A recent study in Pediatrics found that fourth and seventh graders who slept near a smartphone or with a TV in the room slept less and had a higher prevalence of perceived insufficient sleep than their peers who did not. The findings led researchers to caution against unrestricted screen access in children’s bedrooms and suggest that interactive media such as video games and smartphones may be more disruptive to sleep than TV.
But just how should primary care providers handle the conversation about media and sleep? Michael Rich, MD, MPH, from Boston Children’s Hospital Division of Adolescent Medicine, and director of the hospital’s Center on Media and Child Health, weighs in.
“Sleep issues are very common in this age group,” says Rich, adding that media is not the only factor. Early morning school start times, evening activities and homework can contribute to sleep issues, which encompass inadequate sleep duration and sleep quality. The potential health effects include obesity, nutrition, learning issues and mental health.
“Media has become the most universal environmental health influence. The media we use and how we use them affect our health, whether we know it or not. We’ve become aware of the effects of the quality of the food we eat and the air we breathe, but we are not so good about connecting the dots between what we feed our minds and our health,” he says.
Rich acknowledges that researchers are in the early stages of gathering data about how media change children and teens, as well as adults. “We don’t know what the long-term effects of new media use are; we can only measure the short-term effects and extrapolate from there.”
Where’s that smartphone?
It’s not uncommon for kids who sleep with a smartphone to leave it on overnight, so they can respond to text messages. But when they are expecting the vibration, they don’t reach stage 4 REM sleep, where items such as the day’s algebra lesson move from short-term memory to the learning centers of the brain.
He suggests primary care providers make sleep and screen time part of their patients’ medical history and offer anticipatory guidance.
This means asking patients if they sleep with a smartphone or TV in the bedroom, if they have problems falling asleep in school or retaining the day’s lessons. Providers also should be on the alert for potentially media-related health conditions like obesity.
Partner with parents
As for communicating with parents, Rich recommends providers encourage them to work with children to help them master time-management skills. Plan their 24-hour day, slotting in time for sleep, at least one sit-down meal with family, outside playtime and homework, and then see what’s left for media use. “It’s best to establish these routines at the start of children’s school careers, but they can be done retroactively.” Other tips include reminding parents to model mindful and focused media use and set a policy that smartphones are charged overnight in the parents’ bedroom at an agreed-upon time.
Because there is no algorithm for when to refer a patient with a sleep issue to an expert, Rich encourages primary care providers to rely on gut instinct. “When you know, or suspect, you can’t help with an issue, then it’s time to refer the patient.”
The Center on Media and Child Health, with funding from Harvard Pilgrim Health Care, has developed a Toolkit for Clinicians for incorporating media awareness into health maintenance and other clinical visits. This research-based resource includes history forms, discussion guides and tip sheets.