Associations of outdoor play and screen time with nocturnal sleep duration and pattern among young children

Is there an association between anthropogenic heat flux and sleep problems among children? Findings from a multicity study in China

As a significant factor in climate change, the negative impact of anthropogenic heat flux (AHF) on human health has garnered considerable attention. However, evidence of the associations between AHF and sleep problems is limited. This study aims to explore the associations between AHF and sleep problems in children. We conducted a cross-sectional investigation involving 187,448 children aged 6-18 years across 14 cities in China from April 2012 to May 2018. We utilized the Sleep Disturbance Scale for Children adapted for Chinese children to assess sleep problems. Socio-economic data, remote sensing of nighttime light and vegetation, and energy consumption were utilized to evaluate participants' exposure to AHF. Mixed-effects models were employed to explore the associations. After adjusting for social demographic and behavioral factors, each standard deviation (SD) increase in total AHF was associated with a β (95% confidence interval) of 3.27 (3.21, 3.33) for total t-score and an odds ratio (95% confidence interval) of 1.90 (1.84, 1.95) for sleep disorders. In addition, these associations were stronger in girls, children not exclusively breastfed, those engaging in less daily exercise, or residing in proximity to major roads. We concluded that AHF was significantly associated with increased risk of sleep problems.

Association Between Adequate Sleep and Participation in Occupational Areas in School-Age Children

Adequate sleep tailored to children's age is important for their well-being. This study aimed to examine the association between adequate sleep and children's participation in occupational areas. This study was a retrospective cross-sectional analysis of secondary data obtained from the 2020 National Survey of Children's Health in the United States. This study included 6,818 children aged 6 to 11 years. The mean age was 8.48 years (standard deviation = 1.72). Multivariate regression models revealed that adequate sleep was significantly associated with increased participation in occupational areas (17% more in leisure, 95% confidence interval [CI]: 1.11-1.23; 15% more in play, 95% CI: 1.07-1.22; 11% more in education, 95% CI: 1.01-1.22) in school-age children, but not with participation in work and social participation. Adequate sleep is associated with increased participation of school-age children in occupational areas.

Child-, Family-, and Community-Level Correlates of 24-Hour Movement Behaviors in Ethiopian Young Children: The SUNRISE Study

BACKGROUND

Understanding the factors influencing 24-hour movement behaviors is important for designing appropriate health promotion strategies. We examined the multidimensional correlates of physical activity, sedentary behavior, screen time, and sleep among children under 5 years of age in Ethiopia.

METHODS

Cross-sectional study conducted in Adama and Lume district, Ethiopia. Children were recruited from urban kindergartens and rural villages. Physical activity, sedentary time, and sleep were assessed using accelerometry. Screen time and correlates were parent reported. Variables were selected a priori, using the social ecological model and considering country context. Linear mixed models were used to test associations between child-, family-, and community-level correlates and time spent in 24-hour movement behaviors, accounting for clustering effect.

RESULTS

Four hundred and thirty children participated (mean age 4.2 [0.6] y). Girls spent less time in total of physical activity (TPA) and moderate- to vigorous-intensity physical activity (MVPA) and more time sedentary than boys. Children who spent more time outdoors had higher TPA and MVPA, longer sleep duration, and shorter sedentary and screen time. Children of educated parents had lower TPA and MVPA and higher sedentary time than those with no formal education. Children of parents who reported using a screen device with their child for educational purposes spent less time in MVPA, had shorter sleep, and had more screen time than those who did not. Rural children had higher TPA and MVPA, longer sleep, and shorter sedentary and screen time than urban children.

CONCLUSION

We identified key correlates of 24-hour movement behaviors in Ethiopian children. Designing tailored health promotion strategies to support healthy levels of movement behaviors, particularly in urban areas, is needed.

May family routines impact oral health in American children?

Objectives

The present study aimed to assess the association between family routines and dental caries and self-rated oral health status.

Methods

Data from the 2020-2021 National Survey of Children's Health (NSCH) completed at United States were used. Our outcome variables were self-reported dental caries (yes/no) and poor oral health condition (yes/no). Our independent variables were related to family routines: (1) Going to bed at the same time (yes/no); (2) Days having dinner together (0-7days); (3) Hours spent in front of the TV, computer, cell phone or other electronic devices (screen time); and (4) adequate sleep (yes/no). We used socioeconomic factors, health insurance coverage, family structure and neighborhood characteristics as covariates. Univariate and multiple logistic regression were used to analyze the data.

Results

For the dental caries outcome, children with regular bedtimes (AOR = 0.68, 95% CI: 0.58-0.79), more frequent family dinners (AOR = 0.90, 95% CI: 0.85-0.96), and supportive neighborhoods (AOR = 0.88, 95% CI: 0.78-0.99) were less likely to report dental caries. Increased screen time (AOR = 1.10, 95% CI: 1.04-1.15) was associated with higher self-reported dental caries. For oral health status, children with regular bedtimes, (AOR = 0.60, 95% CI: 0.48-0.75), supportive neighborhoods (AOR = 0.81, 95% CI: 0.68-0.97), and with more neighborhood amenities (AOR = 0.92, 95% CI: 0.88-1.00) reported better health. More screen time (AOR = 1.11, 95% CI: 1.02-1.21) and poor neighborhood conditions (AOR = 1.13, 95% CI: 1.02-1.26) correlated with poor oral health.

Conclusions

Findings from this study indicate that family routines play a significant role in children's oral health. Future research should focus on interdisciplinary family- and community-level interventions that are tailored to support healthy habits and address the needs of families.

