Television and DVD/Video Viewing in Children Younger Than 2 Years

The impact of parental migration on screen exposure among children aged 1-66 months in rural China

BACKGROUND

Screen exposure, particularly recreational screen exposure, is an integral part of children's lives. However, little is known about how family factors influence children's excessive screen exposure, especially in the context of 69 million left-behind children experiencing parent-child separation in China. This study mainly concentrates on the correlation between parental migration, type of caregiver, depression and disciplinary practices of the caregiver and children's screen exposure, including average daily screen time (on weekdays or weekends) and screen content (recreational activities or learning activities).

METHODS

For a cross-sectional study, we collected data of family basic features, parental migration status and children's screen use in the past week from caregivers of 1,592 children aged 1-66 months in Anhui province. Children were classified into left-behind children (LBC), previously left-behind children (PLBC) and never left-behind children (NLBC) based on their parental migration. Multiple linear regression and binary logistic regression were used to identified the association between family factors and children's screen exposure.

RESULTS

Overall, PLBC had higher rates of screen exposure, as well as higher average daily exposure times, than NLBC and LBC. The results of logistic regression showed that PLBC had a higher likelihood of excessive screen use compared to NLBC (60 min/day, OR = 1.40, p < 0.05; 120 min/day, OR = 1.76, p < 0.05). The higher the score of disciplinary practices, the less time children spent on screens for entertainment (B = -3.37, p < 0.01).

CONCLUSIONS

Our findings provide insights into the risks of children's screen exposure in different contexts of parental migration. The study emphasizes the urgent need to pay attention to PLBC's screen use and to strengthen caregivers' discipline and supervision over children's screen exposure.

Types of On-Screen Content and Mental Health in Kindergarten Children

Importance

Excessive screen time has been associated with a higher risk for mental health problems, but whether the associations differ by screen content types is unclear.

Objective

To examine the allocation of and longitudinal changes in screen exposure across different content types and to explore their associations with mental health in children aged 3 to 6 years.

Design, Setting, and Participants

This cohort study used 3-wave, lagged generalized estimating equation models to analyze data from the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) study in Shanghai, China. The cohort was a representative sample of kindergarten children. Data were collected between November 2016 and May 2019 when children were aged 3 to 4 years (wave 1), 4 to 5 years (wave 2), and 5 to 6 years (wave 3). Data analysis was performed between June 2022 and May 2023.

Exposure

Screen exposure (total daily time and time with each type of content, including educational programs, entertainment programs, non-child-directed programs, electronic games, and social media) was collected when children were aged 3, 5, and 6 years.

Main Outcomes and Measures

Mental health of children at age 3, 5, and 6 years was reported by parents using the Strengths and Difficulties Questionnaire.

Results

Of the 15 965 children included in the representative sample, 8270 were males (51.7%) and the mean (SD) age at wave 1 was 3.73 (0.30) years. As children developed from ages 3 to 6 years, the proportion of screen exposure to educational programs (≤1 hour per day: 45.0% [95% CI, 43.5%-46.5%] to 26.8% [95% CI, 25.3%-28.3%]) and entertainment programs (≤1 hour per day: 44.4% [95% CI, 42.8%-45.9%] to 32.1% [95% CI, 30.4%-33.9%]) decreased, whereas exposure to social media increased (≤1 hour per day: 1.5% [95% CI, 1.2%-1.9%] to 27.1% [95% CI, 25.5%-28.7%]). The associations between on-screen content and mental health varied. For a given total screen time, a higher proportion of screen exposure to educational programs was associated with a lower risk for mental health problems (adjusted odds ratio [AOR], 0.73; 95% CI, 0.60-0.90), whereas non-child-directed programs were associated with a higher risk for such problems (AOR, 2.82; 95% CI, 1.91-4.18). Regardless of the content, total screen time was consistently associated with mental health problems.

Conclusions and relevance

Results of this study indicated that both total screen time and different types of content were associated with mental health problems in children aged 3 to 6 years. Limiting children's screen time, prioritizing educational programs, and avoiding non-child-directed programs are recommended.

Forced Straightening of the Back Does Not Improve Body Shape

BACKGROUND

Sitting for a long time causes various postural problems, such as slump sitting. It has been reported that employing a corrected sitting position while lifting the sternum is effective in improving this form of posture. We investigated how a corrected sitting posture with the lifting of the sternum is different from a forced position that is applied through the command and passive positions.

MATERIALS AND METHODS

The postural angle of 270 subjects aged 19-23 years was measured in the passive, forced, and corrected positions using a Saunders inclinometer and a Formetric 4D system.

RESULTS

As a result, the corrected position had a small range (min-max) at all angles, but the forced position and passive position had a large range (min-max). The lumbar lordosis angle in the corrected position showed positive values throughout its range (min-max), while the other groups showed negative values, which indicates the kyphotic position of the lumbar section. In addition, the percentage error in the corrected position was small, but it presented high values in the other groups. When comparing the average angles between the groups, there were substantial changes observed between the corrected position and the other groups. It was found that the corrected position with the sternum lifted, which is applied to improve slump sitting in the clinical environment, exhibited an angle that differed from that of the forced position and the passive position.

CONCLUSIONS

Our results suggest that a forced position on the command "scapular retraction" does not meet the clinical assumptions of posture correction, in contrast to the corrected position with the lifting of the sternum for the improvement of slump sitting. The accurate correction of the position of the sternum and sacrum improves the position of the spine in the sagittal plane, enabling physiological values for the kyphosis and lordosis angle parameters to be obtained. This approach combines the ease of execution and precision of the effect. The fact that this method does not require complex tools to accurately correct the body encourages the implementation of this solution in clinical practice.

Associations between screen viewing at 2 and 3.5 years and drawing ability at 3.5 years among children from the French nationwide Elfe birth cohort

The effect of screen viewing on children's cognitive development has been of concern among parents and researchers. This study investigated the association between children screen time, as reported by parents, and drawing ability, and the confounding effects of socioeconomic characteristics (such as parental education, household income, migration status) and children's competing activities (such as drawing practice, extracurricular activity, outdoor time, sleep time, time playing with parents). Participants included 7577 children aged 3.5 years (50% girls) who underwent the Draw-a-person test (McCarthy score [range = 0-12 points]) in the French nationwide Elfe birth cohort, initiated in 2011. Sex-stratified zero-inflated Poisson regression models were used. Increased screen time was associated with a higher likelihood to obtain a null score in boys (OR 1.15, 95% CI 1.07-1.23) and girls (1.13 [1.03-1.24]) and a lower score in girls only (β =  - 0.02, 95% CI - 0.04; - 0.01). After adjusting for SES, associations were no longer observed, indicating that the association between screen time and drawing abilities was confounded by socioeconomic characteristics.

The Relationship between Language and Technology: How Screen Time Affects Language Development in Early Life-A Systematic Review

Screen time refers to the amount of time a child is exposed to a screen, that is, television, computer, smartphone, or any other digital medium. Prolonged screen time in the first years of life may affect a child's cognitive abilities, especially language acquisition. A systematic review was conducted, following the PRISMA-P guidelines, with the aim to explore the available literature relating to the impact of screen time on children's language development. This review identified 18 articles. The articles reviewed showed that prolonged screen time and exposure to screens in the first 2 years of life can negatively affect language development and communication skills, in terms of comprehension and vocabulary range. In addition, overexposure to screens in the early years can affect overall cognitive development, especially attention to environmental stimuli, social experiences, problem solving, and communication with others, e.g., the alternance of rhythms and roles in a conversation. In conclusion, our systematic review supports the idea that preschool screen time has negative effects on children's cognitive and language development. Television seems to be the medium most detrimental to children's skills, as it is used in a passive manner and is often characterised by language and content that do not suit the child's processing mode. Future studies should increasingly focus on the digital media that children possess at an early age, such as mobile phones and tablets, and on how children relate to the online world, such as social networks.

