Prevalence, trajectories, and determinants of television viewing time in an ethnically diverse sample of young children from the UK

Evaluation of Physical Activity, Sedentary Patterns, and Lifestyle Behavior in Spanish Preschool Children from the CORALS Cohort

BACKGROUND

Physical activity (PA) and sedentary lifestyle are recognized as modifiable risk factors for non-communicable diseases. Healthy habits in early childhood tend to persist throughout life. This study aims to evaluate the physical activity and sedentary behavior patterns in a cohort of Spanish preschool children using device-based measures, and compare these patterns by sex. This study analyzed a sample of 643 preschoolers aged 3-6 years with valid accelerometry data from the Childhood Obesity Risk Assessment Longitudinal Study (CORALS) cohort (NCT06317883; May 30, 2024).

RESULTS

67% of preschoolers met the international PA recommendations, with 72.1 min of moderate-vigorous PA (MVPA) per day. Boys exhibited higher levels of MVPA than girls, and MVPA increased with age in both groups. Sedentary time was higher on weekends, and boys spent more time watching TV than girls. Involvement in extracurricular sports was reported by 67.5% of children, with boys showing a greater engagement in outdoor activities.

CONCLUSIONS

A relevant proportion of Spanish preschool children meet the international PA recommendations, with variations based on sex, age, and day of the week, reflecting global trends at this stage of life. Future interventions should address sex-specific preferences and age-related changes to enhance the effectiveness of promoting active lifestyles in this population.

The Impact of Modifiable Parenting Factors on the Screen Use of Children Five Years or Younger: A Systematic Review

Most children under age 5 exceed recommended screen time guidelines, with lifelong implications for children's psychosocial, cognitive, socio-emotional, and physiological outcomes. Socio-ecological models point towards the important contribution of parental knowledge, modelling, practices, self-efficacy and style on child screen use. This study aimed to determine the extent to which these parenting factors influence child screen use, as well as the moderating role of screen media type (i.e. fixed vs. portable) on the relationship between parenting factors and child screen use. A systematic literature search for peer-reviewed studies published in English from 1982 to 2023 was conducted and yielded 87 eligible studies. Greater parental modelling, mealtime viewing, and the use of screens as a babysitting, mood regulation or reinforcement tool, were associated with higher child screen use. Contrastingly, higher levels of parental self-efficacy, and the implementation of screen use rules were associated with lower child screen use. Interventions targeting these parenting factors pose as a promising avenue to reduce child screen use. An authoritative parenting style was associated with lower child screen use, while authoritarian and permissive styles were associated with higher child screen use. The evidence for parental knowledge and co-viewing and, a neglectful parenting style was inconsistent or inconclusive. Finally, no observable trends or patterns in the data regarding the role of screen media type emerged. Future research should look to address issues in the measurement of child screen use to ensure comprehensive and objective assessments.

Screen Exposure and Early Childhood Development in Resource-Limited Regions: Findings From a Population-Based Survey Study

BACKGROUND

The content of children's screen exposure and interactive coviewing with caregivers are important determinants of early childhood development (ECD) that have been overlooked in past research in resource-limited rural regions. Given the prevalence of digital devices and diverse digital content today, determining screen use practices that minimize the negative impacts on children's development is crucial for promoting healthy screen use among children.

OBJECTIVE

This study aims to examine screen exposure among children aged <3 years in rural China and investigate its relationship with ECD outcomes, focusing on duration, content, coviewing, and interaction.

METHODS

The sample includes all children aged between 6 and 26 months and their primary caregivers residing in the study area. A survey of screen exposure and household characteristics was conducted for 1052 eligible households. Caregivers reported the duration of screen exposure, defined as the average daily screen time over the past month; the content of exposure, defined by the time spent on educational and child-friendly content; and the caregiver's presence and interaction with the child during exposure. ECD outcomes were evaluated using the third edition of the Bayley Scales of Infant and Toddler Development assessment scale and the Brief Infant Toddler Social Emotional Assessment. Ordinary least squares regression, logistic regression, and chi-square tests were conducted.

RESULTS

In total, 28.23% (297/1052) of the children in our sample were first exposed to screens before the age of 12 months. Children exposed to screens had an average daily screen time of 27.57 (SD 38.90) minutes. Children who were exposed to screens before the age of 12 months and those who had longer screen time between the ages of 12 and 18 months were more likely to be at risk of motor developmental delays. Children exposed to educational content for >15 minutes on a daily basis had fewer social-emotional or behavioral problems than those with no screen exposure and a lower risk of delay in motor skills development than those exposed to educational content for <15 minutes on a daily basis. Caregiver interaction during screen exposure was associated with a lower risk of cognitive and language delays and better socioemotional skills.

CONCLUSIONS

The type of content viewed and how caregivers engaged in children's screen time were strongly associated with ECD outcomes. Guiding parents to select educational content for their children and engaging in interactive coviewing may better protect children from the negative effects of screen exposure. The findings complement conclusions regarding the impact of screen exposure on ECD in resource-limited rural areas.

The relationship between problematic media use and sleep problems in preschool children: A descriptive cross-sectional study

OBJECTIVE

This study aimed to investigate the relationship between problematic media use and sleep problems in preschool children.

METHODS

A total of 152 children and their parents participated in this descriptive and cross-sectional study. Data were collected through the Descriptive Information Form, the Children's Sleep Habits Questionnaire (CSHQ), and the Problematic Media Use Measure-Short Form (PMUM-SF).

RESULTS

The mean age of children included in the study was 5.12 ± 0.62 years. The most frequently used screen-based media device was television (n = 71; 46.7 %). The average screen time was 105.00 ± 63.51 min, with a range of 10-300 min. A statistically significant, positive correlation was found between the Problematic Media Use Measure-Short Form and Children's Sleep Habits Questionnaire scores. Additionally, it was determined that screen time had a statistically significant positive correlation with the Problematic Media Use Measure-Short Form and Children's Sleep Habits Questionnaire scores. Furthermore, problematic media use was determined to significantly affect sleep problems.

CONCLUSION

The study's results confirmed that children's problematic media use had a statistically significant effect on their sleep problems. As children's problematic media use levels increased, their sleep problem levels increased. Our study also showed that as screen time increased, the level of problematic media use and sleep problems increased. To prevent problematic media use and sleep problems in children, intervention programs focused on limiting children's screen time and improving their sleep quality are recommended.

Problematic Digital Technology Use Measures in Children Aged 0 to 6 Years: Scoping Review

BACKGROUND

In the interest of accurately assessing the effects of digital technology use in early childhood, researchers and experts have emphasized the need to conceptualize and measure children's digital technology use beyond screen time. Researchers have argued that many patterns of early digital technology use could be problematic, resulting in the emerging need to list and examine their measures.

OBJECTIVE

We aimed to review existing empirical literature that is using measures for problematic digital technology use in preschool children with the end goal of identifying a set of reliable and valid measures, predicting negative outcomes for children's health, development, or well-being.

METHODS

We conducted a scoping review across the Web of Science, PubMed, and Google Scholar databases to identify peer-reviewed publications that were published from January 2012 to December 2023, were written in the English language, described an empirical study, and included a measure of problematic digital technology use beyond exposure (ie, screen time) in children aged 0 to 6 years.

RESULTS

The search yielded 95 empirical studies, in which 18 composite measures of problematic use and 23 measures of specific problematic use aspects were found. Existing composite measures conceptualize problematic use as either a group of risky behaviors or as a group of symptoms of a presumed underlying disorder, with the latter being more common. Looking at their conceptual background and psychometric properties, existing composite measures fall short of reliably assessing all the crucial aspects of problematic digital technology use in early childhood. Therefore, the benefits and shortcomings of single-aspect problematic digital technology use measures are evaluated and discussed.

CONCLUSIONS

On the basis of current research, early exposure to digital technologies, device use before sleep, and solitary device use represent measures that have been consistently associated with negative outcomes for children. In addition, potential measures of problematic use include device use during meals, device use for emotional regulation, device multitasking, and technoference, warranting further research. Public health benefits of defining problematic digital technology use as a group of risky behaviors rather than a group of addiction symptoms are discussed.

Association between excessive screen time and falls, with additional risk from insufficient sleep duration in children and adolescents, a large cross-sectional study in China

Objective

Falls is a major global public health issue that occur in all age groups. However, the association between screen time, sleep duration and falls in children and adolescents remains unclear.

Methods

This study included children and adolescents who participated in the 2017 Nutrition and Health Surveillance of Children and Lactating Mothers in China. Screen time, sleep duration and falls in the past 12 months were assessed using baseline questionnaires completed by the participants. We utilized a multivariate logistic regression model to estimate the association between screen time, sleep duration, and falls in children and adolescents. Stratified analyses and sensitivity analyses were performed using the same modelling strategies.

