Screen time and young children: Promoting health and development in a digital world

Bedtime Screen Use Behaviors and Sleep Outcomes in Early Adolescents: A Prospective Cohort Study

PURPOSE

To determine prospective associations between bedtime screen use behaviors and sleep outcomes one year later in a national study of early adolescents in the United States.

METHODS

We analyzed prospective cohort data from 9,398 early adolescents aged 11-12 years (48.4% female, 45% racial/ethnic minority) in the Adolescent Brain Cognitive Development Study (Years 2-3, 2018-2021). Regression analyses examined the associations between self-reported bedtime screen use (Year 2) and sleep variables (Year 3; self-reported sleep duration; caregiver-reported sleep disturbance), adjusting for sociodemographic covariates and sleep variables (Year 2).

RESULTS

Having a television or Internet-connected electronic device in the bedroom was prospectively associated with shorter sleep duration one year later. Adolescents who left their phone ringer activated overnight had greater odds of experiencing sleep disturbance and experienced shorter sleep duration one year later, compared to those who turned off their phones at bedtime. Talking/texting on the phone, listening to music, and using social media were all prospectively associated with shorter sleep duration, greater overall sleep disturbance, and a higher factor score for disorders of initiating and maintaining sleep one year later.

DISCUSSION

In early adolescents, several bedtime screen use behaviors are associated with adverse sleep outcomes one year later, including sleep disturbance and shorter weekly sleep duration. Screening for and providing anticipatory guidance on specific bedtime screen behaviors in early adolescents may be warranted.

Early Childhood Screen Use Contexts and Cognitive and Psychosocial Outcomes: A Systematic Review and Meta-analysis

Importance

The multifaceted nature of screen use has been largely overlooked in favor of a simplistic unidimensional measure of overall screen time when evaluating the benefits and risks of screen use to early childhood development.

Objective

To conduct a systematic review and meta-analysis to examine associations of screen use contexts in early childhood with cognitive and psychosocial outcomes.

Data Sources

PsycINFO, Embase, MEDLINE Ovid, ProQuest, CINAHL, Web of Science, and Scopus were searched from inception to December 31, 2023.

Study Selection

A total of 7441 studies were initially identified. Studies were included if they examined associations between a contextual factor of screen use among children aged 0 to 5.99 years and cognitive or psychosocial development. Observational, experimental, and randomized clinical trial study designs were included.

Data Extraction and Synthesis

All studies were independently screened in duplicate following PRISMA guidelines. Effect sizes of associations (r) from observational studies were pooled using random-effects 3-level meta-analyses. The remaining study designs were narratively synthesized.

Main Outcomes and Measures

Screen use contexts included content (child directed and age inappropriate), type (program viewing and game or app use), co-use (or solo use), background television, caregiver screen use during child routines, and purpose. Outcomes were cognitive (executive functioning, language, and academic skills) or psychosocial (internalizing and externalizing behavior problems and socioemotional competence).

Results

Overall, 100 studies (176 742 participants) were included, and of these, 64 observational studies (pooled sample sizes ranging from 711 to 69 232) were included in meta-analyses. Program viewing (n = 14; k = 48; r, -0.16; 95% CI, -0.24 to -0.08) and background television (n = 8; k = 18; r, -0.10; 95% CI, -0.18 to -0.02) were negatively associated with cognitive outcomes, while program viewing (n = 6; k = 31; r, -0.04; 95% CI, -0.07 to -0.01), age-inappropriate content (n = 9; k = 36; r, -0.11; 95% CI, -0.17 to -0.04), and caregiver screen use during routines (n = 6; k = 14; r, -0.11; 95% CI, -0.20 to -0.03) were negatively associated with psychosocial outcomes. Co-use was positively associated with cognitive outcomes (n = 8; k = 28; r, 0.14; 95% CI, 0.03 to 0.25).

Conclusions and Relevance

Findings show small to moderate effect sizes that highlight the need to consider screen use contexts when making recommendations for families, clinicians, and educators beyond screen time limits; including encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers.

Context of digital media use in early childhood: Factors associated with cognitive development up to 36 months of age

The influence of digital media on child cognitive development is a complex factor that goes beyond screen time. This study investigates the broader impact of digital media on child cognitive development, considering contextual variables such content type, parental mediation, and maternal mental health. Brazilian mothers (N = 212) of children 4-36 months old answered an online survey. Results showed that children's screen time increases with age. The model with unmediated use, non-educational content, and mother's screen time explains 28.7 % of children's screen time variance. Non-educational content and simultaneous screen media use explained 5.3 % of the variance in toddlers' cognitive development. Mothers with common mental disorders tended not to mediate their children's media use. We discuss the influence of caregivers' availability to mediate infants' and toddlers' digital media use and its impact on children's cognitive development. These findings underscore the necessity for educational and awareness campaigns aimed at fostering access to high-quality digital content for children during critical stages of development.

Parental Mediation, Digital Media Usage, and Health Literacy: An Exploration Among Chinese Elementary School Students

This study examines the relationship between parental interactions, digital media usage, and health literacy among 19,386 elementary students (ages 6-11) in Guangdong Province, China, using the framework of parental mediation theory. Path analysis revealed that increased digital media usage is associated with decreased health literacy, particularly for short video platforms, which exhibit a significant negative correlation (β = -.335). Parental interaction was found to significantly reduce the use of instant messaging apps (β = -.007) and short video platforms (β = -.008), with the influence being moderated by the student's residence status (boarding or non-boarding). The findings highlight the importance of frequent parental interaction in limiting digital media usage and enhancing health literacy among children. This study suggests that parental mediation theory should pay closer attention to environmental or living status factors, as they can significantly influence its mechanisms of action. Overall, this research contributes to the discourse on digital behavior in childhood and offers evidence-based insights for improving educational and health literacy strategies.

Correlates of lifestyle patterns among children in Singapore aged 10 years: the growing up in Singapore towards healthy outcomes (GUSTO) study

OBJECTIVE

To characterise lifestyle patterns (comprising dietary and movement behaviour aspects) of children in Singapore and examine the correlates of these patterns.

DESIGN

An observational study approach was used. Children recorded their diet and activities over two weekdays and two weekend days on a validated web-based assessment, My E-Diary for Activities and Lifestyle (MEDAL). Lifestyle patterns were derived using principal component analysis, and the correlations of these with multiple known determinants organised by distal, intermediate, and proximal levels of influence were studied.

SETTING

Children of the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort.

PARTICIPANTS

Ten-year-old children (n = 397).

RESULTS

Three lifestyle patterns, "high snacks and processed food", "balanced" and "mixed", were identified. We focused on the more health-promoting "balanced" pattern, characterised by lower screen-viewing and higher consumption of fruits, vegetables, wholegrains, and dairy. Among the distal factors, girls were more adherent to the "balanced" pattern compared to boys, and children of parents with lower education levels were less adherent to this pattern. Among intermediate factors, children of mothers with higher diet quality were more adherent to the "balanced" pattern. Among the proximal factors, engagement in active transport, leisure sports, and educational activities outside of school were positively associated with the "balanced" pattern, whereas screen-viewing while travelling was negatively associated with this pattern. Having siblings, pet ownership, mother's physical activity, parenting style, parental bonding, child's outdoor time, and breakfast consumption were not associated with children's lifestyle patterns.

CONCLUSIONS

These findings provide direction for future interventions by identifying vulnerable groups and contexts that should be prioritised.

Digital dilemmas and existing recommendations for healthy screen time use for children and adolescents

As technology continues to play an integral role in our daily lives, concerns regarding the appropriate and healthy use of screen time have prompted health organizations and authorities worldwide to establish guidelines and recommendations. This paper comprehensively summarizes existing recommendations and guidelines for screen time use from various countries, highlighting key similarities, differences, and emerging trends. However, there is a dire need to expand the existing repertoire of guidelines and recommendations to different age groups and strategies depending on user engagement for healthy screen time use.