Emotional and Behavioral Correlates of Exposure to Electronic Media in School-Aged Children: A Prospective Study

BACKGROUND

Exposure to electronic media is increasing from early childhood. This study aimed to examine the association between screen time and behavioral outcomes in school-aged children with a prospective birth-cohort.

METHODS

We examined the association between screen time and behavioral outcomes in school-aged children with a Korean birth-cohort study. Participants were 2,150 children, recruited during their fetal period, assessed annually for developmental outcomes. Media exposure was assessed at T4 (3.2 y/o), T8 (7.3 y/o), and T10 (9.4 y/o). After exclusions for missing data, 1,368 children were categorized into four groups (Low-Low, Low-High, High-Low, and High-High) based on average daily media time in early childhood and during schooldays, respectively. Children's temperament was assessed from T1 (0.5 y/o) to T4. Emotional and behavioral outcomes were assessed using the Child Behavior Checklist (DSM-oriented subscales) at T8 and T10.

RESULTS

We found that early-years temperament was generally similar between the media-time groups: they only differed significantly on Activity at T1 and Emotionality at T2 (1.2 y/o). However, compared to the Low-Low group, the Low-High group had significantly higher odds of high-risk scores for Conduct Problems (increased odds ratios [ORs] of 1.82 at T8 and 1.83 at T10) and Anxiety Problems (increased ORs of 1.60 at T8 and 1.82 at T10). Self-rated self-esteem and overall happiness at T10 also significantly differed among the four groups.

CONCLUSION

Our findings suggest the negative impacts of media exposure on the emotional and behavioral development of school-aged children, which substantiates the guidelines that restrict media exposure during childhood.

Screen Media Dependency and Its Associated Factors Among Preschool Children in Kuala Lumpur

Introduction: Excessive screen time among young children is associated with screen dependency. At this moment, there is a lack of data on screen dependency among young children in Malaysia. This study aimed to measure the prevalence of screen dependency and its associated factors among preschool children in Kuala Lumpur. Methods: A cross-sectional study was carried out at registered preschools in Kuala Lumpur. 300 parents of preschool children aged 4 to 6 years old who fulfilled the inclusion and exclusion criteria were recruited via simple random sampling. The Screen Dependency Scale (SDS) were used to assess their dependency to screen media. Univariate and multivariate statistics were analysed using IBM SPSS version 27. Results: The prevalence of screen dependency among preschool children in Kuala Lumpur was 65.7%. Multivariate logistic regression analysis identified that using the screen to resolve children’s quarrels (aOR 2.855, 95% CI 1.187 - 6.868), children who use smartphones (aOR 2.735, 95% CI: 1.244 - 6.013), children’s screen time exceeds 2 hours over the weekend (aOR 2.261, 95% CI: 1.058 - 4.830) and having a television in the bedroom (aOR 5.562, 95% CI: 1.591 - 19.442) were predictors for screen dependency. While active co-use mediation (aOR 0.505, 95% CI: 0.302 - 0.845) were protective. Conclusion: The prevalence of screen dependency was high among preschool children in Kuala Lumpur. Active screening at health care clinics or in schools is essential to identify early children with risk factors for screen dependency.

Primary Care Counseling of Parents Regarding Childhood Screen Media Use

Parental beliefs and motivation are instrumental in improving childhood digital media use (DMU). Parents (n = 611) completed questionnaires about childhood DMU assessing knowledge, interest in counseling, motivation to change, self-efficacy, and beliefs. Less than a third correctly recognized screen time limits. Twenty-seven percent received childhood DMU information from a doctor, while 46% stated they would like such information. Only 2% had a doctor-recommended DMU plan. Interest in DMU topics, motivation to improve, and management self-efficacy were moderate. Top negative beliefs were addiction to DMU (52%), sleep problems (39%), obesity (33%), social skills (33%), and inappropriate content (32%). Differences between age categories existed for social (48%, P = .01) and language (14%, P = .01) concerns (highest for toddlers), attention concerns (27%, P = .02; highest in preschoolers), and depression (13%, P < .001) and low self-esteem (8%, P = .04; highest in teens). Findings support further development of approaches to address DMU, tailored by age-specific common parental views.

The COVID-19 pandemic: Electronic media use and health among US College students

Objective: To explore differences before and during the COVID-19 pandemic in electronic media use (i.e. TV watching, social media use, screen time), health (i.e. physical, behavioral, social, mental), and the relationship between them among college students. Participants: Nine hundred sixty-five United States college students with 367 participating before and 598 during the pandemic (after March 2020). Methods: Using a multiple cross-sectional design, participants completed an online self-report questionnaire and biometric data was gathered in-person for the Pre-COVID group. Results: During the pandemic, time spent watching TV and social media was 14% higher and total screen time was 30% higher (d = .39). Health variations were mixed with both adverse and beneficial differences. Most correlations between electronic media use and health variables were lower in strength during the pandemic. Conclusions: Differences between electronic media use and health before and during the pandemic suggest potential mixed effects of the pandemic on college student media use and health.

Effect of Media Exposure on Social Development in Children

Purpose

The prevalence of autism spectrum disorder in children, who show problems in social development, is increasing rapidly. If children watch media at an early age, they lose the time to interact with their parents and will not be able to play creatively, which can have a negative impact on social development. This study was performed to evaluate the association of media exposure with social developmental delay.

Methods

The sample consisted of 96 patients with social developmental delay who visited the developmental disorder clinic from July 2013 to April 2019. The control group included 101 children who visited our developmental clinic with normal developmental screening test results during the same period. The data were collected using self-reported questionnaires with questions regarding media exposure time, content, background media or foreground media, the age of first exposure, and media exposure with or without parents.

Results

In regard to media exposure time, 63.5% of the social developmental delay patients were exposed to media for more than 2 hours a day compared to 18.8% of the control group (P < .001, [OR] = 8.12). In the risk factor analysis of media exposure on social development, male gender, media exposure before 2 years of age, exposure for more than 2 hours, and exposure alone without parents were statistically significant.

Conclusion

Media exposure was a significant risk factor for social developmental delay.

Development and Validation of a New Gadget Addiction Scale (Screen Dependency Scale) among Pre-School Children in Malaysia

BACKGROUND

Excessive screen time in young children is associated with many harmful consequences including screen dependency. Research has shown a worrying prevalence of media-related dependency among adolescents and pre-school children. There are a few available questionnaires among adolescents but none for pre-school children. This study aimed to design and validate a questionnaire to assess screen dependency among pre-school children aged 4 to 6 years old.

METHODOLOGY

A cross-sectional two-phase study was carried out to develop the scale. In phase 1, a preliminary parent-report measure questionnaire was developed in Bahasa Malaysia. Later, it was sent to four experts for content validity followed by face validity. In Phase 2, a total of 386 parents of pre-school children aged 4 to 6 years old, split into two samples, were involved in the field study for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

RESULT

Sample 1 was used to perform EFA to determine the factorial structure of the SDS. All items with a factor loading of >0.4 were included. Sample 2 was used to perform the CFA. RMSEA and CFI analysis showed that the SDS has a good fit and confirms the dimensional structure found via EFA. The final questionnaire consists of 15 items with a 4 factors' structure and has excellent internal consistency reliability.

