Screen time use in children less than five years old
Keywords:child, health care, parents, screen
Introduction: While the limited use of high-quality and appropriate media may have a positive influence, excessive exposure carries health risks for young children and their families. Research suggests that increased screen time in young children is linked to negative health outcomes, including obesity, decreased cognitive and language development and reduced academic success. In this study we aimed to characterize the screen-time habits in a healthy population of children, aged between six months and five years, of two Family Healthcare Units of an urban area in northern Portugal, and to review the current literature on children’s screen time and health-related issues.
Methods: This is a cross-sectional, observational and analytic study. We selected a convenience sample of children aged between six months and five years who were assessed at a scheduled surveillance visit and a questionnaire was applied to the caregivers between February and July 2018.
Results: One hundred sixty-six children were included. The mean age was 30 months; 53% were males. Television dominated total screen time. About 85% of children under two years-old and 80% of infants six to 12-months-old were exposed to screens daily, with 79% of them spending up to one hour per day in front of screens. The majority of parents of children aged two years and older were present and set limits on their children’s screen use. Overall, only 39% of parents affirmed to be aware of current guidelines for screen time. In our study, children’s screen time habits were not related with parents’ socioeconomic or academic status. Parents’ knowledge about current guidelines also did not minimize children’s screen use (p=0,094).
Discussion/Conclusion: Young children are exceeding screen time recommendations. Given that parents play a key role in the development of their children’s behaviors and that there is no evidence to support introducing screens at an early age, interventions to reduce children’s screen-time in the current media environment are needed.
Active Healthy Kids Canada. Report on Physical Activity: Is Canada in the Running? 10th ed, 2014:43. Available at www.participaction.com/sites/default/files/downloads/Participaction-2014FullReportCard-CanadaInTheRunning_0.pdf. Accessed June, 2019.
Canadian Radio-television and Telecommunications Commission. Communications Monitoring Report. Ottawa, Ont., 2016:149. Available at: www.crtc.gc.ca/eng/publications/reports/PolicyMonitoring/2016/cmr.pdf. Accessed June, 2019.
Common Sense Media. Zero to eight: children’s media use in America 2013. Available at: https://www.commonsensemedia.org/research/zero-to-eight-childrens-media-use-in-america-2013. Accessed July 2017.
Lauricella AR, Wartella EA, Rideout VJ. Young children’s screen time: The complex role of parent and child factors. J Appl Develop Psychol 2015; 36:11–7.
Vandewater EA, Rideout VJ, Wartella EA, Huang X, Lee JH, Shim MS. Digital childhood: Electronic media and technology use among infants, toddlers, and preschoolers. Pediatrics. 2007; 119:e1006–15.
Roy R, Paradis G. Smartphone Use in the Daily Interactions Between Parents and Young Children. Philadelphia: Society for Research in Child Development (poster), 2015. Available at: www.csustan.edu/sites/default/files/groups/Child%20Development/srcd_poster_2015_-smartphones.pdf. Accessed April, 2017.
Cheung C, Bedford R, Urabain I, Karmiloff-Smith A, Smith T. Daily touchscreen use in infants and toddlers is associated with reduced sleep and delayed sleep onset. Scientific Reports 2017; 7: 46104.
Lerner C, Barr R. Screen Sense: Setting the Record Straight; Research-Based Guidelines for Screen Use for Children Under 3 Years Old. Zero to Three 2014. Available at: www.zerotothree.org/resources/series/screen-sense-setting-the-record-straight. Accessed June, 2017.
Radesky JS, Schumacher J, Zuckerman B. Mobile and interactive media use by young children: The good, the bad, and the unknown. Pediatrics. 2015; 135:1–3.
Linebarger DL, Vaala SE. Screen media and language development in infants and toddlers: An ecological perspective. Dev Rev. 2010; 30:176–202.
Courage ML, Howe ML. To watch or not to watch: Infants and toddlers in a brave new electronic world. Dev Rev. 2010; 30:101–15.
Roseberry S, Hirsh-Pasek K, Golinkoff RM. Skype me! Socially contingent interactions help toddlers learn language. Child Dev. 2014; 85:956–70.
Thakkar RR, Garrison MM, Christakis DA. A systematic review for the effects of television viewing by infants and pre-schoolers. Pediatrics. 2006; 118:2025–31.
Moody AK, Justice LM, Cabell SQ. Electronic versus traditional storybooks: Relative influence on preschool children’s engagement and communication. J Early Childhood Literacy 2010; 10:294–313.
American Academy of Pediatrics: Council on Communications and Media. Media and Young Minds. Pediatrics. 2016; 138:e20162591.
Chonchaiya W, Pruksananonda C. Television viewing associates with delayed language development. Acta Paediatr 2008; 97: 977–82.