Children at Risk of Specific Learning Disorder: A Study on Prevalence and Risk Factors

BACKGROUND

Specific learning disorder (SLD) is a neurodevelopmental condition characterised by significant academic difficulties despite normal intelligence and adequate education. The difficulties with reading, writing, and arithmetic may manifest independently or concurrently at different ages. Early symptoms may appear in preschool, including delays in social skills, motor skills, and language development. This study aimed to assess the prevalence of preschool children at risk for SLD and related psychiatric disorders.

METHOD

Data were collected from 515 preschool children in Edirne City, Turkey, using a screening scale for early symptoms of SLD. Socio-demographic information was obtained, and children at risk were invited for a psychiatric evaluation.

RESULTS

The mean age of the participants was 72.5 ± 5.6 months. It was determined that 5.7% of the preschool children who participated in the questionnaire were at risk of SLD according to the screening scale scores. Factors such as a father's low education, the mother smoking during pregnancy, a longer stay in the neonatal intensive care unit, longer screen time, and consanguinity between parents were associated with an increased risk of SLD.

CONCLUSION

This study emphasises the importance of early identification and intervention for SLD and the need to consider associated psychiatric comorbidities. Identifying the risk factors in preschool children may facilitate timely intervention and prevent academic and social difficulties in later years.

Measurement Method Options to Investigate Digital Screen Technology Use by Children and Adolescents: A Narrative Review

The role and potential impact of digital screen technology in the lives of children is heavily debated. Current evidence is limited by the weakness of measures typically used to characterise screen use, predominantly proxy- or self-reports with known inaccuracy and bias. However, robust and detailed evidence is needed to provide practical trustworthy guidance to families and professionals working with families. The purpose of this paper is to support researchers to select measurement method(s) that will provide robust and detailed evidence. The paper outlines the challenges in measuring contemporary screen use by children, using a child-technology interaction model to organise considerations. A range of different methods used to measure digital screen technology use in children and adolescents (i.e., questionnaires, diaries, electronically prompted sampling, direct observation, fixed room cameras, wearable/portable cameras, audio recorders, screen-device onboard logging, remote digital trace logging and proximity logging) are described along with examples of their use and constructs typically measured as well as a summary of the advantages and disadvantages of each method. A checklist and worked examples are provided to support researchers determining the best methods or combination of methods for a research project.

Evidence for Changes in Screen Use in the United States During Early Childhood Related to COVID-19 Pandemic Parent Stressors: Repeated Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic transformed the home lives of many families in the United States, especially those with young children. Understanding the relationship between child and parent screen time and family stressors exacerbated by the pandemic may help inform interventions that aim to support early child development.

OBJECTIVE

We aim to assess the changing relationship between family screen time and factors related to pandemic-induced remote work and childcare or school closures.

METHODS

In the spring of 2021 we administered a survey, similar to one administered in the spring of 2019, to a national sample of parents of young children (aged 6 to 60 months). Using iterative sampling with propensity scores, we recruited participants whose sociodemographic characteristics matched the 2019 survey. Participants were aged >18 years, proficient in English or Spanish, and residing in the United States. The main outcomes were changes in child screen time (eg, mobile phone, tablet, computer, and television) and parenting technoference, defined as perceived screen-related interference with parent-child interactions. Additional survey items reported pandemic-related job loss, and changes to work hours, work location, caregiving responsibilities, day care or school access, and family health and socioeconomic status.

RESULTS

We enrolled 280 parents, from diverse backgrounds. Parents reported pandemic-related changes in child screen time (mean increase of 1.1, SD 0.9 hours), and greater parenting technoference (3.0 to 3.4 devices interfering per day; P=.01). Increased child screen time and parenting technoference were highest for parents experiencing job loss (mean change in child screen time 1.46, SD 1.03; mean parenting technoference score 3.89, SD 2.05), second highest for working parents who did not lose their job (mean change in child screen time 1.02, SD 0.83; mean parenting technoference score 3.37, SD 1.94), and lowest for nonworking parents (mean change in child screen time 0.68, SD 0.66; mean parenting technoference score 2.66, SD 1.70), with differences significant at P<.01. School closure and job loss were most associated with increased child screen time during the pandemic after controlling for other stressors and sociodemographic characteristics (d=0.52, P<.001; d=0.31, P=.01). Increased child screen time and school closure were most associated with increased parenting technoference (d=0.78, P<.001; d=0.30, P=.01).

CONCLUSIONS

Work and school changes due to the COVID-19 pandemic were associated with increased technology interference in the lives of young children. This study adds to our understanding of the interaction between technology use at home and social factors that are necessary to support early childhood health and development. It also supports possible enhanced recommendations for primary care providers and childcare educators to guide parents in establishing home-based "screen time rules" not only for their children but also for themselves.

Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers' Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study

BACKGROUND

The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions.

OBJECTIVE

This study aims to explore schoolchildren's knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating.

METHODS

A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated.

RESULTS

We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren's homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren's homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children's knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate.

CONCLUSIONS

The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers' perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren's nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating.

Executive dysfunction as a possible mediator for the association between excessive screen time and problematic behaviors in preschoolers

Excessive screen time in children is a growing concern for parents and healthcare providers worldwide because it frequently leads to behavioral problems. Although executive dysfunction is proposed to be one of the contributing factors to maladaptive behaviors, little is known about the link between screen time and behaviors. This study aimed to identify whether executive dysfunction contributes to the negative behaviors of children exposed to excessive screen time. A cross-sectional study was conducted on preschool-aged children from public and private schools in Chiang Mai, Thailand. The parents/guardians of each child completed the questionnaires regarding clinical characteristics and screen time use, the Behavior Rating Inventory for Executive Function-Preschool (BRIEF-P), and the Strengths and Difficulties Questionnaire (SDQ). Children with more than one hour of media exposure per day were considered to have excessive screen time. Multivariable Gaussian regression was analyzed to compare the BRIEF-P and SDQ scores between the excessive and appropriate screen time groups. Causal mediation analysis was performed to examine the effects of total screen time on increasing behavioral problems with executive functioning as a mediator. A total of 1,126 preschoolers were included in the analyses. After controlling for age, sex, socioeconomic status, and maternal education, the excessive screen time group had significantly higher BRIEF-P global executive composite score than the appropriate screen time group (mean difference of global executive composite score = 1.49, 95% CI [0.12, 2.86], and p = 0.033). Concurrently, there were significant differences in externalizing behavior subscales and SDQ total difficulties scores between the excessive and appropriate screen time groups (mean difference of total difficulties score = 0.90, 95% CI [0.29, 1.50], and p = 0.004). A significant average causal mediation effect (ACME) of screen time on behavioral problems mediated through executive functioning was β = 0.28, 95% CI [0.13-0.44], which was more than half of the total effect (54.9%, 95% CI [37.4-100%]). The current study suggests that the increase in behavioral issues in preschoolers might be partly explained by the direct effect of excessive screen time and the mediating effect of impaired executive functioning. Our results may raise concerns about the necessity to limit screen time and monitor for executive function deficits and behavioral problems in young children with high screen time.

Exploring possibilities for the development of healthy eating habits in preschool settings: parent's and teacher's perspectives

Adoption of eating habits starts early in life, through interaction with family members and alongside preschool settings that offer context for developing healthy lifestyles among children. The aim of this study was to explore the perceptions and practices of teachers and parents related to the development of healthy eating habits among preschool children. Focus groups were conducted with a total sample of 48 parents and teachers (three focus groups among parents and three among teachers) from 15 kindergartens in the Republic of Srpska, Bosnia, and Herzegovina. All of the mentioned kindergartens are part of the "Nutrition friendly preschool/school initiative", a program aimed at creating and developing settings that support and improve children's health. Focus groups were audiotaped, transcribed verbatim, and analyzed according to the Framework Method. Teachers emphasized that good communication and support from parents are important factors for the development of healthy eating habits. During COVID-19, direct communication with parents was restricted, and mutual activities among teachers, children, and parents were reduced. Lack of knowledge, finance, and time are perceived by parents as main obstacles to the improvement of children's healthy eating habits. All participants in the focus groups agreed that more education and informative material are needed so their skills related to good nutrition can be improved and adopted in a culture-sensitive way. Mutual support, education, and dissemination of informative materials are imposed as particularly important needs by all actors involved in the upbringing of children in order to support the development of children's healthy eating habits.

