Abstract
The COVID-19 pandemic and the restrictions to minimize transmission of the virus affected the population worldwide. As a result of prolonged home confinement in Greece, changes in work schedules, disruptions of the educational process, the challenge of online learning, the constant need for self-protection, and the restrictions on social interaction, the family life was dramatically altered. In this study, sleep patterns of preschool children were recorded, and effects of screen time and diet were investigated in relation to quarantine due to COVID-19. Parents of 146 children provided data on their children’s night-time sleep habits, dietary habits, and screen time exposure. Children’s sleep problems were measured with the Children’s Sleep Questionnaire. Descriptive and qualitative analyses showed that most parents (54.1%) reported that children’s sleep habits changed during the imposed home confinement. Children with more sleep problems were more likely to have increased screen exposure. The present study provides evidence on the negative impact of COVID-19 lockdown on the sleep behavior of Greek preschoolers. Focused action is needed to safeguard and promote preschoolers’ physical and mental health during the lockdown and the recovery period.
Highlights
-
Preschoolers’ sleep behavior has been highly influenced by the imposed lockdowns
-
Prolonged screen exposure is associated with increased sleep difficulties
-
Reasons for screen exposure were mainly related to education, entertainment, communication, familiarity with technology, and gaming
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
The data that support the outcomes of the present study are available on demand from the corresponding author.
References
Altena, E., Baglioni, C., Espie, C. A., Ellis, J., Gavriloff, D., Holzinger, B., Schlarb, A., Frase, L., Jernelöv, S., & Riemann, D. (2020). Dealing with sleep problems during home confinement due to the COVID‐19 outbreak: Practical recommendations from a task force of the European CBT‐I Academy. Journal of Sleep Research, 29(4), e13052. https://doi.org/10.1111/jsr.13052.
Astill, R. G., Van der Heijden, K. B., Van IJzendoorn, M. H., & Van Someren, E. J. (2012). Sleep, cognition, and behavioral problems in school-age children: a century of research meta-analyzed. Psychological Bulletin, 138(6), 1109–1138. https://doi.org/10.1037/a0028204.
Belmon, L. S., van Stralen, M. M., Busch, V., Harmsen, I. A., & Chinapaw, M. J. (2019). What are the determinants of children’s sleep behavior? A systematic review of longitudinal studies. Sleep Medicine Reviews, 43, 60–70. https://doi.org/10.1016/j.smrv.2018.09.007.
Brown, S. M., Doom, J. R., Lechuga-Peña, S., Watamura, S. E., & Koppels, T. (2020). Stress and parenting during the global COVID-19 pandemic. Child Abuse and Neglect, 110, 104699. https://doi.org/10.1016/j.chiabu.2020.104699.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa.
Bruni, O., Malorgio, E., Doria, M., Finotti, E., Spruyt, K., Melegari, M. G., Villa, M. P., & Ferri, R. (2022). Changes in sleep patterns and disturbances in children and adolescents in Italy during the Covid-19 outbreak. Sleep Medicine, 91, 166–174. https://doi.org/10.1016/j.sleep.2021.02.003.
Cartanyà-Hueso, À., Lidón-Moyano, C., Cassanello, P., Díez-Izquierdo, A., Martín-Sánchez, J. C., Balaguer, A., & Martínez-Sánchez, J. M. (2021). Smartphone and tablet usage during COVID-19 pandemic confinement in children under 48 months in Barcelona (Spain). Healthcare, 9(1), 96. https://doi.org/10.3390/healthcare9010096.
Creswell, J. W., & Clark, V. L. P. (2017). Designing and conducting mixed methods research. Sage publications
Cellini, N., Di Giorgio, E., Mioni, G., & Di Riso, D. (2021). Sleep and psychological difficulties in Italian school-age children during COVID-19 lockdown. Journal of Pediatric Psychology, 46(2), 153–167. https://doi.org/10.1093/jpepsy/jsab003.
Chassiakos, Y. L. R., Radesky, J., Christakis, D., Moreno, M. A., & Cross, C., Council on Communications and Media. (2016). Children and adolescents and digital media. Pediatrics, 138(5), e20162593. https://doi.org/10.1542/peds.2016-2593.
Council on Communications and Media. (2016). Media and young minds. Pediatrics, 138(5), e20162591. https://doi.org/10.1542/peds.2016-2591.
Córdova, F. V., Barja, S., & Brockmann, P. E. (2018). Consequences of short sleep duration on the dietary intake in children: A systematic review and metanalysis. Sleep Μedicine Reviews, 42, 68–84. https://doi.org/10.1016/j.smrv.2018.05.006.
Davis, K. F., Parker, K. P., & Montgomery, G. L. (2004). Sleep in infants and young children: Part one: normal sleep. Journal of Pediatric Health Care, 18(2), 65–71. https://doi.org/10.1016/s0891-5245(03)00149-4.