CONCLUSIONS

The Screen Dependency Scale (SDS) is a reliable and valid questionnaire to detect screen dependency among pre-school children aged 4 to 6 years old in Malaysia.

Excessive audio-visual stimulation leads to impaired social behaviour with an effect on amygdala: Early life excessive exposure to digital devices in male rats

Today, the effect of extreme early-life exposure to digital devices is suggested as a risk factor for neurodevelopmental disorders. However, the multitude of factors that influence brain development with subsequent behavioural abnormalities have not been fully elucidated. Herein, we simulated extreme early-life exposure to digital devices in rats by audio and visual stimulation and investigated its effects on autism-related behaviours and brain structural alteration. Male rat pups were exposed to excessive audio-visual stimulation (EAVS) from PND (post-natal day) 12 to PND 35, with and without maternal separation (MS). Autism-related behaviours including abnormal sociability, stereotype behaviours, anxiety and locomotor dysfunction were tested at PND 42. Brain structural alternation was examined by considering the amygdala, mPFC (medial prefrontal cortex) and hippocampal regions while performing 3D quantitative stereological analysis. We found that EAVS led to social behaviour deficit and higher locomotion in rats, which were associated with increases in the number of neurons and volume of the amygdala. We also showed that MS did not exaggerate the effect of extreme sensory stimulation on behaviour and the structure of the brain. This study proposed EAVS in rats as an animal model of early exposure to digital devices for investigating possible neurobiological alternations underlying autistic-like behaviours with an emphasis on the amygdala area.

"Katerina gets mad": Infants' physiological and behavioral responses to co-viewing educational, self-regulatory media

A growing body of research has focused on the physiological impact of media on older children and adolescents. Less research has been focused on the potential physiological impact of media on infants and younger children, especially media designed to be age appropriate and educational in content. In this study, we examined respiratory sinus arrhythmia (RSA) in infants (N = 269, M_age  = 17.13 months) while they co-viewed an educational video clip that modeled emotion regulation and contrasted their physiological response to an unoccupied baseline and a frustration paradigm (arm-restraint). Given parent reports showing the calming effect of educational media viewing in young children, we anticipated that a similar pattern of calming would be observed physiologically in infants. Results showed that relative to baseline, most infants demonstrated an increase in RSA while co-viewing, suggesting greater parasympathetic (regulatory) activation consistent with behavioral calming. However, infants who demonstrated vagal withdrawal during co-viewing (decrease in RSA) were more likely to have parents who used a tablet to help infants go to sleep at night. Vagal withdrawal was also associated with increased levels of negative affect observed during the co-viewing task. Findings are discussed in relation to the contextual effect of co-viewing age-appropriate, educational media on children's physiological responses.

Differential diagnosis between autism spectrum disorder and other developmental disorders with emphasis on the preschool period

BACKGROUND

Neurodevelopmental disorders are a heterogeneous group of conditions that manifest as delays or deviations in the acquisition of expected developmental milestones and behavioral changes. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in communication and social interaction and by repetitive and restricted patterns of behavior, interests and activities. The aim of this review is to discuss the clinical features of the differential diagnoses of ASD that are prevalent among preschoolers, focusing on their similarities and disparities.

DATA SOURCES

The international medical literature search was conducted using PubMed and was revised regarding the subject using single and/or combined keywords as follows: differential diagnosis, preschoolers, diagnostic challenge, attention deficit hyperactivity disorder, intellectual disability, high abilities/giftedness, childhood apraxia of speech, social communication disorder, Landau-Kleffner syndrome, stereotyped movement disorder and excessive screen time.

RESULTS

We describe conditions commonly found in clinical practice, taking ASD as a reference. We addressed converging and divergent aspects of behavior, cognition, communication, language, speech, socialization, and stereotypes for the diagnosis of ASD and other disorders identified as potential differential or comorbid diagnoses.

CONCLUSIONS

The ranking and characterization of symptoms appear to be essential for better understanding the underlying common ground between children with developmental disorders and children with ASD, thus properly diagnosing and directing social, professional, or medication interventions. This detailed discussion adds to the literature since, although ASD differential diagnoses are frequently mentioned and discussed in textbooks and journal articles, they rarely occupy a prominent place as we aimed herein.

Effects of screen exposure on young children's cognitive development: A review

The past decade has witnessed a rapid increase in the use of screen media in families, and infants are exposed to screens at younger ages than ever before. The objective of this review is twofold: (1) to understand the correlates and demographic factors determining exposure to screens, including interactive screens, when available, and (2) to study the effects of watching screens and using touchscreens on cognitive development, during the first 3 years of life. We argue that the effects of screen viewing depend mostly on contextual aspects of the viewing rather than on the quantity of viewing. That context includes the behavior of adult caregivers during viewing, the watched content in relation to the child's age, the interactivity of the screen and whether the screen is in the background or not. Depending on the context, screen viewing can have positive, neutral or negative effects on infants' cognition.

Sociodemographic and behavioural factors of adherence to the no-screen guideline for toddlers among parents from the French nationwide Elfe birth cohort

Background

Excessive screen time in infancy and childhood has been associated with consequences on children’s development and health. International guidelines call for no screen time before age 2 years, whereas in France, the most prominent guidelines recommend no screen before age 3 years. However, data are lacking on parental adherence to the no-screen guideline for toddlers and factors of adherence in France. Using data from the French nationwide Elfe birth cohort, we estimated adherence to the no-screen guideline at age 2 years and examined related factors, including sociodemographic characteristics, parental leisure activities and screen time.

Methods

In 2011, 18,329 newborns and their parents were enrolled in 349 randomly selected maternity units across mainland France. At age 2 years, screen exposure of 13,117 toddlers was reported by parents in phone interviews. Data on sociodemographic characteristics, parental leisure activities and screen time were collected from both parents. Three patterns of parental leisure activities were derived by principal component analysis: literate (e.g.,reading), screen-based, and physical/artistic activities. Multivariable logistic regression models were used to examine the associations of sociodemographic characteristics, parental leisure activities and parental screen time with adherence to the no-screen guideline for toddlers.

Results

Overall, 1809/13,117 (13.5%) families adhered to the no-screen guideline for toddlers. Adherence was reduced with maternal age < 40 years, low parental education, single-parent household and parental migration status. After adjusting for sociodemographic characteristics, adherence to the guideline was positively associated with a parental literate activity pattern (mothers: odds ratio [95% confidence interval]: 1.15 [1.08, 1.22]); fathers: 1.15 [1.07, 1.23]) and negatively with a screen-based activity pattern (mothers: 0.73 [0.69, 0.77]; fathers: 0.81 [0.76, 0.87]). With each additional hour of parental screen time, mothers and fathers were less likely to adhere to the guideline (mothers: adjusted odds ratio 0.80 [0.77, 0.83]; fathers: 0.88 [0.85, 0.91]).

Conclusions

Adherence to the no-screen guideline for toddlers in France was low. Parental leisure activities and parental screen time are major factors of adherence to the no-screen guideline and could be considered in targeted public health interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01342-9.