Evaluation of Screen Time in Children Under Five Years Old

INTRODUCTION

Due to the rapid advancement of technology, there has been a noteworthy increase in the diversity and abundance of activities involving children. The most effective methods to enhance and facilitate children's media interactions are to minimize, reduce, use with caution, and establish healthy patterns. We aimed to evaluate media exposure of children below five years of age.

MATERIAL AND METHODS

This is a prospective, observational, cross-sectional study that was conducted between December 2017 and September 2019 in Eskişehir, Türkiye. To assess the frequency of electronic device usage among children under the age of five, including televisions, laptops, tablets, and mobile phones, as well as its impact on their sleep patterns and physical measurements, and to evaluate families' understanding of the terms "screen time" and "back screen time," we developed a questionnaire.

RESULTS

We analyzed a total of 731 questionnaires: 334 (45.7%) were girls, 397 (54.3%) were boys, and the mean age was 33.55±16.37 months. Upon examining the technical equipment accessible to the children in our study, we found that 98.6% possessed a television, 96.9% owned a mobile phone, 54% had a laptop, 49.5% had a tablet, and 34.1% possessed a gaming console. The study revealed the following proportions of electronic devices in children's rooms: 13% televisions, 11.9% tablets, 7.4% laptops, and 7% mobile phones. There has been a substantial increase in the amount of time they spend watching television and playing computer games among children who have at least one sibling. There was a statistically significant disparity between the television viewing periods and the body mass index of children older than two years old. Additionally, we have seen a significant disparity in the presence of media devices in children's bedrooms and the subsequent impact on their sleep duration and patterns throughout both nighttime and daytime. Around 65.8% of parents did not know of the concept of screen time, while 88.4% of parents did not know of the concept of back screen time.

DISCUSSION

Parental compliance with the current guidelines for screen time is insufficient, among parents with children under the age of five, even though exposure to screens begins in the first months of life. Our analysis highlighted the necessity for parents to establish and enforce a unified and logical media usage policy for all children residing in the household. It is crucial to allocate sufficient time during the routine healthcare visit to discuss these recommendations.

"I Just Wanted a Dentist in My Phone"-Designing Evidence-Based mHealth Prototype to Improve Preschool Children's Oral and Dental Health: Multimethod Study of the Codevelopment of an App for Children's Teeth

BACKGROUND

Dental caries in preschool children is a global health concern. With increased access to technology and the disruption of health care during the pandemic, mobile health apps have been of interest as potential vehicles for individuals' health maintenance. However, little is known about caring for their child's teeth and what their preferences would be regarding the content or design of an oral health app.

OBJECTIVE

This study aims to co-design the prototype of an app named App for Children's Teeth with parents, providing a source of information for them about caring for their children's teeth and promoting positive dental habits.

METHODS

This multimethod study conducted user involvement research with a purposive sample of parents or carers of children aged ≤6 years to (1) understand their use of the internet through the eHealth Literacy Scale and interviews, (2) determine their opinions about content related to children's oral health, and (3) collect feedback about the app's acceptability using the Theoretical Framework of Acceptability. There were three stages: (1) interviews with parents to understand their needs, preferences, and abilities; (2) prototype design with app developers; and (3) parent feedback interviews using the think aloud method for data collection. Data were deductively analyzed using a codebook strategy, whereas data from the think aloud sessions were analyzed inductively using reflexive thematic analysis.

RESULTS

The prototype design stage involved 10 parents who reported using the internet for health information but found it to be scattered and contradictory. Parents generally welcomed the App for Children's Teeth but expressed concerns about screen time and practicality. They suggested guidance regarding oral hygiene practices, teething symptoms, and pain relief. Parents appreciated features such as clear fonts, categorization according to their child's age, and "In a Nutshell" bullet points. Topics that resonated with parents included information about teething, finding a dentist, and breastfeeding. They believed that the app aligned with their goals and offered suggestions for future developments, such as outlining the process of finding a dentist and incorporating a forum for parents to communicate and exchange ideas.

CONCLUSIONS

The coproduction design approach highlighted parents' need for solutions such as mobile health apps to access reliable information about oral health. Parents identified key design concepts for the app, including a simple and uncluttered interface, content categorization according to their child's age, and practical guidance supported by visual aids. Despite potential challenges related to screen time restrictions, parents provided insights into how such an app could fit seamlessly into their lives.

TRIAL REGISTRATION

Open Science Framework; https://osf.io/uj9az.

Family Meal Environment Differentially Conditions the Prospective Association between Early Childhood Screen Time and Key Social Relationships in Adolescent Girls

Background: Despite screen time recommendations, children are increasingly spending time on electronic devices, rendering it an important risk factor for subsequent social and developmental outcomes. Sharing meals could offer a way to promote psychosocial development. This study examines the interaction between family meal environment and early childhood screen time on key adolescent social relationships. Methods: Participants are 1455 millennial children (49% boys) from the Quebec Longitudinal Study of Child Development birth cohort. Parents reported on child screen use at ages 2 and 6 years and family meal environment quality at age 6 years. Parents and children reported on parent-child relationships and peer victimization experiences, respectively, at age 13 years. Sex-stratified multiple regression estimated the direct association between screen time trends, family meal environment quality, and their interaction on later social relationship outcomes. Results: For girls, when preschool screen time increased, sharing family meals in high-quality environments was associated with more positive and less conflictual relationships with their mothers, whereas meals shared in low- and moderate-quality environments were associated with fewer instances of victimization by their peers. Non-linear associations were not significant for boys. Conclusion: Capitalizing on family meal environment represents a simple/cost-efficient activity that can compensate for some long-term risks associated with increased screen use, above and beyond pre-existing and concurrent individual and family characteristics. Public health initiatives may benefit from considering family meals as a complementary intervention strategy to screen use guidelines.

Familial context influences media usage in 0- to 4-year old children

Background

The use of digital media (e.g., smartphones, tablets, etc.) and the Internet have become omnipresent for every age group and are part of children's and parents' everyday life. Focusing on young children, the availability of media devices, their use as well as associated problems (e.g., in social, emotional and motor development) have increased in recent years. Of particular interest for prevention of these problems in early childhood is the relationship between the familial context (parental digital media use, Problematic Internet Use, school graduation, presence of siblings) and the digital media use of infants and toddlers. The present study's goal was to describe media usage in 0-4-year-old children and to identify the potential relationship between familial context factors and child media usage.

Methods

The sample included N = 3,035 children aged 0 to 3;11 years (M = 17.37 months, SD = 13.68; 49.13% female). Recruitment took place within the framework of a restandardization study for a German developmental test. The parents of the participants answered a questionnaire on socio-demographics, on child media use, and on parental media use. Questions on parental media use included the full version of the Short Compulsive Internet Use Scale (S-CIUS).

Results

Significant increases in media usage times with child age were identified, but no significant gender differences. A multiple regression analysis revealed that increasing maternal total media usage time, a higher parental S-CIUS score, lower school leaving certificate of both mother and father, and increasing child's age led to higher child media usage time. Having siblings diminished young children's media usage in this study. Having more than one child and having children aged over a year was associated with a higher parental S-CIUS score.

Conclusion

Family factors such as maternal media use time, Problematic Internet Use and lower school graduation are significantly associated with young children's digital media use. Parents should be aware of their personal influence on their children's media use which might be due their role in terms of model learning.

