The Relationship between Screen Time Activity and Sleep Habits Among School-Aged Children in Shah Alam, Selangor

The Relationship between Screen Time Activity and Sleep Habits Among School-Aged Children in Shah Alam, Selangor

Noor Shida Hashim¹, Lyidia Dahlia Dahlan^*2, Squiter Macroy Wilsom Mukan²

1Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Malaysia

²Faculty of Health Sciences, Universiti Teknologi MARA Sarawak Campus, Sarawak, Malaysia

*Corresponding Author

DOI : https://dx.doi.org/10.47772/IJRISS.2024.8110272

Received: 20 November 2024; Accepted: 27 November 2024; Published: 24 December 2024

ABSTRACT

Introduction: Screen time impacts children’s health as electronic device usage rises, affecting sleep quality and growth. Balancing screen use is essential. Objective: This study aimed to investigate the relationship between screen time activities and sleep habits among school-aged children in Shah Alam, Selangor. The research was conducted to address the growing concern regarding the impact of screen time on children’s sleep patterns. Method: This study was conducted in Shah Alam, Selangor involving 379 school-aged children aged 7-12 years old. A sample of school-aged children was selected, and data on their screen time activities and sleep habits were collected using standardized measures. Results: The findings revealed a significant association between increased screen time and disrupted sleep patterns among the respondents. Recommendation: The implications of these findings for parents, educators, and healthcare professionals are discussed, along with recommendations for promoting healthy screen time habits and improving sleep quality among school-aged children. This study contributes to the growing body of research on the impact of screen time on children’s health and well-being, highlighting the need for further attention to this important public health issue.

Keywords: Screen time activities, Sleep habit, School-aged children, Gadget, Sleep Pattern

INTRODUCTION

In the modern era, the prevalence of screen time activities among school-aged children has raised concerns regarding its impact on their overall well-being, particularly in relation to sleep habits. The World Health Organization (2019) define screen time as the duration spent engaging in screen-based activities, which encompasses a wide range of sedentary behaviors such as watching television, using smartphones, computers, tablets, and playing video games. As children increasingly interact with electronic devices in their daily lives, the potential effects of excessive screen time on various aspects of health have come under scrutiny.

Sleep plays a vital role in the healthy development and well-being of children, with recommended sleep durations varying across age groups. Insufficient sleep in childhood can lead to learning difficulties, behavioral issues, and mood disturbances, with long-term implications for physical and mental health. Factors contributing to inadequate sleep or sleep deprivation in children include medical conditions, mental health disorders, and poor sleep hygiene practices. Furthermore, the use of electronic devices before bedtime has been linked to disruptions in sleep patterns and poor sleep quality among school-aged children.

Research has highlighted the detrimental effects of screen time on children’s sleep habits, with studies indicating a correlation between screen time activities and sleep insufficiency in young individuals. A study by Amelia and Ramdani (2019) found that screen time, particularly involving bedtime television and smartphone use, was associated with sleep disturbances in a significant percentage of children. Additionally, a systematic review by Lund et al. (2021) explored the impact of technology use on children’s sleep, suggesting potential mechanisms through which electronic device usage before bedtime may affect sleep quality.

Given the increasing prevalence of screen time activities among children worldwide, understanding the relationship between screen time and sleep habits is crucial for promoting optimal health and well-being in school-aged children. This study aims to investigate the association between screen time activities and sleep habits among school-aged children in Shah Alam, Selangor. By examining the effects of screen time on sleep quality and duration, this research seeks to provide insights into promoting healthy screen habits and fostering optimal sleep patterns in young individuals.

LITERATURE REVIEW

Screen Time Activity Among School-Aged Children

Amelia and Ramdani (2019) conducted a cross-sectional study that targeted school-aged children in the age range of 9-11 years old in 6 elementary schools in Purbalingga, Central Java, Indonesia. The screen time activities in this study include watching TV, using a cell phone, playing video games, or using a computer. This study revealed that 85.9% of children between 9 and 11 years old perform excessive screen time activities for over 2 hours. The screen time activity is predominantly 52.9% watching television and 30.4% in the bedroom. The screen time activity is predominantly 52.9% by watching television and there are 30.4% of them watching TV in the bedroom. During the school week, they could watch 5.85 hours of television before bed, and on weekends, they could watch 7.15 hours of television before bed. The research results indicate that children use their phones for longer than they do computer or video game play, 1.58 hours per day during the school day and 3.87 hours per day during the weekend.
A study in Australia revealed that 11% of students adhered to the International Screen Time Guidelines, which recommended only 2 hours of screen time per day. The majority of the students spent more than 12 hours daily on technology for non-academic purposes (Howie et al., 2020). This is similar to a study by Raj et al., 2022 in Selangor, Malaysia, where 91.4% of children below five years old were found to excessively spend their time on screen activities with a median of 3 hours. Likewise, in China, Lin et al. (2022) reported that 61.4% of children did not follow the World Health Organization’s (WHO) recommended screen time. The mean score for children who spent time on TV and smartphones was 0.6(SD=0.9) hours and 0.3 (SD = 0.6) hours, respectively. In line with studies, most children did not meet the WHO guidelines on screen time.

