Research

JAMA Pediatrics | Original Investigation

Assessment of Changes in Child and Adolescent Screen Time

During the COVID-19 Pandemic
A Systematic Review and Meta-analysis
Sheri Madigan, PhD; Rachel Eirich, MSc; Paolo Pador, BSc(Hons); Brae Anne McArthur, PhD; Ross D. Neville, PhD

Supplemental content
IMPORTANCE To limit the spread of COVID-19, numerous restrictions were imposed on
youths, including school closures, isolation requirements, social distancing, and cancelation
of extracurricular activities, which independently or collectively may have shifted screen
time patterns.

OBJECTIVE To estimate changes in the duration, content, and context of screen time of
children and adolescents by comparing estimates taken before the pandemic with those
taken during the pandemic and to determine when and for whom screen time has increased
the most.

DATA SOURCES Electronic databases were searched between January 1, 2020, and March 5,
2022, including MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of
Controlled Trials. A total of 2474 nonduplicate records were retrieved.

STUDY SELECTION Study inclusion criteria were reported changes in the duration (minutes per
day) of screen time before and during the pandemic; children, adolescents, and young adults
(ⱕ18 years); longitudinal or retrospective estimates; peer reviewed; and published in English.

DATA EXTRACTION AND SYNTHESIS A total of 136 articles underwent full-text review. Data
were analyzed from April 6, 2022, to May 5, 2022, with a random-effects meta-analysis.

MAIN OUTCOMES AND MEASURES Change in daily screen time comparing estimates taken
before vs during the COVID-19 pandemic.

RESULTS The meta-analysis included 46 studies (146 effect sizes; 29 017 children; 57% male;
and mean [SD] age, 9 [4.1] years) revealed that, from a baseline prepandemic value of 162
min/d (2.7 h/d), during the pandemic there was an increase in screen time of 84 min/d (1.4
h/d), representing a 52% increase. Increases were particularly marked for individuals aged 12
to 18 years (k [number of sample estimates] = 26; 110 min/d) and for device type (handheld
devices [k = 20; 44 min/d] and personal computers [k = 13; 46 min/d]). Moderator analyses
showed that increases were possibly larger in retrospective (k = 36; 116 min/d) vs longitudinal
(k = 51; 65 min/d) studies. Mean increases were observed in samples examining both
recreational screen time alone (k = 54; 84 min/d) and total daily screen time combining
recreational and educational use (k = 33; 68 min/d).

CONCLUSIONS AND RELEVANCE The COVID-19 pandemic has led to considerable disruptions
in the lives and routines of children, adolescents, and families, which is likely associated with
increased levels of screen time. Findings suggest that when interacting with children and
caregivers, practitioners should place a critical focus on promoting healthy device habits,
which can include moderating daily use; choosing age-appropriate programs; promoting Author Affiliations: Department of
Psychology, University of Calgary,
device-free time, sleep, and physical activity; and encouraging children to use screens as
Calgary, Alberta, Canada (Madigan,
a creative outlet or a means to meaningfully connect with others. Eirich, Pador, McArthur); Alberta
Children’s Hospital Research
Institute, Calgary, Alberta, Canada
(Madigan, Eirich); School of Public
Health, Physiotherapy and Sports
Science, University College Dublin,
Dublin, Ireland (Neville).
Corresponding Author: Sheri
Madigan, PhD, Department of
Psychology, University of Calgary,
2500 University Ave, Calgary, AB T2N
JAMA Pediatr. doi:10.1001/jamapediatrics.2022.4116 1N4, Canada (sheri.madigan@
Published online November 7, 2022. ucalgary.ca).

(Reprinted) E1
© 2022 American Medical Association. All rights reserved.

Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
 Research Original Investigation
T
o limit the spread of the COVID-19 virus, numerous re-
strictions were imposed on the daily lives of children
and adolescents globally, including repeated school clo-
sures, cancellation of extracurricular activities, social and
physical distancing from peers and other sources of interper-
sonal support (eg, teachers and coaches), and mandated home
quarantining due to COVID-19 exposure. Parents, in parallel,
also experienced substantial challenges, including financial
instability, job insecurity, loss of child care, and increased
home-schooling responsibilities, which individually and
collectively resulted in increased family stress and mental
distress.1-3 To cope with such unparalleled disruptions to nor-
mal living conditions, many children and families likely used
digital devices to occupy their time during the pandemic. Popu-
lation-level increases in child and adolescent screen time have
therefore been expected.4,5 Trajectories of screen use dem-
onstrate that children with high screen use often remain high
users throughout preschool and middle childhood.6,7 Meta-
analyses have also documented significant associations of child
screen time with poor sleep,8 physical activity,9 language and
communication skills,10 mental health,11 and academic12 out-
comes. Up to 80% of apps for children are also purposely built
with manipulative design features (eg, fabricated time pres-
sure, gifts, and attractive lures to encourage longer gameplay),13
which can be persuasive in maintaining children’s attention.
Therefore, a critical time-sensitive research focus should be
to determine the degree to which child and adolescent screen
time increased during the COVID-19 pandemic in terms of the
duration of use as well as the content and context of use.
Although most empirical studies suggest that screen time
increased during the pandemic, there is considerable variabil-
ity in the direction and magnitude of change between stud-
ies. For example, Welling et al 14 reported no significant
changes, Morrison et al15 reported a decrease of 15 min/d, and
McArthur et al4 and Pietrobelli et al16 reported increases of
102 min/d and 292 min/d, respectively, before vs during the
pandemic. Thus, there is a need to explain between-study vari-
ability in COVID-19–associated changes in screen time. The
variation in design affordances across devices and platforms,
such as their mobility and intended use, may yield variations
in the patterns of change across device type. With more than
1.5 billion children worldwide moving to online school at the
outset of the pandemic,17 context of use should also be exam-
ined because screen time could have increased for educa-
tional use.
One expected, developmentally relevant moderator of
changes in screen time is child age because screen time in-
creases across childhood.18,19 Variability could also be sex spe-
cific, with studies showing that screen time is higher for boys
than for girls,19-21 and informant dependent because youths
(vs parents) may be more reliable estimators of their own
behavior.11,22 Between-study variability may also be associ-
ated with the populations under investigation, such as chil-
dren and adolescents with medical (eg, obesity) or clinical
(eg, autism spectrum disorder) diagnoses who may have
been prone to receiving or requesting more screen time.23-26
Another source of heterogeneity could be study design, with
some studies providing longitudinal change in cohorts of
E2 JAMA Pediatrics Published online November 7, 2022 (Reprinted)
© 2022 American Medical Association. All rights reserved.
Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic
Key Points
Question To what extent has the COVID-19 pandemic been
associated with changes in the duration, content, and context
of daily screen time among children and adolescents globally?
Findings In this systematic review and meta-analysis of 46
studies including 29 017 youths (ⱕ18 years), pooled estimates
comparing estimates taken before and during the COVID-19
pandemic revealed an increase in screen time of 84 min/d, or
52%. Screen time increases were highest for individuals aged
12 to 18 years and for handheld devices and personal computers.
Meaning This study shows an association between the COVID-19
pandemic and increases in screen time; practitioners and
pandemic recovery initiatives should focus on fostering healthy
device habits, including moderating use, monitoring content,
prioritizing device-free time, and using screens for creativity
or connection.
children by comparing pandemic data with historical prepan-
demic data, whereas other studies were cross-sectional and
asked participants to retrospectively recall prepandemic
screen time (an approach prone to recall bias). 27 Finally,
government-mandated restrictions and their seasonal timing
varied across countries, which could have affected estimates
across studies.
The objectives of this study were to conduct a systematic
review and meta-analysis of global changes in child and ado-
lescent screen time before vs during the COVID-19 pandemic
and to determine the degree to which these changes differed
across devices, context of use, age groups, sexes, devices, popu-
lation types, methods, and region and season (ie, geographic
latitude). Together, these objectives can inform practition-
ers, programs, and policies seeking to put child and adoles-
cent sedentary behaviors at the forefront of global pandemic
recovery efforts.
Methods
Search Strategy
In this meta-analysis, 4 electronic databases (MEDLINE,
Embase, PsycINFO, and the Cochrane Central Register of Con-
trolled Trials) were searched for studies published between
January 1, 2020, and March 5, 2022. Search strategy terms in-
cluded screen time, sedentary behavior, and COVID-19 (eTable 1
in the Supplement). Retrieved studies were imported into
Covidence,28 where duplicates were automatically removed.
Reference lists of included studies and relevant systematic
reviews were also hand searched. This review was registered
as a protocol with PROSPERO (CRD42022320709).
Selection Criteria