Parents' Knowledge, Attitudes, and Practices Regarding Baby Walkers, Baby Car Seats, Oral Health, and Child Screen Time in Saudi Arabia: A Cross-Sectional Study

Background Awareness of age-appropriate milestones and developmental stages is crucial for parents to identify any potential delays or concerns early on and seek appropriate interventions. This study aimed to assess the knowledge, attitudes, and practices of caregivers in Saudi Arabia regarding baby walkers, baby car seats, early dental visits, and screen time for young children. Methods A cross-sectional survey was conducted among parents in Saudi Arabia using a structured questionnaire. A convenience and snowball sampling method was employed to recruit participants from various regions of the country. The questionnaire aimed to assess parents' knowledge regarding the recommended use of baby walkers and baby car seats, their awareness of the importance of early dental visits, and their understanding of appropriate screen time guidelines. Additionally, the survey explored parents' practices toward these recommendations. Descriptive statistics were used to analyze the data, and associations between variables were examined using the chi-squared test. Results A total of 1318 participants were included. The analysis revealed that the majority of the participants (n=1066,81.3%) use a baby walker, while only (n=292,22.3%) consider that they should never be used. Overall, (n=388,29.6%) of the participants never used a car seat for their infants or children. In terms of early childhood dental visits, approximately (n=518,39.5%) of the participants reported actually taking their child to the dentist within the recommended timeframe. Regarding screen time for children, (n=148,11.3%) of the participants reported that their children spend >5 hours daily in front of the screen.  Conclusions Raising parents' awareness about recent childcare recommendations and safe practices is crucial for promoting optimal child development, preventing health problems, facilitating evidence-based decision-making, reducing risks, enhancing parental confidence and empowerment, and nurturing positive parent-child relationships.

[Use of screens, sedentary lifestyle, and physical activity in children under six years of age, during the period of preventive and compulsory social isolation in AMBA: online survey]

Introduction

Within the context of the COVID-19 pandemic, children were confined to their homes. The Buenos Aires Metropolitan Area (AMBA) region has the highest urban density in Argentina and has been the epicenter of COVID-19 infections and deaths. The objectives of this study are to characterize the habits of screen use, sedentary lifestyle and physical activity and describe their associations, in children under six years of age from AMBA, Argentina.

Methods

analytical and cross-sectional study, in which data from the online survey (Google Forms®) were used. Through a non-probabilistic convenience sampling, fathers, mothers, legal guardians, and caregivers of children under six years of age were invited to participate. The survey was available during four months of the quarantine period and was made up of 31 questions about screen use, physical activity, and sedentary lifestyle of children.

Results

256 surveys were answered, the majority (79.6%) were female and 50.8% in the age range of 31-40 years.

Conclusion

The television is the most used and children begin to use touch screens from one year. The play time of adults with children and the time that they usually carry out activities such as reading a book or drawing is one to two hours per day. There was an association between owning the screen and using it for more hours. The lower the income level, the more time adults play with their children.

Ground Rules for Preschooler Exposure to the Digital Environment: A Review of Studies

Background

The range of digital technologies that children use from an early age has expanded significantly. Most studies demonstrate that preschoolers now spend substantially longer on digital devices and start using them at a younger age. Finding a solution for this challenge has research merits and relevance, as the data on benefits and harm of early preschoolers' exposure to digital devices is contradictory. This poses a need to determine theoretically sound and practically validated criteria that could guide the duration and quality of children's exposure to the digital environment.

Objective

To review studies that contain recommendations on preschoolers' exposure to the digital environment, namely, exposure limits and evidence to justify the limitation of preschoolers' time on digital media.

Design

The analysis starts by identifying theoretical foundations that researchers use in their studies of children's behavior in the digital environment. This is followed by an overview of 40 studies that include research papers, official reports, and methodological recommendations made by healthcare and governmental organizations.

Results

The review identified the following ground rules for children's exposure to the digital environment: to provide for child's interaction with a digital device, to use educational applications that will develop skills appropriate to the child's age, to ensure mandatory supervision of children's engagement by an adult who limits the exposure according to child's age-related capabilities and creates conditions for active exploration of the real rather than a virtual world. Children's cognitive development suffers the most from passive intake of digital content.

Conclusion

The data herein can help to develop strategies to promote healthy and educational engagement of children with digital devices and media; however, the review highlights the insufficiency of psychophysiological research that would make it possible to practically validate the recommendations on the duration of preschoolers' exposure to the digital environment.

High Problematic Screen Exposure among Children Aged 2-5 Years Visiting the Department of Pediatrics of a Tertiary Care Centre

Introduction

The effects of problematic screen exposure in the early years have adverse effects on cognition, reasoning, executive, and social skills, and physical health. The study aimed to assess the prevalence of problematic screen exposure in children between 2 to 5 years of age visiting the Department of Paediatrics of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among caregivers of children aged 2 to 5 years of age in a tertiary care centre from 16 July 2023 to 30 September 2023 after an ethical clearance from the Institutional Review Committee. This study excluded children with chronic disease and behavioural disorders. The problematic screen exposure was assessed using the Problematic Screen Exposure Score. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 310 respondents, 216 (69.67%) (64.55-74.79, 95% Confidence Interval) children had a high problematic screen exposure score. The mean age of children was 3.46±1.033 with 89 (41.20%) children having their first exposure before 12 months of age, 131 (60.64%) exceeding daily usage of >2 hr, and 198 (91.66%) children viewing age-inappropriate media content.

Conclusions

The prevalence of high problematic screen exposure was comparable to that of the prevalence found in studies done in similar settings.

Keywords

children; preschool; screen time.

Changes in screen time from 4 to 7 years of age, dietary patterns and obesity: Findings from the Generation XXI birth cohort

BACKGROUND AND AIMS

Increased screen exposure is associated with unhealthy eating behaviours and obesity. Screen time (ST) changes from pre-school to school age, and associations with dietary patterns (DP) and obesity remain unknown. We, therefore, analysed ST changes from 4 to 7 years of age, associated factors, and the relation with DP and obesity.

METHODS AND RESULTS

We included 4531 children evaluated at 4 and 7 years, as part of the Generation XXI birth cohort (Porto, Portugal). ST was assessed for weekdays and weekend, and average daily time was estimated. Associations between covariates and ST changes, and between ST changes and 3 DP previously identified (Energy-dense foods, Snacking, and Healthier) were estimated by odds ratios (OR) and 95% confidence interval (95%CI), using adjusted multinomial regression models. From 4 to 7 years, 31.5% of the children decreased their ST, 21.8% increased, 16.5% maintained low (≤60 min), and 30.2% maintained high (61-120 min or >120 min) ST. After adjustment, lower maternal education (OR = 2.33, 95%CI:1.82-2.99) and lower family income (OR = 1.72, 95%CI:1.35-2.21) were associated with higher odds of increasing ST, while being a girl was associated with 35% decreased odds of increasing ST. Children that increased and those that maintained high ST showed greater odds of presenting a Snacking DP at 7 years (OR = 2.34, 95%CI:1.64-3.35) and (OR = 2.65, 95%CI:1.89-3.72), respectively. No statistically significant differences were found regarding changes in ST and the child's BMI.

CONCLUSION

Children increasing screen exposure during this period were more frequently from lower socioeconomic strata and presented unhealthier DP.

Infants' and toddlers' language development during the pandemic: Socioeconomic status mattered

The disruption caused by the COVID-19 pandemic has raised concerns about children's development. Here, we examined the impact of the pandemic on Canadian infants' and toddlers' (N = 539) language development. Specifically, we assessed changes in 11- to 34-month-olds' activities that are known to affect vocabulary development (i.e., screen and reading times). We also compared these children's vocabulary sizes with those of 1365 children collected before the pandemic using standardized vocabulary assessments. Our results show that screen and reading times were most negatively affected in lower-income children. For vocabulary growth, no measurable change was detected in middle- and high-income children, but lower-income 19- to 29-month-olds fared worse during the pandemic than during pre-pandemic times. Moving forward, these data indicate that educators and policymakers should pay particular attention to children from families with lower socioeconomic status during times of crisis and stress.

Knowledge is power: Relationship between professional recommendations, maternal attitudes, and screen time exposure of infants

PURPOSE

The American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend infants avoid screen media exposure, yet most infants are regularly exposed. This study aimed to explore screen exposure, maternal attitudes regarding screen media effects, and pediatricians' recommendations to better understand widespread screen media use with infants younger than 18 months of age in hopes of informing mitigation efforts.

