Introduction
Today’s children are growing up with an array of electronic
media at their fingertips. Screens are ubiquitous in this
digital world. The screen, whether it is computer, mobile
phone, tablet or television, is a symbol of modern life.
Infants, toddlers and pre-schoolers are now using the new
screen-based technologies at increasing rates. Screen-viewing
is a common sedentary behaviour among pre-schoolers [1].
Mobile media use among two to four years-old children has
significantly increased during the last decade. Even infants,
six to eleven months-old, are using touch screens in this
high-tech era. Exposure to digital screens during early
childhood can be habit-forming and can lead to overuse during
future life [2]. Infants and toddlers have difficulty to
transfer new learning from a screen which is a 2D
representation to a 3D object in real life. There are several
developmental risks associated with young children’s use of
screen media.
Screen Time
‘Screen time’ of children refers to the time spent by children
with any screens including the computers, tablets, smart
phones, television or video games. Childhood screen-time has
been increasing over the last few years and studies have shown
negative associations between increased screen-time and
several domains of child development. High level of screen
time has negative impact on cognitive functioning and academic
achievement of children [3]. Increased screen time is linked
to delay in language development [4]. Studies suggest that
increased screen time in infants and toddlers is associated
with autistic-like behaviour, hyperactivity, reduced attention
span and irritability [5]. High screen time is also associated
with deleterious effects on socioemotional development of
children. Screen media exposure at 6 months of age is
associated with lower cognitive development at 14 months of
age [6]. Excessive screen time is also associated with a
number of deleterious behavioural outcomes in young children.
Hence interventions to reduce screen media use in young
children are essential.
Screen Media Use in Young Children
Television dominates total screen time and television viewing
is a very common screen-based activity among young children
[7]. Many young children are exposed to several hours of
background television on a day.
There is high prevalence of exposure to mobile devices in
young children. In the research conducted regarding young
children’s use of mobile media devices, it was found that
96.6% of young children used mobile devices. Half the children
by four years of age had their own television and
three-fourths of children had their own mobile device. Most of
the children started using the mobile media devices before one
year of age. 70% of the parents gave mobile devices to
children while doing daily tasks or domestic chores. By two
years of age, most of the children used a mobile device daily.
One-third of the children between three and four years of age,
were engaged in media multitasking [8].
In the study including 422 parents of children aged 1-60
months, to determine mobile media use in early childhood, the
median age at the first time use of a mobile device was found
to be one year. 6 months old infant, was the youngest to use a
mobile device. 68 % of children below five years of age, owned
a “tablet”, which was the most commonly owned mobile device.
70.8% of the children used mobile devices for watching videos.
91.5% of the parents were not informed by a doctor regarding
the adverse effects of exposure to mobile devices at very
young age [9].
Effects of Screen Media on Language and Cognitive
Development
Viewing television increases the risk of delay in language
development in children. Cognitive and language delays in
young children are related to the television viewing time
[10]. Early onset and high frequency of television viewing is
associated with significant delay in the development of
language skills. Children who watched television for more than
two hours a day and started watching television during infancy
are at greatest risk for delay in language development [11].
In the meta-analysis including 18905 participants from 42
studies, it was found that higher quantity of screen use is
associated with lower language skills [12]. For children less
than two years old, television viewing has negative
associations for language development and executive function
[13]. Television viewing has negative impact on the
development of cognitive abilities of young children [7].
Screen Media Exposure and Behaviour Problems
Viewing cartoons in television at young age has negative
effect on children's attentional abilities [14]. Longitudinal
data of early television exposure and subsequent attentional
problems were analysed by Christakis DA et al, including 1278
children at age 1 and 1345 children at age 3. It was found
that early television exposure is associated with attentional
problems at 7 years of age [15]. Exposure to entertainment
television before 3 years of age, is significantly associated
with attentional problems in children [16].
Sustained exposure to television is a risk factor for
behaviour problems in children [17]. Tamana SK, Ezeugwu V,
Chikuma J, et al, conducted study to examine screen-time
exposure and behavioural morbidity in pre-school children.
This research showed that screen-time of more than two-hours a
day is associated with an increased risk of externalizing
behaviour problems and specifically inattention problems in
young children [18]. Daily television exposure at 18 months of
age is associated with hyperactivity and inattention at 30
months of age [19]. Excessive television viewing of more than
two hours per day is associated with difficulties in
self-regulation during childhood.
Role of Parents
Infants and toddlers learn language skills and social skills
very effectively through face-to-face interaction with
parents. Hence parents should find time for face-to-face
interactions with very young children. Preschool children also
learn best from direct interactions with parents.
In the systematic review and meta-analysis examining the
association between parent training and language development
in young children with a mean age of less than six years,
Roberts MY et al found that parent training interventions are
associated with significant improvement in child language
development [20]. The recommended first-line treatment for
attention-deficit/hyperactivity disorder in preschool children
is parent training intervention [21].
Parents should become the role models for children especially
related to digital habits. Electronic devices should never
become the family’s sole source of entertainment. Everyone in
the family should be encouraged to find time for meals without
any screens and parents should make it a habit to engage in
screen-free activities with their children. Avoid all screen
media for very young children up to 2 years of age. For
children of 3 to 5 years, screen time should be limited to one
hour a day of high-quality programs. Background television
should be eliminated. Screens should be kept out of children's
bedroom.
Conclusion
Television viewing and use of mobile media devices, among
young children, has become pervasive and heavy in this digital
era. There are significant health implications of using screen
media during early childhood. Increased screen time in
toddlers and pre-school children is associated with several
negative health outcomes which includes impairment in
cognitive development, language delay, autistic-like
behaviour, hyperactivity and reduced attention span. High
levels of screen time in early childhood has negative impact
on academic, behavioural, language and social outcomes in
later life.
For children of ages two and under, experts recommend no
screen time at all. Interventions should be implemented to
limit children's duration of screen exposure after two years
of age. Parents should be the best role-models for children
regarding the healthy use of digital devices. Children younger
than 5 years need quality family time for the best child
development.
Several scientific studies have shown that training parents to
implement language and communication intervention techniques
leads to improved outcomes for children. For young children
with delay in language development, parent training
interventions should be provided at the earliest to improve
the language skills of children. Attention skills also can be
improved significantly through parent mediated interventions.
Parental awareness should be provided regarding the negative
impacts of screen media on young children, in order to ensure
adequate cognitive, language, academic and behavioural
development. Parent-child communication should be improved and
parents should encourage the young children to take part in
developmentally healthy play activities without screens.
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