Screen time and sleep duration in pediatric critical care: Secondary analysis of a pilot observational study

Purpose Quantify and describe screen time (screen type, child engagement, adult co-viewing) in eight critically ill children and determine its association with sleep duration before (parent report) and during (actigraphy) a 24-h period in the PICU. Design and methods Exploratory secondary analysis of 24-h video and actigraphy recordings in eight children 1–4 years old in the PICU. Videos were coded for screen time using Noldus Observer XT® software. Screen time was compared to American Academy of Pediatrics recommendations (0 h/day <2 years, ≤1 h/day 2–5 years). Parents completed the Brief Infant Sleep Questionnaire-Revised-Short Form (BISQ-R-SF) to understand children's pre-hospital sleep. Actigraphy was used to measure PICU sleep duration. Associations between screen time and sleep were determined with bivariate analyses. Results Average age was 23.1 months (SD = 9.7). Daily screen time was 10.7 h (SD = 7), ranging from 2.4 to 21.4 h. Children (15.1% of sampling intervals) and adults (16.3%) spent little time actively engaged with screen media. BISQ-R-SF scores ranged from 48.9 to 97.7. Children had an average of 7.9 (SD = 1.2) night shift (19:00–6:59) sleep hours. Screen time was associated with worse pre-hospital sleep quality and duration with large effect sizes (rs= −0.7 to −1) and fewer nighttime sleep hours with a medium effect size (rs= −0.5). Conclusions All children exceeded screen time recommendations. Screen time was associated with worse pre-hospital sleep quality and duration, and decreased PICU sleep duration. Large-scale studies are needed to explore PICU screen time and sleep disruption. Practice implications Clinicians should model developmentally appropriate screen media use in PICU.