DESIGN AND METHODS

Surveys consisting of 10 Likert-style questions were distributed real-time to a purposive sample of 193 mothers with infants 18 months of age or younger in Georgia, Pennsylvania, and New York.

RESULTS

Seventy-nine percent of infants exceeded AAP/WHO guidelines and 61% of respondents couldn't recall receiving pediatrician recommendations regarding screen exposure for their infant. Mothers with higher levels of education were associated with an accurate reflection of the adverse effects of screen usage on infant development (ANOVA; F = 10.122; df = 3; p < .001). Accurate maternal attitudes regarding adverse effects on infants was associated with less daily screen exposure (Spearman correlation; r = -0.428; p < .001).

CONCLUSIONS

Findings suggest that knowledge about adverse side effects of screen media usage with infants is associated with less daily exposure; and, that pediatricians may not routinely review guidelines for infants with their families, underscoring the importance of other methods of knowledge dissemination.

PRACTICE IMPLICATIONS

Nurses, as trusted healthcare providers, can provide counseling on infant screen media usage creating an opportunity for augmented knowledge dissemination across maternal demographics potentially leading to less screen exposure in this vulnerable population.

Impact of 2019 Novel Coronavirus (2019-nCov) Pandemic and Lockdown on Parents and Caregivers in Ontario, Canada

The COVID-19 pandemic has impacted parents' and children's well-being. This study aimed to evaluate the impact of the COVID-19 pandemic and its preventive measures on children's well-being and their parents' anxiety level. Parents/caregivers were invited to respond to a self-administered survey. The primary outcome was to assess the rate and severity of parental anxiety during the pandemic/lockdown. Four hundred and thirty parents completed the survey. Ninety-two (21%) and 10 (2%) parents reported that their children gained or lost weight during the pandemic, respectively. Eighty-one (19%) parents reported a regression in their children's developmental milestones, particularly in toileting, speech, and social interaction. The GAD-7 mean scores increased by 2.9 points (95% CI [2.5, 3.25]; P < .001) in comparison with prepandemic scores. Adjusted multivariable analysis showed that having children with psychological conditions and a maternal education level less than a university degree were significantly associated with higher parental anxiety.

Paediatricians' awareness of Canadian screen time guidelines, perception of screen time use, and counselling during the COVID-19 pandemic

Objectives

Paediatricians are essential in guiding families on screen time use as digital media becomes increasingly prevalent. While this has been highlighted through the COVID-19 pandemic there is no literature on paediatricians' awareness of Canadian screen time guidelines, or perception of these guidelines during this time. The aim of this study was to assess pediatricians' knowledge, attitudes, and comfort with the Canadian Paediatric Society's (CPS) screen time guidelines, specifically during the COVID-19 pandemic.

Methods

Our survey was developed by a paediatric resident and paediatric endocrinologist, reviewed by local experts, and sent electronically to members of the CPS Community and Developmental Paediatrics sections.

Results

All 53 respondents were aware of current CPS screen time guidelines, and the majority self-reported fair to excellent knowledge of guidelines for both age groups (<5 years and school-aged children/adolescents). Over 80% noticed increased screen use during the pandemic, and 98% were somewhat or very concerned about screen use and their patients' health and well-being. Pediatricians reported concerns about associations between increased screen time with worsening behaviour, mental health concerns, obesity, and sedentary lifestyle. The greatest barrier to reducing screen time was perceived insufficient motivation or support from caregivers/families.

Conclusions

Responding Canadian paediatricians are knowledgeable and comfortable with current screen time guidelines in Canada. Despite this, there is increasing concern with health outcomes associated with screen use. These results highlight paediatricians' important role in counselling patients and may encourage further local advocacy and public education around screen use and associated health risks in children.

Relationship Between Speech Delay and Smart Media in Children: A Systematic Review

The increasing prevalence of smart media usage among children has raised concerns about its potential impact on various aspects of child development. One such area of worry is speech delay, as early language acquisition is critical for cognitive, social, and educational development. The purpose of this systematic review was to investigate and synthesize available research data in order to determine the association between speech delay and the usage of smart media in children. To perform this systematic review, a thorough literature search was conducted using relevant keywords in electronic databases, such as PubMed, Scopus, PsycINFO, Google Scholar, Web of Science, and Embase. We included studies published during the last 10 years investigating the impact of smart media on children's speech delay using various research designs. The findings showed that extended exposure to electronic media for children was negatively associated with expressive vocabulary and language skills in children, in addition to decreased language scores and speech delays. Educational apps and shared media engagement with parents correlated with stronger language skills. The introduction of smart devices at a later stage of development (24 months of age and older) was associated with positive language development, whereas early introduction was associated with speech delay. However, six-month abstinence from devices led to speech improvement in the affected children. These findings highlight the need to balance interactive screen time and other forms of interaction to enhance speech development.

Associations between physical activity, screen time, sleep time and selected academic skills in 8/9-year-old children

BACKGROUND

High levels of physical activity (PA), low levels of screen time, combined with sufficient sleep time, provide better health benefits. However, few studies have examined the association of these behaviours with academic skills. Therefore, this study aims to determine how PA, screen time, and sleep time are related to selected academic skills of 8/9-year-old children while examining compliance with the guidelines on PA, sedentary behaviour, and sleep among this population group.

METHODS

This cross-sectional study included 114 primary school children (50% girls) aged 8-9years old from 2nd grade. The levels of PA, screen time, and sleep were assessed using self-reported questionnaires. The selected academic skills (based on reading and writing) were assessed by a battery of methods designed to diagnose the causes of school failure in students aged 7-9. Non-linear regression was applied to build multivariate models aimed at finding the most significant predictors for the selected academic skills separately.

RESULTS

Sixty-seven percent of children met the sleep guidelines, 22% met the screen time guidelines, and only 8% met PA guidelines. In terms of screen time, boys spent more time playing games than girls (p = .008). Moderate to vigorous intensity physical activity (MVPA) was associated with higher/better scores of the visual-auditory integration (B = -0.07, p = .040). Not meeting the sleep guidelines was associated with lower scores in visual-auditory integration among children (B = 0.12, p = .042). Children who did not meet the screen time guidelines had lower scores in perceptual-motor integration (B = -0.09, p = .040).

CONCLUSIONS

Participating in PA, limiting screen time and sufficient sleep time may benefit/support academic skills in children.

Why Do Iranian Preschool-Aged Children Spend too Much Time in Front of Screens? A Preliminary Qualitative Study

There is evidence that Iranian preschool children are increasingly spending their time in front of screens (screen time: ST; time spent with any screen such as TVs, computers, tablets, smartphones, game consoles, or video games), but few studies have explored the possible causes of such an increase. Given this, the present study aimed to qualitatively explore determinants of excessive ST in Iranian children. To this end, parents of preschool children were interviewed, and their answers were qualitatively clustered to identify additional important factors. Key informant interviews were conducted with parents of preschool children in Tehran (Iran). A semi-structured interview was developed to assess child and family life, daily routine, family rules, family interactions, and home climate as possible contributing factors to ST. Parents' audiotaped statements were transcripted verbatim, coded, and clustered into main themes using thematic analysis with the MaxQda^® software. A total of 20 parents of children aged 2 to 7 were interviewed, and a total of 6 key themes and 28 subthemes were extracted from their interviews. The results of the analysis identified a broad range of both independent and interrelated factors leading to the development and maintenance of ST behaviors among preschool children. Our findings indicate that the central concept is the family. Considering screen-related behaviors, family life encompasses parental health literacy (e.g., parenting pattern, monitoring standards, thoughtful parenting), family psychological atmosphere (e.g., presence of parents, family norms, parent-parent and parent-child interaction, congruency/incongruency of parents with each other) and the digital structure of the home. The child's and parents' actions and characteristics can influence family interactions. A child's and parent's behavior is also influenced by social/cultural factors. Parents' behaviors and attitudes, family communications, and interactions contribute to healthy ST habits in children. It is not possible to examine the child's behavior without considering the family and the dominant environment, since the behavior of family members as a whole affects each family member. Given this, interventions should make parents aware of their role and responsibilities in reducing children's ST and consider the family system as a whole, and interventions also can benefit from considering the parental perceptions of children's behaviors.

