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Few Teens Meet Sleep, Screen, Exercise Guidelines

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Feb. 22, 2019 -- Kathy Ferony has four sons between the ages of 12 and 19. Between recess and the fact that they’re all avid baseball players, she feels good about the exercise they’re getting. And even though they’re night owls, she says they seem happy and get good grades with 6½ to 8 hours of sleep a night. But she says the real challenge in her family is screen time.

“Their use of screens drives me crazy,” Ferony says. “To get them to be healthy, we have to keep fighting their screen time urge.”

Pat Jesten says she feels comfortable with the screen time her teenage son Chris gets. He’s a competitive swimmer, so she knows he’s getting enough exercise. What she worries about is his sleep, which she says is so deeply impacted by his school duties that she tracks it on his Apple watch.

“I wonder if he should drop some honors classes so he has less homework and can sleep more. He thinks he needs it for college. But I know sleep is health, and I think if you’re a hard worker and have a drive to succeed, you will,” Jesten says.

When it comes to the right amount of screen time, exercise, and sleep, research published this month in JAMA Pediatrics finds only 5% of teens are meeting guidelines, and girls are less likely to do so than boys. Just 3% of teen girls met the recommendations, compared to 7% of boys, in research conducted by Gregory Knell, PhD, a postdoctoral research fellow at the University of Texas Health Science Center at Houston School of Public Health in Dallas.

“We were expecting it to be low, but I didn’t expect it to be just 5%,” he says.

Guidelines suggest children ages 6 to 12 should get 9-12 hours a night, and those ages 14 to 18 should get 8-10 hours a night. All children between the ages of 6 and 18 should get at least 1 hour of moderate to vigorous aerobic exercise a day, and should limit screen time and exposure to all screen-based digital media to less than 2 hours in a 24-hour period.

Knell says his research marks the first time all three of these behaviors (sleep, exercise, and screen time) have been analyzed together in a national sample of American teens.

“The reason we found this to be important is there is now some evidence to suggest that the health effects of meeting all three behaviors is stronger or more important than meeting any one of the behaviors,” he explains. “The 24-hour activity cycle is more important for health than any one behavior independent of another.”

The Science of Sleep, Screen Time, and Exercise

Research has clearly said that good sleep, adequate exercise, and limited screen time help teens and children. Children who are physically active have lower rates of obesity, better bone and cardiovascular health, and have better overall fitness. There are also positive effects on brain health, thinking skills, and academics. Lack of exercise has also been linked to depression in teens, especially girls.

Children who sleep better have better attention at school, lower rates of anxiety and depression, and they just do better in school. There’s a lot of research showing frequent use of phones and tablets makes sleep problems worse. A variety of things, including what teens are looking at, delayed bedtimes, getting to sleep later, mental arousal, exposure to bright screen light, and even exposure to electromagnetic fields are all likely playing a role. 

“In our study, we found that making more phone calls, using a tablet more, and mobile phone dependency decreases sleep quality and increases wake time after sleep onset, indicating a poorer and more fragmented sleep in those adolescents using more phones and tablets,” explains Alba Cabré-Riera of the Barcelona Institute for Global Health, the first author of a study published in late 2018 on the topic.

Research also shows lack of sleep or changes in how long teens sleep affect their coordination, as well as their ability to pay attention at school and how well they do in school. It also suggests a connection with depression and other negative health outcomes.

Kati Duncan, a clinical psychologist in Chesapeake, VA, says poor sleep or inadequate sleep can also mimic ADHD symptoms. She assesses learning issues in children and teens, and she says lack of sleep -- some get as little as 3 to 4 hours -- is the trigger that sends as many as 70% of patients to her.

“I can tell you that I evaluate lots of kids for ADHD who really just need more sleep and less screen time,” she says. “Sleep deprivation can look a lot like ADHD in terms of poor focus and an inability to sit still. Parents need to understand the amount of sleep teens are getting can hurt. When they are tired, they also want to shut down. And when they do that, they put themselves in front of an electronic device, and that furthers that addiction.”

Knell says his research reflects that more people are realizing all of these behaviors are connected.