Relationship between physical activity and neighborhood environment in preschool children during COVID-19.-A cross-sectional study using 24-hour activity records

Maintaining physical activity and the development of physical and cognitive functions are essential especially in vulnerable populations such as children. Considering the substantial impact of the COVID-19 epidemic on preschool children and the lack of research focusing on this age group, this study examined the duration of physical activity among preschool-aged children on weekend days and its relationship with the environment. This study was conducted between October and November 2021, with the cooperation of 357 parents of preschoolers attending kindergartens, nurseries, and childcare centers. Physical activity was assessed using a 24h physical activity record. A questionnaire was used to collect basic data on the neighborhood environment. Stepwise multiple regression analysis was used to analyze the relationship between the five physical activity measures (sedentary time, screen time, indoor playing time, outdoor playing time, and going out time) and the questionnaire data. Our findings revealed a relationship between physical activity and the neighborhood environment; however, the R2 values were low. Despite low prediction accuracy, the results of this study were similar to those of previous studies, indicating a positive correlation of physical activity with the absence of undulating roads, a crime-free environment, and safety around the home. Overall, these findings emphasize the need for providing children with opportunities for outdoor physical activity and play in the context of the COVID-19 recovery phase for adherence to the relevant guidelines.

Lifestyle Behaviours in Pre-Schoolers from Southern Spain-A Structural Equation Model According to Sex and Body Mass Index

OBJECTIVES

The present study aimed to examine the relationship between screen time (ST), sleep time (SLT), physical fitness (PF), Mediterranean diet (MD) adherence, eating behaviours, and body mass index (BMI) in a sample of pre-schoolers from Granada (Spain). In order to address this aim, an explanatory model was developed to examine existing relationships between ST, SLT, PF, MD, pro-intake (PRO-I) and anti-intake (ANT-I) behaviours, and BMI. Further, the proposed structural model was examined via multi-group analysis as a function of sex and BMI.

METHODS

A cross-sectional study was conducted with 653 three- to six-year-old pre-schoolers attending 18 different schools invited to take part in the present study. Structural equation modelling (SEM) was employed to analyse relationships between study variables as a function of sex and BMI.

RESULTS

SEM analysis revealed negative associations between ST and PF (p < 0.005), ST and MD adherence (p < 0.005), ST and SLT (p < 0.005), MD adherence and ANT-I behaviours (p < 0.005), and MD adherence and BMI (p = 0.033). In contrast, positive associations emerged between SLT and MD adherence (p < 0.005), and PRO-I behaviours and BMI (p < 0.005). SEM revealed differences according to sex and BMI.

CONCLUSIONS

The study highlights significant relationships between lifestyle behaviours and physical and dietary outcomes in pre-schoolers from southern Spain, with variations based on sex and BMI. These findings suggest the need for interventions aimed at reducing ST and promoting better sleep, PF, and dietary habits in order to limit weight-related and general health risks in pre-schoolers from southern Spain.

Managing Screen Use in the Under-Fives: Recommendations for Parenting Intervention Development

The impact of excessive screen use on children's health and development is a public health concern and many countries have published recommendations to limit and guide the use of screen media in childhood. Despite this, international studies report that the majority of parents and children do not adhere to screen use recommendations. Existing research aiming to understand children' screen use has largely focused on older children, and on demographic and structural aspects of the child's environment. Parents play a central role in determining young children's screen use and identify numerous barriers to developing healthy screen use practices with their children. However, no clear models exist that incorporate key parenting factors in understanding children's screen use, which presents an impediment to intervention development. Likewise, while some evidence exists for interventions to improve children's screen use behaviours, most are focused on older children and parental involvement has generally been limited. In this paper, we overview key factors associated with screen use in young children (< 5 years) and summarise the existing evidence base for interventions designed to support healthy screen use. This paper proposes a conceptual model linking aspects of parenting and the socio-ecological environment to young children's screen use. Our proposed model could be used to design longitudinal studies of screen use predictors and outcomes, and inform intervention development. Finally, the paper provides key recommendations for future research, intervention development and testing.

Playground Design: Contribution to Duration of Stay and Implications for Physical Activity

BACKGROUND

The study goal was to identify playground features associated with visitor length of stay and physical activity.

METHODS

We observed playground visitors over 4 days during summer 2021 in 60 playgrounds in 10 US cities, selected based on design, population density, and poverty levels. We observed 4278 visitors and documented their length of stay. We observed an additional 3713 visitors for 8 min, recording their playground location, activity level, and use of electronic media.

RESULTS

People stayed an average of 32 min (range 5 min-4 h). Stay time varied by group size, with larger groups staying longer. The presence of restrooms increased the likelihood of staying longer by 48%. Playground size, mature trees, swings, climbers, and spinners were associated with longer stays. When a teen was a part of the group observed, the group was 64% less likely to stay longer. The use of electronic media was associated with lower amounts of moderate-to-vigorous physical activity compared to non-media users.

CONCLUSIONS

To increase population-level physical activity and time spent outdoors, playground features associated with a longer stay should be considered when renovating or building new playgrounds.

Risk of Obesity Among Children Aged 2-6 Years Who Had Prolonged Screen Time in Taiwan: A Nationwide Cross-Sectional Study

OBJECTIVE

To evaluate the risk of obesity in preschool children with prolonged screen time in Taiwan.

METHODS

Using a nationwide survey with random sampling, we collected information on 8378 preschool children aged 2-6 years among 206 preschools in Taiwan from 2016 to 2019. Socioeconomic data, body mass index, and lifestyle of the preschool children and their caregivers were compared among the groups of preschool children who had moderate and prolonged daily screen time. We used multiple log-binomial regression models to calculate the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) of obesity associated with prolonged screen time.

RESULTS

The prevalence of obesity in the preschool children was 13.1%, and the average screen time was 104.6 minutes. Children's age, sleep hours, outdoor play time, sugar intake, snack eating before dinner, sleep disturbance, and obesity, as well as caregiver's sex, age, education, screen time, exercise time and parent obesity were factors related to high screen time for preschool children. Compared with children with moderate screen time, children with prolonged screen time had a higher risk of obesity (PR, 1.45; 95% CI, 1.18-1.79). With a 60-minute increase in screen time, the risk of obesity increased, with an PR of 1.10 (95% CI, 1.03-1.17).

CONCLUSION

Preschool children with prolonged screen time had an increased risk of obesity in Taiwan. Interventions may be needed for this very susceptible population.

