Indian Pediatrics

, Volume 56, Issue 9, pp 773–788 | Cite as

Screen Time in Under-five Children

  • Nimran Kaur
  • Madhu GuptaEmail author
  • Prahbhjot Malhi
  • Sandeep Grover
Review Article



Screen-viewing in childhood is primarily a mean of entertainment, during the unstructured time. We aimed to review the burden of the problem, delineate the associated factors and correlates, evaluate the impact of screen-time on the overall health of under-five children, and the interventions to reduce screen-time.

Evidence acquisition

Published articles from January 2009 to June 2018 were searched through PubMed, Clinical Key, Scopus, Embase, and Google Scholar using key Medical Subject Heading words.


The burden of screen-time varied from 21% to 98% in the middle-income, and 10% to 93.7% in the high-income countries. The social ecological model was used to illustrate associated factors and correlates including child, caregiver, micro and macro digital-media environment related factors. The interventions included increase in the physical activity, reduction in the body mass index, improving sleep and dietary behaviors etc. The effectiveness of these interventions ranged from 0.3 minutes (standard error 13.3) to −47.16 minutes (standard error 2.01).


Clinicians should obtain history of screen-time in children, and advise limiting the screen exposure according to the child’s age. There is a need to generate evidence on burden and effectiveness of interventions among children in the Indian settings, owing to the limited data.


Digital-media Obesity Screen exposure Sedentary behaviors Smartphone Television 


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Acknowledgement: Dr. Kamal Kishore, Lecturer, Department of Biostatistics, PGIMER for providing technical inputs in the methods of this review.

Funding: None.


