(Reuters Health) - Higher use of electronic media is tied to poorer sleep quality in children as young as three, a new study from Germany suggests.

The study investigated the association between media consumption - including electronic media such as television, DVDs and computer gaming as well as books - with overall sleep quality in 530 three-year-olds born in southern Germany in 2012 and 2013.

Based on parent responses to a questionnaire, higher electronic media consumption was strongly linked to poor overall sleep quality, including worsening bedtime resistance, sleep anxiety, and daytime sleepiness.

“Previous studies have shown that media use, particularly electronic media use in the evening, is associated with poor sleep in adolescents and adults. This study shows that such relationships can be observed much earlier in life - even in the first 3-4 years,” said Dr. Daniel Buysse, a sleep medicine researcher at the University of Pittsburgh in Pennsylvania, who was not involved in the study.

Reading is a safer bet at bedtime, noted Lauren Hale, Professor of Family, Population, and Preventive Medicine at the Stony Brook University School of Medicine in New York.

“Books at night may not be innately beneficial for sleep, but compared to using screen-based media, they present an alternative that is not disruptive to sleep health,” said Hale, who also wasn’t involved in the new research.

Nearly 40 percent of parents reported never reading books to their children. Dr. Yolanda Reid-Chassiakos, clinical assistant professor of pediatrics at the University of California, Los Angeles, who was not involved in the study, called that “surprising and disappointing.”

All but one family had electronic media devices at home, nine 3-year-olds owned a device such as a mobile phone or tablet themselves and three children had a TV in their bedroom, researchers wrote in the journal Sleep Medicine.

Nearly one in seven children watched more than one hour of TV per day. “This exceeds the recommended ‘up to 30 minutes’ after the age of 2 years,” said study coauthor Jon Genuneit of Ulm University in an email.

Dr. Nitun Verma, spokesperson for the American Academy of Sleep Medicine, was surprised that increased electronic media consumption wasn’t linked with less reading or being read to. “But this doesn’t mean there is no connection. It is likely because they (study authors) didn’t study enough people,” he said in an email.

The researchers note that they lacked data on the content of media consumed, and on the children’s physical activity. The study is ongoing, however. Starting next year, the research team will collect data on physical activity, Genuneit said.

The study wasn’t a controlled experiment, so it cannot prove a causal link between higher electronic media consumption and lower sleep quality.

It is also unclear whether children are consuming more electronic media at bedtime because they have trouble sleeping, or the other way around.

“On a near-daily basis I talk with parents who tell me their child can’t fall asleep without the TV on, and yet, rather ironically, they are seeing me because their child can’t fall asleep,” said Dr. Jonathan Hintze, a pediatric sleep medicine specialist with the Children’s Hospital of Greenville Health System in South Carolina, who was not involved in the study.

Poor sleep quality can impair mood, performance and health, noted Kristen Knutson, an associate professor of neurology (sleep medicine) at Northwestern University. “We need to understand . . . how to mitigate these effects because people are not going to stop using (electronic devices),” said Knutson, who did not work on the German study.

SOURCE: bit.ly/2mEf20I Sleep Medicine, online December 12, 2017.