Screen time during the COVID-19 pandemic in children has increased in relation to school closings. Studies indicate that the average time children spend on screens daily has risen from 3 hours before the lockdown to over 6 hours during the lockdown. According to Eyimaya and Irmak (2021), during the COVID-19 pandemic, 71.7% of parents in Turkey stated that their children’s screen time had increased, reaching approximately 6.42 h/day. A similar study by Carroll et al. (2020) recruited 254 Canadian families with young children and found an 87% increase in screen time among children during the COVID-19 pandemic. Online education and study-related activities frequently contribute to this rise. This data implies that students’ screen time increased dramatically during the pandemic due to their remaining at home and easy access to the internet for entertainment and social networking purposes.

Sleep Habits Among School-Aged Children

Mishra et al. (2017) conducted a cross-sectional study among school-aged children attending government elementary schools in Lucknow, India, to examine the school children’s pre-sleep routines, duration, and pattern of sleep and the relationship between their sleep habits. The survey evaluated the respondents’ bedtime, wake-up time, nighttime routine, total sleep length, and daytime nap duration on weekdays and weekends. After analysing the data, they discovered that the average sleep duration on weekdays was 8.9 (1.2) hours, whereas on weekends, it was 10.7 (1.1) hours. Weekend wake-up times were significantly delayed in all age groups. The age groups of 6–10 and 11–15 years old showed more difficulties (34.3% and 34.2%, respectively) in waking up in the morning on weekdays. In comparison, those in higher grades have greater sleep debt.

During the COVID-19 pandemic, the children’s sleep habits were also affected. A cross-sectional study conducted by Top and Çam (2022) found a 55.5% prevalence of sleep disruption in 6-12-year-old children in Turkey during the COVID-19 pandemic. The most prevalent sleep problems were bedtime resistance, delay in sleep onset, and altered sleep duration. Meanwhile, Dondi et al. (2021) discovered that 69.3% of families in Italy indicated that their children had greater difficulty going to sleep as well, and 30.2% reported that their children had more difficulty staying asleep during the pandemic. Overall, these studies found that children’s food intake (more or less), mood (loneliness, melancholy, concern, or nervousness), or missing outdoor activities caused sleep difficulties.

The Relationship Between Screen Activity and Sleep Habits Among School-Aged Children.

Excessive screen time negatively influences health, significantly decreasing the duration and quality of sleep. Based on Chindamo et al. (2019) study revealed that there is an association between longer sleep onset latency and screen time usage. The odds of a shorter total sleep time were increased with daily tablet or smartphone use, and the odds of a longer sleep onset latency were increased with frequent (3-5 times a week) or daily use, regardless of other factors.

Majumdar, Biswas, and Sahu (2020) identified a negative correlation between increasing cell phone usage and sleep duration. Another study result aligns with this study, which found that 74.3% of respondents reported poor sleep, and smartphones had the highest score in the United Arab Emirates (Bani‐Issa et al., 2022). These findings could be explained by referring to Staples et al. (2021), who also found that children who reported using a screen before bed had shorter sleep duration and higher sleep variability when compared to children who did not report using a screen before bed.

Amelia and Ramdani (2019) reported that excessive screen time in children will experience sleep deprivation. The study indicates major factors for children experiencing insufficient sleep are two or more hours of watching TV, two more hours of using a cell phone, more than two hours of screen time, and performing sleep problems. Overall, it was discovered that there is a negative correlation between screen time and sleep quality, with increased screen time resulting in lower sleep quality.

A study conducted by Amelia and Ramdani (2019) found that there is a correlation between screen time and sleep deprivation among boys who were unable to fall asleep for more than two hours and experienced sleep disturbances. While the girls watch television for at least two hours found to be experiencing sleep disturbances.