Is children's speech development changing? Preliminary evidence from Australian English-speaking 3-year-olds

Purpose: Around 9% of children have difficulty acquiring intelligible speech despite typical sensory, neuro-motor and cognitive function. Speech-language pathologists (SLPs) rely on descriptions of children's speech errors to identify speech sound disorder (SSD) and determine intervention targets and goals. Existing normative data, however, need re-evaluation to reflect changes in populations and the language learning environment. This research evaluates whether developmental phonological patterns widely accepted as describing typical acquisition predict speech errors in a recent sample of pre-school children.Method: In 2015, 99 neurotypical children aged 3;0-3;8 years;months were assessed using the Diagnostic Evaluation of Articulation and Phonology (DEAP). Their performance was compared to studies describing speech development by children of the same age for phone repertoire and phonological patterns.Result: There were differences for both measures. Phone repertoire differences were marginal, but changes in phonological pattern use were unexpected. Suppression of three developmental phonological patterns (stopping of fricatives, final consonant deletion and voicing contrasts) was delayed compared to previous norms. Atypical consonant cluster reduction, sometimes considered a marker for disorder, was observed in 10% of children.Conclusion: There were qualitative differences in the speech development of the 2015 cohort of children compared to previous developmental norms. Valid and current normative data are necessary for the accurate identification of children needing intervention. The differences we found reinforce the need for regular updating of assessment tools, as well as greater understanding of how children's language learning environments are changing and potentially influencing speech development.

Determinants of Excessive Screen Time among Children under Five Years Old in Selangor, Malaysia: A Cross-Sectional Study

Excessive screen time interferes with the health and development of children. However, the screen time situation among Malaysian children remains poorly understood. This study aims to identify the prevalence and determinants of excessive screen time among children under five years in Selangor, Malaysia, using the latest World Health Organization guidelines. In this cross-sectional study, 489 parent−child dyads were randomly selected from nine government health clinics in Petaling district, Selangor. Total screen time and factors were assessed using validated self-administered questionnaires and analysed using multiple logistic regression. The overall prevalence of excessive screen time was 91.4% with a median of 3.00 h. The majority of children utilized television (66%), followed by handheld devices (30%) and computers (4%). Determinants of screen time identified were Malay ethnicity, (aOR 3.56, 95% CI 1.65−7.68), parental age of ≥30 years (aOR 3.12, 95% CI 1.58−6.16), parental screen time >2 h a day (aOR 2.42, 95% CI 1.24−4.73), moderate self-efficacy to influence a child’s physical activity (aOR 2.29, 95% CI 1.01−5.20) and the positive perception on the influence of screen time on a child’s cognitive wellbeing (aOR 1.15, 95% CI 1.01−1.32). Parents play an important role in determining their child’s screen time. Future interventions should focus on addressing parental determinants to ensure age-appropriate screen time.

Young children's screen time during the first COVID-19 lockdown in 12 countries

Older children with online schooling requirements, unsurprisingly, were reported to have increased screen time during the first COVID-19 lockdown in many countries. Here, we ask whether younger children with no similar online schooling requirements also had increased screen time during lockdown. We examined children’s screen time during the first COVID-19 lockdown in a large cohort (n = 2209) of 8-to-36-month-olds sampled from 15 labs across 12 countries. Caregivers reported that toddlers with no online schooling requirements were exposed to more screen time during lockdown than before lockdown. While this was exacerbated for countries with longer lockdowns, there was no evidence that the increase in screen time during lockdown was associated with socio-demographic variables, such as child age and socio-economic status (SES). However, screen time during lockdown was negatively associated with SES and positively associated with child age, caregiver screen time, and attitudes towards children’s screen time. The results highlight the impact of the COVID-19 lockdown on young children’s screen time.

Is Motor Milestone Assessment in Infancy Valid and Scaled Equally Across Sex, Birth Weight, and Gestational Age? Findings From the Millennium Cohort Study

Is the assessment of motor milestones valid and scaled equivalently for all infants? It is not only important to understand if the way we use gross and fine motor scores are appropriate for monitoring motor milestones but also to determine if these scores are confounded by specific infant characteristics. Therefore, the aim of the study is to investigate the latent structure underlying motor milestone assessment in infancy and measurement invariance across sex, birth weight, and gestational age. For this study, the birth cohort data from the United Kingdom Millennium Cohort Study (MCS) was used, which includes the assessment of eight motor milestone tasks from the Denver Developmental Screening Test in 9-month-old infants (N = 18,531), depicting early motor development of the first children of generation Z. Confirmatory factor analyses showed a better model fit for a two-factor structure (i.e., gross and fine motor development) compared to a one-factor structure (i.e., general motor development), and multiple indicators multiple causes modeling revealed no differential item functioning related to sex, birth weight, and gestational age. The study provides support for the use of gross and fine motor scores when assessing motor milestones in infants—both boys and girls with different birth weights and of varying gestational ages. Further investigation into widely adopted assessment tools is recommended to support the use of valid composite scores in early childhood research and practice.

Infant media use: A harm reduction approach

There are a myriad of potentially harmful developmental outcomes associated with infant digital media use. Studies revealing risk associated with early media use have informed the current American Academy of Pediatrics (AAP) recommendations that discourage most digital media use among children under 18 months of age. Recent research advances, however, suggest potential benefits of technology engagement in this age group. Additionally, surveys of parents reveal that most infants engage with digital media for at least 30 min a day, exceeding the AAP recommendations. In response to these discoveries and cultural trends, some scholars have made compelling cases to adapt the AAP guidelines for infants. A helpful model for developing infant digital media use guidelines for families may be the harm reduction approach. The intent of this review is to suggest adaptations to the AAP guidelines for infant media engagement using a harm reduction framework. This review describes the challenge of restrictive guidelines, briefly summarizes the harm reduction approach, provides a review of risks and benefits associated with infant media use in each developmental domain (physical, cognitive, and socioemotional), summarizes correlates of infant screen media use, and examines intervention strategies for reducing screen time. The paper concludes with examples of possible adaptations to current AAP infant media use recommendations using harm reduction and bioecological frameworks.

Exploring parents' provision of factors related to the establishment of physical activity between normal weight and overweight infants

PURPOSE

Infancy is a critical time for the prevention of obesity and establishment of healthy behaviors such as physical activity that help to control weight. A limited amount of research has examined if factors related to infant physical activity vary by infant weight status. Therefore, the purpose of this mixed methods triangulation study was to examine differences in motor development, the home environment, and infant-parent play behaviors as well as to explore how parents promote active play opportunities with normal weight infants (NWIs) and overweight infants (OWIs).

DESIGN AND METHODS

We used a mixed methods triangulated approach to combine quantitative and qualitative data strands to examine variables associated with active play in normal weight (n = 16) and overweight (n = 11) infants. Data were analyzed using a two-tailed Mann-Whitney U nonparametric test and a summative content analysis approach.

RESULTS

Although there were no differences in infants' motor development and parent play behaviors based on infant weight, several other differences were found. OWIs had less access to materials that stimulate locomotor movement. Further, parents of OWIs more often reported utilizing cognitive play strategies in comparison to parents of NWIs who more often reported using physical play strategies. Parents felt they were the greatest influence on their child's activity regardless of infant size. Importantly, all parents desired more specific guidelines on how to encourage active play and preferred this information was delivered by their healthcare provider.

PRACTICE IMPLICATIONS

To meet parents' desires and potentially improve infants' developmental outcomes through the establishment of healthy physical activity behaviors, pediatric nurses could provide more specific guidance on providing active opportunities for infants.

