Effect of Screen Time on Social, Emotional, and Behavioural Problems in Children at a Tertiary Care Centre

Background Electronic screen-based media use among children has surged globally due to rapid technological advances, wide device availability, and evolving family routines. Excessive screen time affects cognitive development by reducing executive functioning, impairing memory retention, and limiting problem-solving. Behavioral problems, such as hyperactivity, aggression, and attention disorders, are also linked to excessive screen use. Methods A cross-sectional analytical study was conducted among 118 children aged 18 months to five years attending a tertiary care pediatric OPD over 18 months. Eligible children were enrolled by consecutive sampling. Screen exposure was assessed using the "Seven in Seven" questionnaire, categorized as high (≥7) or low (<7). Behavioral problems were evaluated using the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5), administered to all 118 children (confirmed against the master chart). Associations between screen exposure, behavioral outcomes, and risk factors were analyzed using the chi-square test or Fisher's exact test when the expected cell count was <5. A p-value of ≤0.05 was considered statistically significant. Standard multivariable logistic regression was unusable due to quasi-complete separation between screen exposure and several covariates, so Firth's penalized-likelihood logistic regression was used instead to identify independent factors, reporting adjusted odds ratios (aOR) and 95% CIs. Results Mean age was 3.59 ± 1.27 years; 67.8% were boys. Mean screen time score was 8.54 ± 2.99. CBCL classification is as follows: 62.71% clinical, 19.49% borderline, and 17.80% normal. The high exposure group (n = 78, 66.1%) is the following: 72 (92.3%) clinical, 5 (6.4%) borderline, and 1 (1.3%) normal; the low exposure group (n = 40, 33.9%) is the following: 20 (50.0%) normal, 18 (45.0%) borderline, and 2 (5.0%) clinical (χ² = 87.60, df = 2, p < 0.001). Externalizing problems (59.4%) predominated over internalizing (28.3%). On bivariate analysis, high exposure was significantly associated with lower physical activity (Welch t = 7.83, df = 60.7, p < 0.001), father's education (FET = 86.41, p < 0.001), mother's education (FET = 56.71, p < 0.001), father's occupation (FET = 110.85, p < 0.001), mother's occupation (FET = 69.11, p < 0.001), and family type (FET = 52.69, p < 0.001; all Fisher's exact given sparse cells); residence (p = 0.841) and sibling presence (p = 0.054) were not significant. In multivariable Firth regression, only father's occupation remained independent (skilled vs unskilled: aOR = 133.1, 95% CI: 4.3-4099.8, p = 0.005; professional vs unskilled: aOR = 577.1, 95% CI: 10.3-32198.4, p = 0.002); physical activity, father's education, family type, and sibling presence lost significance after adjustment. Conclusions In this cross-sectional, tertiary-care OPD-based sample, high screen exposure was significantly associated with clinically significant behavioral problems in preschool children, predominantly externalizing symptoms. Given the cross-sectional design and referral-based sampling, findings should be interpreted as associational rather than causal and are most generalizable to symptomatic children presenting to tertiary care rather than the general preschool population.