Results

A total of 564 participants (5.7%) self-reported falls in the past 12 months. Multivariate logistic regression analysis revealed that high screen time (> 2 h per day) was associated with a higher incidence of falls (cOR:1.46, 95% CI: 1.22-1.74, p < 0.001). The combination of high screen time and low sleep duration was associated with an increased risk of falls compared to the recommended low screen time and high sleep duration group (cOR: 1.62, 95% CI: 1.25-2.09, p < 0.001). After adjusting for relevant covariates, the associations remained significant (aOR: 1.30, 95% CI: 1.08-1.56, p = 0.006; aOR: 1.43, 95% CI: 1.10-1.87, p = 0.008).

Conclusion

Our study demonstrates that both high screen time and the combination of high screen time and low sleep duration were associated with an increased risk of falls. Interventions to promote healthy physical development should commence in early childhood to decrease the incidence of fall injuries in children and adolescents.

Screen time among preschoolers: exploring individual, familial, and environmental factors

Screen-based activity refers to the use of screened devices, which are changing from stationary devices such as televisions and desktop computers to newer portable devices such as smartphones and electronic tablets. The exposure of younger children to all types of screened devices has increased. This review aimed to provide an overview of previous studies and identify the correlations associated with screen-based activities in preschoolers. We conducted a systematic literature review of databases including PubMed, Embase, and PsycInfo targeting quantitative studies published between 2010 and 2019. We then analyzed the associations between screen time and various individual, familial, and environmental factors in healthy children aged 0-6 years. We specifically included studies that provided a subgroup analysis for this age category to systematically identify the factors influencing screen time patterns among preschoolers. The search yielded 36 articles that met the inclusion criteria. We investigated age, sex, and social, family, and personal factors as well as media parenting. The results suggested that media parenting for screen-based activities was an important protective factor. Limited research has been conducted on preschoolers' screen-based activities with both stationary and portable screened devices. Most factors have been studied using stationary devices and are too infrequent for solid conclusions to be reached. Parental screen time and the setting of appropriate media limits were crucial protective factors against excessive media exposure. However, information about family and personal factors remain scarce, and further research is needed.

Media Device Use and Vision Disorders in the Pediatric Age: The State of the Art

INTRODUCTION

Evidence is consistent with increased screen viewing time among children and adolescents, and anticipation at the age at which children interact with media devices. Incorrect use of technology, as well as overuse, may lead to serious consequences. This study aims to revise scientific international literature and to describe the potential eye risks correlated to screen viewing time in the pediatric age.

MATERIALS AND METHODS

A review of the literature was performed according to the PRISMA 2020 guidelines, using the search terms "media device" and "eye" with the filter "age 0-18".

RESULTS

Analyzing the international literature, we found 26 articles. Pre-myopia, myopia, digital eye strain, and acute acquired comitant esotropia were listed as potential and time-related consequences associated with the incorrect use of media devices among children and adolescents.

DISCUSSION

Family education on media device exposure and potential risk for children and adolescents' sight in case of prolonged digital/screen exposure is required. During pediatric check controls, a dialogue with families on prolonged media device use at a close distance should be undertaken. Pediatricians and ophthalmologists should consider screen viewing time in case of ocular problems.

Effectiveness of a program to lower unwanted media screens among 2-5-year-old children: a randomized controlled trial

Background

Limited interventions exist on reducing unwanted screen time (ST) among children from low- and middle-income countries (LMICs), so we developed and assessed the effectiveness of the program to lower unwanted media screen time (PLUMS) among children aged 2-5 years in Chandigarh, Union Territory, North India.

Methods

An open-label randomized control parallel group trial per CONSORT guidelines was conducted among randomly selected 340 families with children aged 2-5 (±3 months) years in Chandigarh, India. PLUMS was implemented at the family level with a focus on modifying the home media environment and targeted individual-level interventions using parent and child modules for 2 months. A post-intervention (immediately) and a follow-up assessment after 6 months was done. During the follow-up period, the interaction was done passively via WhatsApp groups. The control group received routine healthcare services. Validated and standardized tools, including a digital screen exposure questionnaire with a physical activity component, preschool child behavior checklist, and sleep disturbance scale for children, were used to collect data at baseline, post-intervention, and follow-up periods. The primary outcome was the mean difference in ST (minutes/day) among children in the intervention group versus the control group. Generalized estimating equation (GEE) analysis was performed to adjust for clustering.

Results

An equal number of families (n = 170) were randomly assigned to the intervention and control arms. In the post-intervention assessment, 161 and 166 families continued while, at the follow-up assessment, 154 and 147 were in the intervention and control arm, respectively. The mean difference in ST on a typical day [27.7 min, 95% Confidence Interval (CI) 5.1, 50.3] at the post-intervention assessment significantly (p < 0.05) decreased in the intervention (102.6 ± 98.5 min) arm as compared with the control (130.3 ± 112.8 min) arm. A significant reduction in ST (β = -35.81 min, CI -70.6, -1.04) from baseline (β = 123.1 min) to follow-up phase (β = 116 min) was observed in GEE analysis. The duration of physical activity increased both at post-intervention (β = 48.4 min, CI = +6.6, +90.3) and follow-up (β = 73.4 min, CI = 36.2, 110.5) assessments in the intervention arm.

Conclusion

The PLUMS intervention significantly reduced the children's mean ST on a typical day and increased the physical activity immediately post-intervention and during the 6-month follow-up period. These results might guide the policymakers to include strategies in the national child health programs in the Southeast Asia Region to reduce unwanted ST.Clinical trial registration: https://clinicaltrials.gov/, identifier CTRI/2017/09/009761.

Early-Life Digital Media Experiences and Development of Atypical Sensory Processing

Importance

Atypical sensory processing is challenging for children and families, yet there is limited understanding of its associated risk factors.

Objective

To determine the association between early-life digital media exposure and sensory processing outcomes among toddlers.

Design, Setting, and Participants

This multicenter US study used data that were analyzed from the National Children's Study (NCS), a cohort study of environmental influences on child health and development, with enrollment from 2011 to 2014. Data analysis was performed in 2023. The study included children enrolled in the NCS at birth whose caregivers completed reports of digital media exposure and sensory processing.

Exposures

Children's viewing of television or video at 12 months (yes or no), 18 months, and 24 months of age (hours per day).

Main Outcomes and measures

Sensory processing was reported at approximately 33 months of age on the Infant/Toddler Sensory Profile. Quadrant scores (low registration, sensation seeking, sensory sensitivity, and sensation avoiding) were categorized into groups representing typical, high, and low sensory-related behaviors, and multinomial regression analyses were performed.

Results

A total of 1471 children (50% male) were included. Screen exposure at 12 months of age was associated with a 2-fold increased odds of being in the high category of low registration (odds ratio [OR], 2.05; 95% CI, 1.31-3.20), while the odds of being in the low category instead of the typical category decreased for sensation seeking (OR, 0.55; 95% CI, 0.35-0.87), sensation avoiding (OR, 0.69; 95% CI, 0.50-0.94), and low registration (OR, 0.64; 95% CI, 0.44-0.92). At 18 months of age, greater screen exposure was associated with increased risk of high sensation avoiding (OR, 1.23; 95% CI, 1.03-1.46) and low registration (OR, 1.23; 95% CI, 1.04-1.44). At 24 months of age, greater screen exposure was associated with increased risk of high sensation seeking (OR, 1.20; 95% CI, 1.02-1.42), sensory sensitivity (OR, 1.25; 95% CI, 1.05-1.49), and sensation avoiding (OR, 1.21; 95% CI, 1.03-1.42).

Conclusions and Relevance

In this cohort study, early-life digital media exposure was associated with atypical sensory processing outcomes in multiple domains. These findings suggest that digital media exposure might be a potential risk factor for the development of atypical sensory profiles. Further research is needed to understand the relationship between screen time and specific sensory-related developmental and behavioral outcomes, and whether minimizing early-life exposure can improve subsequent sensory-related outcomes.

Evaluation of Screen Time in Children Under Five Years Old

INTRODUCTION

Due to the rapid advancement of technology, there has been a noteworthy increase in the diversity and abundance of activities involving children. The most effective methods to enhance and facilitate children's media interactions are to minimize, reduce, use with caution, and establish healthy patterns. We aimed to evaluate media exposure of children below five years of age.

MATERIAL AND METHODS

This is a prospective, observational, cross-sectional study that was conducted between December 2017 and September 2019 in Eskişehir, Türkiye. To assess the frequency of electronic device usage among children under the age of five, including televisions, laptops, tablets, and mobile phones, as well as its impact on their sleep patterns and physical measurements, and to evaluate families' understanding of the terms "screen time" and "back screen time," we developed a questionnaire.