The relationship between smartphone overuse and sleep in younger children: a prospective cohort study

STUDY OBJECTIVES

Younger children and adolescents are exposed to various smart devices in the modern world, and their use of smart devices is rapidly increasing worldwide. Although smart devices have often been considered to have negative effects on sleep of children and adolescents, such effects have not been studied among younger children. Sleep is considered particularly important for learning and memory, and also has implications for emotional regulation and behavior. Therefore, this study was conducted to examine the effects of smartphone overuse on sleep in 5- to 8-year-old children.

METHODS

Participants were from the Kids Cohort for Understanding of Internet Addiction Risk Factors in Early Childhood (K-CURE) Study, an observational prospective cohort study in Korea. Smartphone screen time and total sleep time were assessed using parental questionnaires. Sleep problems of children were assessed using the Children's Sleep Habits Questionnaire (CSHQ). Analysis of covariance was used to examine the association between smartphone overuse and sleep habits in children. All statistical analyses were conducted using SPSS version 21.0 (IBM Corporation, Armonk, NY).

RESULTS

Total sleep time of the smartphone overuse group (smartphone use over 1 hour daily) was shorter than that of the control group (F = 6.362, P < .05). Children in the smartphone overuse group showed statistically significant higher scores in the CSHQ total score and nocturnal awakening subscale score (P < .05).

CONCLUSIONS

Excessive smartphone use was related to shorter total sleep time in children. Use of a smartphone was also associated with significant reductions in the quality of sleep in younger children.

Screens across the pond: Findings from longitudinal screen time research in the US and UK

Digital media are increasingly pervasive in the lives of young children. This increase in the availability of digital media might have long-run implications for child development; however, it is too soon to definitively conclude the direction of effects. In part due to this lack of certainty, leading health organizations have chosen to make different recommendations to parents of young children: Many international health organizations (e.g., the American Academy of Pediatrics, World Health Organization) recommend very young children be limited to under one hour of screen time daily, whereas others (e.g., Royal College of Paediatrics and Child Health) have intentionally opted not to make recommendations about specific limits. These guidelines might contribute to parents in different countries making meaningfully different choices about children's use of digital media. Using a sample of N = 303 families recruited in Cambridgeshire, England and New York City prior to the birth of couples' first child, we explore predictors of digital media use across the first two years of life. Data were collected when children were 4, 14, and 24 months of age. Results of latent growth curve analyses show that generally, children spend more time engaging with digital media as they grow older; however, growth mixture models reveal most children fit into one of two classes: One group of children (High Media Users; 52.2 %) engages with a substantial amount of digital media, whereas the other (Low Media Users; 48.8 %) engages with relatively little. Children in the US were approximately 30 % more likely to be in the Low Media Users group and there were no differences in group membership on the basis of parents' psychosocial wellbeing. While these differences could be due to a number of factors, these findings may reflect the power of pediatric recommendations.

Associations among exposure to television or video, language development, and school achievement in childhood: a prospective birth cohort study

PURPOSE

Exposure to electronic media, which begins in early childhood, has been gradually increasing. This study investigated the associations between time watching television or video (TV time), children's language development, and school achievement using a large prospective design.

METHODS

The participants underwent annual assessment from birth (T1; 5.5 months) to T8 (87.9 months). We used a parental questionnaire to evaluate TV time annually from T3 (2.2 years) to T8 (7.3 years), by the item asking "How many hours does your child usually spend a day watching TV or videos?". Children were grouped by TV time using group-based trajectory analysis. Among 2150 participants, 1087 were included in the final analysis. The Korean version of the Denver II and the Korean-Ages and Stages questionnaires were administered to evaluate early childhood development (T1 to T3). The Receptive and Expressive Vocabulary Test was used to assess children's language development at T8. Questionnaires completed by both parents and teachers were used to evaluate school achievement at T8.

RESULTS

Participants were divided into "Low Descending" (LD), "Medium Flat" (MF), "High Ascending" (HA), and "Extremely High Descending" (XHD) groups. Early language development at T1 and T2 did not significantly differ among all groups. However, language development at T3 and T8, and school achievement at T8 differed significantly, and were the highest in LD and lowest in HA.

CONCLUSION

We found a negative association between greater TV time and children's language and cognitive development. Thus, unchecked TV exposure could be detrimental to childhood cognitive development.

Examining joint parent-child interactions involving infants and toddlers when introducing mobile technology

Research suggests that parents play a critical role in introducing technology to their young children and that parent-child joint engagement with technology can improve learning and social outcomes. The present mixed-methods study extends the current literature by directly observing the interactions of 30 parents with their infant or toddler child (ages 12-24 months) while introducing and engaging with familiar and novel mobile technologies. Qualitative analysis of observations yielded five overarching themes that described key content of parent-child interactions. Subthemes further clarified the types of verbal interactions of the child and of the parent, as well as issues of control over the device, activities and selection choices, skill needs/supports, and interest in the interactions. Developmental milestones and parental surveys contributed to the understanding of developmental change and family media use. Familiarity with the device influenced frequencies of identified themes with greater likelihood for fewer interactions, scaffolds and more passive screen activities with familiar technology. More varied verbal scaffolding was related to higher developmental scores. Physical scaffolding was provided infrequently, despite limited skill in the children. Counter to parental expectations, initiating and sustaining interest even for a short period of time was challenging in some cases. Outcomes suggest that parents engage in a wide array of relevant scaffolds with variability across individuals and child age. Overall, the study provides a rich and complex description of interactions and behaviors when parents introduce mobile devices to their infants and toddlers.

Explaining Screen-Time Behavior Among Preschoolers in Northern India Using Multi Theory Model: A Parental Cross-Sectional Survey

BACKGROUND

Screen-time (ST) is the time spent on digital media. The American Academy of Pediatrics recommends the daily ST of less than an hour for preschoolers. However, increased ST among preschoolers is becoming a public health concern.

OBJECTIVE

This study assessed the multi-theory model (MTM)'s applicability in explaining the ST behavior change among preschoolers through parents.

METHODS

A quota sample of 72 parents was drawn from Northern India. Data were analyzed using multiple regression.

RESULTS

Behavioral confidence (p < 0.001) and changes in the physical environment (p < 0.001) significantly predicted the initiation of reducing ST. The sustenance of limiting ST was significantly predicted by the emotional transformation (p < 0.001), practice for change (p < 0.001), and changes in the social environment (p = 0.001).

CONCLUSIONS

The study highlights the usability of the MTM model in designing and testing interventions for parents to limit ST among their children.

Electronic Media and Early Childhood: A Review

BACKGROUND

This review summarizes the state of knowledge of use of new media on the development in early childhood in 6 sections: descriptive utilization data, psychosocial and emotional development, cognition and language, motor development, nutrition and sleep, and influence of parental media consumption.

METHODS

The review is based on a literature search of this topic in peer-reviewed journals. We included 87 articles, books, and book chapters. The used literature data bases were ERIC, PsycARTICLES, PsycINFO and PSYNDEX.

RESULTS

Manifold studies describe in young children's utilization data the pervasive nature of digital exposure and impressive usage times and availability. They confirm adverse influences of electronic media use (television, video games) on children's emotional and behavioral problems and well-being, e. g. on physical activity, sleep and obesity. In general a positive effect in sense of knowledge transfer of age could be found for high quality educational media, however predominantly the impact of media use at younger age was negative.