METHODOLOGY

The study was conducted using a cross-sectional approach in Shah Alam, Selangor. A self-administered survey questionnaire was adapted from Klakk et al. (2020) and Owens et al. (2000) to determine the relationship between screen time activities and sleep habits among school-aged children in Shah Alam, Selangor. The questionnaire was available in both English and Malay languages. There were three distinct components that made up the questionnaire total. The first section is a sociodemographic factor, which consists of 5 questions about the relationship to the children, gender of the children, age of the children, race, and the average family monthly outcome. The second section is the screen time usage. The questionnaire consists of 3 items which are screen media environment (2 items) and child screen media use (1 item). The screen media environment was rated by a nominal scale (yes/no) and five-point scale that ranged from ‘every day’ to ‘never’. Points ranging from 4 to 0 were given to each response. The children’s screen media use was rated on a six-point scale for weekends and weekdays. Points ranging from 5 to 0 were given to each response. Section 3 is to measure the children’s sleep habits and duration. This section contained 2 items that needed to be answered in a statement, and 11 items were rated on a three-point scale with usually (5 to 7 times/week), sometimes (2 – 4 times a week) and rarely (0-1/week). The items were grouped into bedtime resistance (3 items), sleep onset delay (1 item), sleep duration (1 item), night waking (2 items) and daytime sleepiness (4 items). The parents responded to the questionnaire by themselves, answering the questions concerning the number of hours that their children slept each day, both on school days and on weekends. A high score implies sleep disturbance.

Setting and Sample

There were 27224 school-aged children in Shah Alam, Selangor (Maklumat Pendidikan Asas Negeri Selangor, 2023). By using Rao soft Sample Size calculation, the recommended sample size for this study is 379 with a 5% margin error, 95% confidence level, and 50% response distribution. Parents with schoolchildren aged between 7 to 12 years old in Shah Alam, Selangor were included in this study. Meanwhile, parents with children who are disabled (e.g., Syndrome Down, Autism, Attention Deficit Hyperactivity Disorder (ADHD), cerebral palsy, and disability) were excluded from participating.

Ethical Consideration

This study has been approved by the ethical committee of University Technologic MARA (UiTM). The approval number is FERC/FSK/MR/2023/00257.

Data Analysis

Data were analysed independently using Statistical Packages for the Social (SPSS) Sciences version 26.0 to carry out descriptive and inferential statistics.

RESULT

Table 1 shows the characteristics of respondents who participated in this study: relationship to the children, gender of the children, age of the children, race, and the average family monthly outcome. Most of the respondents were mothers (59.6%). The majority of children in this study were boys (52.2%) and aged 7 – 9 years old (64.9%). Over half of the children were of Malay descent (68.6%). Based on the result, around 48.5% of the respondents have a monthly income between RM2500 – RM5000.

Table 1: Frequency and percentage distribution of demographic variables (n=379)

Children have access to multiple screen devices (see Table 2). Children most commonly used electronic devices are television (60.7%), smartphone (19.5%), tablet/iPad (12.1%), and laptop (5.8%). Only 4.7% of children used handheld game consoles, while 4% had familiarity with desktop computers.

Table 2: The percentage of digital device access. (n=379)

Table 3 shows the frequency and percentage of duration and content of media used during weekdays and weekends. The WHO recommended screen time in school-age children is less than 2 hours. During weekdays, most children spend more than 2 hours on social media and video calls were 66.7% and 62% respectively. Meanwhile, during the weekend, most children spend more than 2 hours on entertainment and playing games 79.9% and 65.6% respectively.

Table 3: Children’s daily media use on weekdays and weekends by type of activity in percentage per time category according to professional recommendation of 2 hours of screen time. (n = 379).

Table 4 shows the children’s total screen time during weekdays and weekends within the past month. On weekdays, the average total screen time activity was approximately 8.70 hours (M = 8.70). Meanwhile, on weekends, the average total screen time activity increased to approximately 12.86 hours (M = 12.86).

Table 4: Children’s total screen time activity within the past month

Table 5 shows the children sleep habits of school-aged children in Shah Alam that were categorized into bbedtime resistance, ssleep onset delay, nnight wakings, ssleep duration and dlaytime sleepiness. The findings suggest that children in Shah Alam generally exhibit positive sleep habits with minimal bedtime resistance, quick sleep onset, and relatively consistent sleep duration.

Table 5: The children’s sleep habit

Table 6 shows the children’s sleep duration in the past weeks. The mean of total duration of sleep on weekdays (M = 8.65, SD = 1.18) and on weekends (M = 10.07, SD = 3.08) indicates children sleep considerably more or less than the mean of 8.65 hours on weekdays and sleep significantly longer on the weekends within the mean of 10.07 hours.

Table 6: Children’s total sleep duration in the past week.