RESULTS

We analyzed a total of 731 questionnaires: 334 (45.7%) were girls, 397 (54.3%) were boys, and the mean age was 33.55±16.37 months. Upon examining the technical equipment accessible to the children in our study, we found that 98.6% possessed a television, 96.9% owned a mobile phone, 54% had a laptop, 49.5% had a tablet, and 34.1% possessed a gaming console. The study revealed the following proportions of electronic devices in children's rooms: 13% televisions, 11.9% tablets, 7.4% laptops, and 7% mobile phones. There has been a substantial increase in the amount of time they spend watching television and playing computer games among children who have at least one sibling. There was a statistically significant disparity between the television viewing periods and the body mass index of children older than two years old. Additionally, we have seen a significant disparity in the presence of media devices in children's bedrooms and the subsequent impact on their sleep duration and patterns throughout both nighttime and daytime. Around 65.8% of parents did not know of the concept of screen time, while 88.4% of parents did not know of the concept of back screen time.

DISCUSSION

Parental compliance with the current guidelines for screen time is insufficient, among parents with children under the age of five, even though exposure to screens begins in the first months of life. Our analysis highlighted the necessity for parents to establish and enforce a unified and logical media usage policy for all children residing in the household. It is crucial to allocate sufficient time during the routine healthcare visit to discuss these recommendations.

The relationship between parent's self-reported exposure to food marketing and child and parental purchasing and consumption outcomes in five countries: findings from the International Food Policy Study

Food and beverage marketing influences children's food preferences and dietary intake. Children's diets are also heavily influenced by their family environment. The aim of this study was to assess the relationship between parent's self-reported exposure to unhealthy food marketing and a range of outcomes related to children's desire for and intake of unhealthy foods and beverages. The study also sought to examine whether these outcomes varied across different countries. The analysed data are from the International Food Policy Study and were collected in 2018 using an online survey. The sample included 5764 parents of children under 18, living in Australia, Canada, Mexico, the United Kingdom, or the United States. Binary logistic regressions assessed the link between the number of parental exposure locations and children's requests for and parental purchases of unhealthy foods. Generalized ordinal regression gauged the relationship between the number of exposure locations and children's consumption of such items. Interaction terms tested if these associations varied by country. Parental exposure to unhealthy food marketing was positively associated with parents reporting child purchase requests and purchase outcomes; and differed by country. Increased parental exposure to unhealthy food marketing was associated with slightly lower odds of children's weekly consumption of unhealthy foods, and this association varied by country. In conclusion, parental report of a greater range of food marketing exposure was associated with a range of outcomes that would increase children's exposure to unhealthy food products or their marketing. Governments should consider developing more comprehensive restrictions on the marketing of unhealthy foods.

Physical activity and TV viewing parenting practices for toddlers among South Asian and white families in the UK: born in Bradford 1000 study

BACKGROUND

Children of South Asian (SA) origin in the UK have lower levels of physical activity (PA), compared to their White counterparts. Parents play an important role in establishing PA habits among young children. The aim of this study was to compare PA and television (TV) viewing parenting practices for young children between SA British (SAB) and White British (WB) parents living in the UK.

METHODS

We conducted a secondary analysis of the Born in Bradford (BiB) 1000 study, using survey data at child ages 24 and 36 months. The study sample included three groups of mothers (n = 1,149): foreign-born SAB (n = 458), UK-born SAB (n = 276), and WB (n = 455). Mothers completed a survey about parenting practices (i.e., PA supports, PA restrictions, TV viewing restrictions) at child age 24 months and child PA and TV viewing behaviors at child ages 24 and 36 months. Parenting practices were compared among the three groups. Multivariable linear regression analyses compared children's weekly walking frequency and daily TV viewing hours by parenting practices in the three groups.

RESULTS

The foreign-born SAB group showed the lowest frequencies of PA-supportive parenting practices (verbal encouragement: 3.7 ± 3.1 times/week; logistic support: 1.5 ± 1.8 times/week) and the highest frequencies of PA-restrictive parenting practices (7.8 ± 7.7 times/week) among the three groups (p < 0.01). Children of Foreign-born SAB mothers had the most frequent TV watching during a mealtime (4.0 ± 3.1 times/week) among the three groups (p < 0.01). Less frequent PA-supportive parenting practices and SA ethnicity were associated with lower walking frequency at 24 and 36 months of age among children (p < 0.01). More frequent exposure to TV at mealtimes and SA ethnicity were associated with higher TV viewing time at 24 and 36 months of age among children (p < 0.01).

CONCLUSIONS

This study demonstrated that SAB parents, particularly those who are foreign-born, apply parenting practices for their young children that are less supportive of PA and more supportive of TV viewing, and their children have lower PA and higher TV viewing time, compared with their WB counterparts.

Why Do Iranian Preschool-Aged Children Spend too Much Time in Front of Screens? A Preliminary Qualitative Study

There is evidence that Iranian preschool children are increasingly spending their time in front of screens (screen time: ST; time spent with any screen such as TVs, computers, tablets, smartphones, game consoles, or video games), but few studies have explored the possible causes of such an increase. Given this, the present study aimed to qualitatively explore determinants of excessive ST in Iranian children. To this end, parents of preschool children were interviewed, and their answers were qualitatively clustered to identify additional important factors. Key informant interviews were conducted with parents of preschool children in Tehran (Iran). A semi-structured interview was developed to assess child and family life, daily routine, family rules, family interactions, and home climate as possible contributing factors to ST. Parents' audiotaped statements were transcripted verbatim, coded, and clustered into main themes using thematic analysis with the MaxQda^® software. A total of 20 parents of children aged 2 to 7 were interviewed, and a total of 6 key themes and 28 subthemes were extracted from their interviews. The results of the analysis identified a broad range of both independent and interrelated factors leading to the development and maintenance of ST behaviors among preschool children. Our findings indicate that the central concept is the family. Considering screen-related behaviors, family life encompasses parental health literacy (e.g., parenting pattern, monitoring standards, thoughtful parenting), family psychological atmosphere (e.g., presence of parents, family norms, parent-parent and parent-child interaction, congruency/incongruency of parents with each other) and the digital structure of the home. The child's and parents' actions and characteristics can influence family interactions. A child's and parent's behavior is also influenced by social/cultural factors. Parents' behaviors and attitudes, family communications, and interactions contribute to healthy ST habits in children. It is not possible to examine the child's behavior without considering the family and the dominant environment, since the behavior of family members as a whole affects each family member. Given this, interventions should make parents aware of their role and responsibilities in reducing children's ST and consider the family system as a whole, and interventions also can benefit from considering the parental perceptions of children's behaviors.

Social and Demographic Factors Associated With Obese Children in the Age Group of 6-12 Years Attending a Tertiary Care Institute in Central India and the Prevalence of Depression in These Children: An Observational Study

INTRODUCTION

Childhood obesity in India is on the rise and is rarely raised as a concern. In the central Indian states, focus is largely on undernutrition. Thus, studies related to risk factors for being overweight and obese and the impact of obesity on the psychology of children are lacking. Hence, a hospital-based study with objectives to identify social and demographic factors associated with obesity and the estimation of the prevalence of depression among these children was conducted.

METHODS

This observational study was conducted in a tertiary care institute in the state of Chhattisgarh from July 2020 to October 2021. Children with obesity as per the WHO (> 95th percentile for the BMI) in the age group of 6-12 years were included after due consent. A proforma was administered targeting the objectives of the study and the Childhood Depression Rating Scale (CDR-S) and clinical evaluation identified the depressed.

RESULTS

Among the 5,019 children screened during the study period, 54 met the inclusion criteria (1.07%). Fifty percent of children were from the upper middle class as per the Kuppuswamy scale. Seventy percent consumed junk food more than three times a week. Twenty-three children (42.6%) engaged in physical activity of > 1 hour and 49(90.7%) had a screen time of > 2 hours. The prevalence of depression among these children stood at 5.6% with the mean age being 11.67 years. Multiple logistic regression showed an inverse association of depression with physical activity.

CONCLUSION

Obesity is prevalent in higher socioeconomic groups. Many risk factors like screen time, junk food consumption, and physical activity are modifiable. The prevalence of depression increased with age. Physical activity showed an inverse relation to depression in obese children.

Objectively measured infant and toddler screen time: Findings from a prospective study

Objective

Screen time guidelines recommend no screens under two years due to the potential negative impacts on development. While current reports suggest many children exceed this, research relies on parent reports of their children's screen exposure. We objectively assess screen exposure during the first two years and how it differs by maternal education and gender.

Methods

This Australian prospective cohort study used speech recognition technology to understand young children's screen exposure over an average day. Data collection occurred every six months when children were 6, 12, 18 and, 24 months old (n = 207). The technology provided automated counts of children's exposure to electronic noise. Audio segments were then coded as screen exposure. Prevalence of screen exposure was quantified, and differences between demographics examined.

Results

At six months, children were exposed to an average of 1hr, 16 min (SD = 1hr, 36 min) of screens per day, increasing to an average of 2 h, 28 min (SD = 2 h, 4 min) by 24-months. Some children at six months were exposed to more than 3 h of screen time per day. Inequalities in exposure were evident as early as six months. Children from higher educated families were exposed to 1hr,43 min fewer screens per day, 95%CI (-2hr, 13 min, -1hr, 11 min) compared to lower educated households, with this difference remaining consistent as children age. Girls were exposed to an additional 12 min of screens 95%CI (-20 min, 44 min) per day compared to boys at six months, but this difference reduced to only 5 min by 24-months.

