Quiet Time Means No Screen Time: A Project Aiming to Increase Restful Sleep within the Pediatric Acute Care Unit

Abstract

The use of blue-light-emitting smart devices prior to bedtime has been identified as one of the reasons of increased pediatric sleep disturbances and poor sleep quantity. Interrupted sleep is a risk factor for healing and well-being in the pediatric acute ward. The aim of this project was to promote high-quality sleep within our pediatric ward by implementing a standardized protocol that eliminated exposure to electronic blue light prior to bedtime, per recommendations from the American Academy of Pediatrics. Our objective was to promote enhanced quantity of sleep and healing by restricting and removing all smart devices during nighttime hours in the pediatric acute ward. We utilized the Bedtime issues, Excessive daytime sleepiness, night Awakenings, Regularity and duration of Sleep, and Snoring validated screening tool, Children Sleep Habit Questionnaire, and included a survey question regarding smart device use to evaluate patients' sleep routine. After the implementation of “no screen time” innovation, patients' and parents' quantity of sleep and total restful hours was reassessed and pre/post results analyzed. The pilot project evaluated 57 patients aged 18 months to 19 years with varying admitting diagnoses. The quiet time innovation results demonstrated improved length and reported uninterrupted sleep among patients. Eliminating electronic screens during evening (sleeping) hours in the acute care setting was associated with improved sleep among pediatric patients, enhancing potential for recovery, promoting well-being, and modeling effects of limiting screen time for participants.

Keywords

sleep - smart devices - pediatrics - pediatric intensive care units

Publication History

Received: 30 August 2023

Accepted: 20 November 2023

Article published online:
19 February 2024

• References

• 1 Schlieber M, Han J. The role of sleep in young children's development: a review. J Genet Psychol 2021; 182 (04) 205-217
• 2 Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS. Association between portable screen-based media device access or use and sleep outcomes: a systematic review and meta-analysis. JAMA Pediatr 2016; 170 (12) 1202-1208
• 3 Higuchi S, Nagafuchi Y, Lee SI, Harada T. Influence of light at night on melatonin suppression in children. J Clin Endocrinol Metab 2014; 99 (09) 3298-3303
• 4 Markham Heid. There's Worrying New Research About Kids' Screen Time and Their Mental Health. TIME. Published online October 29, 2018. Accessed November 30, 2023 at: https://time.com/5437607/smartphones-teens-mental-health/
• 5 American Academy of Pediatrics. Media and Children. www.aap.org Published 2021. Accessed November 30, 2023 at: https://www.aap.org/en/patient-care/media-and-children/
• 6 Foerster M, Henneke A, Chetty-Mhlanga S, Röösli M. Impact of adolescents' screen time and nocturnal mobile phone-related awakenings on sleep and general health symptoms: a prospective cohort study. Int J Environ Res Public Health 2019; 16 (03) 518
• 7 Fry A. How Blue Light Affects Kids' Sleep - SleepFoundation.org. Sleep Foundation. Published January 22, 2021. Accessed November 30, 2023 at: https://www.sleepfoundation.org/children-and-sleep/how-blue-light-affects-kids-sleep
• 8 Somani A, Wiseman A, Hickman MG. et al. Night-time screen media use in the pediatric intensive care unit. Glob Pediatr Health 2021; (e-pub head of publication) DOI: 10.1177/2333794X211049758.
• 9 Thai H, Davis CG, Mahboob W, Perry S, Adams A, Goldfield GS. Reducing social media use improves appearance and weight esteem in youth with emotional distress. Psychology Popular Media 2023 (e-pub ahead of print). doi: https://doi.org/10.1037/ppm0000460s
• 10 Centers for Disease Control and Prevention. The Color of the Light Affects the Circadian Rhythms | NIOSH | CDC. www.cdc.gov Published April 1, 2020. Accessed November 30, 2023 at: https://www.cdc.gov/niosh/emres/longhourstraining/color.html
• 11 Paruthi S, Brooks LJ, D'Ambrosio C. et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016; 12 (06) 785-786
• 12 Lee SI, Matsumori K, Nishimura K. et al. Melatonin suppression and sleepiness in children exposed to blue-enriched white LED lighting at night. Physiol Rep 2018; 6 (24) e13942
• 13 Crowley SJ, Cain SW, Burns AC, Acebo C, Carskadon MA. Increased sensitivity of the circadian system to light in early/mid-puberty. J Clin Endocrinol Metab 2015; 100 (11) 4067-4073
• 14 Hale L, Kirschen GW, LeBourgeois MK. et al. Youth screen media habits and sleep: sleep-friendly screen behavior recommendations for clinicians, educators, and parents. Child Adolesc Psychiatr Clin N Am 2018; 27 (02) 229-245
• 15 Twenge JM. More time on technology, less happiness? Associations between digital-media use and psychological well-being. Curr Dir Psychol Sci 2019; 28 (04) 372-379
• 16 Hill D, Ameenuddin N, Chassiakos YLR. et al. Media and young minds. Policy statement of the American Academy of Pediatrics. Pediatrics 2016; 138 (05) e20162591
• 17 Addictive behaviours: Gaming disorder. Accessed November 30, 2023 at: www.who.int http://www.who.int/features/qa/gaming-disorder/en/
• 18 Hybschmann J, Topperzer MK, Gjærde LK. et al. Sleep in hospitalized children and adolescents: a scoping review. Sleep Med Rev 2021; 59: 101496
• 19 Park J. Sleep promotion for preterm infants in the NICU. Nurs Womens Health 2020; 24 (01) 24-35
• 20 Module 6. Improving Your Sleep and Alertness, Improve Sleep by Avoiding Light | NIOSH | CDC. www.cdc.gov Published April 2, 2020. Accessed November 30, 2023 at: https://www.cdc.gov/niosh/work-hour-training-for-nurses/longhours/mod6/07.html
• 21 Bevan RS, Halloran L, Adamolekun A, Mattina C, Dublon V. G263(P) “No Speaking, Children Sleeping” a quality improvement approach to improving children's sleep on a hospital ward. Disease Childhood 2017; (e-pub ahead of print) DOI: 10.1136/archdischild-2017-313087.257.
• 22 Gardner G, Collins C, Osborne S, Henderson A, Eastwood M. Creating a therapeutic environment: a non-randomised controlled trial of a quiet time intervention for patients in acute care. Int J Nurs Stud 2009; 46 (06) 778-786
• 23 Hedges C, Hunt C, Ball P. Quiet time improves the patient experience. J Nurs Care Qual 2019; 34 (03) 197-202
• 24 Lim R. Benefits of quiet time interventions in the intensive care unit: a literature review. Nurs Stand 2018; 32 (30) 41-48
• 25 Twenge JM. Increases in depression, self-harm, and suicide among U.S. adolescents after 2012 and links to technology use: possible mechanisms. Psychiatr Res Clin Pract 2020; 2 (01) 19-25