Table 7 portrays the relationship between screen time activity and sleep habits among school-aged children. There was a positive correlation between bedtime resistance and total screen time activity on weekdays (r = .11, p = .031). However, this relationship was not significant on weekends (r = .08, p = .138); this shows that the impact of screen time on bedtime resistance may vary depending on the day of the week. There was a weak negative correlation between total screen time activity on weekdays and sleep duration (r = -0.043 p = .408) and a weak negative correlation between sleep duration and total screen time activity on weekends (r = -.038, p = .457).

Table 7: The relationship between screen time activity and sleep habits among school-aged children.

DISCUSSION

The duration of screen time activities among school-aged children

The data reveals a concerning trend among school-aged children in Shah Alam, where a significant number of them exceed the recommended daily screen time limit of 2 hours. This issue becomes particularly pronounced during weekends when the average total screen time activity escalates to approximately 12.86 hours. These findings corroborate existing research, emphasizing the detrimental effects of excessive screen time on children’s health and development, as acknowledged by the World Health Organization (WHO, 2019).

Specifically, prolonged screen time has been associated with a range of physical health concerns, including obesity, compromised sleep quality, and musculoskeletal problems (Amelia & Ramdani, 2019). The prevalence of high screen time, especially during weekends, underscores the urgency of addressing these concerns. It underscores the imperative for parents and educators to remain vigilant about uncontrolled digital device access among children.

In response to these findings, it is imperative for parents and educators to advocate for a balanced approach to screen time. Encouraging children to participate in a diverse array of activities, encompassing physical exercise, social interactions, and creative pursuits, can help mitigate the negative consequences of excessive screen time. This approach aligns with recommendations from the literature, which highlight the significance of promoting alternative activities to reduce dependence on electronic devices (Howie et al., 2020).

Establishing clear guidelines and limits on screen time is fundamental to instilling healthy habits. Such guidelines, when complemented with the provision of alternative activities and hobbies, can effectively contribute to reducing children’s screen time, fostering overall well-being, and promoting holistic development (Raj et al., 2022). It is also crucial to consider the influence of age and gender in shaping children’s screen time habits. By discerning potential variations in screen time usage among different age groups or genders within the surveyed children, tailored interventions and support strategies can be formulated. This approach aligns with insights from the literature review, which underscores the importance of acknowledging demographic factors when addressing screen time-related issues (Amelia & Ramdani, 2019).

The sleep habits among school-aged children

The data indicates that average children tend to exhibit less bedtime resistance. This suggests that they may have established smoother bedtime routines. This observation is consistent with existing literature emphasizing the importance of consistent bedtime routines in reducing bedtime resistance, as Mishra et al. (2017) stated. This finding also aligns with the study by Top and Çam (2022), where significant number of children has experienced night waking, with some waking up more than once during the night.

The study suggests that children in Shah Alam generally wake up independently, tend to wake up early, and occasionally experience daytime sleepiness. These findings raise discussions about the potential consequences of early waking and daytime sleepiness on children’s cognitive functioning and mood. Additionally, the literature review identifies factors such as screen time and changes in daily routines as potential contributors to sleep difficulties in children, as highlighted by Amelia and Ramdani (2019).

The relationship between screen time activity and sleep habits among school-aged children

The analysis revealed a statistically significant positive and weak correlation between bedtime resistance and total screen time activity on weekdays (R = 0.25, p < 0.05). This suggests that higher screen time during weekdays is associated with increased bedtime resistance among children. However, the study found no statistically significant relationship between bedtime resistance and total screen time activity on weekends. This result contrasts with the literature review, which did not differentiate between weekdays and weekends and reported a high prevalence of excessive screen time among children (Amelia & Ramdani, 2019).

Additionally, the study found very weak negative correlations between sleep duration and total screen time activity, both on weekdays (R = -0.09) and weekends (R = -0.08), but these relationships were not statistically significant at the 0.05 level. This result aligns with the literature review’s general consensus that excessive screen time negatively impacts sleep duration (Chindamo et al., 2019), although the literature review reported stronger associations. Furthermore, the correlation between daytime sleepiness and total screen time activity on weekdays was not statistically significant (R = 0.06) in the study, indicating a lack of a strong association between these variables. The literature review did not specifically address the correlation between daytime sleepiness and screen time activity, making it challenging to compare these findings.

CONCLUSION

This study provides a comprehensive overview of sleep habits and screen time among school-aged children in Shah Alam, Selangor. The finding emphasizes the need for tailored interventions and guidelines for specific demographic groups are needed to promote healthier sleep and screen time management.