Tomopoulos S, Dreyer BP, Berkule S, Fierman AH, Brockmeyer C, Mendelsohn AL. Infant media exposure and toddler development. Arch Pediatr Adolesc Med. 2010; 164:1105–11.
Duch H, Fisher EM, Ensari I, Font M, Harrington A, Taromino C, et al. Association of screen time use and language development in Hispanic toddlers: a cross-sectional and longitudinal study. Clin Pediatr (Phila). 2013; 52:857–65.
Christakis DA, Gilkerson J, Richards JA, Zimmerman FJ, Garrison MM, Xu D, et al. Audible television and decreased adult words, infant vocalizations, and conversational turns: a population based study. Arch Pediatr Adolesc Med. 2009; 163:554–8.
Casey BJ, Cannonier T, Conley M, O.Cohen A, Barch D, Heitzeg M et al. The Adolescent Brain Cognitive Development (ABCD) Study: Imaging acquisition across 21 sites. Developmental Cognitive Neuroscience. 2018;43-54.
Bel-Serrat S, Mouratidou T, Santaliestra-Pasías AM, Iacoviello L, Kourides YA, Marild S, et al. Clustering of multiple lifestyle behaviours and its association to cardiovascular risk factors in children: the IDEFICS study. Eur J Clin Nutr. 2013; 67:848–54.
Bruni O, Sette S, Fontanesi L, Baiocco R, Laghi F, Baumgartner E. Technology use and sleep quality in preadolescence and adolescence. J Clin Sleep Med. 2015; 11:1433–41.
Garrison MM, Christakis DA. The impact of a healthy media use intervention on sleep in preschool children. Pediatrics. 2012; 130:492–9.
Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS.. Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatr. 2016; 170:1202-8.
Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. World Health Organization. 2019. Available at: https://apps.who.int/iris/handle/10665/311664.
Mazur A, Caroli M, Radziewicz-Winnicki I, Nowicka P, Weghuber D, Neubauer D, et al. Committee Report. Reviewing and addressing the link between mass media and the increase in obesity among European children: The European Academy of Paediatrics (EAP) and The European Childhood Obesity Group (ECOG) consensus statement. Acta Pædiatrica 107 (Suppl. 2). 2017.
Canadian Paediatric Society, Digital Health Task Force. Position Statement. Screen time and young children: Promoting health and development in a digital world. Paediatrics & Child Health, 2017:461–8.
American Academy of Pediatrics: Council on Communications and Media. Children and Adolescents and Digital Media. Pediatrics. 2016; 138:e20162593.
Chen W, Adler JL. Assessment of Screen Exposure in Young Children, 1997 to 2014. JAMA Pediatr. 2019; 173:391-3.
Radesky JS, Kistin C, Eisenberg S, Gross J, Block G, Zuckerman B, et al. Parent perspectives on their mobile technology use: The excitement and exhaustion of parenting while connected. J Dev Behav Pediatr. 2016; 37:694–701.
Courage ML, Setliff A. When babies watch television: Attention-getting, attention-holding, and the implications for learning from video material. Dev Rev. 2010; 30:220–38.
Ford C, Ward D, White M. Television viewing associated with adverse dietary outcomes in children ages 2-6. Obes Rev. 2012; 13:1139-47.
Lapierre MA, Piotrowski JT, Linebarger DL. Background television in the homes of US children. Pediatrics. 2012; 130:839–46.
Lillard AS, Li H, Boguszewski K. Television and children’s executive function. Adv Child Dev Behav. 2015; 48:219–48.
Lin LY, Cherng RJ, Chen YJ, Chen YJ, Yang HM. Effects of television exposure on developmental skills among young children. Infant Behav Dev. 2015; 38:20–6.
Gentile DA, Reimer RA, Nathanson AI, Walsh DA, Eisenmann JC. Protective effects of parental monitoring of children’s media use: A prospective study. JAMA Pediatr.2014; 168:479–84.
Hamilton K, Spinks T, White KM, Kavanagh DJ, Walsh AM. A psychosocial analysis of parents’ decisions for limiting their young child’s screen time: An examination of attitudes, social norms and roles, and control perceptions. Br J Health Psychol. 2016; 21:285–301.
Hinkley T, Salmon J, Okely AD, Crawford D. The correlates of preschoolers’ compliance with screen recommendations exist across multiple domains. Prev Med. 2013; 57:212–9.
Royal College of Paediatrics and Child Health. The health impacts of screen time: a guide for clinicians and parents.https://www.rcpch.ac.uk/sites/default/files/2018-12/rcpch_screen_time_guide_-_final.pdf Date accessed: January 30, 2019.
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