Conclusion

Using an objective measure of screen exposure, many families exceed screen time guidelines, the extent increasing with child's age. Furthermore, substantial differences between maternal education groups emerge as young as six months old. This highlights the need for education and supports for parents around screen use in the early years, balanced within the realities of modern life.

Correlates of screen time in the early years (0-5 years): A systematic review

The majority of young children engage in high levels of screen time. To inform future interventions, knowledge on correlates of screen time is important. This review expands on previous work by focusing on the entire early childhood range, and including a broad focus regarding types of correlates and screens. A literature search (PubMed, Embase, PsycINFO, SPORTDiscus) was performed from 2000 up to October 2021. Included studies (cross-sectional and prospective) examined associations between a potential correlate and screen time (duration or frequency) in typically developing, apparently healthy children aged 0-5 years. Methodological quality was assessed by two independent researchers. Fifty-two of 6,614 studies were included. Two studies had high methodological quality. We found moderate evidence for a positive association between an electronic device in the bedroom, parental screen time, having a TV on at home, descriptive norms and screen time, and a negative association between sleep duration, household features, high value on physical activity, monitoring screen time, being in childcare, parental self-efficacy and screen time. We found no evidence for an association for child sex, body mass index, physical activity, temperament, number of siblings, being a first-born, neighborhood-related factors, socio-economic indicators, and parental marital status, physical activity, weight status, depression, wellbeing, sex, age and positive outcome expectations. The evidence for other investigated correlates was inconsistent or insufficient. Despite the evidence for moderate associations, we were unable to draw strong conclusions. More high-quality research is needed to identify correlates of screen time in early childhood.

Screen time among school-aged children of aged 6-14: a systematic review

BACKGROUND

Screen time refers to the time an individual spends using electronic or digital media devices such as televisions, smart phones, tablets or computers. The purpose of this study was to conduct systematic review to analyze the relevant studies on the length and use of screen time of school-aged children, in order to provide scientific basis for designing screen time interventions and perfecting the screen use guidelines for school-aged children.

METHODS

Screen time related studies were searched on PubMed, EMBASE, Clinical Trials, Controlled Trials, The WHO International Clinical Trials Registry Platform, the Cochrane Central Register of Controlled Trials, CNKI, and Whipple Journal databases from January 1, 2016 to October 31, 2021. Two researchers independently screened the literature and extracted the data, and adopted a qualitative analysis method to evaluate the research status of the length and usage of screen time of school-aged students.

RESULTS

Fifty-three articles were included. Sixteen articles studied screen time length in the form of continuous variables. Thirty-seven articles studied screen time in the form of grouped variables. The average screen time of schoolchildren aged 6 to 14 was 2.77 h per day, and 46.4% of them had an average screen time ≥ 2 h per day. A growth trend could be roughly seen by comparing studies in the same countries and regions before and after the COVID-19 outbreak. The average rates of school-aged children who had screen time within the range of ≥ 2 h per day, were 41.3% and 59.4% respectively before and after January 2020. The main types of screen time before January 2020 were watching TV (20 literatures), using computers (16 literature), using mobile phones/tablets (4 literatures). The mainly uses of screens before January 2020 were entertainment (15 literatures), learning (5 literatures) and socializing (3 literatures). The types and mainly uses of screen time after January 2020 remained the same as the results before January 2020.

CONCLUSIONS

Excessive screen time has become a common behavior among children and adolescents around the world. Intervention measures to control children's screen use should be explored in combination with different uses to reduce the proportion of non-essential uses.

Displacement of peer play by screen time: associations with toddler development

BACKGROUND

Young children's digital media use may adversely affect child development, but the mechanisms of this association are unclear. We evaluated whether screen time displaces reading and peer play time, which are subsequently associated with child development.

METHODS

When children were 12, 18, 24, 30, and 36 months, mothers (n = 3894) reported the time their children spent on screens, being read to by an adult, and playing with other children. At 36 months, mothers completed the Ages and Stages Questionnaire©, an assessment of their child's developmental status.

RESULTS

In unadjusted models, screen time from 12 to 36 months was not associated with reading but was associated with less time engaging in play with peers. In adjusted models accounting for developmental delay at 12 months, family and child characteristics, screen time was not directly associated with developmental delay. More peer play time was associated with a lower likelihood of developmental delay, and having higher screen time increased the likelihood of developmental delay indirectly through reduced peer play time. Results were similar for developmental delays in fine and gross motor, communication, and personal-social domains.

CONCLUSIONS

Screen time in early childhood did not displace reported time spent reading, but did displace reported peer play time.

IMPACT

Among children 1-3 years of age, more screen time was associated with less time engaged in peer play but not less reading with an adult. Having higher screen time from 1 to 3 years increased the odds of developmental delay indirectly through reduced peer play time. Ensuring that children engage in adequate time playing with peers may offset the negative associations between screen time and child development.

Association between screen time and suspected developmental coordination disorder in preschoolers: A national population-based study in China

Introduction

Excessive screen exposure (ESE) is a growing global public health concern. This study aims to investigate the potential association between ESE and suspected developmental coordination disorder (DCD) in Chinese pre-schoolers, with or without siblings.

Method

A retrospective cohort study was conducted, involving 126,433 children from 551 cities in China. The Little Developmental Coordination Disorder Questionnaire (LDCDQ) was employed to evaluate motor impairment in children, while parents provided information on their children’s screen time in the past year. A mixed and multi-level logistic regression model was used to analyze the associations of all screen exposure measurements from the past year with LDCDQ scores and the risk of suspected DCD.

Results

The prevalence of excessive screen exposure was 67.6% (&gt;1 h per day) and 28.9% (&gt;2 h per day) in Chinese pre-schoolers. One hour’s increase in weekday daily screen time, weekend daily screen time, and screen time before sleep in the past year was associated with a decreased total score of the LDCDQ (β were −0.690, −0.398, and −1.587, p &lt; 0.001) and an increased risk of suspected DCD by 15.3%, 9.1%, and 46.8% when adjusting for the child, family and maternal health characteristics. Excessive screen exposure decreased the total LDCDQ scores by 1.335 (&gt;1 vs. ≤1 h) and 1.162 (&gt;2 vs. ≤2 h) and increased risks of suspected DCD by 44.0% (&gt;1 vs. ≤1 h) and 31.1% (&gt;2 vs. ≤2 h) with statistical significance (each p &lt; 0.05). The stratified analysis showed that the association between screen time and LDCDQ score was stronger in children without siblings than in those with siblings.

Conclusion

The risk of suspected DCD was highest for screen time exposure before bed compared with average weekday and weekend exposures. Parents should be advised to prevent their children from using electronic screens unsupervised, especially in one-child families.

The effect of screen time on the presentation and treatment of primary monosymptomatic nocturnal enuresis

BACKGROUND

We aimed to investigate if there was any relationship between screen time (ST) and the severity of primary monosymptomatic nocturnal enuresis (PMNE) and treatment success.

METHODS

This study was conducted in urology and child and adolescent phsychiatry clinic in Afyonkarahisar Health Sciences University Hospital. After diagnosis patients were seperated by the ST for exploring causation. Group 1 > 120, Group 2 < 120 (min/day). For the the treatment response, patients were grouped again. Group 3 patients were administered 120 mcg Desmopressin Melt (DeM) and were requested < 60 min ST. Patients in Group 4 were given 120 mcg DeM solely.

RESULTS

The first stage of the study included 71 patients. The ages of the patients ranged from 6 to 13. Group 1 comprised 47 patients, 26 males and 21 females. Group 2 comprised 24 patients,11 males and 13 famales. Median age was 7 years in both groups. The groups were similar in respect of age and gender (p = 0.670, p = 0.449, respectively). A significant relationship was determined between ST and PMNE severity. Severe symptoms were seen at the rate of 42.6% in the Group 1, and at 16.7% in the Group 2 (p = 0.033). 44 patients completed the second stage of the study. Group 3 comprised 21 patients, 11 males and 10 females. Group 4 comprised 23 patients,11 males and 12 famales. Median age was 7 years in both groups. The groups were similar in respect of age and gender (p = 0.708, p = 0.765, respectively). Response to treatment was determined as full response in 70% (14/20) in Group 3 and in 31% (5/16) in Group 4 (p = 0.021). Failure was determined in 5% (1/21) in Group 3 and in 30% (7/23) in Group 4 (p = 0.048). Recurrence was determined at a lower rate in Group 3 where ST was restricted (7% vs. 60%, p = 0.037).

CONCLUSION

High screen exposure may be a factor for PMNE aetiology. And also reducing ST to a normal range can be an easy and beneficial method for treatment of PMNE. Trial Registration ISRCTN15760867( www.isrctn.com ). Date of registration: 23/05/2022. This trial was registered retrospectively.