  1. 1.
    Barber SE, Kelly B, Collings PJ, Nagy L, Bywater T, Wright J. Prevalence, trajectories, and determinants of television viewing time in an ethnically diverse sample of young children from the UK. Int J Behav Nutr Phys Act. 2017;14:88–99.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Reid Chassiakos Y, Radesky J, Christakis D, Moreno MA, Cross C. Children and adolescents and digital media. Pediatrics. 2016;138:e20162593–e.PubMedCrossRefGoogle Scholar
  3. 3.
    Pearson N, Biddle SJH. Sedentary behavior and dietary intake in children, adolescents, and adults. Am J Prev Med. 2011;41:178–88.PubMedCrossRefGoogle Scholar
  4. 4.
    Kourlaba G, Kondaki K, Liarigkovinos T, Manios Y. Factors associated with television viewing time in toddlers and preschoolers in Greece: The GENESIS study. J Public Health. 2009;31:222–30CrossRefGoogle Scholar
  5. 5.
    Davey S, Davey A. Assessment of smartphone addiction in Indian adolescents: A mixed method study by systematic-review and meta-analysis approach. Int J Prev Med. 2014;5:1500–11.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Cheng S, Maeda T, Yoichi S, Yamagata Z, Tomiwa K; Japan Children’s Study Group. Early television exposure and children’s behavioral and social outcomes at age 30 months. J Epidemiol. 2010;20:S482–9.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Lin LY, Cherng RJ, Chen YJ, Chen YJ, Yang HM. Effects of television exposure on developmental skills among young children. Infant Behav Dev 2015;38:20–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Byeon H, Hong S. Relationship between television viewing and language delay in toddlers: evidence from a Korea national cross-sectional survey. PLoS One. 2015;10:e0120663.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Pagani LS, Fitzpatrick C, Barnett TA, Dubow E. Prospective associations between early childhood television exposure and academic, psychosocial, and physical well-being by middle childhood. Arch Pediatr Adolesc Med. 2010;164:425–31.PubMedCrossRefGoogle Scholar
  10. 10.
    Carson V, Janssen I. Associations between factors within the home setting and screen time among children aged 0–5 years: a cross-sectional study. BMC Public Health. 2012;12:539.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Carson V, Spence JC, Cutumisu N, Cargill L. Association between neighborhood socioeconomic status and screen time among pre-school children: a cross-sectional study. BMC Public Health. 2010;10:367.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Christakis DA, Garrison MM. Preschool-aged children’s television viewing in child care settings. Pediatrics. 2009;124:1627–32.PubMedCrossRefGoogle Scholar
  13. 13.
    Asplund KM, Kair LR, Arain YH, Cervantes M, Oreskovic NM, Zuckerman KE. Early childhood screen time and parental attitudes toward child television viewing in a low-income latino population attending the special supplemental nutrition program for women, infants, and children. Child Obes. 2015;11:590–9.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Emond JA, Tantum LK, Gilbert-Diamond D, Kim SJ, Lansigan RK, Neelon SB. Household chaos and screen media use among preschool-aged children: A cross-sectional study. BMC Public Health. 2018;18:1210.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Fulton JE, Wang X, Yore MM, Carlson SA, Galuska DA, Caspersen CJ. Television viewing, computer use, and BMI among U.S. children and adolescents. J Phys Act Health. 2009;6:S28–35.PubMedCrossRefGoogle Scholar
  16. 16.
    Lee ST, Wong JE, Ong WW, Ismail MN, Deurenberg P, Poh BK. Physical Activity Pattern of Malaysian Preschoolers: Environment, Barriers, and Motivators for Active Play. Asia Pacific J Public Health. 2016;28:21S–34S.CrossRefGoogle Scholar
  17. 17.
    Wu CST, Fowler C, Lam WYY, Wong HT, Wong CHM, Loke AY. Parenting approaches and digital technology use of preschool age children in a Chinese community. Italian J Pediatr. 2014;40:44.CrossRefGoogle Scholar
  18. 18.
    Hinkley T, Salmon J, Okely AD, Crawford D, Hesketh K. Preschoolers’ physical activity, screen time, and compliance with recommendations. Med Sci Sport Exerc. 2012;44:458–65.CrossRefGoogle Scholar
  19. 19.
    Downing KL, Hinkley T, Salmon J, Hnatiuk JA, Hesketh KD. Do the correlates of screen time and sedentary time differ in preschool children? BMC Public Health. 2017;17:285.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Jago R, Stamatakis E, Gama A, Carvalhal IM, Nogueira H, Rosado V, et al. Parent and child screen-viewing time and home media environment. Am J Prev Med. 2012;43:150–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Brown JE, Broom DH, Nicholson JM, Bittman M. Do working mothers raise couch potato kids? Maternal employment and children’s lifestyle behaviours and weight in early childhood. Soc Sci Med. 2010;70:1816–24.PubMedCrossRefGoogle Scholar
  22. 22.
    Tandon PS, Zhou C, Lozano P, Christakis DA. Preschoolers’ total daily screen time at home and by type of child care. J Pediatr. 2011;158:297–300.PubMedCrossRefGoogle Scholar
  23. 23.
    Chang HY, Park E-J, Yoo H-J, Lee JW, Shin Y. Electronic media exposure and use among toddlers. Psychiatry Investig. 2018;15:568–73.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Verma S, Suman N, Verma P. Effect of electronic gadgets on cognitive milestones of children below 2 years of age. International Archives of Integrated Medicine. 2018;5:52–4.Google Scholar
  25. 25.
    Ruangdaraganon N, Chuthapisith J, Mo-suwan L, Kriweradechachai S, Udomsubpayakul U, Choprapawon C. Television viewing in Thai infants and toddlers: Impacts to language development and parental perceptions. BMC Pediatr. 2009;9:34.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Kirkorian HL, Pempek TA, Murphy LA, Schmidt ME, Anderson DR. The impact of background television on parent-child interaction. Child Dev. 2009;80:1350–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Russo-Johnson C, Troseth G, Duncan C, Mesghina A. All tapped out: Touchscreen interactivity and young children’s word learning. Front Psychol. 2017;8:578.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Kirkorian HL, Choi K, Pempek TA. Toddlers’ word learning from contingent and noncontingent video on touch screens. Child Dev. 2016;87:405–13.PubMedCrossRefGoogle Scholar
