Background: Adequate sleep is essential for various health outcomes (e.g., obesity, diabetes, and cardiovascular disease). However, sleep time is threatened by the increased opportunities for unsupervised screen time available to children of all ages. The American Academy of Sleep Medicine recommends that elementary-aged children sleep between 9-12 hours per night. Further, the American Academy of Pediatrics recommends that children's recreational screen time be limited to less than two hours per day. Excess screen use can delay bedtime and lead to less restful sleep. The purpose of this study was to examine the association between adhering to screentime guidelines (/day) and the likelihood of meeting sleep guidelines (9-12 hours/day) in 2nd-grade children.

Methods: This study utilized two waves (2015-2016 and 2019-2020) of 2nd graders' parent-reported weighted survey data from the Texas School Physical Activity and Nutrition (SPAN) cross-sectional survey.

Results: The final analytic sample included (n=3,193) individuals (53% female, 62% Hispanic) across two years of data collection. 65% of parents/guardians reported their children met the sleep guidelines, while 33% of parents/guardians reported their children meeting the screentime guideline. After controlling for BMI, race/ethnicity, school disadvantage, education, sex, and year of collection, parents who reported their children met the screentime guideline had 1.53 greater odds of meeting sleep guidelines compared to children whose parent/guardians reported their children did not meet the screentime guidelines OR (1.53 95%CI = 1.18, 1.99). In stratified analyses, we found that the associations between meeting sleep and screen time guidelines were primarily true for White children. A higher proportion of white children were more likely to meet both sleep time and screen time recommendations compared to black and Hispanic children, while Black and Hispanic children were as likely to meet screen time guidelines as White children; both groups had significantly lower odds of meeting sleep guidelines compared to White children OR 0.32 (95%CI = 0.18, 0.58) and OR 0.49 (95%CI = 0.29, 0.83) respectively.

Discussion: Children's ability to meet the recommended sleep guidelines is associated with screentime guideline adherence. Further exploration is needed to understand racial/ethnic differences in guideline adherence for screentime and sleep. Interventions targeting sleep characteristics (e.g., duration, quality, and timing) should consider concomitantly targeting screentime adherence in elementary-aged children.

Key Take Away Points

1.Children's ability to meet the recommended sleep guidelines is associated with screen-time guideline adherence

2. Studies employing longitudinal designs should examine developmental trajectories in obesogenic behaviors and their relationship with risk for numerous health outcomes while accounting for parent rules and cultural norms

Author Biography

Dr. Ethan Hunt is a post-doctoral research fellow with the Michael and Susan Dell Center for Healthy Living. Dr. Hunt's research focuses on childhood obesity prevention, health disparities, and obesogenic behaviors.


The authors would like to acknowledge all the participating school districts, schools, families, research staff, and state-wide partners who contributed to the success of Texas SPAN