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.

Effect of the INSIGHT Firstborn Parenting Intervention on Secondborn Sleep

BACKGROUND AND OBJECTIVES

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers improved firstborn infant sleep compared with controls. The goals of this analysis were to test intervention spillover effects on secondborn siblings and examine birth order differences in infant sleep.

METHODS

Secondborns (n = 117) of INSIGHT mothers were enrolled in an observational cohort, SIBSIGHT. The Brief Infant Sleep Questionnaire was collected at 3, 16, and 52 weeks. Generalized linear mixed models assessed differences among secondborns by firstborn randomization, as well as birth order differences at 16 and 52 weeks.

RESULTS

The RP group secondborns slept 42 minutes longer at night (95% confidence interval [95% CI]: 19-64) and 53 minutes longer total (95% CI: 17-90) than control secondborns. RP secondborns were more likely to self-soothe to sleep (odds ratio [OR] = 2.0, 95% CI: 1.1-3.7) and less likely to be fed back to sleep after waking (OR = 0.5, 95% CI: 0.3-0.9) than secondborns of control mothers. RP secondborns were more likely to have a bedtime ≤8 pm at 3 (OR = 2.9, 95% CI: 1.1-7.7) and 16 weeks (OR = 4.7, 95% CI: 2.0-11.0). Few differences in sleep parenting practices were observed when comparing siblings within families. Secondborns slept 37 minutes longer than firstborns at 16 weeks (CI: 7-67, P = .03).

CONCLUSIONS

The INSIGHT RP intervention for first-time mothers had a spillover effect to secondborns, positively impacting sleep duration and behaviors. Intervening with first-time mothers benefits both firstborns and subsequent children.

[A comparative study of recreational screen time in neurodevelopmental disorders]

INTRODUCTION

Digital screen time has been largely studied in children populations, but few have focused on children with neurodevelopmental disorders. Our main objective was to study the characteristics of use of recreational screens (television (TV) and video games), in children with neurodevelopmental disorders.

SUBJECTS AND METHODS

We conducted a case-control study in which children with neurodevelopmental disorders under the age of 6 were compared with controls of the same age range. We analysed TV and video game exposure through a designed questionnaire for parents that included daily time exposure, sociodemographic characteristics, home media environment, sociocultural habits, attitudes and beliefs about TV.

RESULTS

Sixty-one individuals with developmental and 153 controls were enrolled. Children with developmental problems spend more time watching TV than controls (124,4 ± 83,4 vs 71,5 ± 47,4 min / day p <0,001), while video game time was similar in both groups (37,6 ± 39, 6 vs 31,7 ± 32,6 min / day p = 0,138). Children with neurodevelopmental disorders began earlier to watch TV than controls. There were no relevant differences between groups in demographics, Sociocultural, environmental and attitudinal and belief variables.

CONCLUSIONS

Children with neurodevelopmental disorders start watching TV at an earlier age and consume more screen time than healthy children. Our findings indicate that Children with neurodevelopmental disorders are more vulnerable to screen abuse, and stress the importance to offer anticipatory guidance to their parents.

Global Prevalence of Meeting Screen Time Guidelines Among Children 5 Years and Younger: A Systematic Review and Meta-analysis

IMPORTANCE

Pediatric guidelines suggest that infants younger than 2 years avoid screen time altogether, while children aged 2 to 5 years receive no more than 1 hour per day. Although these guidelines have been adopted around the world, substantial variability exists in adherence to the guidelines, and precise estimates are needed to inform public health and policy initiatives.

OBJECTIVE

To derive the pooled prevalence via meta-analytic methods of children younger than 2 years and children aged 2 to 5 years who are meeting guidelines about screen time.

DATA SOURCES

Searches were conducted in MEDLINE, PsycINFO, and Embase up to March 2020.

STUDY SELECTION

Studies were included if participants were 5 years and younger and the prevalence of meeting (or exceeding) screen time guidelines was reported.

DATA EXTRACTION AND SYNTHESIS

Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive the mean prevalence rates.

MAIN OUTCOMES AND MEASURES

Prevalence of meeting screen time guidelines.

RESULTS

From 63 studies, 95 nonoverlapping samples with a total of 89 163 participants were included. For children younger than 2 years, the pooled prevalence of meeting the screen time guideline (0 h/d) was 24.7% (95% CI, 19.0%-31.5%). Moderator analyses revealed that prevalence of meeting screen time guidelines varied as a function of year of data collection (increased over time), measurement method (higher when questionnaires compared with interview), and type of device use (higher when a combination of screen use activities compared with television/movies only). For children aged 2 to 5 years, the mean prevalence of meeting the screen time guideline (1 h/d) was 35.6% (95% CI, 30.6%-40.9%). Moderator analyses revealed that the prevalence of meeting screen time guidelines varied as a function of type of device use (higher when screen time was television/movies only compared with a combination of screen use activities).

CONCLUSIONS AND RELEVANCE

The findings of this meta-analysis indicate that only a minority of children 5 years and younger are meeting screen time guidelines. This highlights the need to provide support and resources to families to best fit evidence-based recommendations into their lives.

Life style, dietary patterns and physical activity in different obesity phenotypes of 2–18 year old children in Tabriz, Iran

BACKGROUND: This study aimed to evaluate the eating habits, physical activity, and body size perception by obesity status among 2–18 year old children in Iran. METHODS: This cross sectional study included 250 children and adolescents aged between 2 and 18. Participants’ anthropometric measurements were measured, adherence of Mediterranean Diet was evaluated by a questionnaire, the Mediterranean Diet Quality Index for children and adolescents (KIDMED), body satisfaction, and perception of body size. RESULTS: Mean age of subjects was 9.07±4.80 years, and 52.4% were girls. The KIDMED index score was 16.3% low, 54.3% moderate and 29.4% good. 72.7% of parents with overweight children and 36.4% with obese children, were perceived that their child was normal, and compared with 58.3% of overweight and 7.7% of obese participants perceived normal body size. There were no significant differences between physical activity in any weight status (p > 0.05) and between boys and girls in the KIDMED index and any of foods intake. There was a significant difference in mean differences of KIDMED index in boys in the four obesity statuses (P = 0.04), as well as in food consumption (P = 0.04), except for pulses in boys and girls. CONCLUSION: The percentage of obesity in boys is more compared to girls, the lowest KIDMED index score is for boys in the obesity group. Therefore, adopting healthier dietary habits and lifestyle in childhood is especially important for boys and also for girls. Registration number: IR.TBZMED.REC.1400.880

Prevalence and Determinants of Screen-Viewing in Children Under Two Years in Suva, Fiji

OBJECTIVE

To determine the prevalence of screen-viewing and factors affecting this behavior among children aged less than two years in Suva, Fiji.

METHODS

This cross-sectional study was conducted at three randomly selected maternal and child health (MCH) clinics among parents or accompanying guardians of 379 children. Data collection was carried out using a 20-item self-administrated questionnaire.

RESULTS

The prevalence of screen-viewing in children was 66.2%. Screen-viewing was more prevalent in children aged 12-24 months (89%) than in children below 12 months (57%). The risk of screen-viewing was high among those who had parents as daytime caregivers (RR (95% CI) = 0.93 (0.82 - 1.04), P=0.001), iTaukei (RR (95% CI) = 0.79 (0.71-0.87), P=0.001), and children younger than 12 months (RR (95% CI) = 0.64 (0.57-0.71), (P=0.001). Results show that availability of screen devices at home is significantly related to children's screen viewing (RR (95% CI) =1.03 (0.64-1.65), P=0.03).

CONCLUSION

The study found early exposure and early adaptation to screen-viewing in children due to several determinants, and suggests the need for anticipatory guidance to parents.

Prevalence of Screen Time Among Children Aged 2 to 5 Years in Chandigarh, a North Indian Union Territory

OBJECTIVE

To estimate the prevalence of screen time (ST) and its associated effects, including emotional and behavioral changes, sleep disturbances, and physical activity levels, in children aged 2 to 5 years.

METHODS

We conducted a cross-sectional study among 400 randomly selected children aged 2 to 5 years in Chandigarh, North India. We used a validated, pretested, semistructured digital-screen exposure and physical activity questionnaire; an abbreviated standard Child Sleep Habit Questionnaire; and a standard Preschool Child Behavior Checklist. We considered ST as excessive if it was more than 1 hour per day as per the American Academy of Pediatrics 2016 guidelines. IBM SPSS Statistics for Macintosh, version 25.0, was used to perform linear regression model analysis and stepwise binary multivariate logistic regression.

