Indian Academy of Pediatrics Guidelines on Screen Time and Digital Wellness in Infants, Children and Adolescents

World of sounds (Seslerin Dünyası): A mobile auditory training game for children with cochlear implants

OBJECTIVES

The aim of this study is to develop a mobile auditory training application based on gaming for children aged 3-5 years using cochlear implants and to evaluate its usability.

METHODS

4 games were developed in the scope of the application World of Sounds; the crucible sound for auditory awareness, mole hunting for auditory discrimination, find the sound for auditory recognition, and choo-choo for auditory comprehension. The prototype was applied to 20 children with normal hearing and 20 children with cochlear implants, all of whom were aged 3-5. The participants were asked to fill out the Game Evaluation Form for Children. Moreover, 40 parents were included in the study, and the Evaluation Form for the Application was applied.

RESULTS

According to the form, at least 80% of children using cochlear implants, and all children in the healthy group, responded well to the usability factors. All factors were obtained as highly useable by parents of the children using cochlear implants. The results indicated that in the healthy group, the usefulness and motivation factors were above moderate, and the other factors were highly useable. In the mole-hunting game, there was no significant difference between the groups in the easy level of the first sub-section (p > 0.05). There was a significant difference between the groups in terms of the other sub-sections of the mole-hunting game and all sub-sections of the crucible sound, find the sound, and the choo-choo games (p < 0.05). While there was no correlation between duration of cochlear implant use and ADSI scores and the third sub-section of the crucible sound game (p > 0.05); a correlation was found in the other sub-sections of crucible sound and all sub-sections of the mole hunting, find the sound, and Choo-Choo games (p < 0.05).

CONCLUSION

It is thought that the application World of Sounds can serve as an accessible option to support traditional auditory rehabilitation for children with cochlear implants.

Screen Time and Child Behavioral Disorders During COVID-19 Pandemic: A Systematic Review

Background

The extensive use of various electronic games and communication devices, particularly among children and adolescents, has raised concerns, particularly during the COVID-19 pandemic. This study investigated the link between screen time and internalizing disorders, such as anxiety and depression, among individuals aged ≤18 during the global COVID-19 pandemic.

Methods

This systematic review aims to summarize scientific publications from 2019 to early 2022 by searching databases, including the Cochrane Library, PubMed, Web of Science, Scopus, and PsycINFO, to identify suitable studies. In each paper, we searched the following keywords and their synonyms: screen, child, high school, middle school, and psychiatric disorders. The quality of the selected papers was evaluated using a checklist recommended by the National Institutes of Health (NIH) for observational cohort studies.

Results

Out of 986 reports identified, we included 12 papers with 14,483 participants. The study revealed a negative correlation between screen time (TV, computer, video games, and mobile phones) and behavioral outcomes. Smartphones were the most frequently used devices, with video games being more prevalent among older participants for education, communication, and entertainment purposes. The prevalence of depression ranged between 10% and 25%. Furthermore, anxiety and depression were identified as predictors of increased screen usage. Some results displayed variation based on the type of screen exposure, the questionnaires used, and the age of the participants.

Conclusions

The findings imply an indirect association between increased screen time and depression and anxiety. It is crucial to consider limitations on screen time exposure and parental supervision as measures to prevent certain mental disorders.

The relationships between screen exposure, parent-child interactions and comprehension in 8-month-old infants: The mediating role of shared viewing and parent-child conversation

OBJECTIVE

To explore the relationships between screen exposure, parent-child interactions and comprehension in 8-month-old infants, and to examine whether shared viewing and parent-child conversation during screen exposure may play mediating role in that relationships.

METHODS

The sample included 437 infants aged 8 months from the Children's Health Department of Guiyang Maternal and Child Health Hospital during January 2022 to February 2023. The use of electronic screen devices was assessed using a screen exposure questionnaire. The Brigance Parent-child interactions Scale was used to assess parent-child interactions and the Putonghua Communicative Development Inventory (PCDI) scale was used to assess infants' word comprehension.

RESULTS

48.7% of infants were found to be using screens 1-2 days per week. There was a significant difference (p < 0.05) in the PCDI-comprehension scores of screen-exposed infants compared to non-screen-exposed infants. Shared viewing and parent-child conversation during screen exposure were positively associated with parent-child interactions (p < 0.05). Mediation analysis revealed that parent-child conversation fully mediated between screen exposure and PCDI-comprehension, but partially mediated between parent-child interactions and PCDI-comprehension.

CONCLUSIONS

Shared viewing and parent-child conversation during screen exposure may mediate between screen exposure and comprehension development. Shared viewing, parent-child conversation and parent-child interactions may be protective factors for screen exposure in comprehension development. Suggests that parents should accompany and communicate with their children when they use electronic screen devices to reduce the negative impact of screen exposure on children's comprehension.

