Parental concern and multiple dimensions of preschool children's digital media use: a cross-sectional study

Digital media exposure is widespread during early childhood, yet the relationship between parental concern regarding children's screen use and children's actual digital media behaviours remains poorly understood. We examined the relationship between parental concern and multiple dimensions of children's screen media use, including screen time, age at first exposure, and type of content.

Cross-sectional data from 892 preschool children (2-6 years) recruited from the District of Coimbra, Portugal, and participating in the ScreenHealth project (2024) were analysed. Parents reported children's screen use, socio-demographic characteristics, and concern regarding screen exposure. Screen time was categorised. Regression models were used to assess associations.

Concerns regarding inappropriate content, problematic or addictive screen use, and visual health were the most frequently reported by parents, whereas concerns about sleep and unhealthy food and drink advertising were less common. Moderate parental concern was associated with higher odds of children belonging to higher screen time categories (OR = 1.78, 95% CI: 1.29-2.47, p < 0.001) and with predominantly entertainment-oriented screen use (OR = 2.18, 95% CI: 1.28-3.71, p = 0.004), whereas no significant associations were observed for age at first exposure to digital media. Older child age and lower paternal educational attainment were independently associated with higher screen time categories.

Parental concern regarding children's screen use was associated with multiple dimensions of preschool children's digital media use but was not consistently associated with lower screen exposure. These findings suggest that parental concern alone may be insufficient to explain or predict children's screen use behaviours. Longitudinal studies are needed to clarify the direction of these associations. Interventions supporting healthy digital media use during early childhood should combine evidence-based guidance with practical, context-sensitive strategies that help families establish sustainable screen-use practises.