RESULTS

Approximately 59.5% of children (mean age 3.5 ± 0.9 years) had excessive ST. ST was higher on weekdays (58.5%) compared with the weekends (56.8%). Higher ST correlated positively with the mother's level of education (r = +0.219) and higher per capita family income (r = +0.227). Screen time was also positively correlated with attending daycare centers (adjusted odd's ratio [aOR] = 1.82, confidence interval [CI] = 1.18-2.81), caregivers ST of more than 2 hours (aOR = 1.68, CI = 1.12-2.56), and the absence of digital-media rules at home (aOR = 3.3, CI = 0.92-11.65). It was negatively correlated (i.e., protective) with lower mother's education (i.e., up to middle school) (aOR = 0.62, CI = 0.41-0.96) and watching educational digital-media content (aOR = 0.53, CI = 0.33-0.87).

CONCLUSION

We observed a high prevalence of excessive ST among children aged 2 to 5 years. Screen time was significantly associated with being in daycare centers, higher caregivers' ST, lower mothers' educational status, and educational digital content.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Development and evaluation of the digital-screen exposure questionnaire (DSEQ) for young children

Background

Over the last three decades, the accessibility and usage of mobile devices have increased among young children. This study’s objective was to develop a validated caregiver-reported digital-screen exposure questionnaire (DSEQ) for children aged 2–5 years.

Methods

DSEQ was developed in five phases. Phase 1, a draft questionnaire was developed by reviewing the literature on existing tools (n = 2) from 2009–2017. Phase 2, face-to-face interviews with primary caregivers (n = 30) were conducted in a tertiary-care-hospital for acculturation. Nine experts assessed the face and content validity of the draft Hindi and English questionnaire. Phase 3, a pilot study conducted among randomly selected families (n = 40) to evaluate the feasibility of DSEQ in field settings. Phase 4, test-retest reliability was done among 30 primary caregivers selected randomly in another urban cluster. Phase 5, the internal consistency of DSEQ was checked by conducting a cross-sectional study among randomly selected 400 primary caregivers in Chandigarh, North India. IBM SPSS Statistics for Macintosh, version 25.0, was for data management and analysis.

Results

A valid DSEQ with 86 items under five domains, including sociodemographic, screen-time exposure and home media environment, level of physical activity, media-related behaviors, and parental perceptions was developed. The pilot study showed that it was feasible to use the DSEQ in the field. DSEQ was reliable with kappa value ranging from 0.52 to 1.0, and intra-class coefficient of 0.62–0.99 (p<0.05). A strong internal consistency was observed for three domains including, screen-time exposure and home media environment (Cronbach’s alpha of 0.82), media-related behaviors (Cronbach’s alpha of 0.74) and physical activity (Cronbach’s alpha 0.73).

Conclusions

The developed DSEQ has good face and content validity and acceptable evidence of internal consistency and test-retest reliability. The DSEQ can be used for measuring digital screen exposure and its correlates among children aged 2 to 5 years.

A comparison of self-reported exposure to fast food and sugary drinks marketing among parents of children across five countries

Exposure to unhealthy food and beverage marketing is an important environmental determinant of dietary intake. The current study examined self-reported exposure to marketing of unhealthy foods and beverages across various media channels and settings among parents of children younger than 18 years in five high and upper-middle income countries. Data from 4827 parents living with their children were analyzed from the International Food Policy Study (2017), a web-based survey of adults aged 18-64 years from Canada, the United States (US), the United Kingdom (UK), Australia, and Mexico. Respondents reported their exposure to marketing of fast food and of sugary drinks across media channels/settings overall and how often they see fast food and sugary drink marketing while viewing media with their children. Regression models examined differences across countries and correlates of marketing exposure. Parents in Mexico and the US reported greater exposure to marketing for fast food and sugary drinks compared to parents in Australia, Canada, and the UK. Patterns of exposure among parents were generally consistent across countries, with TV, digital media, and radio being the most commonly reported media channels for both fast food and sugary drinks. Exposure to marketing of fast food and sugary drinks was associated with a variety of sociodemographic factors, most strongly with ethnicity and education, and sociodemographic trends differed somewhat between countries. The findings demonstrate differences in self-reported parental exposure to marketing of fast food and sugary drinks between countries, and may help to evaluate the impact of marketing restrictions implemented over time.

Global effect of COVID-19 pandemic on physical activity, sedentary behaviour and sleep among 3- to 5-year-old children: a longitudinal study of 14 countries

BACKGROUND

The restrictions associated with the 2020 COVID-19 pandemic has resulted in changes to young children's daily routines and habits. The impact on their participation in movement behaviours (physical activity, sedentary screen time and sleep) is unknown. This international longitudinal study compared young children's movement behaviours before and during the COVID-19 pandemic.

METHODS

Parents of children aged 3-5 years, from 14 countries (8 low- and middle-income countries, LMICs) completed surveys to assess changes in movement behaviours and how these changes were associated with the COVID-19 pandemic. Surveys were completed in the 12 months up to March 2020 and again between May and June 2020 (at the height of restrictions). Physical activity (PA), sedentary screen time (SST) and sleep were assessed via parent survey. At Time 2, COVID-19 factors including level of restriction, environmental conditions, and parental stress were measured. Compliance with the World Health Organizations (WHO) Global guidelines for PA (180 min/day [≥60 min moderate- vigorous PA]), SST (≤1 h/day) and sleep (10-13 h/day) for children under 5 years of age, was determined.

RESULTS

Nine hundred- forty-eight parents completed the survey at both time points. Children from LMICs were more likely to meet the PA (Adjusted Odds Ratio [AdjOR] = 2.0, 95%Confidence Interval [CI] 1.0,3.8) and SST (AdjOR = 2.2, 95%CI 1.2,3.9) guidelines than their high-income country (HIC) counterparts. Children who could go outside during COVID-19 were more likely to meet all WHO Global guidelines (AdjOR = 3.3, 95%CI 1.1,9.8) than those who were not. Children of parents with higher compared to lower stress were less likely to meet all three guidelines (AdjOR = 0.5, 95%CI 0.3,0.9).

CONCLUSION

PA and SST levels of children from LMICs have been less impacted by COVID-19 than in HICs. Ensuring children can access an outdoor space, and supporting parents' mental health are important prerequisites for enabling pre-schoolers to practice healthy movement behaviours and meet the Global guidelines.

Explaining Screen-Time Behavior Among Preschoolers in Northern India Using Multi Theory Model: A Parental Cross-Sectional Survey

BACKGROUND

Screen-time (ST) is the time spent on digital media. The American Academy of Pediatrics recommends the daily ST of less than an hour for preschoolers. However, increased ST among preschoolers is becoming a public health concern.

OBJECTIVE

This study assessed the multi-theory model (MTM)'s applicability in explaining the ST behavior change among preschoolers through parents.

METHODS

A quota sample of 72 parents was drawn from Northern India. Data were analyzed using multiple regression.

RESULTS

Behavioral confidence (p < 0.001) and changes in the physical environment (p < 0.001) significantly predicted the initiation of reducing ST. The sustenance of limiting ST was significantly predicted by the emotional transformation (p < 0.001), practice for change (p < 0.001), and changes in the social environment (p = 0.001).

CONCLUSIONS

The study highlights the usability of the MTM model in designing and testing interventions for parents to limit ST among their children.

Differential exposure to, and potential impact of, unhealthy advertising to children by socio-economic and ethnic groups: A systematic review of the evidence

Children's exposure to advertising of unhealthy food and nonalcoholic beverages that are high in saturated fats, salt and/or sugar is extensive and increases children's preferences for, and intake of, targeted products. This systematic review examines the differential potential exposure and impact of unhealthy food advertising to children according to socio-economic position (SEP) and/or ethnicity. Nine databases (health, business, marketing) and grey literature were searched in November 2019 using terms relating to 'food or drink', 'advertising' and 'socioeconomic position or ethnicity'. Studies published since 2007 were included. Article screening and data extraction were conducted by two independent reviewers. Quality of studies was assessed using the Newcastle-Ottawa quality scale. Of the 25 articles included, 14 focused on exposure to unhealthy food advertising via television, nine via outdoor mediums and two via multiple mediums. Most studies (n = 19) revealed a higher potential exposure or a greater potential impact of unhealthy food advertising among ethnic minority or lower SEP children. Few studies reported no difference (n = 3) or mixed findings (n = 3). Children from minority and socio-economically disadvantaged backgrounds are disproportionately exposed to unhealthy food advertising. Regulations to restrict unhealthy food advertising to children should be implemented to improve children's diets and reduce inequities in dietary intake.

Parental perception on screen time and psychological distress among young children

OBJECTIVE

We aimed to assess the parent-reported screen time of children, identify the perceived risk factors for increased screen time and its relationship to psychological distress in children.

MATERIALS AND METHOD

A cross sectional study was conducted at a teaching hospital in Karachi, Pakistan. A total of 230 employees from medical and non-medical departments were included. Participants were employees with child/children ages 4-12 year who consented to participate in the study, we included 135 fathers and 91 mothers. The questionnaire included (i) demographic data (ii) Media history exam form and (iii) parent reported strength and difficult questionnaire (SDQ).

