Rebecca M.C. Spencer, PhD, on How TV Impacts Children’s Sleep

A good night’s sleep is key to children’s mental and physical health. Could watching TV and having a TV in the bedroom jeopardize children’s sleep quality and duration? 

A new study, led by Rebecca M.C. Spencer, PhD, from the Department of Psychological & Brain Sciences at the University of Massachusetts, Amherst, examined this association.¹ 

We spoke with Dr Spencer about her findings.

NEUROLOGY CONSULTANT: Can you provide additional insight into your study’s findings?

Rebecca Spencer: We found that children who watched less than 1 hour of TV per day got 22 more minutes of sleep than children who watched TV more than 1 hour per day—that is a huge difference. Whether the children watched for 1 to 3 hours or more than 4 hours did not matter. In other words, 1 to 3 hours of TV is just as bad as 4 or more hours. That is on weekdays. On weekends, children who watch TV the most (4 or more hours) sleep even less than they do on weekdays and less than children who watch less TV; those who watch 1 to 3 hours of TV do sleep a bit longer on weekends. Moving forward, the time aspect needs to be more fine-grained, for 1 to 3 hours is a significant range.

It is also interesting that the children that watch a lot of TV (more than 1 hour a day) actually nap more during the day. However, if you look at their total sleep time across 24 hours, this napping does not make up for what they lose overnight—they still end up with less sleep than those who watch less than 1 hour of TV a day.

We also determined that children with TVs in their room watch more adult TV programs. While we did not have quite enough data in this study to show whether the type of program a child watches before bed has a direct impact on sleep, we do know from related work that adult programming is more stimulating, having more mature content such as guns, and quicker story lines.  

Additionally, we did not see an effect of age in our results. While 33 months to 71 months may seem like a wide age range, children mature at very different rates in this window, causing some children aged 3 years to be more mature than some children aged 6 years. It is heterogeneous. We would expect the effect TV has on sleep to continue through childhood. The effects may even get worse because as these children get older, it may become harder for them to nap and help make up for lost sleep.

NEURO CON:  While some children do not have a TV in their bedroom, they might have a phone, tablet, or other video device. Do you know the impact these devices have on sleep compared with TVs? 

RS: We would expect the effects could possibly be similar. However, from casual conversations, it may also be less harmful because parents can take children’s devices away at bedtime—they cannot take away the TV. Also, some children may choose less-stimulating apps, like drawing, on their handheld device. 

Handheld devices may also provide more child-oriented content from which the child can choose to interact. I expect that children with TVs in their bedrooms may choose adult content because not much children’s content is available later into the night. This is certainly something to follow-up on.

NEURO CON: In what ways can TV’s effects on children’s sleep affect their overall health? And what are the signs clinicians should look out for when determining whether a child is watching too much TV?

RS: Sleep is important for physical and mental health. In children, less sleep is associated with poor immune function, poor executive function, poor learning/memory, emotional outbursts, and more. We see that children who have restricted sleep exhibit ADHD-like behaviors, such as poor inhibitory control and inattention. This paints a very devastating picture for TV’s effects.  

Our results give clinicians simple questions to ask parents: is there a TV in your child’s bedroom, and do they watch more than 1 hour of TV a day, particularly in the evening? These questions could lead to conversations to get parents to reconsider these choices.

NEURO CON: How should a health care provider approach the conversation with parents about limiting TV use or even taking the TV out of a child’s bedroom?

RS: We have the support of the American Academy of Pediatrics (AAP)² and the World Health Organization³ in limiting screen time. That is useful when clinicians ask the question about TV use, for they can cite the AAP as recommending less TV and that the organization has good reason to do so, for watching TV seems to affect children’s sleep, which in turn can harm how they perform in school. I do not see a reason to tiptoe around it. If the clinician asks, “Why does your child have a TV in their bedroom?” this gets the parents to think about it. But also, if the parents say, “Having a TV in the bedroom helps my child fall asleep,” clinicians can prove that it does not.

NEURO CON:  In what way do you hope your research impacts clinical practice?

RS: I hope that this work spurs clinicians to inquire. In fact, right now, pediatricians ask about sleep, but they do not have a functional response if the child is not sleeping enough. Using this study’s findings is a way to address sleep in a functional way. Rather than asking, “How much does your child sleep?” and giving the family no path to improve, these findings shift the question to, “How much TV does your child watch? Can we reduce this?”

References:

1. Helm AF, Spencer RMC. Television use and its effects on sleep in early childhood [published online April 13, 2019]. Sleep Health. https://doi.org/10.1016/j.sleh.2019.02.009.

2. Media and children communication toolkit. American Academy of Pediatrics. November 2016. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-and-Children.aspx. 

3. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. World Health Organization. April 2019. https://apps.who.int/iris/bitstream/handle/10665/311664/9789241550536-eng.pdf.