Types of Screen Time and Developmental Outcomes Among Children Aged 0-6 Years in Thailand: A Cross-Sectional Study

Excessive screen time during early childhood can affect developmental outcomes. However, evidence on the differential effects of screen time types in Thailand remains limited. In this study, we examined associations between different types of screen time and developmental outcomes among children aged 0-6 years in Thailand.

This cross-sectional study was conducted in community kindergartens and primary healthcare centres in Thailand. A multistage area-selection procedure was used to select the study settings, followed by convenience sampling of caregiver-child pairs. Data on screen time and related characteristics were collected through structured caregiver interviews. Children's developmental outcomes were assessed using the Developmental Surveillance and Promotion Manual by trained public health practitioners. Adjusted multivariable logistic regression models were used to examine associations between different types of screen time and suspected developmental delays.

In total, 465 caregiver-child pairs were included. The mean age of children was 41.97 (SD 19.76) months. The median daily screen time was 2.25 h (IQR 1.83-3.00), with 78.9% exceeding recommended limits. Each additional hour of total screen time was associated with increased odds of suspected developmental delays across developmental domains, particularly receptive language delay (aOR 1.52, 95% CI 1.30-1.79) and gross motor delay (aOR 1.49, 95% CI 1.21-1.84). Recreational screen time showed the strongest associations, particularly for receptive language delay (aOR 2.39, 95% CI 1.73-3.30) and personal-social delay (aOR 2.27, 95% CI 1.68-3.08). In contrast, educational screen time was associated with lower odds of receptive language delay (aOR 0.45, 95% CI 0.23-0.88) and expressive language delay (aOR 0.40, 95% CI 0.16-0.99), whereas communication-based screen time was associated with lower odds of personal-social delay (aOR 0.14, 95% CI 0.02-0.95).

Higher total and recreational screen time were associated with increased odds of suspected developmental delays, whereas educational and communication-based screen time were associated with lower odds in specific domains. Limiting recreational screen time and promoting age-appropriate, high-quality, interactive screen use may support child development.