RESULT

The average daily screen time reported was 2.5 (1.5-5) hour for boys and 2 (1-4) hour for girls. Preschoolers had greater screen time as compared to school-aged children (Median (IQR): 3 (1.5-5.6) vs 2 (1-4), P = 0.46). The children owned devices with approximately equal distribution of preschoolers and school-aged children (19 (27.1%) and 48 (30%), P = 0.661 respectively). Emotional score was found higher in school-aged group in comparison to preschoolers (p = 0.036). Moreover, mother screen time and number of devices owned by a child were found to be positively associated with child's screen time.

CONCLUSION

We conclude that as we are embracing the digital age providing a tech free zone to children is virtually impossible. Children screen time related activities in our part of the world exceeds the limitation. Parental awareness and co-viewing screen with their children are essential to avoid media related behavior problems.

Prosocial television and prosocial toddlers: A multi-method, longitudinal investigation

How screen use might affect early childhood outcomes is an important question for parents, but existing research is patchy. In particular, screen time is often examined in relation to sleep and aggression, but much less is known about its links with prosocial behaviour. To address this gap, we conducted semi-structured observations and interviews / questionnaires with both mothers and fathers in a sample of 195 (predominantly affluent and educated) British families tracked across three time-points, when the first-born child was 14-, 24-, and 36-months old. We also applied an objective coding scheme to assess the relative frequency of prosocial behaviour in the programmes and films children were watching at age 24-months. While our results showed no overall associations between prosocial behaviour and either screen time or screen content, there were interaction effects. Specifically, children whose favourite programmes were slow-paced and rich in prosocial content were particularly likely to show developmental gains in sharing. We discuss these findings in terms of their implications for parents, researchers, and policy makers.

Infant screen media usage and social-emotional functioning

There has been little research on whether and how screen media usage affects social-emotional (SE) function prior to two years of age, even though early SE development is understood to be nurtured through interpersonal experience, mainly withthe primary caregiver. This study sought to characterise infant screen media usage and understand how it may link with concurrent SE function by testing associated effects on reducing parent-infant interaction and of parent psychological factors. Questionnaire responses from 327 UK-based parents of infants aged 6-24 months showed diverse usage in the amount of time spent on screen media ('screen time') and amount of parental involvement (co-sharing and co-referencing). Infants with possible SE delay experienced more screen time than those at low risk. The study tested three mediation models and found support for the displacement and not distancing hypothesis based on this community sample. While screen time predicted both SE competence and SE problems, reduced parent-infant play partially mediated the effect on SE competence. Parent depressed mood was positively linked with infant SE problems, but there was little evidence that increased screen time mediated this effect. Also, parent reflective function and attitudes toward parent-infant play were unrelated to screen time. Though longitudinal study is warranted, the findings implicate screen media usage as potentially directly and indirectly relevant when addressing infant mental health.

Association of Early-Life Social and Digital Media Experiences With Development of Autism Spectrum Disorder-Like Symptoms

IMPORTANCE

Despite growing evidence that parent-child interactions and time viewing digital media affect child development, these factors have rarely been studied in association with autism spectrum disorder (ASD) symptoms.

OBJECTIVE

To determine the association of experiential factors, including social activities and screen viewing in the first 18 months of life, perinatal factors, and demographic factors, with ASD-like symptoms and risk on the Modified Checklist for Autism in Toddlers (M-CHAT) at 2 years.

DESIGN, SETTING, AND PARTICIPANTS

Data for this cohort study were derived from the National Children's Study, a US multicenter epidemiological study of environmental influences on child health and development. A total of 2152 children were enrolled at birth from October 1, 2010, to October 31, 2012. Data were analyzed from December 1, 2017, to December 3, 2019.

EXPOSURES

Caregivers reported whether the child viewed television and/or videos (yes or no) at 12 months of age, hours of viewing at 18 months of age, time spent by the caregiver reading to the child (number of days per week compared with daily) at 12 months of age, and frequency of playing with the child (daily or less than daily) at 12 months of age. Prematurity, maternal age at birth, child sex, household income, race/ethnicity, and caregiver English-language status were included in analysis.

MAIN OUTCOMES AND MEASURES

Significant association of exposures with ASD risk by M-CHAT and/or ASD-like symptoms assessed by revised M-CHAT (M-CHAT-R) total score in multiple regression models.

RESULTS

Among the 2152 children included in the analysis (1099 boys [51.1%]), television and/or video viewing (yes or no) at 12 months of age was significantly associated with greater ASD-like symptoms at 2 years of age (change, 4.2%; 95% CI, 0.1%-8.3%) but not with ASD risk (risk prevalence rates, 8.3% vs 4.4%; adjusted odds ratio [AOR], 1.40; 95% CI, 0.86-2.29). Similarly, parent-child play daily compared with less than daily was significantly associated with fewer ASD-like symptoms at 2 years of age (change, -8.9%; 95% CI, -16.5% to -0.9%) but not with ASD risk (risk prevalence rates, 6.4% vs 14.0%; AOR, 0.58; 95% CI, 0.31-1.08). However, high screen viewing at 18 months of age was not significantly associated with ASD-like symptoms (change, 10.7%; 95% CI, -2.0% to 23.0%) or ASD risk by M-CHAT (AOR, 1.18; 95% CI, 0.56-2.49) at 2 years of age.

CONCLUSIONS AND RELEVANCE

This cohort study found greater screen exposure and less caregiver-child play early in life to be associated with later ASD-like symptoms. Further research is needed to evaluate experiential factors for potential risk or protective effects in ASD.

Objectively-measured sedentary time and physical activity in a bi-ethnic sample of young children: variation by socio-demographic, temporal and perinatal factors

Background

Evidence suggests that South Asian school-aged children and adults are less active compared to the white British population. It is unknown if this generalises to young children. We aimed to describe variability in levels of physical activity and sedentary time in a bi-ethnic sample of young children from a deprived location.

Methods

This observational study included 202 South Asian and 140 white British children aged 1.5 to 5y, who provided 3181 valid days of triaxial accelerometry (Actigraph GT3X+). Variability in sedentary time and physical activity levels were analysed by linear multilevel modelling. Logistic multilevel regression was used to identify factors associated with physical inactivity (failing to perform ≥180 min of total physical activity including ≥60 min moderate-to-vigorous physical activity (MVPA) per day).

Results

There were no significant ethnic differences in the overall levels of behaviours; South Asian and white British children spent half of daily time sedentary, just over 40% in light physical activity, and the remaining 7.5 to 8% of time in MVPA. Sedentary time was lower and physical activity levels were higher in older children, and levels of MVPA and vector magnitude counts per minute (CPM) were higher on weekends compared to weekdays. In South Asian children, sedentary time was lower on weekends. Sedentary time was lower and physical activity levels were higher in spring compared to winter in white British children, and in all seasons compared to winter in South Asian children. South Asian children born at high birth weight performed more MVPA, and in both ethnicities there was some evidence that children with older mothers were more sedentary and less active. Sedentary time was higher and light physical activity was lower in South Asian children in the highest compared to the lowest income families. South Asian girls performed less MVPA, registered fewer vector magnitude CPM, and were 3.5 times more likely to be physically inactive than South Asian boys.

Conclusions

Sedentary time and physical activity levels vary by socio-demographic, temporal and perinatal characteristics in young children from a deprived location. South Asian girls have the most to gain from efforts to increase physical activity levels.

Trial registration

The Pre-schoolers in the Playground (PiP) pilot randomized controlled trial is registered with the ISRCTN (ISRCTN54165860; http://www.isrctn.com).

Factors associated with accelerometer measured movement behaviours among White British and South Asian children aged 6-8 years during school terms and school holidays

OBJECTIVES

To investigate factors associated with movement behaviours among White British (WB) and South Asian (SA) children aged 6-8 years during school terms and holidays.

DESIGN

Cross-sectional.

SETTING

Three primary schools from the Bradford area, UK.

PARTICIPANTS

One hundred and sixty WB and SA children aged 6-8 years.

PRIMARY AND SECONDARY OUTCOMES

Sedentary behaviour (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) measured by accelerometry during summer, winter and spring and during school terms and school holidays. Data were analysed using multivariate mixed-effects multilevel modelling with robust SEs. Factors of interest were ethnicity, holiday/term, sex, socioeconomic status (SES), weight status, weekend/weekday and season.

RESULTS

One hundred and eight children (67.5%) provided 1157 valid days of data. Fifty-nine per cent of children were WB (n=64) and 41% (n=44) were SA. Boys spent more time in MVPA (11 min/day, p=0.013) compared with girls and SA children spent more time in SB (39 min, p=0.017) compared with WB children in adjusted models. Children living in higher SES areas were more sedentary (43 min, p=0.006) than children living in low SES areas. Children were more active during summer (15 min MVPA, p<0.001; 27 LPA, p<0.001) and spring (15 min MVPA, p=0.005; 38 min LPA, p<0.001) and less sedentary (-42 min and -53 min, p<0.001) compared with winter. Less time (8 min, p=0.012) was spent in LPA during school terms compared with school holidays. Children spent more time in MVPA (5 min, p=0.036) during weekend compared with weekdays. Overweight and obese children spent more time in LPA (21 min, p=0.021) than normal-weight children.