Time to Play in Javanese Preschool Children-An Examination of Screen Time and Playtime before and during the COVID-19 Pandemic

This comparative-descriptive multi-national research examined the screen time and playtime of preschool children aged 1-6 years before and during the COVID-19 pandemic. Parents reported on the play and screen habits of preschool-aged children on the weekday and weekends using a questionnaire on the lifestyle habits of their children. Results indicated a significant difference in screen time and playtime on the weekday and weekend before the pandemic (screen time: 1.91 ± 2.40 vs. 2.16 ± 2.60 h; playtime: 3.55 ± 2.49 vs. 4.11 ± 2.58 h, both p < 0.05), but during the COVID-19 pandemic, only the weekday-weekend difference in screen time was significantly different (screen time: 2.87 ± 3.15 vs. 3.26 ± 3.18 h, p < 0.05; playtime: 3.25 ± 3.41 vs. 3.48 ± 2.41, p > 0.05). Before- and during-COVID-19 comparisons showed that the average daily screen time increased by 150% from 2.04 h to 3.06 h (p < 0.05), while the average play time decreased by 12.3% (3.83 to 3.36 h, p < 0.05). Based upon international guidelines for movement behaviours of young children, special attention and actions are needed to manage the excessive daily screen time and preserve the average daily playtime of Javanese preschool children. These results present useful benchmarking data for parents, teachers, and health authorities to initiate ameliorative interventions to better balance children's screen time and playtime as Indonesia emerges from the COVID-19 pandemic to a COVID-19 endemic.

Outdoor time, screen time and sleep reported across early childhood: concurrent trajectories and maternal predictors

BACKGROUND

Understanding the developmental trajectories of outdoor time, screen time and sleep is necessary to inform early interventions that promote healthy behaviours. This study aimed to describe concurrent trajectories of outdoor time, screen time and sleep across the early childhood period and their maternal predictors.

METHODS

Data across five time points at child age 4, 9, 19, 42 and 60 months from the INFANT intervention were analysed. Mothers reported their child's usual outdoor time, screen time and sleep duration, in addition to a range of maternal beliefs, attitudes, expectations and behaviours. Group-based multi-trajectory modelling was used to model concurrent trajectories of children's behaviours. Multinomial logistic regression models determined the associations of maternal predictors with trajectory groups, adjusting for child sex and baseline age, intervention allocation, and clustering by recruitment.

RESULTS

Of the 542 children recruited, 528 had data for outdoor time, screen time and sleep at one or more time points and were included in trajectory analyses Four trajectories were identified: 'unstable sleep, increasing outdoor time, low screen' (~ 22% of sample), 'high outdoor time, low screen, high sleep' (~ 24%), 'high sleep, increasing outdoor time, low screen' (~ 45%), 'high screen, increasing outdoor time, high sleep' (~ 10%). The 'high sleep, increasing outdoor time, low screen' group, comprising the largest percentage of the sample, demonstrated the healthiest behaviours. Predictors of group membership included: views of physically active children, screen time knowledge, screen time use, self-efficacy, physical activity optimism, future expectations for children's physical activity and screen time, perceptions of floor play safety, and maternal physical activity, screen time, and sleep quality.

CONCLUSIONS

Four distinct trajectories of outdoor time, screen time and sleep were identified, with the most common (and healthiest) characterized by high levels of sleep. Maternal beliefs, attitudes, expectations and behaviours are important in the development of movement behaviour trajectories across early childhood. Future interventions and public policy may benefit from targeting these factors to support healthy movement behaviours from a young age.

Neighborhood and Family Characteristics Associated with Adiposity and Physical Activity Engagement among Preschoolers in a Small Rural Community

The purpose of this study was to evaluate family and home/neighborhood characteristics associated with physical activity (PA) and adiposity among young children living in a small rural community.

METHODS

Participants were 30 parents and their youngest child aged 2-5 years. Children wore accelerometers for 7 days. Parents completed questionnaires about family lifestyle behaviors, parenting practices, and home/neighborhood characteristics.

RESULTS

None of the family lifestyle behaviors were associated with child BMI percentile. Backyard size was inversely associated with moderate to vigorous physical activity on weekday afternoons (rho = -0.488, p = 0.006), as was perception of neighborhood dangers (rho = -0.388, p = 0.034). Perceived neighborhood safety (rho = 0.453, p = 0.012), the presence of sidewalks (rho = 0.499, p = 0.012), and public playground use (rho = 0.406, p = 0.026) were each associated with higher weekday afternoon MVPA.

CONCLUSIONS

Findings suggest neighborhood safety, sidewalks, and use of public playgrounds are positively associated with MVPA among preschoolers, while backyard size and access to play equipment at home are not. These findings have implications for rural communities where space is plentiful but access to community space and sidewalks may be limited.

Play-Sleep Nexus in Indonesian Preschool Children before and during the COVID-19 Pandemic

The COVID-19 pandemic has transformed Indonesians' behaviors and has had an impact on many facets of daily life. People's lives are becoming increasingly dependent on digital technologies, which is a phenomenon with conflicting effects on people's health and happiness. This cross-sectional study focused on one such influence, namely, how the shift from the period before to during COVID-19 has affected children's playtime and sleep duration. As part of a multicenter study, 618 adult caregivers (parents, family members, or babysitters) who visited the kindergarten in question on behalf of preschool children aged 2-5 years (4.04 ± 1.39) were surveyed on the children's play and sleep habits before and during the COVID-19 pandemic in Indonesia, particularly Java Island (before pandemic, N = 309; during pandemic, N = 309). ANOVA was used for a statistical analysis to describe the difference between groups and within time collections. Significant favorable relationships were found between pre-pandemic and post-pandemic playtime and sleeping time on weekdays, weekends, and averaged weekday-weekend (r = 0.437; 0.180 and 0.321, all p < 0.05) were detected. Before the pandemic, children's playtime (4.11 vs. 3.55 h) and sleep duration (10.92 vs. 10.70 h) were significantly greater on the weekend than on the weekday (p < 0.05) but not during the pandemic (playtime: 3.48 vs. 3.45 h and sleep duration: 10.83 vs. 10.80 h; all p > 0.05). The COVID-19 pandemic had no impact on sleep duration or playtime in Javanese preschool children. Efforts should be intensified to promote the value of playtime and sleep duration among children in this age range so that the future of Indonesian children's can be ensured.

