JMIR Publications

ABSTRACT

Background:

It is unclear how exposure to different types of screen content is associated with early development among preschool children.

Objective:

The aim was to precisely evaluate the screen exposure time across different content types and to explore the associations with the Ages and Stages Questionnaire, Third Edition (ASQ-3) score and five capacity domains in children aged 3 to 6 years.

Methods:

This monitoring study used intelligent technology to collect data on the seven-day screen time and the time spent viewing each content type. Participants were from two representative samples of kindergarten children in Shanghai, China. The data were collected between March 2023 and July 2023. Screen exposure data (total daily time and time for each type of content according to different classification methods, including application category, age restriction, educational content, screen pace, screen interaction, fantastical or realistic content, date and time) were collected from children aged between 3 and 6 years. A self-designed questionnaire and the Healthy Screen Viewing for Children (HSVC) intelligent technology application were used to assess screen exposure to all media and tablets. The ASQ-3 was used to assess early development in 3- to 6-year-old children.

Results:

Of the 535 children included in the total sample, 298 were boys (55.7%), and 194 were aged 3 to 4 years (36.3%). Linear regression analysis suggested that a screen time longer than 60 minutes and exposure to cell phones and tablets were negatively associated with the ASQ-3 score. Among 365 participants with data collected by the HSVC application, median regression showed that the median total ASQ-3 score was negatively associated with the time spent viewing noneducational content (=-0.053, 95% CI=-0.107~-0.022, P=0.046), the time spent viewing both educational and noneducational content (=-0.033, 95% CI=-0.084~-0.007, P=0.016), and fast-paced content (=-0.025, 95% CI=-0.059~-0.002, P=0.031). The present study also revealed that the median total fine motor score was negatively associated with the time spent viewing parental guidance (PG) rated content (=-0.021, 95% CI=-0.035~-0.004, P=0.016), noneducational content (=-0.032, 95% CI=-0.054~-0.008, P=0.004), educational and noneducational content (=-0.017, 95% CI=-0.028~-0.007, P=0.003), fast-paced content (=-0.029, 95% CI=-0.050~-0.010, P<0.001), fantastical content (=-0.039, 95% CI=-0.055~-0.009, P=0.004), and fantastical and realistic content (=-0.017, 95% CI=-0.030~-0.006, P=0.034) and screen use during the work day (=-0.035, 95% CI=-0.061~-0.009, P=0.019).

Conclusions:

The results of the present study indicated that the time spent viewing noneducational, fast-paced and fantastical content was negatively associated with early development among children aged 3 to 6 years. Limiting screen time for programs or games, including noneducational, fast-paced and fantastical content, is recommended.