Effects of Excessive Screen Time on Child Development: An Updated Review and Strategies for Management

Children's heavy reliance on screen media has raised serious public health issues since it might harm their cognitive, linguistic, and social-emotional growth. This study examines the effects of screen time on many developmental domains and covers management and limitation techniques for kids' screen usage. Screen media has a wide range of cognitive consequences, with both beneficial and detrimental effects noted. Screens can improve education and learning; however, too much time spent in front of a screen and multitasking with other media has been related to worse executive functioning and academic performance. As screen time reduces the amount and quality of interactions between children and their caregivers, it can also have an impact on language development. Contextual elements like co-viewing and topic appropriateness are key in determining how language development is impacted. Additionally, excessive screen usage has detrimental effects on social and emotional growth, including a rise in the likelihood of obesity, sleep disorders, and mental health conditions including depression and anxiety. It can obstruct the ability to interpret emotions, fuel aggressive conduct, and harm one's psychological health in general. Setting boundaries, utilizing parental controls, and demonstrating good screen behavior are all techniques that parents may use to manage children's screen usage. We can reduce the possible negative impacts of excessive screen time and promote children's healthy development and well-being by increasing knowledge and encouraging alternative activities that stimulate development.

Prevalence, determinants and consequences of problematic smartphone use among preschoolers (3-5 years) from Dhaka, Bangladesh: A cross-sectional investigation

The problematic smartphone use (PSU) has been becoming a challenging health issue for preschoolers aged 3-5 years as it has severe adverse effect on their psychological, physical, and cognitive development. The scarcity of scientific research on this issue in the context of Bangladesh motivated the authors for conducting this cross-sectional study to explore the prevalence of PSU with its influential factors and adverse effects on preschooler's psychological and physical development based on primary data collected from 400 mothers. The multivariable ordinal logistic regression (OLR) was used to compute the adjusted likelihoods. The estimated prevalence of PSU was approximately 86 %, where about 29 % were severely problematic user. The likelihood of preschoolers' PSU was observed to increase with >1 h/day usage of smartphone by children (Adjusted Odds Ratio (AOR): 3.92). Other important factors were parental smartphone use, education, profession, family income, and mother's age. Both of moderate and severe PSU had adverse effect on preschoolers' health- severe PSU was found to increase the likelihood of psychological and physical problems by 6.03 and 3.29 times, respectively. The preschoolers with PSU reported to suffer from many physical and mental health problems such as attention deficit and hyperactivity disorder (ADHD), emotional instability, aggressiveness, depression, lack of control, impaired vision and hearing, obesity, body imbalance, and lack of brain development. It is now prime time to undertake strategic policies considering the findings for limiting the preschoolers' usage of smartphone, which will make Bangladesh susceptible to protect its future generation from harmful effects of PSU.

Risk of Obesity Among Children Aged 2-6 Years Who Had Prolonged Screen Time in Taiwan: A Nationwide Cross-Sectional Study

Objective

To evaluate the risk of obesity in preschool children with prolonged screen time in Taiwan.

Methods

Using a nationwide survey with random sampling, we collected information on 8378 preschool children aged 2-6 years among 206 preschools in Taiwan from 2016 to 2019. Socioeconomic data, body mass index, and lifestyle of the preschool children and their caregivers were compared among the groups of preschool children who had moderate and prolonged daily screen time. We used multiple log-binomial regression models to calculate the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) of obesity associated with prolonged screen time.

Results

The prevalence of obesity in the preschool children was 13.1%, and the average screen time was 104.6 minutes. Children's age, sleep hours, outdoor play time, sugar intake, snack eating before dinner, sleep disturbance, and obesity, as well as caregiver's sex, age, education, screen time, exercise time and parent obesity were factors related to high screen time for preschool children. Compared with children with moderate screen time, children with prolonged screen time had a higher risk of obesity (PR, 1.45; 95% CI, 1.18-1.79). With a 60-minute increase in screen time, the risk of obesity increased, with an PR of 1.10 (95% CI, 1.03-1.17).

Conclusion

Preschool children with prolonged screen time had an increased risk of obesity in Taiwan. Interventions may be needed for this very susceptible population.

Parental perspectives on technology use to enhance communication and closeness during the COVID-19 parental presence restrictions

Objective

To explore parental perspectives on the use of technology in neonatal intensive care units (NICU), and its impact during COVID-19 parental presence restrictions.

Methods

Co-designed online survey targeting parents of infants admitted to a Canadian NICU from March 1st, 2020 until March 5th, 2021.

Results

Parents (n = 117) completed the survey from 38 NICUs. Large variation in policies regarding parental permission to use technology across sites was reported. Restrictive use of technology was reported as a source of parental stress. While families felt that technology helped them feel close to their infant when they could not be in the NICU, it did not replace being in-person.

Conclusion

Large variation in policies were reported. Despite concerns about devices in NICUs, evidence on how to mitigate these concerns exists. Benefits of using technology to enhance parental experiences appear substantial. Future study is needed to inform recommendations on technology use in the NICU.

Correlation of Screen Time With Eating Behavior Among School-Going Children Aged 8 to 10 Years in East Delhi, India

Background and aim:

Excessive screen time (ST) negatively impacts physical activity and eating behavior among children <5 years. There is a dearth of data on older Indian children; hence, the present study aimed to assess the effect of ST on eating behavior among older children.

Methods:

The present cross-sectional study purposively recruited 100 school-going children. E-questionnaire was prepared to gather information regarding the demographic profile and self-reported weight and height. For the assessment of ST, the SCREENS questionnaire was used. Eating behavior was assessed using the Children Eating Behavior Questionnaire, and for physical activity, the PAQ-C was used. The nutrition status of children was assessed using body mass index (BMI) for age cut-offs.

Results:

The results revealed that 52% of the children were using screens for > 4 hours per day excluding school-related activities and online classes. ST of children was directly proportional to the parent’s ST ( P < .05). There was a negative correlation between ST and the physical activity of children ( P < .01). A positive correlation was observed between ST and emotional overeating, desire to drink, slow eating, satiety responsiveness, food fussiness, and emotional undereating ( P < .01). BMI was positively associated with ST and negatively associated with physical activity, though the results were not significant. Satiety responsiveness (a food-avoiding subscale) was negatively associated with BMI ( P < .05).

Conclusion:

The present study concludes that excessive ST among 8 to 10 years old school-going children has been associated with physical inactivity and poor eating behavior which could lead to an increased risk of being overweight and obese.

Play therapy in children with autism: Its role, implications, and limitations

Play is a pleasurable physical or mental activity that enhances the child’s skills involving negotiation abilities, problem-solving, manual dexterity, sharing, decision-making, and working in a group. Play affects all the brain's areas, structures, and functions. Children with autism have adaptive behavior, adaptive response, and social interaction limitations. This review explores the different applications of play therapy in helping children with autism disorder. Play is usually significantly impaired in children with autism. Play therapy is mainly intended to help children to honor their unique mental abilities and developmental levels. The main aim of play therapy is to prevent or solve psychosocial difficulties and achieve optimal child-healthy growth and development. Play therapy helps children with autism to engage in play activities of their interest and choice to express themselves in the most comfortable ways. It changes their way of self-expression from unwanted behaviors to more non-injurious expressive behavior using toys or activities of their choice as their words. Play therapy also helps those children to experience feeling out various interaction styles. Every child with autism is unique and responds differently. Therefore, different types of intervention, like play therapy, could fit the differences in children with autism. Proper evaluation of the child is mandatory to evaluate which type fits the child more than the others. This narrative review revised the different types of play therapy that could fit children with autism in an evidence-based way. Despite weak evidence, play therapy still has potential benefits for patients and their families.

