9 and 12 months post partum.

Primary and secondary outcome measures Women reported the usual hours their infants slept during the day and night and their infants’ usual use of five screen media activities at 3, 6, 9 and 12 months post partum. Adjusted mixed-effects regression analyses modelled the associations between infant screen time and sleep outcomes while disaggregating the between-infant and within-infant effects.

Results Among 558 mother–infant dyads, 374 (67.0%) infants were black and 304 (54.5%) households earned <$20 000 per year. Half (254, 50.2%) of the infants engaged with screens at 3 months of age, while 326 (72.9%) engaged at 12 months. The median value of the average daily screen time over the study period was 50 (IQR: 10–141) min. Infant screen time was inversely associated with night-time sleep duration only when considering between-infant effects (adjusted beta: −2.9; 95% CI −5.9 to 0.0; p=0.054 for log-transformed screen time). Effects were stronger for television+DVD viewing specifically (adjusted beta: −5.2; 95% CI −9.1 to −1.4; p<0.01 for log-transformed television+DVD time). For example, an infant who averaged 1 hour of television+DVD viewing over the study period slept, on average, 9.20 (95% CI 9.02 to 9.37) hours per night by 12 months compared with 9.60 (95% CI 9.41 to 9.80) hours per night for an infant with no screen time over the study period. There were no significant within-infant effects between screen time and night-time sleep, and screen time was not associated with daytime sleep or night-time awakenings.

Conclusions Screen time during infancy was inversely associated with night-time sleep duration; however, causal associations remain uncertain.

Trial registration number NCT01788644.

  • paediatrics
  • public health
  • sleep medicine

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors JAE and SEB-N had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. TO, RK and SEB-N designed the initial cohort study, obtained funding and acquired the data. JAE, AJO and SEB-N conceptualised and designed the current secondary analysis. JAE analysed the data and AJO, BN and SEB-N provided critical input during data analysis. JAE drafted the manuscript and all authors provided critical revision to the manuscript for important intellectual content. All authors read and approved the final version of the manuscript.

  • Funding This study was supported by a grant from the National Institutes of Health (R01DK094841) and a mentored research scientist training award from the National Institutes of Health (5K01DK117971). The sponsors had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.