Study inclusion criteria were reported changes in the dura-
tion (minutes per day) of screen time before and during
the COVID-19 pandemic within the same group of children;
children, adolescents, and young adults (≤18 years); longitu-
dinal or retrospective study; peer reviewed; and published in
jamapediatrics.com
 Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic
English. Exclusion criteria were case studies, reports, and quali-
tative analyses. Study inclusion was determined by 2 inde-
pendent coders (S.M. and P.P.), who coded all titles or ab-
stracts in Covidence (mean random agreement probability,
93%). Independent coders (S.M. and P.P.) reviewed all full-
text articles against the inclusion criteria. Discrepancies were
resolved via consensus.
Data Extraction
Changes in the duration of daily screen time before vs during
the pandemic were extracted from each study. Inferential sta-
tistics (P value, z score, t value, and CI) were extracted to cal-
culate the SE of these changes. When studies included male
and female individuals, separate subsample data were ex-
tracted to account for heterogeneity arising from real differ-
ences in screen use between sexes. Data extraction was con-
ducted by 2 coders (P.P. and R.D.N.). Intercoder agreement
was 94%.
Moderators
Continuous moderators were baseline (prepandemic) screen
time (minutes per day), number of months between assess-
ments of screen time, sample geographic latitude, and study
quality. Categorical moderators were device type or content
(handheld device use, personal computers, television, vid-
eogaming, and social media), content (recreational and recre-
ational plus educational [ie, total]), age group (preschool
[≤5 years] and primary school [>5 to ≤12 years], and second-
ary school [>12 to ≤18 years]), sex (percentage of female indi-
viduals), study design (longitudinal or retrospective), infor-
mant (parent or youth), and population (clinical [autism
spectrum disorder and psychiatric patients, k = 4] vs nonclini-
cal; medical [obesity and diabetes, k = 16] vs nonmedical
samples, where k is the number of sample estimates).
Study Quality
Study quality was assessed with items from the National
Institutes of Health Quality Assessment Tool for Observa-
tional Cohort and Cross-Sectional Studies. 29 Each study
received a score of 0 (criterion unmet) or 1 (criterion met) for
11 quality indicators, which were tallied to give a quality
score from 0 to 11 (eTable 2 and eTable 3 in the Supplement).
The study followed the Preferred Reporting Items for Sys-
tematic Reviews and Meta-analyses (PRISMA) reporting
guideline. Data for this study were freely available through
published studies.
Data Analysis
Random-effects meta-analyses30 were conducted in SAS, ver-
sion 9.4 (SAS Institute Inc) from April 6 through May 5, 2022.
The inverse square method was used to weight sample
estimates.31 Between-sample heterogeneity was summa-
rized with the τ statistic, representing the typical differences
in the meta-analyzed mean between samples. Effect sizes were
calculated by following the Cohen32 principle of standardiza-
tion (ie, by dividing outcomes by their respective between-
person SD of pre–COVID-19 screen time). Standardized thresh-
olds for small, moderate, large, and very large effect sizes were
jamapediatrics.com
© 2022 American Medical Association. All rights reserved.
Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
Original Investigation Research
Figure 1. PRISMA Flow Diagram Detailing Search Strategy
2909 Records identified through 3 Additional records identified
database searching through other sources
2474 Records after duplicates removed
2474 Records screened
2338 Records excluded
136 Full-text articles assessed
for eligibility
90 Full-text articles excluded
73 Wrong indication or outcome
6 Wrong study design
5 Duplicate data
4 Wrong patient population
1 Independent samples
1 Data not available
46 Studies included in meta-analysis
146 Effect sizes included in
meta-analysis
0.2, 0.6, 1.2, and 2 SDs, respectively.33 Sampling uncertainty
is represented as 90% CIs. Precision of estimation 33 was
deemed inadequate or unclear when the 90% CI included
substantial positive and negative values (ie, −0.2 and 0.2
SDs, respectively). When the 90% CI included both trivial and
substantial (positive or negative) values, the outcome was in-
terpreted as “possibly” substantial. Publication bias and
potential outliers were evaluated with the random-effects
output (ie, the random-effect solutions for each sample esti-
mate) from the meta-analytic model described earlier. Publi-
cation bias was evaluated with a scatterplot of the random-
effect solutions and the SEs for each sample estimate. Potential
outliers were detected when the P value for the random-
effect solution was less than a threshold given by P < .05
divided by the degrees of freedom for the sample estimate
random-effect solution in question.
Results
Our search strategy produced 2474 nonduplicate records, and
136 underwent full-text review (Figure 1). Forty-six studies met
the full inclusion criteria, with 146 available estimates. Of the
146 estimates, 87 represented changes for all devices com-
bined, 20 for handheld devices, 13 for personal computers,
11 for television, 9 for video gaming, and 6 for social media.
Study Characteristics
Across the 46 studies (Table 1),4,14-16,24-26,34-72 29 017 chil-
dren and young adults aged 18 years or younger were repre-
sented (57% male and 43% female). The mean (SD) age was
(Reprinted) JAMA Pediatrics Published online November 7, 2022 E3
 E4
Table 1. Characteristics of the Included Studies
Screen Clinical Medical
Source Country No.a SES Male, % Female, % Age, y Study design Screen type purpose condition condition
Aguilar-Farias et al,34 2021 Chile 3157 Low 51 49 3.1 Retrospective AD R NOCLIN NOMED
Beck et al,35 2021 US 145 NR 45 55 8.0 Retrospective AD R NOCLIN MED
Brzęk et al,36 2021 Poland 1316 NR 45 55 3.0 Longitudinal AD R NOCLIN NOMED
Burkart et al,37 2022 US 127 Diverse 53 47 9.8 Longitudinal AD R NOCLIN NOMED
Cardy et al,38 2021 Canada 414 Middle-upper 31 69 11.7 Retrospective AD R + ED CLIN NOMED
Research Original Investigation

