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Child Psychiatrist /Adult Psychiatrist

Daily Screen Time Affects the Psychological Well-Being of Young Children

Keypoint: Children living in poverty experience higher rates of daily screen time.

An average daily screen time of 2 hours or more is associated with lower psychological well-being among preschool-aged children in the United States, according to study findings published in the JAMA Network Open. High screen time (HST) was particularly prevalent among children living in poverty.

Young Children

Previous research has demonstrated that screen time among young children has increased globally, especially at the onset of the COVID-19 pandemic. However, relatively little is known about whether these levels have remained elevated in preschool-aged children in the US across race, ethnicity, and family income.

To this aim, investigators conducted a cross-sectional, population-based survey study using data collected between 2018 to 2021 from the National Survey of Children’s Health (NSCH) to evaluate screen time among US children 6 months to 5 years of age (as reported by their primary caregivers). Primary caregivers reported each child’s daily screen time and the investigators used the American Academy of Pediatrics (AAP) screen time recommendations to define HST as 1 hour or greater for children 6 months to 1 year of age, and at least 2 hours per day for children 2 to 5 years of age. The primary outcome of interest was psychological well-being, assessed using 4 NSCH items in the survey that included questions on flourishing and externalizing behaviors.

A total of 48,775 participants were included for analysis, 50.7% of which were girls. Overall, 50.7% (95% CI, 49.7%-51.7%) of children had HST.

In 2019, the overall proportion of children with HST was 49.2% (95% CI, 47.0%-51.5%). This value increased to 55.3% (95% CI, 53.4%-57.2%) in 2020 during the pandemic and returned to pre-pandemic levels in 2021 (50.0%; 95% CI, 48.3%-51.6%). These values were even more pronounced among children living in poverty, as the proportion of children with HST was 60.9% (95% CI, 55.4%-66.4%) in 2020 and remained elevated at 58.9% (95% CI, 53.7%-64.1%) in 2021.

The investigators found that HST was associated with worse psychological well-being among young children. Children 3 to 5 years of age had lower odds of flourishing if they had an average daily screen time of 2 hours (adjusted odds ratio [aOR], 0.81; 95% CI, 0.66-0.99), 3 hours (aOR, 0.68; 95% CI, 0.52-0.88), or 4 or more hours (aOR, 0.53; 95% CI, 0.42-0.69), relative to children with only 1 hour of daily screen time. No association was found between daily screen time and flourishing among children 6 months to 2 years of age.

A similar trend was observed with externalizing behaviors. Relative to an average daily screen time of 1 hour, the adjusted externalizing behavior score among children 3 to 5 years of age was increased by 0.5 (95% CI, 0.3 to 0.8) points with 2 hours of daily screen time, 1.3 (95% CI, 1.0 to 1.6) points higher with 3 hours, and 2.1 (95% CI, 1.7 to 2.5) points higher with 4 or more hours per day.

By race/ethnicity, the overall proportion of children with high screen time was highest among non-Hispanic Black participants (64.4%), followed by Hispanic participants (55.8%), and non-Hispanic White participants (45.0%).

The investigators concluded, “These findings highlight urgent needs to provide support for healthy screen use to families with young children.”

Study limitations include the use of proxy-reported measures for screen time and psychological well-being and incremental vs continuous measurement of screen time. Additionally, there was a lack of data on the type of screen content children were consuming.

Note: This article originally appeared on Psychiatry Advisor

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