A randomized clinical trial published in JAMA Pediatrics studied the impact of PASTI (Parent-Administered Screen Time Intervention) on toddlers’ screen time, sleep, and attention.
The families were randomly assigned to one of three groups: the PASTI group, a bedtime box (BB only) group, or a no-intervention (NI) group that continued their usual routines.
Based on the findings, PASTI had a high retention rate of 99% and a high adherence rate of 94% among families. It also led to a significant reduction in parent-reported screen time compared to the NI and BB-only groups.
Moreover, toddlers in the PASTI group had small to medium improvements in their sleep efficiency and had fewer night awakenings.
Note that the PASTI group did not show significant changes in attention levels when measured objectively, although parents noticed some positive changes in their children’s ability to control their behavior and impulses.
Understanding the Research
The study was designed as a randomized clinical trial (RCT) and was done over 7 weeks in toddlers aged 16 to 30 months. It involved families with toddlers who had at least 10 minutes of screen time within the hour before bed on three or more days a week.
These were the procedures:
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The PASTI intervention group: Families were instructed to eliminate screen time before bed and provided with a family bedtime box that contained alternative activities (reading, puzzles, etc.).
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The bedtime box (BB only) group: Families received similar materials minus the screen time guidelines.
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The no-intervention (NI) group: Families continued their usual bedtime activities without receiving additional support.
According to the results, most families during the study found the PASTI intervention easy to remember. Moreover, these were the outcomes regarding sleep and attention:
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Sleep outcomes: Compared to the NI group, PASTI participants reported shorter daytime sleep duration and fewer night awakenings. Families also showed a higher sleep efficiency compared to the NI group, which meant that the intervention may help toddlers sleep more effectively.
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Attention outcomes: Although cutting back screen time helped with sleep, it didn’t have a big effect on attention in the PASTI and NI groups.
Future studies might look into how managing screen time affects children’s attention and other areas of their development long term.
Practical Strategies for Parents and Caregivers
Here are some tips parents and caregivers can try to help toddlers sleep better and maybe even improve their behavior by managing screen time before bed:
Set clear screen time limits during the day
Setting a specific time for screens earlier in the day can help make sure toddlers aren’t using screens close to bedtime. When you give them screen time, it needs to be purposeful or intentional — rather than using screens to fill time throughout the day.
Here’s a resource on screen time tips for families, which include giving kids small rewards each time they follow screen time rules.
Focus on alternative bonding activities
Doing fun activities together, like telling stories, singing, or playing simple games, can take the place of screen time. They don’t just help keep screens away — they also help parents and children feel closer.
Make their bedtime routines predictable and calming
Parents can do this by setting up a series of relaxing activities that happen in the same order every night. This will help toddlers know what to expect so that bedtime becomes smoother.
You could start by giving them a warm bath, then putting on their pajamas and dimming the lights. Finish the routine with their favorite story and a goodnight gesture (such as a hug, a song, or saying goodnight to their toys).
Aside from these bedtime rituals, here’s a handout with more tips to improve sleep.
According to the researchers, future studies should look more closely at the different ways toddlers use screens and the situations in which they use them.
For more resources to promote positive behaviors in children and teens, check out our Healthy Habits Posters and Self-Care Worksheets.