Psychometric properties of the ScreenQ for measuring digital media use in Portuguese young children

AIM

Digital media use is prevalent among children and linked to potential developmental and health risks, but validated measures of children's digital media use are lacking. The aim of this study was to validate the Portuguese version of the ScreenQ with three distinct children's age groups.

METHODS

Parents of children living in Portugal completed an online survey including the 16-item version of the ScreenQ and items related to home activities and digital media use. A combination of classical and modern theory (Rasch) methods was used for analysis.

RESULTS

A total of 549 mothers and 51 fathers of 325 girls and 322 boys from 6 months to 9 years and 11 months-old responded to the survey. Point-measure correlations were all positive and endorsement of item values were within acceptable ranges. Cronbach's coefficient α was acceptable for a new measure and test-retest reliability was high. Statistically significant correlations were found between ScreenQ total scores and relevant demographic, play-related, parenting, and digital media-use items.

CONCLUSION

The Portuguese version of the ScreenQ exhibited sound psychometric properties, including internal consistency and concurrent validity referenced to external items. Higher ScreenQ scores were correlated with higher digital media multitasking, lower parent-child interaction, and higher concerns regarding child's learning and behaviour.

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

Background

Sleep is essential for child and adolescent health and well-being. There is an increasing interest in whether electronic media use affects children and young adolescents’ sleep. Prior reviews have focused on a school-aged population. Moreover, it is crucial that research continuously addresses the processes of technology and media use and the implication on sleep. This systematic review examines the evidence of electronic media use related to sleep among 0–15-year-olds.

Methods

Searches were carried out in four databases (CINAHL, Web of Science, EMBASE, and Medline). Inclusion criteria included age ≤ 15 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 independent reviewers. Data was extracted using a standardized data extraction form. Synthesis was done by summarizing results across studies by age groups of 0–5, 6–12, and 13–15 years within four sleep domains: Bedtime and sleep onset; Sleep quality; Sleep duration; Daytime tiredness.

Results

The search identified 10,719 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 (n = 3), quasi-experimental studies (n = 2), prospective cohort studies (n = 15), and cross-sectional studies (n = 29). Evidence for an association between electronic media use and sleep duration was identified, with stronger evidence for 6–15-years-olds than 0–5-year-olds. The evidence for a relationship between electronic media use and other sleep outcomes was more inconclusive. However, for 6–12-year-old children, there was evidence for associations of electronic media use with delayed bedtime and poor sleep quality. For 13–15-year-olds, there was evidence for associations between screen time and problems falling asleep, and between social media use and poor sleep quality.

Conclusions

Overall, electronic media use was generally 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’s impact on other sleep outcomes. Public awareness and interventions could be promoted about the potential negative impact on children’s sleep of electronic media devices that are used excessively and close to bedtime.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11640-9.

A Longitudinal Analysis Examining the Associations of Tummy Time With Active Playtime, Screen Time, and Sleep Time

BACKGROUND

Evidence links tummy time (ie, the time spent in awake prone positioning that is encouraged and supervised by an adult) to infants' health outcomes such as gross motor and total development. However, the associations between tummy time and other movement and sleep behaviors as the child develops remain unknown. The aim of this study was to examine whether early introduction and practice of tummy time within the first 6 months of age were associated with active and outdoor playtime, screen time, and nocturnal sleep time of children when they were 12 and 24 months old.

METHODS

A longitudinal analysis was conducted using data extracted from an Australian trial. Using telephone surveys with mothers, demographic data were collected from third trimester of pregnancy and tummy time data were collected at 6 months of age. Data on playtime, screen time, and nocturnal sleep duration as dependent variables were collected at 12 and 24 months of age. Multiple logistic regression models were built to investigate the associations.

RESULTS

Children who started tummy time within 4 weeks of age were more likely to have >10 hours sleep at night at 12 months (adjusted odds ratio 1.54, 95% confidence interval, 1.08-2.19). They were more likely to have >3 hours per day of outdoor play and have <1 hour per day of screen time at 24 months. Children who practiced tummy time every day were more likely to have >2 hours per day of active play at 12 months and have <1 hour per day of screen time at 24 months.

CONCLUSIONS

Starting tummy time earlier and frequently was associated with more favorable movement and sleep of young children at 12 and 24 months of age.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

[Outdoors of course!]

Outdoor play makes children healthier. An active lifestyle is particularly important for optimal growth and development of children. Restrictions due to the Corona virus make this more apparent. The professional network 'View Outside' collected the lifestyle consequences for visual, motoric, postural, weight, sleep and psychosocial youth health. We strongly recommend spending two hours a day outdoors, of which a minimum of one hour should be at least moderately intensive exercise. Other lifestyle measures are reducing sedentary behavior, rules on screen use and regular change of activities when sedentary.

Sleep disorders reveal distress among children and adolescents during the Covid-19 first wave: results of a large web-based Italian survey

Background

Measures to contain the Covid-19 pandemic led to significant lifestyle changes for children and adolescents mainly related to the closure of schools and recreational activities, reduced social interaction, and increased family concerns.

Methods

A cross-sectional online survey of 78 questions investigating social determinants of health, mood changes, symptoms of anxiety, increase in sleep disorders and unusual repetitive movements was offered to parents living in Italy with children ≤18 years; including families of children with disabilities, autism spectrum disorders, chronic diseases, and specific learning disabilities. The survey was conducted on the Qualtrics platform 6 months after the beginning of the pandemic and distributed in hospitals and paediatricians’ waiting rooms as well as through social networks. The primary outcomes were the increase in sleep disorders among children and adolescents. Possible risk factors were investigated through multivariable regression.