Parental Perceptions of Child's Play in the Post-Digital Era: Parents' Dilemma with Digital Formats Informing the Kindergarten Curriculum

Digital technology affordance has been recognized as a social and learning tool, and the requirements for digitalizing the kindergarten curriculum have been present for decades. Digitalization in a child's early years can present conflict with parents, as the societal and economic demands of digitalized society for a child's digital technology use are in dissonance with guidelines and recommendations of health organizations that caution against preschool children's technology use. Kindergarten curricular reform in Slovenia was conducted in the 1990s. In this period, the use of digital learning technology and digital play for the development of children learning predispositions and early literacy was already recognized. At the time of curriculum design, it integrated some elements of digital learning technology. Now, 30 years after the design of the new curriculum, we are facing the post-digital era. Learning technology in the early years is a matter of partnership with parents; accordingly, this descriptive survey study includes a non-randomized sample of 306 parents. We are considering how child's play is structured in the primary environment and how parents perceive digital technology in the current post-digital age of seamless, digitally saturated social practices. Parents are aware of the risks of technology and of its benefits for learning. The findings show correlations between a child's digital screen technology use and parents' attitudes and perceptions of digital play. Parents that offer digital screen technology to a child have less agreeable attitudes regarding its possible risks to a child.

Screen-related discord and dismay in low-income Mexican American families with toddlers: A qualitative study

PURPOSE

Understanding parental experiences with managing their toddler's screen use is important to inform the design of interventions addressing early childhood screen use, yet current evidence is limited. To enhance our understanding of the context of toddler screen use, this study characterizes the screen-related discord and dismay parents experience in families with toddlers.

DESIGN AND METHODS

In-depth interviews were conducted to explore everyday experiences with screen use among low-income Mexican American caregivers of toddlers (21 mothers, 10 fathers, 1 grandmother). Transcripts were content analyzed to identify prominent themes.

RESULTS

Three themes were identified. Experiences of screen-related discord and dismay arose (1) between parent and child, (2) between parents, and (3) surfaced as parental internal dissonance about toddler screen use. Parent-child discord resulted from parental limit setting and child reactions to parental screen use, which often included tantrums. Parent-partner discord included patterns of agreeing to disagree and direct disagreement between partners. Parents also reported their own feelings of ambivalence and dismay as they struggled to reconcile their preferences against their toddler's actual screen use, while living in a screen-saturated world.

CONCLUSIONS

Findings offer insight into types of screen-related discord and dismay low-income Mexican American parents experience as they attempt to manage their toddler's screen use.

PRACTICE IMPLICATIONS

Although discord in families is normal, the screen-specific discord reported by participants warrants consideration in efforts promoting healthy screen use in families. Providers can tailor their counseling to consider the range of screen-related discord families of toddlers may experience.

Contemporary screen time modalities and disruptive behavior disorders in children: a prospective cohort study

BACKGROUND

Cross-sectional studies have demonstrated associations between screen time and disruptive behavior disorders (conduct disorder and oppositional defiant disorder); however, prospective associations remain unknown. This study's objective was to determine the prospective associations of contemporary screen time modalities with conduct and oppositional defiant disorder in a national cohort of 9-11-year-old children.

METHODS

We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,875). Modified Poisson regression analyses were conducted to estimate the associations between baseline child-reported screen time (total and by modality) and parent-reported conduct or oppositional defiant disorder based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) at 1-year follow-up, adjusting for potential confounders.

RESULTS

Participants reported an average of 4 hr of total screen time per day at baseline. Each hour of total screen time per day was prospectively associated with a 7% higher prevalence of conduct disorder (95% CI 1.03-1.11) and a 5% higher prevalence of oppositional defiant disorder (95% CI 1.03-1.08) at 1-year follow-up. Each hour of social media per day was associated with a 62% higher prevalence of conduct disorder (95% CI 1.39-1.87). Each hour of video chat (prevalence ratio [PR] 1.21, 95% CI 1.06-1.37), texting (PR 1.19, 95% CI 1.07-1.33), television/movies (PR 1.17, 95% CI 1.10-1.25), and video games (PR 1.14, 95% CI 1.07-1.21) per day was associated with a higher prevalence of the oppositional defiant disorder. When examining thresholds, exposure to >4 hr of total screen time per day was associated with a higher prevalence of conduct disorder (69%) and oppositional defiant disorder (46%).

CONCLUSIONS

Higher screen time was prospectively associated with a higher prevalence of new-onset disruptive behavior disorders. The strongest association was between social media and conduct disorder, indicating that future research and interventions may focus on social media platforms to prevent conduct disorder.

Screen technology exposure and infant cognitive development: A scoping review

PROBLEM

There has been some concern that screen exposure is harmful to an infant's cognitive development, but the effects of screen technologies on cognition are not fully understood. A scoping review was conducted to determine what evidence exists about screen exposure and cognitive development in children ages birth to 24 months.

ELIGIBILITY CRITERIA

Inclusion = 1) English language; 2) studies focusing on children under 24 months of age; 3) cognitive development; 4) screen exposure. Exclusion = 1) articles over 25 years old; 2) structure, function and physiology of the brain; 3) social development; 4) psychosocial development; 5) motor development; 6) abnormal development/mental health; 7) behavior; 8) content only, not screen exposure e.g., social media; 9) secondary sources.

SAMPLE

Ten studies met the inclusion criteria. Articles included one retrospective chart review, six longitudinal studies, two cross-sectional studies, and one prospective study.

RESULTS

Of the ten studies in this review, six reported correlations between screen exposure and cognitive delay, one study reported positive cognitive outcomes and three reported no significant positive or negative outcomes.

CONCLUSIONS

From the evidence in this scoping review, no causal relationship has been found between screen exposure and infant cognitive harm. Some correlations between screen exposure and cognitive delay were reported. Some positive cognitive outcomes were also reported.

IMPLICATIONS

Future research should focus on the context of screen viewing as opposed to dosage or exposure. More robust methodologies should be used to assess infant cognition and screen usage.

Screen media and non-screen media habits among preschool children in Singapore, South Korea, Japan, and Finland: Insights from an unsupervised clustering approach

The main purpose of the research was to describe the daily screen media habits and non-screen media habits like indoor and outdoor play, and sleep of preschool children aged 2 to 6 years from Singapore, South Korea, Japan, and Finland using a content-validated online questionnaire (SMALLQ®) and unsupervised cluster analysis. Unsupervised cluster analysis on 5809 parent-reported weekday and weekend screen and non-screen media habits of preschool children from the four countries resulted in seven emergent clusters. Cluster 2 (n = 1288) or the Early-screen media, screen media-lite and moderate-to-vigorous physical activity-lite family made up 22.2% and Cluster 1 (n = 261) or the High-all-round activity and screen media-late family made up 4.5%, respectively represented the largest and smallest clusters among the seven clusters that were emergent from the pooled dataset. Finland was best represented by Cluster 2 and Japan was best represented by Cluster 3 (High-screen media-for-entertainment and low-engagement family). Parents from Finland and Japan displayed greater homogeneity in terms of the screen media and non-screen media habits of preschool children than the parents from South Korea and Singapore. South Korea was best represented by Clusters 6 (Screen media-physical activity-engagement hands-off family) and 7 (Screen media-lite, screen media-late and high-physical activity family). Singapore was best represented by Clusters 4, 5, 6 and 7, and these clusters ranged from Low all-round activity-high nap time family to Screen media-lite, screen media-late and high-physical activity family. Future research should explore in-depth reasons for the across-country and within-country cluster characteristics of screen media and non-screen media habits among preschool children to allow for more targeted interventions.

Prevalence and description of digital device use among preschool children: A cross-sectional study in Kota Setar District, Kedah

INTRODUCTION

Digital device helps children enhance academic, cognitive and psychomotor skills. However, prolonged use causes physical inactivity, poor interpersonal skills and communication problems. Information on digital device use among young children in Malaysia is currently limited. Hence, this study aimed to determine the prevalence of digital device utilisation among preschool children in Kota Setar District, Kedah.

