Nocturnal enuresis (NE) is a prevalent pediatric condition, affecting 5–10% of children aged 5–15 years, with significant psychosocial and emotional consequences. The etiology of NE is multifactorial, involving genetic predisposition, bladder dysfunction, sleep disturbances, and delayed arousal mechanisms. Recent evidence suggests that excessive screen time before bedtime may exacerbate sleep disorders in children by suppressing melatonin release, delaying sleep onset, and reducing total sleep duration [1]. Blue light emitted from electronic devices disrupts the circadian rhythm, directly impacting sleep quality. However, its specific role in worsening NE has not been explored in detail. This study aims to assess the association between screen exposure duration, content type, and bedtime routine on the severity of NE.

A prospective case-control study was conducted at a tertiary care pediatric urology clinic between January and December 2024. The study included 170 children aged 5–15 years, categorized into:
	•	Cases (n = 85): Children with primary NE (≥2 wet nights/week for >3 months).
	•	Controls (n = 85): Age-matched children without NE.

Parents completed a structured questionnaire covering:
	1.	Screen time duration: <30 min, 30 min–1 hr, 1–2 hrs, >2 hrs.
	2.	Device type: Smartphones, tablets, televisions, gaming consoles.
	3.	Content type: Interactive (video games, social media) vs. passive (videos, cartoons).
	4.	Bedtime routine: Presence of structured pre-sleep activities like reading or relaxation.
	5.	NE severity: Assessed using ICCS criteria (mild: <3 nights/week, moderate: 3–5 nights/week, severe: >5 nights/week).

In a subset of 40 children per group, salivary melatonin levels were measured before and after screen exposure using ELISA. Sleep patterns were assessed using actigraphy and parent-reported sleep diaries. Statistical analysis was performed using multivariate logistic regression to identify risk factors. Ethical approval was obtained, and informed consent was secured from parents.

Children with NE had significantly higher pre-bedtime screen exposure compared to controls (2.1 ± 0.7 hours vs. 0.9 ± 0.5 hours, p < 0.001). Key findings included:
	1.	Duration-dependent risk:
	•	>2 hours of screen time was associated with a 2.8-fold higher risk of NE (OR = 2.8, 95% CI: 1.6–4.9) [2].
	•	Screen exposure within 1 hour before sleep increased enuresis severity (p = 0.002).
	2.	Content type influence:
	•	Interactive content (gaming, social media) led to higher enuresis frequency compared to passive content (p = 0.01) [3].
	•	Video game users had 1.9 times higher odds of experiencing severe enuresis episodes compared to children watching passive content like cartoons.
	3.	Melatonin suppression & sleep disruption:
	•	Melatonin onset was delayed by 45 ± 9 minutes in enuretic children (p < 0.001).
	•	Total sleep duration was reduced by 1.4 ± 0.3 hours, leading to a prolonged first REM cycle latency and lower sleep efficiency (p < 0.001) [2].
	•	Actigraphy data confirmed a 15% increase in nocturnal awakenings in children with excessive screen exposure.

Excessive screen exposure, particularly within one hour before bedtime, significantly worsens NE. The blue light-mediated suppression of melatonin, delayed sleep onset, and reduced sleep duration may contribute to enuresis persistence. Interactive screen use (e.g., gaming, social media) poses a higher risk than passive viewing.

Reducing screen time may serve as a non-invasive, behavioral adjunct to standard enuresis treatments. Future interventional studies should evaluate screen hygiene protocols as part of pediatric enuresis management.

Li S, Jin X, Wu S, Jiang F, Yan C, Shen X. The impact of media use on sleep patterns and sleep disorders among school-aged children in China. Sleep. 2007;30(3):361-367. doi:10.1093/sleep/30.3.361.