Results

Six thousand two hundred ten volunteer parents responded to the questions concerning mood changes, sleep disorders and unusual repetitive movements, and were included in the present study. The majority were female (91.8%) and Italian (97.0%). 72.7% answered that their children had become more nervous, worried, or sad (80.2% in children with learning disabilities); 77.6% reported feelings of loneliness and 69.3% more difficulties in children falling asleep, 30.2% in staying asleep, and 18.7% an increase in nightmares and/or sleep terrors. Statistical analysis identified socioeconomic status, parent’s job loss, food insecurity, family attitude toward the pandemic, and children’s mood swing, feelings of loneliness, or missing outdoor activities, as major risk factors for sleep disorders.

Conclusion

The first Covid-19 lockdown impacted children’s and adolescents’ health through an increase in sleep disorders. In the following phases of the pandemic, this evidence may be useful to investigate and treat these disorders as well as make decisions about containment health policies concerning this age group.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-021-01083-8.

Correlates of Sleep Duration in Early Childhood: A Systematic Review

OBJECTIVE

This systematic review aimed to summarize correlates of sleep duration in children under 5 years of age.

METHODS

Six electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, SPORTDiscus, and Scopus) were searched from inception to May 2019. Observational studies and intervention studies reporting cross-sectional results from baseline data were considered. Data were extracted using a predesigned form and potential correlates were categorized following a sociological framework.

RESULTS

One-hundred and sixteen studies, representing 329,166 children, met the inclusion criteria, with a high risk of bias in 62 included studies. A total of 83 correlates of sleep duration were identified. Among the associations studied four or more times, correlates of nap duration were child's age and nighttime sleep onset/bedtime; correlates of nighttime sleep duration were household income, parent marital status, parental adiposity level, nighttime sleep duration at younger age, nighttime sleep onset/bedtime, nighttime sleep wakeup time, and frequency of current bedtime routine; correlate of total sleep duration was screen time.

CONCLUSIONS

Young children from low-income households, single families, or having overweight parents may be at risk for short sleep duration. Promoting healthy sleep duration from an early age appears essential. Effective practices may include encouraging an earlier bedtime, limiting screen time, and establishing a regular bedtime routine. The absence of consistent evidence in the psychological, cognitive, and emotional domain as well as the physical environmental domain warrants further research.

Spinal pain in pre-adolescence and the relation with screen time and physical activity behavior

Background

To investigate how screen time and physical activity behavior were associated with spinal pain in pre-adolescence.

Methods

This study included 45,555 pre-adolescents who participated in the 11-year follow-up of the Danish National Birth Cohort. The 11-year follow-up included self-reported information on computer and TV behavior, aspects of physical activity, as well as frequency and intensity of spinal pain (neck-, mid back- and low back pain). Data were linked with parental socioeconomic data from Statistics Denmark registers. Associations were estimated using multinomial logistic regression models. To account for sample selection, we applied inverse probability weighting.

Results

Duration of screen time was stepwise associated with the degree of spinal pain. Compared with those spending < 2 h/day in front of a screen, screen time of ≥6 h/day was associated with a substantially increased relative risk ratio (RRR) of severe pain for both girls (RRR: 2.49, 95% CI: 2.13–2.92) and boys (RRR: 1.95, 95% CI: 1.65–2.32). Being physical inactive was likewise associated with higher likelihood of severe spinal pain (RRR: 1.22, 95% CI: 1.10–1.34) relative to those being moderately active. We observed that being physically active was seemingly associated with lower risk of spinal pain among boys with high frequency of screen time.

Conclusion

Findings indicate that both duration of screen time and physical inactivity are correlated with spinal pain in pre-adolescents with the strongest associations for screen time. Reducing screen time or increasing physical activity might help preventing spinal pain in pre-adolescents, particularly among high frequent screen users. Future prospective studies investigating the causal relationship are necessary.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04263-z.

A Study on the Relationship Between Physical Activity, Sedentary Behavior, and Sleep Duration in Preschool Children

Purpose: Explore the role of physical activity (PA) and sedentary behavior (SB) in the sleep of preschool children.

Method: Preschool children (n = 458) from kindergarten were recruited, measures included accelerometer-derived 24 h activity [SB, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), daytime sleep duration (DSP), and nocturnal sleep duration (NSP)]. A self-made questionnaire was used to supplementary survey on different types of SB. The two-layer chi-square test and the Cochran–Mantel–Haenszel test were used and significance set at p < 0.05.

Results: PA is mainly a protective factor for DSP, while SB is mainly a risk factor for NSP of preschool children; Screen-type SB including screen viewing SB and video game SB is a risk factor for NSP, while quiet learning SB have no significant correlation with sleep duration in preschool children; Gender and social economic status are important factors affecting the association of PA, SB, and sleep duration in preschool children.

Conclusions: The relationship between sleep duration at different periods and PA and SB of preschool children is different. Future educators need to gradually realize the different factors affecting the sleep of preschool children at different stages, clarify the protective factors and risk factors, in order to improve the sleep duration of preschool children.

Predictors of Changes in Sleep Duration in Dutch Primary Schoolchildren: the ChecKid Study

BACKGROUND

Healthy sleep duration is essential to health and well-being in childhood and later life. Unfortunately, recent evidence shows a decline in sleep duration among children. Although effective interventions promoting healthy sleep duration require insight into its predictors, data on these factors are scarce. This study therefore investigated (i) which individual (lifestyle), social and cultural factors, and living conditions and (ii) which changes in these factors might be associated with the changes in sleep duration of Dutch primary schoolchildren observed over time.

METHOD

Data from the ChecKid study was used, a dynamic cohort study among 4-13-year-old children living in the city of Zwolle, the Netherlands. Associations between changes in sleep duration and individual (lifestyle) factors (i.e., age, sex, physical activity behavior, sugar-sweetened beverage consumption, screen behavior), social and cultural factors (i.e., parental rules, ethnicity), and living conditions (i.e., parental education, presence of screens in the bedroom, household size) were analyzed using multivariable linear regression.

RESULTS

A total of 1180 children participated, aged 6.6 ± 1.4 years in 2009. Mean sleep duration decreased from 11.4 ± 0.5 h/night in 2009 to 11.0 ± 0.5 h/night in 2012. Older children, boys, children who used screens after dinner, children with greater computer/game console use, and children whose parents had low levels of education had a greater decrease in sleep duration.