  29. 29.
    Paudel S, Jancey J, Subedi N, Leavy J. Correlates of mobile screen media use among children aged 0–8: a systematic review. BMJ Open. 2017;7:e014585.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Duch H, Fisher EM, Ensari I, Harrington A. Screen time use in children under 3 years old: A systematic review of correlates. Int J Behav Nutr Phys Act. 2013;10:102.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Zimmerman FJ, Ortiz SE, Christakis DA, Elkun D. The value of social-cognitive theory to reducing preschool TV viewing: A pilot randomized trial. Prev Med (Baltim). 2012;54:212–8.CrossRefGoogle Scholar
  32. 32.
    Hinkley T, Cliff DP, Okely AD. Reducing electronic media use in 2–3 year-old children: feasibility and efficacy of the Family@play pilot randomised controlled trial. BMC Public Health. 2015;15:779.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Taveras EM. Randomized Controlled Trial to Improve Primary Care to Prevent and Manage Childhood Obesity. Arch Pediatr Adolesc Med. 2011;165:714–22.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    van Grieken A, Renders CM, Veldhuis L, Looman CW, Hirasing RA, Raat H. Promotion of a healthy lifestyle among 5-year-old overweight children: health behavior outcomes of the ‘Be active, eat right’ study. BMC Public Health. 2014;14:59.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Latomme J, Cardon G, De Bourdeaudhuij I, Iotova V, Koletzko B, Socha P, et al. Effect and process evaluation of a kindergarten-based, family-involved intervention with a randomized cluster design on sedentary behaviour in 4- to 6- year old European preschool children: The ToyBox-study. PLoS One. 2017;12:e0172730.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Mendoza JA, Baranowski T, Jaramillo S, Fesinmeyer MD, Haaland W, Thompson D, et al. Fit 5 kids TV reduction program for latino preschoolers. Am J Prev Med. 2016;50:584–92.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Epstein LH, Roemmich JN, Robinson JL, Paluch RA, Winiewicz DD, Fuerch JH, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. 2008;162:239–45.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Yilmaz G, Demirli Caylan N, Karacan CD. An intervention to preschool children for reducing screen time: A randomized controlled trial. Child Care Health Dev. 2015;41:443–9.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Knowlden AP, Sharma M, Cottrell RR, Wilson BRA, Johnson ML. Impact evaluation of enabling mothers to prevent pediatric obesity through web-based education and reciprocal determinism (EMPOWER) randomized control trial. Health Educ Behav. 2015;42:171–84.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Puder JJ, Marques-Vidal P, Schindler C, Zahner L, Niederer I, Burgi F, et al. Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): Cluster randomised controlled trial. BMJ. 2011;343:d6195.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Foster BA, Aquino C, Gil M, Flores G, Hale D. A randomized clinical trial of the effects of parent mentors on early childhood obesity: Study design and baseline data. Contemp Clin Trials. 2015;45:164–9.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Fitzgibbon ML, Stolley MR, Schiffer LA, Braunschweig CL, Gomez SL, Van Horn L, et al. Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: Post intervention results. Obesity (Silver Spring). 2011;19:994–1003.CrossRefGoogle Scholar
  43. 43.
    Fitzgibbon ML, Stolley MR, Schiffer L, Kong A, Braunschweig CL, Gomez-Perez SL, et al. Family-based hip-hop to health: Outcome results. Obesity (Silver Spring). 2013;21:274–83.PubMedCentralCrossRefPubMedGoogle Scholar
  44. 44.
    Haines J, McDonald J, O’Brien A, Sherry B, Bottino CJ, Schmidt ME, et al. Healthy habits, happy homes: randomized trial to improve household routines for obesity prevention among preschool-aged children. JAMA Pediatr. 2013;167:1072–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Skouteris H, Hill B, McCabe M, Swinburn B, Busija L. A parent-based intervention to promote healthy eating and active behaviours in pre-school children: Evaluation of the MEND 2–4 randomized controlled trial. Pediatr Obes. 2015;11:4–10.PubMedCrossRefGoogle Scholar
  46. 46.
    Birken CS, Maguire J, Mekky M, Manlhiot C, Beck CE, DeGroot J, et al. Office-based randomized controlled trial to reduce screen time in preschool children. Pediatrics. 2012;130:1110–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Peng W, Crouse JC, Lin J-H. Using active video games for physical activity promotion: A systematic review of the current state of research. Health Educ Behav. 2013;40:171–92.PubMedCrossRefGoogle Scholar
  48. 48.
    Tremblay MS, LeBlanc AG, Carson V, Choquette L, Connor Gorber S, Dillman C, et al. Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37:370–80.PubMedCrossRefGoogle Scholar
  49. 49.
    Bozzola E, Spina G, Ruggiero M, Memo L, Agostiniani R, Bozzola M, et al. Media devices in pre-school children: The recommendations of the Italian Pediatric Society. Ital J Pediatr. 2018;44:69.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Department of Health and Aging. Get up and Grow: Healthy Eating and Physical Activity for Early Childhood. Canberra, ACT: Australian Government; 2010. Available from: Accessed March 20, 2019.

Copyright information

© Indian Academy of Pediatrics 2019

Authors and Affiliations

  • Nimran Kaur
    • 1
  • Madhu Gupta
    • 1
    Email author
  • Prahbhjot Malhi
    • 2
  • Sandeep Grover
    • 3
  1. 1.Department of Community Medicine and School of Public HealthPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Department of PediatricsPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of PsychiatryPostgraduate Institute of Medical Education and ResearchChandigarhIndia

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