Care Beyond Newborn Survival Including Child Health and Early Childhood Development; Mental and Psychological Health

Last couple of decades have witnessed a substantial decline in child mortality. Now, the need of the hour is to ensure the quality survival of children beyond infancy. Adverse events in the first few years of life have a long-lasting effect on child's development, behavior and personality; and effective interventions during this time have maximum impact to prevent these consequences. Nurturing Care for Early Childhood Development (NC-ECD) is a concept adapted worldwide by health agencies to improve the level of optimum care to children in the first 1000 days as promotion of Early Childhood Development (ECD) is integral for overall social and financial progress of the country and its population. The five components of NC-ECD include good health, adequate nutrition, responsive caregiving, safety and security, and opportunities for early learning. This five-pillar approach emphasizes upon providing quality care by catering to needs like responsive caregiving, safe and secure environment and better learning opportunities apart from health and nutrition, which are already addressed by various health programs. Taking care of mental health of child as well as caregiver is another important aspect of providing optimum care to these children. To accomplish these goals, there is a need to integrate ECD with existing public health programmes with additional focus on elements of early learning opportunities, safety and security, and responsive caregiving.

High Problematic Screen Exposure among Children Aged 2-5 Years Visiting the Department of Pediatrics of a Tertiary Care Centre

Introduction

The effects of problematic screen exposure in the early years have adverse effects on cognition, reasoning, executive, and social skills, and physical health. The study aimed to assess the prevalence of problematic screen exposure in children between 2 to 5 years of age visiting the Department of Paediatrics of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among caregivers of children aged 2 to 5 years of age in a tertiary care centre from 16 July 2023 to 30 September 2023 after an ethical clearance from the Institutional Review Committee. This study excluded children with chronic disease and behavioural disorders. The problematic screen exposure was assessed using the Problematic Screen Exposure Score. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.

Results

Among 310 respondents, 216 (69.67%) (64.55-74.79, 95% Confidence Interval) children had a high problematic screen exposure score. The mean age of children was 3.46±1.033 with 89 (41.20%) children having their first exposure before 12 months of age, 131 (60.64%) exceeding daily usage of >2 hr, and 198 (91.66%) children viewing age-inappropriate media content.

Conclusions

The prevalence of high problematic screen exposure was comparable to that of the prevalence found in studies done in similar settings.

Keywords

children; preschool; screen time.

Mobile phone use by young children and parent's views on children's mobile phone usage

Aims

This study aims to explore the prevalence of mobile phone use among young children aged 6 months to 4 years. We studied the usage patterns, optimal age for use, and the attitudes of parents toward their child's mobile phone use.

Methods

We conducted a cross-sectional study in a pediatric OPD of a tertiary teaching hospital for a period of 2-months. Ethics committee approval and informed consent was taken before conducting the research. A predesigned and validated questionnaire was used to collect data. We calculated a sample size of 90 children at a 95% confidence level. Chi-square test and Fischer's exact test were used as a test of significance at 5% level of significance.

Results

We observed that 73.34% of children were using mobile phones and mobile phone usage increased with age. Children used mobile phones for educational purposes (43.9%), and for less than an hour a day (57.6%). In the 3-4 year age group, 19% used mobile phones for 3 hours or more. While 93.3% of parents felt they shouldn't give their child a phone, 71.4% children of these parents still used one.

Conclusions

Our study highlights a high prevalence of mobile phone use among young children aged 6 months to 4 years. Although parents aimed to limit their child's phone usage, the reality was different. We recommend that guidelines on mobile phone use be followed in India.

A Scoping Review of Digital Well-Being in Early Childhood: Definitions, Measurements, Contributors, and Interventions

Digital well-being concerns the balanced and healthy use of digital technology, and the existing studies in this area have focused on adolescents and adults. However, young children are more vulnerable to digital overuse and addiction than adults; thus, their digital well-being deserves empirical exploration. In this scoping review, we synthesized and evaluated 35 collected studies on young children's digital use and their associated well-being that were published up to October of 2022 to understand the related definitions, measurements, contributors, and interventions. The synthesis of the evidence revealed that (1) there was no consensus about the definition of the concept of digital well-being; (2) there were no effective ways of measuring young children's digital well-being; (3) both child factors (the duration and place of digital use, as well as the child's demographic characteristics) and parent factors (digital use, parental perception, and mediation) contribute to young children's well-being; and (4) there were some effective applications and digital interventions reported in the reviewed studies. This review contributes to the development of this concept by mapping the existing research on young children's digital well-being, as well as proposing a model and identifying the research gaps for future studies.