Dellagiulia, A., Lionetti, F., Fasolo, M., Verderame, C., Sperati, A., & Alessandri, G. (2020). Early impact of COVID-19 lockdown on children’s sleep: A 4-week longitudinal study. Journal of Clinical Sleep Medicine, 16(9), 1639–1640. https://doi.org/10.5664/jcsm.8648.
Dutil, C., Podinic, I., Sadler, C. M., da Costa, B. G., Janssen, I., Ross-White, A., Saunders, T. J., Tomasone, J. R., & Chaput, J. P. (2022). Sleep timing and health indicators in children and adolescents: A systematic review. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 42(4), 150–169. https://doi.org/10.24095/hpcdp.42.4.04.
Eales, L., Gillespie, S., Alstat, R. A., Ferguson, G. M., & Carlson, S. M. (2021). Children’s screen and problematic media use in the United States before and during the covid‐19 pandemic. Child Development, 92(5), e866–e882. https://doi.org/10.1111/cdev.13652.
Eichen, L., Hackl‐Wimmer, S., Eglmaier, M. T. W., Lackner, H. K., Paechter, M., Rettenbacher, K., Rominger, C., & Walter‐Laager, C. (2021). Families’ digital media use: Intentions, rules and activities. British Journal of Educational Technology, 52(6), 2162–2177. https://doi.org/10.1111/bjet.13161.
Eyimaya, A. O., & 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. https://doi.org/10.1016/j.pedn.2020.10.00.
Hartshorne, J. K., Huang, Y. T., Paredes, P. M. L., Oppenheimer, K., Robbins, P. T., & Velasco, M. D. (2021). Screen time as an index of family distress. Current Research in Behavioral Sciences, 2, 100023. https://doi.org/10.1016/j.crbeha.2021.100023.
Janssen, X., Martin, A., Hughes, A. R., Hill, C. M., Kotronoulas, G., & Hesketh, K. R. (2020). Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and meta-analysis. Sleep Medicine Reviews, 49, 101226. https://doi.org/10.1016/j.smrv.2019.101226.
Kaditis, A. G., Ohler, A., Gileles‐Hillel, A., Choshen‐Hillel, S., Gozal, D., Bruni, O., Aydinoz, S., Cortese, R., & Kheirandish‐Gozal, L. (2021). Effects of the COVID‐19 lockdown on sleep duration in children and adolescents: A survey across different continents. Pediatric Pulmonology, 56(7), 2265–2273. https://doi.org/10.1002/ppul.25367.
Khan, M. K., Chu, Y. L., Kirk, S. F., & Veugelers, P. J. (2015). Are sleep duration and sleep quality associated with diet quality, physical activity, and body weight status? A population-based study of Canadian children. Canadian Journal of Public Health, 106(5), e277–e282. https://doi.org/10.17269/cjph.106.4892.
Kontogianni, M. D., Vidra, N., Farmaki, A. E., Koinaki, S., Belogianni, K., Sofrona, S., Magkanari, F., & Yannakoulia, M. (2008). Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents. The Journal of Nutrition, 138(10), 1951–1956. https://doi.org/10.1093/jn/138.10.1951.
Lan, Q. Y., Chan, K. C., Kwan, N. Y., Chan, N. Y., Wing, Y. K., Li, A. M., & Au, C. T. (2020). Sleep duration in preschool children and impact of screen time. Sleep Medicine, 76, 48–54. https://doi.org/10.1016/j.sleep.2020.09.024.
Lewien, C., Genuneit, J., Meigen, C., Kiess, W., & Poulain, T. (2021). Sleep-related difficulties in healthy children and adolescents. BMC Pediatrics, 21(1), 1–11. https://doi.org/10.1186/s12887-021-02529-y.
Lissak, G. (2018). Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study. Environmental Research, 164, 149–157. https://doi.org/10.1016/j.envres.2018.01.015.
Liu, Z., Tang, H., Jin, Q., Wang, G., Yang, Z., Chen, H., Yan, H., Rao, W., & Owens, J. (2021). Sleep of preschoolers during the coronavirus disease 2019 (COVID‐19) outbreak. Journal of Sleep Research, 30(1), e13142. https://doi.org/10.1111/jsr.13142.
López-Bueno, R., López-Sánchez, G. F., Casajús, J. A., Calatayud, J., Tully, M. A., & Smith, L. (2021). Potential health-related behaviors for pre-school and school-aged children during COVID-19 lockdown: A narrative review. Preventive Medicine, 143, 106349. https://doi.org/10.1016/j.ypmed.2020.106349.
Mattimoe, R., Hayden, M. T., Murphy, B., & Ballantine, J. (2021). Approaches to analysis of qualitative research data: a reflection on the manual and technological approaches. Accounting, Finance, & Governance Review, 27(1), 54–69.
Mavroudi, A., Chrysochoou, E. A., Boyle, R. J., Trypsianis, G., Xinias, I., Cassimos, D., Imvrios, G., Katotomichelakis, M., Karagiannidou, A., Karantaglis, N., Kourentas, G., & Warner, J. O. (2018). Validation of the Children’s sleep habits questionnaire in a sample of Greek children with allergic rhinitis. Allergologia et Immunopathologia, 46(4), 389–393. https://doi.org/10.1016/j.aller.2017.09.016.