CONCLUSIONS

This article reports on one of the first large, longitudinal cohort studies on predictors of child sleep duration. The results of the study can inform future interventions aimed at promoting healthy sleep in primary schoolchildren.

Early Electronic Screen Exposure and Autistic-Like Behaviors among Preschoolers: The Mediating Role of Caregiver-Child Interaction, Sleep Duration and Outdoor Activities

Research into early screen exposure has raised growing concerns about its impact upon children’s neuropsychological well-being. However, possible pathways remain unclear. This study therefore aimed not only to evaluate the association between screen exposure during the ages of 0–3 years and preschoolers’ autistic-like behaviors, but also the mediating roles of the frequency of caregiver-child interaction, sleep duration and level of participation in outdoor activities. Based on the 2017 survey of the Longhua Child Cohort Study, data of 29,595 child-caregiver dyads were obtained via a caregiver-reported questionnaire, with the data from 29,461 dyads included in the data analysis. Multiple linear and logistic regression models were employed to estimate the associations between screen exposure, caregiver-child interaction, sleep duration, outdoor activities, and children’s autistic-like behaviors. The results indicated that screen exposure during 0–3 years of age was associated with the presence of autistic-like behaviors at preschool age, and the strength of the association was enhanced with the increase of average daily screen time (Odds Ratios (ORs) ranging from 1.358 to 4.026). The frequency of caregiver-child interaction and sleep duration mediated 5.32% and 1.19% of the variance of the association respectively, but outdoor activities did not mediate the association. Our findings indicate that preschoolers who are exposed to screens at aged 0–3 years might have an increased risk of autistic-like behaviors, and that, the frequency of caregiver-child interaction and sleep duration might function as potential mediators of this association.

The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review

Evidence suggests that excessive screen time in early childhood is related to children's physical and mental health. This study aimed to review the relationships between screen media use and several health indicators in infants, toddlers, and preschoolers. A systematic search was conducted by two independent reviewers on PubMed, Web of Science, Embase, and Cochrane Library to identify the eligible studies, with an end date of 13 August 2019. Included studies (published in English) were peer-reviewed and met the determinate population (children aged 0-7 years with screen media exposure and related health outcomes). The AHRQ, NOS, and the Cochrane Handbook were used to evaluate the cross-sectional study, cohort study, and RCT, respectively. A meta-analysis and narrative syntheses were employed separately. Eighty studies (23 studies for meta-analysis) met the inclusion criteria for the systematic review. Strong evidence of the meta-analysis suggested that excessive screen time was associated with overweight/obesity and shorter sleep duration among toddlers and preschoolers. Excessive screen use was associated with various health indicators in physical, behavioral, and psychosocial aspects. Better-quality research on newer media devices, on various kinds of contents in young children, and on dose-response relationships between excessive screen use and health indicators are needed to update recommendations of screen use.

Sedentary behavior is more related with cardiovascular parameters in normal weight than overweight adolescents

This study analyzed the relationship between sedentary behavior and cardiovascular parameters in normal weight and overweight adolescents. The sample included 449 boys and 555 girls with mean age of 13 years from public schools, which were divided into five geographical regions, with data collections performed in one selected school from each region. Sedentary behavior was assessed by screen time on TV, computer, videogame and cell phone/tablet, with good reliability in adolescents. Physical activity was assessed by Baecke's questionnaire, validated for adolescents. Measures of body weight, height and waist circumference were collected. Adolescents were classified as overweight or normal weight by cut-off points of body mass index for age and sex. Cardiovascular parameters were evaluated by oscillometric device and heart rate by specific monitor. Computer use was positively related to systolic blood pressure (SBP) (β = 0.35; 95%CI = 0.07-0.62) and diastolic blood pressure (DBP) (β = 0.25; 95%CI = 0.05-0.44) in normal weight but not in overweight adolescents. Similar results were observed for cell phone/tablet in SBP (β = 0.46; 95%CI = 0.20-0.72) and DBP (β = 0.36; 95%CI = 0.18-0.54), only for normal weight. The cluster of screen time was related to SBP in normal weight (β = 0.44; 95%CI = 0.03-0.84) and overweight (β = 0.60; 95%CI = 0.01-1.19). Screen time in computer and cell phone/tablet was more related to cardiovascular parameters in normal weight than overweight adolescents.

Screen Time and Sleep of Rural and Urban South African Preschool Children

This study aimed to investigate the extent to which preschool children meet guidelines for screen time (<1 h/day) and sleep (10-13 h/24-h) and explored home factors that affect these behaviors. Parents of preschoolers across income settings in South Africa (urban high-income n = 27, urban low-income n = 96 and rural low-income n = 142) completed a questionnaire. Urban high-income children had higher rates of exceeding screen time guidelines (67.0%) than children from urban low-income (26.0%) and rural low-income (3.5%) settings. Most children (81.0%) met sleep guidelines on weekdays and on weekends (75.0%). More urban high-income children met the sleep guideline, in comparison to both low-income settings. Fewer urban high-income parents (50.0%) thought that screen time would not affect their preschooler's health, compared to urban low-income (90.4%) and rural low-income (81.7%) parents. Weeknight bedtime was positively correlated with both weekday screen time (p = 0.001) and weekday TV time (p = 0.005), indicating that more time on screens correlated with later bedtimes. Meeting screen time and sleep guidelines differs across income settings, but it is evident that parents of preschoolers across all income settings would benefit from greater awareness about guidelines.

Association Between Outdoor Activity and Insufficient Sleep in Chinese School-Aged Children

Background

The aim of this study was to explore the relationship between outdoor activity (OA) and insufficient sleep duration (ISD) among Chinese children and to assess the potential age- and gender-specific effects.