CONCLUSIONS

High frequent media use in early childhood is likely to have a negative impact on psychosocial development, positive effects such as knowledge transfer may be seen beyond the age of 18 months. As parental media use is a strong predictor of child media habits, reducing parental media use and enhancing parent-child interactions might be important areas to address when trying to change the media behavior of young children. In view of the scarcity of studies for early childhood, it is advisable to use digital play and communication devices cautiously and restrictively in this vulnerable development phase.

Are associations between home environment and preschool children's sedentary time influenced by parental educational level in a cross-sectional survey?

Background

Childhood obesity is a major public health concern, especially in low socioeconomic groups. Sedentary time (SED) is an important predictor of obesity. To be able to diminish SED it is important to find modifiable predictors of sedentary behavior. The home environment associated with children’s SED may vary by parental socioeconomic status. This study aims to clarify the association between parental educational level (PEL) and the home environment of 3–6-year-old children, and to examine how home environment associates with children’s SED, and whether PEL modifies these associations.

Methods

A cross-sectional Increased health and wellbeing in preschools (DAGIS) study was conducted in 2015–2016 in Finland. The parents (n = 809) filled in questionnaires assessing PEL, and the home physical and social environment related to children’s SED. Children’s SED was measured with accelerometers, which the children (n = 745) wore for 1 week.

Results

High PEL was associated with a home environment restraining sedentary behaviour compared with low PEL. Stricter descriptive norms about screen time, considering it important to limit the child’s screen time, and satisfaction about the child’s screen time associated with children’s lower SED. The association with parental psychological control and SED was influenced by PEL. In the PEL stratified analyses, however, the associations between psychological control and SED did not reach statistical significance.

Conclusions

Future interventions aiming to decrease SED should pay attention to relevant factors in children’s sedentary behaviour home environment. It is important to acknowledge the possible PEL differences in these factors.

Digital Media Exposure and Predictors for Screen Time in 12-Month-Old Children: A Cross-Sectional Analysis of Data From a German Birth Cohort

Background: Early exposure to digital media may affect the physical and cognitive development in young children. The American Academy of Pediatrics and national guidelines recommend no digital media use at all under the age of 18 months. The aim of our study was to determine the actual exposure to digital media in 12-month-old infants and to reveal potential risk factors for screen time. Methods: In this prospective cross-sectional survey, data was collected from the KUNO Kids birth cohort study using parent-report questionnaires regarding the media exposure of the study child. We determined age at first contact with different digital media, mean screen time on an average weekday, and the influence of major demographic and socioeconomic factors. Results: Data for screen time analysis was available for 630 children. In summary, 45% of children had already been exposed to digital media by their first birthday. The most frequent first digital media exposure was the TV (33.0%) followed by smartphones (16.9%), both most commonly exposed to around the age of 8 months. On a regular weekday, 20% of the children spent 0.5-1 h in front of a TV and 9% were exposed to a smartphone for the same time frame, compared to 31% of joint parent-child media use. Predictors for screen time were having one sibling, less living space per person, and excessive TV use in the household, the latter of which doubled the chance of the child being exposed to digital media. Conclusion: A proportion of 10% of 1-year-old children were already regularly exposed to digital media. The TV remains the most predominant device but new media, particularly smartphones, might be catching up. Our study provides further support that family TV time is a major predictor of infant screen time. Pediatric recommendations should be re-evaluated in the light of the actual exposure to digital media already in infancy and parents should be proactively counseled regarding possible effects on child development.

Digital Devices Use and Language Skills in Children between 8 and 36 Month

Background: Over the past decade, the use of digital tools has grown and research evidence suggests that traditional media and new media offer both benefits and health risks for young children. The abilities to understand and use language represent two of the most important competencies developed during the first 3 years of life through the interaction of the child with people, objects, events, and other environmental factors. The main goal of our study is to evaluate the relationship between digital devices use and language abilities in children between 8 and 36 month, also considering the influence of several factors. Materials and Methods: We conducted a cross-sectional observational study on digital devices use and language abilities in260 children (140 males = 54%) aged between 8 and 36 months (mean = 23.5 ± 7.18 months). All the parents completed a self-report questionnaire investigating the use of digital devices by their children, and a standardized questionnaire for the assessment of language skills (MacArthur-Bates). Linear regression analysis was used to evaluate the relation between different variables. Subsequent moderation analysis were performed to verify the influence of other factors. Results: We found a statistically significant negative relation between the total daily time of exposure to digital devices and the Actions and Gestures Quotient (ß = -0.397) in children between 8 and 17 months, and between the total daily time of exposure to digital devices and Lexical Quotient (ß = -0.224) in children between 18 and 36 months. Gender, level of education/job of parents, modality of use/content of digital device did not significantly affect the result of the regression analysis. Conclusion: In our study we found that a longer time of exposure to digital devices was related to lower mimic-gestural skills in children from 8-17 months and to lower language skills in children between 18 and 36 months, regardless of age, gender, socio-economic status, content, and modality of use. Further studies are needed to confirm and better understand this relation, but parents and pediatricians are advised to limit the use of digital devices by children and encourage the social interaction to support the learning of language and communication skills in this age group.

Environmental and Cognitive Enrichment in Childhood as Protective Factors in the Adult and Aging Brain

Some recent studies have highlighted a link between a favorable childhood environment and the strengthening of neuronal resilience against the changes that occur in natural aging neurodegenerative disease. Many works have assessed the factors – both internal and external – that can contribute to delay the phenotype of an ongoing neurodegenerative brain pathology. At the crossroads of genetic, environmental and lifestyle factors, these relationships are unified by the concept of cognitive reserve (CR). This review focuses on the protective effects of maintaining this CR through the cognitive aging process, and emphasizes the most essential time in life for the development and strengthening of this CR. The in-depth study of this research shows that early stimulation with regard to social and sensory interactions, contributes to the proper development of cognitive, affective and psychosocial capacities. Childhood thus appears to be the most active phase in the development of CR, and as such we hypothesize that this constitutes the first essential period of primary prevention of pathological aging and loss of cognitive capacities. If this hypothesis is correct, early stimulation of the environment would therefore be considered as a true primary prevention and a public health issue. The earlier identification of neurodevelopmental disorders, which can affect personal and professional development across the lifespan, could therefore have longer-term impacts and provide better protection against aging.

Sleep Habits and Electronic Media Usage in Japanese Children: A Prospective Comparative Analysis of Preschoolers

Children are increasingly exposed to electronic media, which can potentially influence their sleep habits. However, few studies have investigated the effects of children's life patterns on sleep habits and electronic media usage. This study investigated the differences in sleep habits and electronic media usage between 18- and 42-month-old children attending nursery schools, kindergartens, or staying at home, and respectively enrolled 183 (boys, n = 93; girls, n = 90) and 215 (boys, n = 104; girls, n = 111) 18- and 42-month-old children who underwent health check-ups. We found that 18-month-old children attending nursery school had significantly earlier wake times on weekdays and shorter sleep durations on weekends than children who stayed at home despite no differences in electronic media usage. There were no differences in sleep duration among 42-month-old children attending nursery schools, kindergartens, or staying at home; however, kindergarteners demonstrated a higher use of portable and home video games. Different life patterns affect electronic media usage in preschool children, especially those attending kindergarten. Particular attention should be paid to the higher usage of electronic media devices by kindergarteners, although they had the same sleep duration, as did other preschool children.

Positive mother-child interactions and parenting styles were associated with lower screen time in early childhood

AIM

This study examined long-term associations between mother-child interactions and parenting styles and electronic screen time.

