Assessment of Risk of Behavioral Problems in Children Below Five Years in Relation to Screen Time: A Cross-Sectional...

Excessive screen time is associated with developmental (mainly socio-cognitive and language) and behavioral problems more in children below five years than in older children and adolescents. The present study was conducted to determine the prevalence and pattern of exposure to excessive screen time in children below five years of age. It was also aimed at determining the prevalence of the risk of behavioral problems in these children in relation to their average daily screen time.

This study was conducted as an observational descriptive study on children attending OPD in the Department of Pediatrics of a tertiary care medical college in central India over the study period of 12 months. Parents were enquired about their socio-demographic details, the daily average screen time of their child, details regarding screen time and exposures, associated factors, sleeping and eating habits, average time spent by parents with their children, and also the behavioral issues according to the preschool pediatric symptom checklist (PPSC). All these questions were asked of the parents and duly filled out by a single doctor. The IAP (Indian Academy of Pediatrics) screen time recommendation was used as a cut-off value for excessive screen time definition, which states screen time recommendations for children below two years and two to five years old.

The daily average screen time greater than one hour (exceeding the recommended guidelines) was found in 57.7% of children. Twenty-six percent of children were exposed to screen time before their first birthday. Among the study participants, 37.7% (n=95) of children were found to be at risk of behavioral problems as per PPSC score, with a mean PPSC score of 6.7±3.3 in these children. The daily average screen time of one to three hours was found in 39.3% of children, three to five hours in 13% of children, and more than five hours in 5.3% of children. The PPCS score was found to be significantly higher in children with higher average screen time, children using multiple devices as compared to single devices, children who preferred electronic devices or devices with toys as preferred sources of entertainment, children becoming restless when devices are not given, children having feeding and sleep issues, and children who spend less time with parents (p<0.05). Multivariate analysis revealed higher odds of behavioral problems in children having more screen time (1-3 hours OR: 1.536; 95% CI: 1.03-7.237; p=0.035, 3-5 hours OR: 2.022; 95% CI: 1.477-8.570; p=0.029, and >5 hours OR: 9.793; 95% CI: 2.065-46.447; p=0.004), children using multiple devices as compared to single devices (OR: 2.43; 95% CI: 1.194-4.95; p=0.014), and children whose parents spend less time with them (<3 hours OR:1.311; 95% CI: 1.02-2.77; p=0.012).

The present study found that almost all children below five years are exposed to digital devices, with the majority of children exceeding the recommended screen time guidelines, and they mostly use it for entertainment purposes. During this period, exposure of children to screens is significantly associated with the risk of behavioral problems. It was observed that excessive screen time, less time spent by parents with their children, and use of multiple devices are significant predictors of increasing risk of behavioral problems in children below five years.