Prevalence and Determinants of Excessive Screen Viewing Time in Children Aged 3-15 Years and Its Effects on Physical Activity, Sleep, Eye Symptoms and Headache

Screen viewing time is the total time spent by a child on any digital/electronic device. The objective of the present study was to determine the prevalence and predictors of excessive screen viewing time in children in Ujjain, India. This cross-sectional, community-based study was conducted through a house-to-house survey using the three-stage cluster sampling method in 36 urban wards and 36 villages of Ujjain District, India. Excessive screen viewing time was defined as screen viewing for >2 h/day. The prevalence of excessive screen viewing time was 18%. Risk factors identified using the multivariate logistic regression model were age (OR: 1.63, p < 0.001); mobile phone use before bedtime (OR: 3.35, p = 0.004); parents' perception about the child's habituation to screen time (OR: 8.46, p < 0.001); television in the bedroom (OR: 35.91, p < 0.001); morning mobile screen viewing time (OR: 6.40, p < 0.001); not reading books other than textbooks (OR: 6.45, p < 0.001); and lack of outdoor play for >2 h (OR: 5.17, p < 0.001). The presence of eye pain was a protective factor for excessive screen viewing time (OR: 0.13, p = 0.012). This study identified multiple modifiable risk factors for excessive screen viewing time.

Musical preferences of Indian children with autism spectrum disorder and acceptability of music therapy by their families: An exploratory study

Background

Music therapy has been in use for children with autism spectrum disorder (ASD) since the 1940s. However, there is limited scientific evidence on its use in the Indian context.

Aim

The present study aims to explore musical preferences of children with ASD and their caregivers' acceptability of music as a form of intervention.

Materials and Methods

It is a cross-sectional study of 120 subjects diagnosed with ASD as per the Diagnostic and Statistical Manual of Mental Disorders-5 identified by convenience sampling. A semi-structured interview schedule consisting of 25 objective response questions with multiple choices and 11 open-ended questions (pertaining to music and the use of music) was used to explore caregivers'/parents' thoughts and beliefs. The responses to open-ended questions were collected in narrative mode. A descriptive approach of content analysis was adopted to analyse the data. The data are presented using descriptive statistics. Institutional Ethics Committee's approval was obtained for conducting the study.

Results

Most of the children liked (89.2%, n = 107) music and responded (88.3%, n = 106) actively (listen intently/hum or sing or dance along) to music. Most subjects preferred rhythm (65%, n = 78) over melody (15%, n = 18). While 98.3% (n = 118) of the parents were willing to try music therapy for their child, 61% of them (n = 72) asked follow-up questions like - "Is there available data on it?" (n = 12; 10.2%) and "Will it be worth investing our time and efforts on it?" (n = 60; 50.8%).

Conclusion

Most of the children including those with auditory sensitivity like music and prefer rhythm over melody. Caregivers possess a positive attitude toward the use of music therapy. However, most of them wish to clarify the scientific basis of the same.

Optimizing Internet Use during Adolescence: eHealth Solutions

Internet offers an immense opportunity as a resource for education, training, and health promotion. This narrative review summarizes the opportunities for health promotion among adolescents through use of the Internet and technology (defined as eHealth). The details of technology and use of Internet for adolescent-health related topics such as nutrition, fitness, sexual health, adventure, and violence were searched through PubMed. The review reports few digital solutions to address key challenges during adolescence like promotion of nutrition and sexual reproductive health, prevention of noncommunicable diseases, substance abuse, and mental health issues. eHealth was concluded as a potential solution for preventive and promotional health practices during adolescence. However, concerns of Internet addiction, safety, privacy, mental health disorders, and misinformation need to be addressed and monitored during adolescence.

The influence of sleep patterns and screen time on the sleep needs of infants and toddlers: A cross-sectional study

PURPOSE

The purpose of this study was to examine the effects of screen time and sleep patterns on the sleep needs of infants and toddlers.

DESIGN AND METHODS

A descriptive cross-sectional data were collected from 304 parents of children aged 6 to 36 months old. The screen use of children and parents was assessed with seven questions and A Brief Infant Sleep Questionnaire (BISQ) was used to assess infant sleep.

RESULTS

The results of this study indicate that children's adherence to the recommended sleep standards is poor. The most important criteria that caused poor sleeping were the number of awakenings at night, the duration of sleeplessness at night and the minimum total sleep time of <9 h. The most frequently used screen type in all of the age groups and parents was TV, followed by smartphones. As the age of the children increased, the rate of all screen-type use also increased. Factors predicting sleep needs included bedtime, the PED usage of children, parents' watching TV and care of the children by the babysitter.

CONCLUSIONS

Sleep needs are associated with the sleep patterns and screen usage of the children and parents.

PRACTICE IMPLICATIONS

Given that screen usage behaviors are tracked from infancy to early childhood, these findings highlight the need for prevention and intervention efforts, as well as for education and policy measures, to limit screen use and exposure from an early age.

Screen-Based Media Use Among Children During the COVID-19 Pandemic

This questionnaire-based study was conducted to assess screen-based media use during the coronavirus disease 2019 (COVID-19) pandemic in children (n=278) aged between 1 to 12 years. Television was the most common media available for use (246, 88.5%), and mobile was the next most commonly available media (230, 82.7%). Daily screen time exposure and use of television (P<0.001), computer/Laptop (P<0.001), and tablet (P=0.001) were significantly more common in those aged 5–12 years. Majority (214, 76.9%) were using screen-based media for educational purposes.