“If you are more physically active during the day, we hypothesize that will lead to better sleep that night. On top of that, if you sleep better at night, we hypothesize you will have more energy the next day to be more physically active,” he explains. “We also know that screen time has a negative effect on sleep quality, so there are things that can done.”

“I hope this is a wake-up call for parents,” Knell says.

Research vs. the Real World

Some say they don’t feel the need for a wake-up call. “I’m pretty sure my kids are not within these guidelines, but they’re doing just fine,” says Jenny Christie, a mother of three from Colorado.

Others parents say teen schedules these days wouldn’t allow them to meet the guidelines -- even if they did want to.

“We want our kids to be engaged in activities and be successful, so between activities and studying, it’s really hard for them to get the right amount of sleep,” says Frances Phan, a Virginia mother whose three children are involved in band and music.

Many parents say the logistics of teen life don’t match up with research-based recommendations.

“Ten hours of sleep for a high school student is impossible,” says Kim Guest, a mother of two teen boys in Raleigh, NC. “My son’s school starts at 7:20, and he leaves the house at 6:50. He would have to go to sleep at 8 at night [to meet the guidelines]. But he doesn’t even get home when play rehearsals are going on until 9 or 10, and then he still has to do homework.”

Terri Tolliver, a mother in Washington, D.C., says 6 to 7½ hours of sleep a night is most typical for her 12-year-old son. “We have a set bed time, but for whatever reason -- late dinner, finishing homework, after-work errands -- he more often than not misses that 9:30 p.m. snooze time. And of course when he does hit the bed at that time, even with smooth jazz and a scent diffuser, he doesn't always go to sleep right away. In the mornings, I have to bring him a smoothie or a cup of tea to get him moving. He never gets up with his alarm.”

Screen time is another stressful challenge for many parents to navigate, and many say their children’s’ schools are adding to the problem.

“The schools have them on iPads, PCs, and Chromebooks more than I’d like,” says Ferony, the mother of four sons.

“Most homework involves screens, so that one is a bust, too, in terms of meeting these guidelines,” Guest agrees.

“That is why I hate school iPads,” echoes Jenny Erard, an Oregon mother of three. “They spend 7 hours a day at school, and at least half that, if not more, they are using an iPad. Then homework is on the iPad. Then all the books from the library they want to read are on the iPad. It’s so hard.”

Negotiating with teens over screen time that’s not related to school is often a challenge too.

“My 12-year-old is very active in sports and gets plenty of exercise away from home, but he would be on screens all day while at home if we let him,” says Marci Jerome, a mother of two.

“We refer to the Xbox as the ‘devil in the corner’ because it causes constant fighting on the weekend over whose turn it is, who has played too long, or who is yelling too loudly at the TV while playing,” Ferony says. “I think it affects their creativeness. This past summer, they said nobody was at the pool because they were all home playing ‘Fortnite.’ They just don’t go out and play anymore. It raises a lot of questions and challenges as a parent.”

Tolliver agrees: “This cow is out to pasture, and I don't know how to put it back in the barn. ‘Fortnite’ is my second child. I feel like I have to monitor this new baby, feed it, scold it, spend time with it ... ugh,” she says. “I've given him leeway because I've told him if he does what he's supposed to do during the week, the weekends are his. But talk about obsessive. Add to that the pressure of his homies who are allowed free rein to play at will. I have taken away all electronics as a form of discipline before, and I swear, I saw signs of withdrawal, although the benefits for me were more time spent together, full conversations, and more activity exploration.” 

Creating Healthier Habits

Knell says when it comes to making changes, it’s best to start small. He says it’s important to know that researchers believe improving any one behavior can help them all.

“Don’t be discouraged by these results or scared off and think, ‘what is the point of trying because this isn’t achievable.’ Small changes you can make in your life and your kid’s life can have a big impact,” he says. “If you do little things with screen time before bed and encourage kids to be physically active during the day, we hypothesize it will lead to better sleep, which leads to more physical activity the next day.”

So go for a walk as a family, park farther away from your destination, take the stairs, go to the park after school or on a bike ride after dinner, and enforce consistent bedtimes. The American Academy of Pediatrics also recommends having media-free times of day -- like during meals and driving -- and media-free areas, like bedrooms.