Material/Methods

A national sample of 62 517 children aged 6–17 years were recruited from 7 provinces of China in the autumn of 2013. Children and their caregivers reported daily sleep duration (<7 h, 7–9 h and ≥9 h), daily OA time (<1 h, 1–2 h, and ≥2 h), and other behavior and demographic information by standardized questionnaire. ISD was defined as <9 h/day. Logistic regression analysis was used to evaluate the relationship between ISD and OA.

Results

In total, 46 639 children (50.9% boys) completed this survey. The prevalence of ISD was 74.9% (73.7% in boys and 76.1% in girls). Stratified by age, compared with <1 h OA, the odds ratios for ISD were 0.67 (95% confidence interval: 0.62–0.72, aged 6–13 years) and 0.69 (0.49–0.98, 14–17 years) in the ≥2 h OA group; 0.91 (0.85–0.97, 6–13 years) and 0.73 (0.54–0.97, 14–17 years) in the 1–2 h OA group. Further stratified by gender, we found similar trends for both boys and girls in each age group, although some results became non-significant.

Conclusions

Adequate OA time per day is associated with decreased risks for ISD among children aged 6–17 years, but age and gender can modify the association.

Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and meta-analysis

Sleep is crucial to children's health and development. Reduced physical activity and increased screen time adversely impact older children's sleep, but little is known about these associations in children under 5 y. This systematic review examined the association between screen time/movement behaviors (sedentary behavior, physical activity) and sleep outcomes in infants (0-1 y); toddlers (1-2 y); and preschoolers (3-4 y). Evidence was selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and synthesized using vote counting based on the direction of association. Quality assessment and a Grading of Recommendations, Assessment, Development and Evaluation was performed, stratified according to child age, exposure and outcome measure. Thirty-one papers were included. Results indicate that screen time is associated with poorer sleep outcomes in infants, toddlers and preschoolers. Meta-analysis confirmed these unfavorable associations in infants and toddlers but not preschoolers. For movement behaviors results were mixed, though physical activity and outdoor play in particular were favorably associated with most sleep outcomes in toddlers and preschoolers. Overall, quality of evidence was very low, with strongest evidence for daily/evening screen time use in toddlers and preschoolers. Although high-quality experimental evidence is required, our findings should prompt parents, clinicians and educators to encourage sleep-promoting behaviors (e.g., less evening screen time) in the under 5s.

The association between 25-hydroxyvitamin D levels and children's sleep-wake patterns: a prospective cohort study

OBJECTIVE

To explore the association between vitamin D in cord blood or in venous blood and children's sleep-wake patterns at two years of age.

METHODS

Data were from 209 children in a birth cohort, Shanghai Sleep Birth Cohort Study (SSBC). 25-Hydroxyvitamin D (25(OH)D) was assessed in cord blood and venous blood samples at two years of age by electrochemiluminescence immunoassay. Children's sleep-wake patterns were measured with the Brief Infant Sleep Questionnaire (BISQ) and Acti-Watch at two years of age.

RESULTS

The prevalence of vitamin D deficiency (defined as <50 nmol/L) was 50.4% in cord blood and 28% at two years of age. The cord blood 25(OH)D level was not significantly associated with children's sleep at two years of age. Children with 25(OH)D deficiency at two years old had shorter reported and actigraphic night sleep duration (NSD) and total sleep duration (TSD) than those with normal 25(OH)D concentration. 25(OH)D level at two years old was positively associated with night and total sleep duration (β_reported-NSD = 0.6, p = 0.011; β_reported-TSD = 0.6, p = 0.029; β_{actigraphic-NSD} = 0.82, p = 0.003; β_{actigraphic-TSD} = 0.78, p = 0.006), but was not associated with daytime sleep duration. There was no significant association between 25(OH)D level with night waking duration and midpoint of sleep either measured subjectively or objectively.

CONCLUSION

We found that not cord blood 25(OH)D level but two-year-old 25(OH)D level was associated with children's sleep-wake patterns at two years of age. These findings suggest more attention should be paid to the assessment of 25(OH)D levels in children with short sleep duration.

Benefits of a bedtime routine in young children: Sleep, development, and beyond

This paper presents a conceptual model and reviews the empirical evidence to support a nightly bedtime routine as a key factor in the promotion of not only healthy sleep, but also of broad development and wellbeing in early childhood. A bedtime routine embodies the characteristics of nurturing care and early child stimulation, which are deemed to be essential for positive outcomes, especially for at-risk children. Furthermore, common, adaptive components of a bedtime routine can contribute to an array of positive developmental outcomes beyond improved sleep, inclusive of language development, literacy, child emotional and behavioral regulation, parent-child attachment, and family functioning, among other outcomes. These bedtime routine components include activities in the broad domains of nutrition (e.g., feeding, healthy snack), hygiene (e.g., bathing, oral care), communication (e.g., reading, singing/lullabies) and physical contact (e.g., massage, cuddling/rocking). A bedtime routine can provide multiple benefits to child and family functioning at a time of day that many parents are present with their children. Although additional research on hypothesized routine-related child outcomes and mechanisms of action are needed, promoting a bedtime routine may be a feasible and cost-effective method to promote positive early childhood development worldwide, particularly for socioeconomically disadvantaged and other at-risk young children.

Temperament Is Associated With Outdoor Free Play in Young Children: A TARGet Kids! Study

OBJECTIVE

Outdoor free play is important for preschoolers' physical activity, health, and development. Certain temperamental characteristics are associated with obesity, nutrition, and sedentary behaviors in preschoolers, but the relationship between temperament and outdoor play has not been examined. This study examined whether there is an association between temperament and outdoor play in young children.

METHODS

Healthy children aged 1 to 5 years recruited to The Applied Research Group for Kids (TARGet Kids!), a community-based primary care research network, from July 2008 to September 2013 were included. Parent-reported child temperament was assessed using the Childhood Behavior Questionnaire. Outdoor free play and other potential confounding variables were assessed through validated questionnaires. Multivariable linear regression was used to determine the association between temperament and outdoor play, adjusted for potential confounders.