METHOD

A cross-sectional study at government preschools in Kota Setar District was conducted from February to April 2020. Selection of preschools and students was done using multistage simple randomisation. A self-administered questionnaire containing demographic and digital device use details was filled by parents.

RESULTS

The prevalence of digital device use among preschool children was 95.9% and mostly used smartphones (94.2%). Most children (95%) did not own the device, and usage was under supervision (95.7%). The reason for supervision was to prevent exposure to inappropriate content (70.5%). The common reasons for allowing digital device use were for educational (37.4%) and entertainment purposes (36%) through videos (30.9%) and games (30.2%). Approximately 21.5% and 50.3% of the children spent more than 1 and 2 hours on digital devices during weekdays and weekends, respectively.

CONCLUSION

The prevalence of digital device use among the preschool children in Kota Setar District was very high. Most of them used digital devices for educational and entertainment purposes under parental supervision. However, some exceeded the recommended screen time on weekends. These findings could promote awareness of digital device use among young children and help design public health awareness programmes and future policies.

Young Children and Screens: Guidelines for Intervention during the Perinatal Period from the French National College of Midwives

Screens and digital media are increasingly present in family environments. This article reports the published data about children's screen use in France and elsewhere. We next synthesize the scientific literature on the relations between screen use and child development and then summarize current national and international guidelines about children's screen use before the age of 5 years. Based on these elements, we propose clinical practice guidelines for counseling women during the perinatal period. Précis: Current knowledge on children's screen use and its relationship to their development is summarized including guidelines and suggestions to help parents monitor screen use.

Video game playing among preschoolers: prevalence and home environment in three provinces from Turkey

We aimed to investigate the video game habits and their relationship with home environment in children 2-5 years in Turkey. A structured questionnaire about the child's demographic, screen, and video gaming characteristics was completed by parents in five health centers from three provinces. One-quarter of 1245 preschoolers were found to play video games. The prevalence of playing video games was higher in older age, male gender, low parental education, families with 3 or more children, having a game console, computers and tablets at home, child's screen time of more than 2 hours per day, child's non-compliance with the parental screen rules, and presence of someone else playing videogame at home. Of the parents, 54.5% did not know the name of the video game the child was playing. Parents should be counseled about supervising on their children's video game playing habits and selection of well-designed games with the right content.

Association between recreational screen time and excess weight and obesity assessed with three sets of criteria in Spanish residents aged 2-14 years

INTRODUCTION AND OBJECTIVE

Studies that assess the association between excess weight and screen time in childhood and adolescence are methodologically heterogeneous, and few studies have analysed the exposure to smartphones and tablets. Our study aimed to assess the association between daily recreational screen time and excess weight (overweight+obesity) and obesity in children aged 2-14 years residing in Spain using different sets of standards.

METHODS

We conducted a cross-sectional study using data from the 2017 Spanish National Health Survey (N=4528). We assessed the prevalence of overweight and obesity applying the criteria of the World Health Organization (WHO), International Obesity Task Force (IOTF), and Orbegozo 2011 study. We categorised daily recreational screen time in minutes as 0-59, 60-119, 120-179, and ≥180. We calculated crude and adjusted prevalence ratios (aPR) of excess weight and obesity based on the daily minutes of recreational screen time with the corresponding 95% confidence intervals (95%CI). Moreover, we calculated crude and adjusted change (aΔ) in the expected number of fulfilled excess weight/obesity criteria based on the minutes of daily recreational screen time with the corresponding 95% CI. We adjusted the association analyses for potential confounders.

RESULTS

We found that spending 180min or more a day of recreational screen time was associated with an increase in the adjusted prevalence of excess weight (e.g. Orbegozo 2011 aPR_≥180, 1.20; 95% CI, 1.02-1.42) and of obesity (e.g. IOTF aPR_≥180, 1.41; 95% CI, 1.06-1.86) as well as an increase in the adjusted number of fulfilled criteria for excess weight (aΔ_≥180, 1.18; 95% CI, 1.06-1.31).

CONCLUSIONS

Longer periods of recreational screen time were associated with excess weight and obesity in children aged 2-14 years. Cohort studies are required to confirm these findings, as this may be a determinant of health in children.

Correlates of sedentary behavior in Asian preschool-aged children: A systematic review

This systematic review aims to identify the multilevel correlates of sedentary behavior (SB) and its sub-domains among preschool-aged children aged 0-7 years in Asia. We systematically searched for studies published from 2000 onwards using terms related to SB correlates and Asia in six databases. Eligible studies were observational and used quantitative methods to examine correlates of total, and domain-specific SB (screen viewing [SV] and non-screen-based SB) in Asian children living in Asia. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis to summarize the evidence on the intrapersonal, interpersonal, environmental correlates of total and domain-specific SB (PROSPERO: CRD42018095268). Twenty-two studies from 4 regions and 12 countries/territories were included. Out of the 94 correlates explored, the following associations were consistent: older age, being a boy, non-Chinese ethnicity (Southeast Asia), younger maternal age, higher maternal and paternal television-viewing time with higher SV; higher SV at earlier age with higher SV and total SB; and presence of TV/computer in the bedroom with higher leisure-time SB. We encourage more studies from low- and middle-income Asian countries with an increased focus on different SB domains, further exploration of environmental correlates, and the use of objective measurements to capture SB.

Development of Spatial Orientation in Two-to-Three-Year-Old Children in Relation to Lifestyle Factors

Various lifestyle factors, including diet, physical activity, and sleep, have been studied in the context of children's health. However, how these lifestyle factors contribute to the development of cognitive abilities, including spatial cognition, remains vastly understudied. One landmark in spatial cognitive development occurs between 2.5 and 3 years of age. For spatial orientation at that age, children learn to use allocentric reference frames (using spatial relations between objects as the primary reference frame) in addition to, the already acquired, egocentric reference frames (using one's own body as the primary reference frame). In the current virtual reality study in a sample of 30-36-month-old toddlers (N = 57), we first demonstrated a marginally significant developmental shift in spatial orientation. Specifically, task performance with allocentric performance increased relative to egocentric performance (ηp2 = 0.06). Next, we explored a variety of lifestyle factors, including diet, in relation to task performance, to explain individual differences. Screen time and gestational weight gain of the mother were negatively associated with spatial task performance. The findings presented here can be used to guide future confirmatory studies about the role of lifestyle factors in the development of spatial cognition.

Predictors of Preadolescent Children's Recreational Screen Time Duration During the COVID-19 Pandemic

OBJECTIVE

Research suggests that children's screen use during the COVID-19 pandemic has doubled. There is a need to understand factors associated with increased use to more adequately inform COVID-19 pandemic recovery efforts aimed at promoting healthy device habits. The objective of this multi-informant study of children aged 9 to 11 years was to examine whether duration of screen use during the COVID-19 pandemic was predicted by sociodemographic factors (e.g., child age and sex), COVID-19 pandemic family stressors, daily routines (e.g., sleep and physical activity), and device use factors (e.g., parent management strategies and content and context of use).

METHODS

Participants included 846 children (M = 9.85, SD = 0.78) and their mothers from the All Our Families cohort, Calgary, Canada. Mothers reported (May-July 2020) on child screen use and COVID-19 pandemic impacts (e.g., job/income loss and stress), and children self-reported (July-August 2020) on their screen use and daily routines (e.g., sleep, physical activity, and device-free activities).

RESULTS

Screen use during the COVID-19 pandemic was highest among male and minoritized children and families reporting high levels of stress. Children had lower durations of screen time when device limits were set by mothers. Children also had lower durations of screen time when they used screens to connect with others and when they engaged in higher levels of physical activity or device-free recreational activities.

CONCLUSION

This study sheds light on children's screen use during the COVID-19 pandemic and supports the current screen use guidelines for school-aged children, suggesting that parents monitor use and foster high-quality screen use (e.g., coviewing or used for connection) and device-free recreational activities when possible.