Intelligent monitoring-based screen exposure patterns and neurodevelopmental outcomes in preschool children

Few studies have analyzed preschoolers' screen exposure patterns, especially combined screen time and content, and the associations with neurodevelopment. This study aims to identify the screen exposure patterns in preschoolers by intelligent technology and to examine their associations with their neurodevelopment. This cross-sectional study enrolled preschool children from two kindergartens in Shanghai. Data were collected from March 2023 to July 2023. Screen time and content types were monitored over 7 consecutive days using an intelligent monitoring technology validated by the 24-h diary method (κ = 0.61). Neurodevelopmental outcomes were assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3); developmental abnormality was defined as a score < 1 SD from the mean in each domain. K-means clustering analysis identified screen exposure patterns, and binary logistic regression was applied to examine associations between screen exposure patterns and neurodevelopmental outcomes. Of 355 preschool children included, 204 were males (57.5%) and 251 (70.7%) were aged between 34.5 months and 50.5 months. K-means cluster analysis yielded 4 screen exposure patterns: restrictive use, moderately educational, noneducational, and educational-dominant pattern. Binary logistic regression showed the moderately educational pattern was associated with gross motor abnormalities (OR = 2.530, 95% CI: 1.089-5.875, P = 0.031), and non-educational pattern with fine motor abnormalities (OR = 3.172, 95% CI: 1.122-8.968, P = 0.029).

This monitoring study identified heterogeneous screen exposure patterns in preschool-aged children, revealing that excessive use of moderately educational content and noneducational content was associated with lower gross motor and fine motor skills. When limiting total screen time, parents should focus on content selection for preschool-aged children. Future research should focus on the objective measurement of different types of screen content and utilize the intelligent monitoring system to conduct cohort studies, aiming to explore the causal associations between screen exposure content and children's development.

• Few studies have analyzed preschoolers' screen exposure patterns (especially combined time and content) or the associations with neurodevelopment, with scarce research using objective measures of both.

• Using validated intelligent monitoring, we identified heterogeneous patterns and found excessive moderately educational/noneducational content linked to lower motor skills.