Chen et al,39 2021 China 535 NR 49 51 10.3 Longitudinal SM, VG, HD R NOCLIN NOMED
Cheng et al,40 2021 Malaysia 123 NR 53 47 11.1 Retrospective AD R + ED NOCLIN MED
Eales et al,41 2021 US 129 Middle-upper 50 50 6.1 Longitudinal AD R + ED NOCLIN NOMED
Garcia et al,26 2021 US 9 NR 89 11 16.9 Longitudinal AD R CLIN NOMED
Ghanamah and Israel 382 NR 51 49 8.0 Retrospective AD R + ED NOCLIN NOMED
Eghbaria-Ghanamah,42 2021
Hossain et al,43 2021 Bangladesh 35 NR 56 44 4.5 Longitudinal AD R NOCLIN NOMED
Hu et al,44 2021 US 129 Diverse 40 60 10.9 Retrospective AD R NOCLIN MED
Jáuregui et al,45 2021 Mexico 631 Middle-upper 53 47 3.0 Retrospective AD R + ED NOCLIN NOMED

JAMA Pediatrics Published online November 7, 2022 (Reprinted)

Jia et al,46 2021 China 2146 Diverse 0 100 17.5 Longitudinal AD R + ED NOCLIN NOMED
Kim et al,47 2021 Japan 290 Diverse 52 48 4.8 Longitudinal T, HD R + ED NOCLIN NOMED
Kim et al,48 2021 Japan 171 NR 57 43 9.7 Longitudinal T, HD, AD R NOCLIN NOMED
López Gil et al,49 2021 Spain 1099 NR 50 50 4.2 Retrospective AD R NOCLIN NOMED
López-Bueno et al,50 2020 Spain 860 NR 51 49 4.0 Retrospective AD R + ED NOCLIN NOMED
Ma et al,51 2021 China 208 NR 53 47 8.9 Longitudinal AD R + ED NOCLIN NOMED
Maheux et al,52 2021 US 704 Diverse 48 52 15.1 Longitudinal SM R NOCLIN NOMED
Maltoni et al,53 2021 Italy 51 NR 100 0 14.7 Longitudinal AD R NOCLIN NOMED
McArthur et al,4 2021 Canada 1333 Middle-upper 53 47 9.5 Longitudinal AD R NOCLIN NOMED
Medrano et al,54 2021 Spain 106 Diverse 49 51 12.0 Longitudinal AD R NOCLIN NOMED
Mirhajianmoghadam et al,55 US 38 NR 50 50 8.1 Retrospective AD R + ED NOCLIN NOMED
2021

© 2022 American Medical Association. All rights reserved.