“Screen time is definitely the hardest for us,” says Liz Gurgel, a Michigan mother of a 14-year-old. “What I struggle with is when I tell my son, ‘enough with the phone,’ and he says, ‘But I’m just watching YouTube videos, and how is that different from you watching TV?’ I should be a better role model, I guess, but I don’t want to give up my TV.”

Knell says that brings up an important point and one he knows isn’t easy for parents. You have to look at how your own habits affect your children.

“Looking at your own phone too much or keeping it by your bed at night doesn’t send the right message to kids,” Knell says. “We know modeling good behaviors has a strong impact on kids’ behaviors, so keep that in mind.”

Duncan says she also refers a lot of patients to sleep and parenting coaches when they’re struggling, and she encourages them to read books and educate themselves about how to make small changes and enforce them.

Research does show parent involvement makes a difference. A study this month published in the journal Sleep Health, for example, found that when parents monitored their teens when they were awake, it affected how they slept. Teens’ perception of that monitoring may affect how long they sleep, too.

Audrey Jung, a psychotherapist in Arizona and the mother of two teens, says ultimately, she stresses there is always room for improvement, but there aren’t one-size-fits-all solutions.

“You have to do what works for your family. You can look out for these studies and look for signs for problems, and you can more quickly address them. But you also have to see your child in a balanced way in terms of their environment. Are things working across the board?”

Jung says that means looking at the sleep and exercise your teen is getting across a week or month -- not just what happens on a given day.

“If parents aren’t active, this is an uncomfortable conversation to have,” she says.

Jung says shared consistent bedtimes, family docking spaces for electronics, and screen time rules that apply to parents and children alike are helpful. She says weekly family meetings and shared calendars can also help keep health behaviors on track.

“We put a 2-month calendar in the kitchen. It teaches my kids as they are sitting down for meals to look up and find problem spots with sleep, for example, and it helps us as parents plan ahead, too,” Jung says.

She says couples’ counseling can help parents get on the same page about rules they want to enforce, and counseling for teens can help them control their behavior and seek healthier habits. Ultimately, Jung says, it’s important to remember this isn’t just about enforcing rules. It’s about teaching teens important lifelong behaviors.

“I have always parented and encouraged the behavioral approach of talking about consequences and understanding the impacts on you and the family for decisions you make about sleep and other behaviors,” Jung says. “I’m for teaching moderation, not jumping off the cuff over small infringements. Ultimately, you just want to raise your child to be responsible.”

WebMD Health News Reviewed by Brunilda Nazario, MD on February 22, 2019


Alba Cabré-Riera, Barcelona Institute for Global Health, Barcelona, Spain.

Jenny Christie, Indian Hills, CO.

Kati Duncan, clinical psychologist, Chesapeake, VA.

Jenny Erard, Bend, OR.

Kathy Ferony, Bowie, MD.

Kim Guest, Raleigh, NC.

Liz Gurgel, Canton, MI.

Pat Jesten, Springfield, VA.

Gregory Knell, PhD, University of Texas Health Science Center, Dallas.

Marci Jerome, Fairfax, VA.

Frances Phan, Springfield, VA.

Audrey Jung, psychotherapist, Phoenix, AZ.

Terri Tolliver, Washington, D.C.

American Academy of Pediatrics: “American Academy of Pediatrics Announces New Recommendations for Children’s Media Use.” 

JAMA Pediatrics: “Prevalence and Likelihood of Meeting Sleep, Physical Activity, and Screen-Time Guidelines Among US Youth.”

Preventive Medicine Reports: “The influence of depression status on weekly exercise in children ages 6 to 17 years.”

Exercise and Sports Sciences Reviews: “Raising an Active and Healthy Generation: A Comprehensive Public Health Initiative.”

Environmental Research: “Telecommunication devices use, screen time and sleep in adolescents.”

Sleep Health: “Young adolescent sleep is associated with parental monitoring.”

SSM Population Health Journal: “Family contexts and sleep during adolescence.”

Journal of Sleep Research: “The impact of sleep on complex gross-motor adaptation in adolescents.”

Revista Medica de Chile: “[Quality of sleep and academic performance in high school students].”


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