CONCLUSION

The results of our study suggest that significant child level factors associated with movement behaviours are ethnicity, sex, weight-status and area SES. Significant temporal factors are weekends, school holidays and seasonality. Interventions to support health enhancing movement behaviours may need to be tailored around these factors.

Impact of high latitude, urban living and ethnicity on 25-hydroxyvitamin D status: A need for multidisciplinary action?

The effects of urban living on health are becoming increasingly important, due to an increasing global population residing in urban areas. Concomitantly, due to immigration, there is a growing number of ethnic minority individuals (African, Asian or Middle Eastern descent) living in westernised Higher Latitude Countries (HLC) (e.g. Europe, Canada, New Zealand). Of concern is the fact that there is already a clear vitamin D deficiency epidemic in HLC, a problem which is likely to grow as the ethnic minority population in these countries increases. This is because 25-hydroxyvitamin D (25(OH)D) status of ethnic groups is significantly lower compared to native populations. Environmental factors contribute to a high prevalence of vitamin D deficiency in HLC, particularly during the winter months when there is no sunlight of appropriate wavelength for vitamin D synthesis via the skin. Also, climatic factors such as cloud cover may reduce vitamin D status even in the summer. This may be further worsened by factors related to urban living, including air pollution, which reduces UVB exposure to the skin, and less occupational sun exposure (may vary by individual HLC). Tall building height may reduce sun exposure by making areas more shaded. In addition, there are ethnicity-specific factors which further worsen vitamin D status in HLC urban dwellers, such as low dietary intake of vitamin D from foods, lower production of vitamin D in the skin due to increased melanin and reduced skin exposure to UVB due to cultural dress style and sun avoidance. A multidisciplinary approach applying knowledge from engineering, skin photobiology, nutrition, town planning and social science is required to prevent vitamin D deficiency in urban areas. Such an approach could include reduction of air pollution, modification of sun exposure advice to emphasise spending time each day in non-shaded urban areas (e.g. parks, away from tall buildings), and advice to ethnic minority groups to increase sun exposure, take vitamin D supplements and/or increase consumption of vitamin D rich foods in a way that is safe and culturally acceptable. This review hopes to stimulate further research to assess the impact of high latitude, urban environment and ethnicity on the risk of vitamin D deficiency.

Ethnic differences in sedentary behaviour in 6-8-year-old children during school terms and school holidays: a mixed methods study

BACKGROUND

Sedentary behaviour (SB) in childhood is a major public health concern. Little is known about ethnic differences in SB during school and holiday weeks among White British (WB) and South Asian (SA) children, which this study aims to address through investigating inclinometer measured SB and exploring reasons for child engagement in SB.

METHODS

A mixed methods study, comprising of a quantitative investigation with 160, 6-8 years old children and a qualitative study with a subsample of 18 children, six parents and eight teachers was undertaken. Children of WB and SA ethnicity in three schools were invited to wear inclinometers for seven school terms (summer/winter/spring) and seven holidays (winter/spring) days during July 2016-May 2017. Total SB, SB accumulated in bouts > 30 min and breaks in SB were explored using multivariate linear mixed effects models which adjusted for wear time, sex, deprivation, overweight status, season, term, weekday and school. Nine focus groups and two interviews were carried out using the Theoretical Domains Framework to explore SB perceptions among parents, teachers and children. Data were analysed using the Framework Approach.

RESULTS

104/160 children provided 836 valid days of data. Children spent on average eight hours of SB/day during term time and holidays, equating to 60% of their awake time, and had on average 111 SB breaks /day. SA children had 25 fewer SB breaks/ day when compared to WB (p < 0.001). Perceived reasons for engagement in SB included: boredom, enjoyment of screen activities (by children), parenting practices, curriculum pressures (by teachers), the need to sit down and learn, and child's preference for screen activities (by parents).

CONCLUSIONS

Children spent 60% of their awake time being sedentary, regardless of ethnicity or school term. There were no significant ethnic differences for any of the SB outcomes except for breaks in SB. Interventions aimed at reducing SB should consider involving parents and teachers and should focus on increasing breaks in SB, especially for SA children, who are at a higher risk of cardio metabolic ill health.

Ethnic background and children's television viewing trajectories: The Generation R Study

This study, conducted in the Netherlands, evaluated the association between ethnic background and children’s TV viewing time at multiple time points and its trajectory. We analyzed 4,833 children with a Dutch, Moroccan, Turkish, or Surinamese ethnic background from the Generation R Study, a population-based study in the Netherlands. Parent-reported television viewing time for children at ages 2, 3, 4, 6, and 9 years was collected by questionnaires sent from April 2004 until January 2015. Odds ratios of watching television ≥1 hour/day at each age were calculated for children from the various ethnic backgrounds. Generalized logistic mixed models (GLMMs) were used to assess the association between ethnic background and television viewing time trajectory. The effect modification by family socioeconomic status was examined in cross-sectional and longitudinal analyses. The percentage of children viewing television ≥1 hour/day increased from age 2 to 9 years for children from all ethnic backgrounds. After adjusting for maternal educational level and net household income, children from all ethnic subgroups had greater odds of watching television ≥1 hour/day at some time points compared with children with a Dutch background (Surinamese: all ages; Moroccan: at ages 4 and 6 years; Turkish: at ages 4 and 9 years). The GLMMs indicated that television viewing trajectories differed between ethnic subgroups. The associations between ethnic background and children’s television viewing time were moderated by maternal educational level for child ages 4 and 6 years (p < 0.05). In longitudinal analyses, the ethnic differences in probability of watching television ≥1 hour/day were larger in children from high-educated mothers than in children from low-educated mothers. In conclusion, ethnic differences in television viewing time were present at all measuring time points. The discrepancy between children with a Dutch background and children with another background was larger in high maternal educational subgroups.

Associations of TV Viewing Duration, Meals and Snacks Eaten When Watching TV, and a TV in the Bedroom with Child Adiposity

OBJECTIVE

This study aimed to examine the associations of TV parameters with adiposity in early life.

METHODS

Data were collected as part of the Born in Bradford (BiB) longitudinal birth cohort study. Child TV viewing duration was parent reported, and BMI, the sum of triceps and subscapular skinfolds, and waist circumference were measured at ~12, 18, 24, and 36 months of age in 1,338 children. Mixed effects models were used to quantify adjusted associations of TV viewing duration with adiposity markers, incorporating data from all time points. Linear regression was used to investigate differences in adiposity levels across frequencies of eating meals and snacks while watching TV at age ~24 months and between children who did and did not have a TV in their bedroom at age ~36 months.

RESULTS

Every 1 h/d of TV viewing was associated with a 0.075-cm larger (95% CI: 0.0034-0.15) waist circumference, independent of covariates including sleep duration, dietary factors, and physical activity level. There was no evidence for any other associations.

CONCLUSIONS

TV viewing duration is independently associated with abdominal adiposity in young children. Limiting TV viewing from an early age may be important for primary prevention of obesity.

Describing objectively measured physical activity levels, patterns, and correlates in a cross sectional sample of infants and toddlers from South Africa

BACKGROUND

Physical activity is considered to have health benefits across the lifespan but levels, patterns, and correlates have not been well described in infants and toddlers under the age of two years.

METHODS

This study aimed to describe objectively and subjectively measured physical activity in a group of South African infants aged 3- to 24-months (n = 140), and to investigate individual and maternal correlates of physical activity in this sample. Infants' physical activity was measured using an Axivity AX3 wrist-worn accelerometer for one week and the mean vector magnitude was calculated. In addition, mothers reported the average amount of time their infant spent in various types of activities (including in front of the TV), their beliefs about infants' physical activity, access to equipment in the home environment, and ages of motor development milestone attainment. Analysis of variance (ANOVA) and pair-wise correlations were used to test age and sex differences and associations with potential correlates.

RESULTS

There were significant age and sex effects on the distribution of time spent at different physical activity intensities (Wilks' lambda = 0.06, p < 0.01). In all cases, the trend was for boys to spend more time in higher intensity physical activity and less time in lower intensity activity than girls; and for time spent in higher intensity activities to be higher in older children. Time spent outside was higher in boys, and this reached significance at 18-months (F = 3.84, p = 0.02). Less concern around floor play was associated with higher physical activity at 12-months in females only (p = 0.03, r = 0.54), and no other maternal beliefs were correlated with physical activity. The majority (94%) of children were exceeding TV time recommendations. When controlling for age and sex, overall TV time was positively associated with BMI z-score (β=0.01, p = 0.05).

CONCLUSION

This study is the first to show sex and age differences in the patterns of physical activity, and to report on objectively measured and maternal reported physical activity and sedentary behaviour in the first two years of life in South Africa infants. Infants and toddlers should be provided with as many opportunities to be active through play as possible, and TV time should be limited.