Miller, M. A., Bates, S., Ji, C., & Cappuccio, F. P. (2021). Systematic review and meta‐analyses of the relationship between short sleep and incidence of obesity and effectiveness of sleep interventions on weight gain in preschool children. Obesity Reviews, 22(2), e13113. https://doi.org/10.1111/obr.13113.
Moore, S. A., Faulkner, G., Rhodes, R. E., Brussoni, M., Chulak-Bozzer, T., Ferguson, L. J., Mitra, R., O’Reilly, N., Spence, J. C., Vanderloo, L. M., & Tremblay, M. S. (2020). Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: A national survey. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 85. https://doi.org/10.1186/s12966-020-00987-8.
Nagata, J. M., Magid, H. S. A., & Gabriel, K. P. (2020). Screen time for children and adolescents during the COVID‐19 pandemic. Obesity, 28(9), 1582–1583. https://doi.org/10.1002/oby.22917.
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), 1043–1052. https://doi.org/10.1093/sleep/23.8.1d.
Ozili, P. K. (2023). The acceptable R-square in empirical modelling for social science research. In Social research methodology and publishing results: A guide to non-native english speakers (pp. 134–143). IGI Global.
Parlapani, E., Holeva, V., Voitsidis, P., Blekas, A., Gliatas, I., Porfyri, G. N., Golemis, A., Papadopoulou, K., Dimitriadou, A., Chatzigeorgiou, A. F., Bairachtari, V., Patsiala, S., Skoupra, M., Papigkioti, K., Kafetzopoulou, C., & Diakogiannis, L. (2020). Psychological and behavioral responses to the COVID-19 pandemic in Greece. Frontiers in Psychiatry, 11, 821. https://doi.org/10.3389/fpsyt.2020.00821.
Philippe, K., Chabanet, C., Issanchou, S., & Monnery-Patris, S. (2021). Child eating behaviors, parental feeding practices and food shopping motivations during the COVID-19 lockdown in France: (How) did they change? Appetite, 161, 105132. https://doi.org/10.1016/j.appet.2021.105132.
Rundle, A. G., Park, Y., Herbstman, J. B., Kinsey, E. W., & Wang, Y. C. (2020). COVID-19 related school closings and risk of weight gain among children. Obesity, 28(6), 1008–1009. https://doi.org/10.1002/oby.22813.
Serra-Majem, L., Ribas, L., Ngo, J., Ortega, R. M., García, A., Pérez-Rodrigo, C., & Aranceta, J. (2004). Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutrition, 7(7), 931–935. https://doi.org/10.1079/PHN2004556.
Tatsiopoulou, P., Holeva, V., Nikopoulou, V. A., Parlapani, E., & Diakogiannis, I. (2022). Children’s anxiety and parenting self‐efficacy during the COVID‐19‐related home confinement. Child: Care, Health and Development, 48(6), 1103–1111. https://doi.org/10.1111/cch.13041.
Van den Broucke, S. (2020). Why health promotion matters to the COVID-19 pandemic, and vice versa. Health Promotion International, 35(2), 181–186. https://doi.org/10.1093/heapro/daaa042.
Ventura, P. S., Ortigoza, A. F., Castillo, Y., Bosch, Z., Casals, S., Girbau, C., Siurana, J. M., Arce, A., Torres, M., & Herrero, F. J. (2021). Children’s Health Habits and COVID-19 Lockdown in Catalonia: Implications for Obesity and Non-Communicable Diseases. Nutrients, 13(5), 1657. https://doi.org/10.3390/nu13051657.
Wang, G., Zhang, Y., Zhao, J., Zhang, J., & Jiang, F. (2020). Mitigate the effects of home confinement on children during the COVID-19 outbreak. The Lancet, 395(10228), 945–947. https://doi.org/10.1016/S0140-6736(20)30547-X.
WHO–UNICEF– Lancet Commissioners. (2020). After COVID-19, a future for the world’s children? The Lancet, 396(10247), 298–300. https://doi.org/10.1016/S0140-6736(20)31481-1.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Ethics approval
Ethical approval was granted before the initiation of the study from the Papageorgiou General Hospital Review Board (105/339/19.02.21) and the Ethics Board of the Research Committee of the Aristotle University of Thessaloniki (6.401/6/23.03.2021). Informed consent prior to survey enrollment was a prerequisite for study inclusion. Confidentiality was assured and participants were able to withdraw consent or discontinue participation at any time.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Tatsiopoulou, P., Holeva, V., Nikopoulou, V.A. et al. Changes in Sleep and Association with Screen Exposure and Diet among Preschool Children During the COVID-19 Pandemic: A Mixed Methods Study. J Child Fam Stud 33, 395–406 (2024). https://doi.org/10.1007/s10826-023-02732-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-023-02732-8