METHODS

We studied 280 healthy children (53.2% girls) enrolled at a mean age of 36 ± 0.4 months from February 2015 to September 2016. The study included retrospective data on 267 children who had been recruited from medical facilities in Thailand at 6 months of age. Mother-child interaction, parenting styles and screen time were assessed at various ages and path analyses were performed to elucidate the directionality and relationships between the variables.

RESULTS

Increased mother-child interaction at 18 months of age was positively associated with less screen time at 2 and 3 years of age. Likewise, nurturing authoritative parenting at 3 years of age was directly related to lower media exposure at 4 years. The total screen time at younger ages had positive direct relationships with relaxed permissive and strict authoritarian parenting styles, but negative direct relationships with nurturing authoritative parenting in subsequent years.

CONCLUSION

Early mother-child interaction and nurturing authoritative parenting were associated with subsequent decreased screen time, while media exposure at the age of two was related to relaxed permissive and strict authoritarian parenting at 3 years of age.

Physical Activity and Sedentary Behaviors of Young Children: Trends from 2009 to 2018

Over the last decade, the lives of children in several countries, including Greece, have been affected by recession. The aim of the present study was (a) to examine time trends in physical activity (PA) and screen time (ST) of Greek preschool children, together with their family affluence (FA), from 2009 until 2018, and to explore the associations among them; and (b) to investigate the connections of parental educational level and children's BMIs to their achieving ST (<1h/day) and PA (11,500 steps/day) guidelines. A total of 652 children from four cross-sectional cohorts participated. PA was recorded with Omron HJ-720IT-E2 pedometers, whereas ST, family affluence (FA) and parental educational level were reported by participants' parents. The results of the one-way ANOVAs that were computed revealed statistically significant differences among cohorts, albeit of no practical importance, in PA, ST and FA. According to the regressions calculated, neither BMI nor the educational level was related to membership in ST and PA guidelines groups. ST was a significant predictor of children's PA in all week periods (school-time, leisure-time, weekend), whereas FA was not such a strong predictor. Multilevel interventions aiming at both ST and PA seem to be imperative for the benefit of young children's health.

Manual Dexterity is not Related to Media Viewing but is Related to Perceptual Bias in School-Age Children

Although the media can have both negative and positive effects on children’s cognitive and motor functions, its influence on their perceptual bias and manual dexterity is unclear. Thus, we investigated the association between media viewing time, media preference level, perceptual bias, and manual dexterity in 100 school-aged children. Questionnaires completed by children and their parents were used to ascertain media viewing time and preference levels. Perceptual bias and manual dexterity were measured using the visual-tactile temporal order judgment task and Movement Assessment Battery for Children—2nd edition, respectively. There were significant positive correlations between age and media viewing time and between media viewing time and media preference level. There was also a significant negative correlation between visual bias and manual dexterity. Hierarchical multiple regression analysis revealed that increasing visual bias was a significant predictor of decreasing manual dexterity. Further, children with low manual dexterity showed significant visual bias compared to those with high manual dexterity, when matched for age and gender. The present results demonstrated that, in school-aged children, although viewing media was not associated with perceptual bias and manual dexterity, there was a significant association between perceptual bias and manual dexterity.

Parental education, television exposure, and children's early cognitive, language and behavioral development

The association between television exposure and children's development is subject to controversial debates. Heavy television exposure may be detrimental to children by overstimulating their developing brains. It may also infringe on time that children would otherwise spend on more developmentally beneficial activities or parental interactions. In the present analysis, we use data from the 2004/5 birth cohort of the Growing Up in Scotland study to investigate relations between hours of weekly television measured around the ages of two to four and as average over this period with children's linguistic, cognitive, and behavioral outcomes around the age of five. Our analysis shows differences in the level and growth of television exposure by parental education. However, we did not find any substantive associations between television exposure and children's cognitive or language ability. We found small associations of television exposure with conduct problems and prosocial behavior, particularly for children of less-educated parents. Overall, the results suggest that the impact of television on children's development is less pronounced than often assumed.

Association of Trajectory and Covariates of Children's Screen Media Time

IMPORTANCE

Many children begin interacting with screen media as early as infancy. Although screen time is associated with negative developmental consequences, few longitudinal studies in the United States have examined covariates of screen time among children under 3 years of age.

OBJECTIVES

To identify trajectories of screen time among children aged 1 to 3 years, to examine their association with screen use at 8 years of age, and to assess potential determinants of screen time.

DESIGN, SETTING, AND PARTICIPANTS

This prospective birth cohort study included 3895 children (3083 singletons and 812 unrelated multiples) in New York State who had screen time data available for at least 1 time point from 1 to 3 years of age; 1156 children had data at 8 years. The study spanned September 4, 2007, through June 12, 2014, in the first phase, and August 29, 2014, through November 15, 2019, in the second phase. Data analysis for the present study was conducted from September 28, 2018, to July 15, 2019.

MAIN OUTCOMES AND MEASURES

Maternal reports of children's television, movie, and computer game times were summed for total daily screen time at 12, 18, 24, 30, and 36 months of age. Two screen time trajectories (low and increasing use) were classified by cluster analysis, and logistic regression was used to model risk factors for the increasing trajectory. Children exhibiting the highest 10th percentile of screen use at each point were examined, and linear mixed models were used to identify risk factors of this high exposure category.

RESULTS

Among the 3895 children included in the analysis (2031 boys [52.1%] and 1864 girls [47.9%]), median daily screen time increased from 30 (interquartile range, 0-60) minutes at 12 months of age to 120 (interquartile range, 75-200) minutes at 36 months of age. Of 1045 children with complete data at all 5 time points, 279 (26.7%) had an increasing screen time trajectory. Female child sex (adjusted odds ratio [aOR], 0.90; 95% CI, 0.81-0.99) and graduate school levels of paternal (aOR, 0.73; 95% CI, 0.56-0.95) and maternal (aOR, 0.60; 95% CI, 0.47-0.77) education, compared with having completed college, were associated with lower risk of increasing trajectory. Maternal nulliparity was associated with higher risk of increasing trajectory (aOR, 1.14; 95% CI, 1.00-1.30). Children with an increasing trajectory from 1 to 3 years of age had an additional 22 (95% CI, 11-33) minutes per day of screen time at 8 years of age. Covariates associated with the highest 10th percentile of screen exposure included paterman graduate school education compared with college (aOR, 0.63; 95% CI, 0.39-0.99), maternal graduate school education compared with college (aOR, 0.55; 95% CI, 0.37-0.82), maternal nulliparity (aOR, 1.98; 95% CI, 1.50-2.61), twins compared with singletons (aOR, 1.41; 95% CI, 1.05-1.91), non-Hispanic black compared with non-Hispanic white race/ethnicity (aOR, 4.77; 95% CI, 2.25-10.10), and type of care (home-based care aOR, 2.17 [95% CI, 1.38-3.41]; parental care aOR, 2.11 [95% CI, 1.41-3.15]) compared with center-based care.

CONCLUSIONS AND RELEVANCE

These findings suggest that a range of parental and child characteristics are associated with screen time. Screen time habits appear to track from as early as infancy, emphasizing the need for earlier interventions.

[Associations of maternal educational background with health and health behavior in infants]

BACKGROUND

The basis for healthy development is established during the first years of one's life. In this early phase, parents can significantly influence the health conditions under which their child grows up. Parental education can play a key role in this regard. This study examines the association of maternal education with health and health behavior in infants.