RESULTS

There were 3393 children with data on outdoor play. The association between negative affectivity and outdoor play was moderated by sex; in boys, for every 1-point increase in negative affectivity score, mean outdoor play decreased by 4.7 minutes per day. There was no significant association in girls. Surgency was associated with outdoor play; for every 1-point increase in surgency/extraversion, outdoor play increased by 4.6 minutes per day.

CONCLUSIONS

Young children's temperamental characteristics were associated with their participation in outdoor free play. Consideration of temperament could enhance interventions and strategies to increase outdoor play in young children. Longitudinal studies are needed to elucidate the relationship between children's early temperament and physical activity.

The skin microbiome: impact of modern environments on skin ecology, barrier integrity, and systemic immune programming

Skin barrier structure and function is essential to human health. Hitherto unrecognized functions of epidermal keratinocytes show that the skin plays an important role in adapting whole-body physiology to changing environments, including the capacity to produce a wide variety of hormones, neurotransmitters and cytokine that can potentially influence whole-body states, and quite possibly, even emotions. Skin microbiota play an integral role in the maturation and homeostatic regulation of keratinocytes and host immune networks with systemic implications. As our primary interface with the external environment, the biodiversity of skin habitats is heavily influenced by the biodiversity of the ecosystems in which we reside. Thus, factors which alter the establishment and health of the skin microbiome have the potential to predispose to not only cutaneous disease, but also other inflammatory non-communicable diseases (NCDs). Indeed, disturbances of the stratum corneum have been noted in allergic diseases (eczema and food allergy), psoriasis, rosacea, acne vulgaris and with the skin aging process. The built environment, global biodiversity losses and declining nature relatedness are contributing to erosion of diversity at a micro-ecological level, including our own microbial habitats. This emphasises the importance of ecological perspectives in overcoming the factors that drive dysbiosis and the risk of inflammatory diseases across the life course.

Do the correlates of screen time and sedentary time differ in preschool children?

BACKGROUND

Preschool children can spend up to 12 h a day in sedentary time and few meet current recommendations for screen time. Little is known about ecological correlates that could be targeted to decrease specific versus total sedentary behaviour. This study examined whether the correlates of screen time and sedentary time differ in preschool boys and girls.

METHODS

Parents participating in the HAPPY Study in 2008/09 in Melbourne, Australia reported their child's usual screen time and potential individual, social and physical environment correlates. Children wore ActiGraph GT1M accelerometers for eight days to objectively assess sedentary time (<100 counts.min-1). Multivariable linear regression analyses were performed, stratified by sex and controlling for child age, preschool/childcare attendance and clustering by centre of recruitment. Correlates significantly associated with screen time or sedentary time in individual models (p < 0.05) were included in final combined models.

RESULTS

Children were sedentary for 301.1 (SD 34.1) minutes/day and spent 108.5 (SD 69.6) minutes/day in screen time. There were no sex differences in screen or sedentary time. In the final models, sleep duration was inversely associated with girls' sedentary time and boys' screen time. The only other consistent correlates for boys and girls were parental self-efficacy to limit screen time and screen time rules, which were inversely associated with screen time for both sexes. Parents reporting that they get bored watching their child play was inversely associated and maternal television viewing was positively associated with boys' screen time. Paternal age was positively associated with boys' sedentary time. Maternal ethnicity was inversely associated and paternal education, child preferences for sedentary behaviour, and parental concerns about child's physical activity and sedentary behaviour were positively associated with girls' screen time.

CONCLUSIONS

The modifiable correlates of total sedentary and screen time identified in this study could be targeted in interventions to reduce these behaviours. With correlates differing for screen and sedentary time, and between boys and girls, interventions may also benefit from including behaviour- and sex-specific strategies.

Background media exposure prolongs nighttime sleep latency in Thai infants

BACKGROUND

Less is known about the effect of screen time and sleep at a younger age on current sleep outcome in infants. Therefore, we examined whether sleep parameter at a younger age and daily exposure of electronic media could predict sleep outcomes in 12-mo-old Thai infants.

METHODS

There were 208 typically developing infants enrolled since 6 mo old. Each main caregiver completed a sleep questionnaire and was interviewed for the infant's screen exposure at 6 and 12 mo of age. Nighttime sleep latency and sleep duration were calculated. Electronic media and sleep outcomes were analyzed using multiple linear regressions and path analysis.

RESULTS

Longer sleep latency at age 12 mo was predicted by longer daily duration of media exposure and longer 6-mo-old sleep latency. Infants who were exposed to electronic media above the median at both ages had longer 12-mo-old nighttime sleep latency compared with those who were exposed to the screen below the median at both ages.

CONCLUSION

Six-month-old nighttime sleep latency and 12-mo-old electronic media exposure could predict 12-mo-old nighttime sleep latency. Relative changes in media exposure over time can provide a better prediction of nighttime sleep latency in Thai infants than screen exposure at either time point.

Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective

The influential scientist Rene J. Dubos (1901–1982) conducted groundbreaking studies concerning early-life environmental exposures (e.g., diet, social interactions, commensal microbiota, housing conditions) and adult disease. However, Dubos looked beyond the scientific focus on disease, arguing that “mere survival is not enough”. He defined mental health as fulfilling human potential, and expressed concerns about urbanization occurring in tandem with disappearing access to natural environments (and elements found within them); thus modernity could interfere with health via “missing exposures”. With the advantage of emerging research involving green space, the microbiome, biodiversity and positive psychology, we discuss ecological justice in the dysbiosphere and the forces—financial inequity, voids in public policy, marketing and otherwise—that interfere with the fundamental rights of children to thrive in a healthy urban ecosystem and learn respect for the natural environment. We emphasize health within the developmental origins of health and disease (DOHaD) rubric and suggest that greater focus on positive exposures might uncover mechanisms of resiliency that contribute to maximizing human potential. We will entrain our perspective to socioeconomic disadvantage in developed nations and what we have described as “grey space”; this is a mental as much as a physical environment, a space that serves to insidiously reinforce unhealthy behavior, compromise positive psychological outlook and, ultimately, trans-generational health. It is a dwelling place that cannot be fixed with encephalobiotics or the drug-class known as psychobiotics.