All the 240 children from 2 KG schools were surveyed but 51 children were excluded (lack of consent – 20, incomplete forms – 24, age less than 2 years – 7). Of the 189 children included in the study, 97 (51.3%) were boys and 92 (48.7%) girls and there was no significant gender difference in screen use (p=0.73). Both schools catered to mostly upper middle class families and a few middle class families as per Kuppuswamy socioeconomic scale revised for 2017 using real-time update tool (8). 83 fathers and 74 mothers had postgraduate degrees. 53(28%) mothers were housewives. There was no statistically significant difference between excessive screen use in children of working mothers and housewives (88% vs. 90%, p= 0.57).
The average screen use in our population was 2.14 hours (SD 0.43) per day. Only 10.5% [11 boys (11.3%) and 9 girls (9.8%)], used screens for less than 1 hour every day. While the majority of children used screens for 1-3 hours per day, a small but significant proportion (n=7, 3.7%) of children viewed screen for more than 3 hours per day. Television remained the commonest screen used (n=145, 76.7%), followed by smartphones (n=98, 51.9%), tablets (n=15, 7.9%) and videogames (n=2, 1.1%). Surprisingly, 14 (7.4%) children had their own smartphones. The most popular content consumed were cartoons (82.5%) followed by YouTube (25.9%) and gaming (13.8%). About 60% of children used a screen in the 1 hour preceding their bedtime while more than 72% used screens during mealtime [Table 1a]. The most common context in which parents permitted screen time is tantrums (58.2%) followed by on demand (54%), as a reward (16.9%) and to pacify (13.8%). Only about 21% planned their child’s screen-time. While most parents (97.4%) practiced restrictive supervision, only 55% of parents consistently supervised screen use in their children, and 28% consistently co-viewed media content with their child [Table 1b]. Speech delay was perceived by 19.6% of parents, but reduced social interaction was a problem for only 3.7%. However, as per the visual development scale by Werner David (WDDPS), parents reported communication delays in 9.5% and reduced social interaction in 6.3%. Delay in age-appropriate attention was seen in 12.2%, play in 6.9 %, and intelligence in 8.5%. The majority of children participated in other activities such as physical activity (64.6%), drawing (66.7%), and crafts (28.6%). They also interacted with other playmates (70.9%) and older family members (45.5%) [Table 1c].
Children who were introduced to screens before the age of 1 year were more likely to have higher screen time (2.5 hours vs. 2.09 hours, P =0.01). Children who had a parent co-viewing content on the screen with them had a lower screen time than children who did not (1.96 hrs. vs. 2.19 hours, p=0.03). We also found meal-time screen use (OR 3.4, 95% CI 1.3 – 8.9, p=0.01) and receiving screen on demand (OR 3.7, 95% CI 1.3 – 10.8, p=0.01), to be significantly associated with increased screen use in preschool children. Setting daily time limits (OR 4.1, 95% CI 1.5 – 10.8, p=0.01), using a computer instead of other devices (OR 3.9, 95% CI 1.1 – 13.6, p=0.05) and giving screen to children in a planned manner (OR 3.0, 95% CI 1.1 – 8.1, p-0.04), resulted in children using a screen for <1 hour per day. Parental supervision was more likely to be inconsistent among children who got a screen on demand (47% vs. 62%, p=0.04) and those who had their own device (OR 3.3, 95% CI 1.0-11.0), whereas parents who gave a screen only in a planned manner were more likely to supervise their child (29% vs. 13%, p=0.01). [Tables 1b and 2].
Though we did not find any significant association between duration of screen use and interest in other activities, a greater proportion of children who had consistent supervision during screen use engaged in physical activity for more than 1 hour per day (OR 2.3, 95% CI 1.3 – 4.2), as well as being interested in other activities such as drawing (OR 1.9, 95% CI 1.0 – 3.5). We found that children who used screen for more than 1 hour a day interacted more with their playmates and older family members as compared to children with lesser screen use, however, this was not significant.
A higher proportion of parents reported deficits in communication, self-care, and play-related activities among children with excessive screen use as compared to children with normal screen use, but the difference was not statistically significant. However, children with inconsistent supervised screen time were reported to have significantly more deficits in social skills (OR 15.3, 95% CI 1.9-121.2), attention (OR 3.2, 95% CI 1.3-8.2), and intelligence (OR 4.1, 95% CI 1.3-13.3) as compared to children whose screen use were consistently supervised [Table 1c and 2].