METHODS

A subsample of the representative German KiGGS study (Wave 1, 2009-2012) on the health of children and adolescents was investigated. Data from 1727 mothers who reported on health-specific characteristics of their infants (0 to 2 years), on their own educational background, and on characteristics of the family were analyzed. The influence of maternal education on indices of health and health behavior in infants was investigated by means of logistic regression; additional predictors were considered in regression models.

RESULTS

Higher maternal education was associated with better health behavior, but not with overall infant health. The impact of maternal education on health behavior remained significant when considering other predictors (financial worries, low maternal age at childbirth, premature birth/low birth weight). Overall, low maternal education was accompanied by an accumulation of additional risks.

CONCLUSIONS

Higher maternal education can help infants have a good start in their lives. The impact of poor health behavior on infant health may not become apparent until later in their lives. For prevention and intervention, it is important to identify sensitive stages of development during childhood and the underlying mechanisms of the relationship between maternal education and infant health behavior.

Time Spent in Sedentary Activity Is Related to Gross Motor Ability During the Second Year of Life

Sedentary activity occupies a substantial amount of time during early childhood, with these habits influenced by changing trends in screen time for very young children. Among school-aged children, motor ability is inversely related to sedentary activity. However, the concept of sedentary activity is rarely investigated in toddlers, and thus little is known concerning its relationship with motor development during this rapidly changing and early period of life. Among two groups of toddlers, aged 18 months ( N = 26) and aged 24 months ( N = 16), this study investigated cross-sectional correlations of motor development (Bayley Scales of Infant Development—III) with daily sedentary activity (accelerometers). In both groups, gross motor ability, but not fine motor ability, was inversely correlated with time spent in sedentary activity. At 18 months, gross motor raw scores inversely correlated significantly with time in sedentary activity ( r = −.533, p < .001) but fine motor raw scores did not ( r = .182, p = .441). Also, at 24 months, gross motor raw scores inversely correlated with time in sedentary activity ( r = −.563, p = .029), while fine motor raw scores did not ( r = −.112, p = .425). These findings add important missing knowledge to the empirical literature regarding sedentary activity in toddlers and its relationship to emerging motor development. Future work might investigate best practices for measuring sedentary activity in this age-group and mechanisms behind its relationship with gross motor skills.

Case-control study found that primary language disorders were associated with screen exposure

AIM

We explored the associations between childhood exposure to screens, including televisions, computers, game consoles, tablets and smartphones and primary language disorders.

METHODS

This multi-centre case-control study comprised 167 children aged 3.5-6.5 years, who were born in 2010-2012 and diagnosed with primary language disorders, and 109 matched controls without language disorders. Questionnaires were completed by their parents who were recruited by 16 family doctors and 27 speech and language therapists in the Ille-et-Vilaine region of France. The data were analysed using a multivariate logistic regression model and presented as adjusted odds ratios (aOR) and 95% confidence intervals (95% CI).

RESULTS

We found that cases (44.3%) and controls (22.0%) exposed to screens in the morning before nursery or primary school were three times more likely to develop primary language disorders (aOR 3.40, 95% CI 1.60-7.23). When this risk was combined with rarely or never discussing screen content with their parents (aOR 2.14, 95% CI 1.01-4.54) they were six times more likely to have language problems (aOR 5.86, 95% CI 1.44-23.95).

CONCLUSION

Being exposed to screens in the morning before school, and rarely or never discussing screen content with parents, meant children were six times more likely to develop primary language disorders.

Screen Media and Autism Spectrum Disorder: A Systematic Literature Review

OBJECTIVE

Previous studies suggest that psychiatric disorders are associated with problematic use of screen media. This article systematically reviews the literature on the associations between screen media and autism spectrum disorder (ASD). The review uses the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHOD

Electronic databases were searched from inception to April 2018, using the term "ASD/autism" along with one of the following terms: "screen time"/"media"/"computer"/"phone"/"television"/"video game."

RESULTS

A total of 16 studies met the inclusion criteria. The studies support the view that children and adolescents with ASD are exposed to more screen time than their typically developing peers or other clinical groups and that the exposure starts at a younger age. The content and context of screen use (e.g., with parents vs alone) may affect the behaviors associated with media exposure. Correlates and long-term consequences of early screen exposure (before the age of 3 years) remain largely unexamined.

CONCLUSION

The current review provides important information about how ASD is associated with screen use and exposure. Future longitudinal research should examine the impact of early screen exposure on child development while accounting for potential moderating environmental factors (e.g., socioeconomic status, parent-child relationship). This will help determine whether-and if so, how much-exposure is detrimental and allow appropriate recommendations and interventions related to screen time among children with ASD.

Like father, like son. Physical Activity, Dietary Intake, and Media Consumption in Pre-School-Aged Children

An imbalance between energy input and energy needs contributes to the growing incidence of overweight children. Pre-schoolers normally like to move, but even at this young age, they are already affected by a lack of physical activity and a high amount of screen time. Media consumption contributes to unhealthy diets and extends the length of time spent sitting. Longer periods of sitting are, independent of the level of activity, seen as a risk factor for the development of obesity. In the present study, 160 pre-schoolers and their parents (128 mothers, 121 fathers) were examined. The results show deviations from actual recommendations regarding physical activity, time spent sitting, dietary intake, and media consumption. Increased screen time was associated with a higher weight status among pre-school-aged children. To provide a healthy upbringing, prevention and intervention measures should be implemented on a behavioral and relational level.

Screen viewing behavior and sleep duration among children aged 2 and below

Background

Few studies have investigated the association between screen viewing (SV) and sleep duration among young children. This study aims to examine the association between total and device-specific SV and sleep duration among children aged 2 and below.

Methods

We conducted a cross-sectional study of 714 Singaporean children aged 2 years and below. Parents were recruited during routine well-child clinic visits from two national polyclinics. In Singapore, all parents visit well-child clinics with their children at regular intervals for routine check-ups and vaccinations. Socio-demographic characteristics, duration of total and device-specific SV, and sleep duration were reported by parents via interviewer-administered questionnaires. Multiple linear regression analysis was used to assess associations between various types of SV and sleep duration, adjusted for socio-demographic variables. Due to significant interaction between SV and age, stratified analyses for children aged less than 6 months and those aged 7–24 months were performed.

Results

The prevalence of daily SV among children was 53.1%; 28.3% in children up to 6 months and 73.8% in children aged 7 to 24 months. TV viewing was reported for 44.3% of all children and mobile device SV for 30.1%. Children’s average sleep duration was 13.9 (SD = 3.5) hours daily and younger children had longer sleep duration than older ones (up to 6 months: mean = 15.6 h, SD = 3.9; 7–24 months: mean = 12.4 h, SD = 2.2; P < 0.01). In the regression analysis among all children, each 1 h per day increment in total SV was significantly associated with 0.26 h shorter sleep duration with similar significant associations for TV (β = − 0.28 h, 95%CI: -0.50, − 0.06) and mobile devices (β = − 0.35 h, 95%CI: -0.61, − 0.09). Stratified analysis revealed significantly greater reductions in sleep with higher SV among children aged 6 months and below (β = − 0.73 h, 95%CI: -1.12, − 0.34), while associations were weaker in older children (β = − 0.13 h, 95% CI: -0.24, − 0.01).

Conclusions

This study provides evidence for a substantial association between longer SV and shorter sleep duration among very young children. These associations appeared stronger among children aged 6 months and below as compared with those aged 7 to 24 months. Further studies are warranted to confirm our findings.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6385-6) contains supplementary material, which is available to authorized users.