ACKNOWLEDGEMENT

Special thanks to the ethical committee UiTM for ethics approval and to all the participants who contributed to this

REFERENCES

1. Amelia, V. L., & Ramdani, M. L. (2019). Screen time activity and its impact to sleep duration of school-aged. MEDISAINS, 17(1), 3.
2. Bani‐Issa, W., Radwan, H., Saqan, R., Hijazi, H., Fakhry, R., Alameddine, M., Naja, F., Ibrahim, A., Lin, N., Naing, Y. T., & Awad, M. (2022). Association between quality of sleep and screen time during the COVID ‐19 outbreak among adolescents in the United Arab Emirates. Journal of Sleep Research.
3. Carroll, N., Sadowski, A., Laila, A., Hruska, V., Nixon, M., WL, D., & Haines, J. (2020). The Impact of COVID-19 on Health Behavior, Stress, Financial and Food Security among Middle to High Income Canadian Families with Young Children. Nutrients, 12(8), 2352.
4. Chindamo, S., Buja, A., DeBaptiste, E., Terraneo, A., Marini, E., Pérez, L. J. G., Marconi, L., Baldo, V., Chimenti, G., Doria, M., Ceschin, F., Malorgio, E., Tommasi, M., Sperotto, M., Buzzetti, R., & Gallimberti, L. (2019). Sleep and new media usage in toddlers. European Journal of Pediatrics, 178(4), 483–490.
5. Dondi, A., Fetta, A., Lenzi, J., Morigi, F., Candela, E., Rocca, A., Cordelli, D. M., & Lanari, M. (2021). Sleep disorders reveal distress among children and adolescents during the Covid-19 first wave: results of a large web-based Italian survey. Italian Journal of Pediatrics, 47(1).
6. Eyimaya, A. Ö., & Irmak, A. Y. (2021). Relationship between parenting practices and children’s screen time during the COVID-19 pandemic in Turkey. Journal of Pediatric Nursing, 56, 24–29.
7. Howie, E. K., Joosten, J., Harris, C. J., & Straker, L. M. (2020). Associations between meeting sleep, physical activity or screen time Behaviour guidelines and academic performance in Australian school children. BMC Public Health, 20(1).
8. Klakk, H., Wester, C. T., Olesen, L. G., Rasmussen, M., Kristensen, P. L., Pedersen, J., & Grøntved, A. (2020). The development of a questionnaire to assess leisure time screen-based media use and its proximal correlates in children (SCREENS-Q). BMC Public Health, 20(1).
9. Lin, Y., Zhang, X., Huang, Y., Jia, Z., Chen, J., Hou, W., Zhao, L., Wang, G., & Zhu, J. (2022). Relationships between screen viewing and sleep quality for infants and toddlers in China: A cross-sectional study. Frontiers in pediatrics, 10, 987523.
10. Lund, L., Sølvhøj, I. N., Danielsen, D., & Andersen, S. (2021). Electronic media use and sleep in children and adolescents in western countries: a systematic review. BMC Public Health, 21(1), 1-14.
11. Majumdar, P., Biswas, A., & Sahu, S. (2020). COVID-19 pandemic and lockdown: cause of sleep disruption, depression, somatic pain, and increased screen exposure of office workers and students of India. Chronobiology international, 37(8), 1191–1200.
12. Jabatan Pendidikan Negeri Selangor (2023). Maklumat Pendidikan Asas Negeri Selangor.
13. Mishra, A., Pandey, R. K., Minz, A., & Arora, V. (2017). Sleeping habits among school children and their effects on sleep pattern. Journal of Caring Sciences, 6(4), 315–323.
14. Owens, J. A., Spirito, A., & McGuinn, M. (2000). The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep, 23(8), 1043-1051.
15. Raj, D., Mohd Zulkefli, N., Mohd Shariff, Z., & Ahmad, N. (2022). Determinants of Excessive Screen Time among Children under Five Years Old in Selangor, Malaysia: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 19(6), 3560.
16. Staples, A. D., Hoyniak, C. P., McQuillan, M. E., Molfese, V. J., & Bates, J. E. (2021b). Screen use before bedtime: Consequences for nighttime sleep-in young children. Infant Behaviour & Development, 62, 101522.
17. Top, F. Ü., & Çam, H. H. (2022). Sleep disturbances in school-aged children 6–12 years during the COVID-19 pandemic in Turkey. Journal of Paediatric Nursing, 63, 125–130.
18. Wong, S., et al. (2020). Cultural influences on sleep patterns and sleep quality among ethnically diverse children in urban settings. Journal of Cultural Diversity and Ethnic Minority Psychology, 26(2), 289-298.
19. World Health Organization. (2019, April 24). Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age.