Mohan et al,56 2021 India 217 Diverse 47 53 13.5 Retrospective AD R + ED NOCLIN NOMED
Moore et al,57 2021 Canada 1526 Middle-upper 48 52 8.1 Longitudinal AD R NOCLIN NOMED
Morrison et al,15 2021 Slovenia 62 NR 50 50 12.0 Longitudinal AD R NOCLIN NOMED
Nathan et al,58 2021 Australia 121 NR 54 46 7.0 Retrospective AD R NOCLIN NOMED
Ng et al,59 2021 Hong Kong 64 NR NR NR 4.4 Longitudinal AD R NOCLIN NOMED
Delisle Nyström et al,60 2020 Sweden 100 NR 58 42 4.0 Longitudinal AD R NOCLIN NOMED

Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
Okely et al,61 2021 Global 852 NR 39 61 4.0 Longitudinal AD R NOCLIN NOMED
Ostermeier et al,62 2021 Canada 48 Middle-upper 51 49 11.0 Longitudinal AD R NOCLIN NOMED
Peddie et al,63 2021 New Zealand 35 Diverse 100 0 16.6 Longitudinal AD R + ED NOCLIN NOMED
Pietrobelli et al,16 2021 Italy 32 NR 50 50 12.8 Longitudinal AD R NOCLIN NOMED

jamapediatrics.com
Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic

(continued)
 Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic Original Investigation Research

9 (4.1) years. Only 9 (20%) of the studies included in this meta-

analysis reported data on the race or ethnicity of their sample,

Sample sizes for data extracted from studies (and not always the number reported for the study as a whole).
condition
and the data on racial and ethnic categories among these 9 stud-
Medical

NOMED
NOMED
NOMED
NOMED
NOMED
NOMED
NOMED
NOMED

NOMED
NOMED
NOMED
ies were inconsistently reported. Studies used parent-

MED
reported (29 studies [63%]) or child-reported (17 studies [37%])
data. In terms of context of use, 29 studies reported changes
condition

in recreational screen use (17 studies for recreational plus edu-

NOCLIN
NOCLIN
NOCLIN
NOCLIN
NOCLIN

NOCLIN
NOCLIN
NOCLIN
NOCLIN
NOCLIN
NOCLIN
Clinical

CLIN
cation use). Most studies (28 [61%]) reported longitudinal es-
timates of change in screen time; the remaining 18 studies
(39%) were retrospective estimates of prepandemic data. Of
the 46 included studies, 14 were from Asia (30%), 12 from
purpose
R + ED

R + ED

R + ED

R + ED

R + ED
Screen

Europe (26%), 12 from North America (26%), 3 from Australia

R
R

R
R
R

R
or New Zealand (7%), 2 from South America (4%), and 2 from
the Middle East (4%), and 1 study (2%) had pooled data from

T, PC, VG, HD, AD

multiple countries. The mean study quality score was 6.8
Screen type

HD, SM, AD

(range, 3-9) (eTable 3 in the Supplement).

SM, VG, AD
SM, VG, AD
T, PC, HD

HD, PC

SM, social media; T, television; VG, videogames.

Meta-analysis
AD

AD
AD

AD
AD
AD

From a baseline value of 162 min/d (2.7 h/d), total daily screen
time across all children increased during the COVID-19 pan-
Retrospective
Retrospective

Retrospective

Retrospective

Retrospective
Study design

Longitudinal

Longitudinal

Longitudinal

Longitudinal
Longitudinal
Longitudinal
Longitudinal

demic by 84 min/d (90% CI, 51-116 min/d), corresponding to a

moderate effect size when standardized (Figure 2). Between-
study heterogeneity was small as summarized by a τ statistic
of 0.3 SDs (90% CI, 0.2-0.5 SDs).
Moderator analyses (Table 2)73 revealed that increases
Age, y

in screen time were particularly marked for individuals 12 to

11.9
11.1

13.9
10.1
11.2
12.0
10.1
5.5
5.8

4.5
9.5

7.3

18 years of age, whose total daily screen time increased by

110 min/d (k = 26; 90% CI, 72-149 min/d), corresponding to a
Female, %

moderate to large effect size. The increase in total daily screen

a

time for preschoolers and primary school children was smaller—

NR, not reported; PC, personal computer; R, recreational; R + ED, R and ED combined; SES, socioeconomic status;
NR
48
41
53
50
17
52
67
52

52
53

approximately 65 min/d—corresponding to a moderate effect

9

MED, known medical condition; NOCLIN, no known clinical condition; NOMED, no known medical condition;

size (preschool k = 12 [mean, 66 min/d; 90% CI, 27-106 min/d];

Abbreviations: AD, all devices; CLIN, diagnosed clinical condition; ED, educational; HD, handheld devices;

primary school k = 49 [mean, 65 min/d; 90% CI, 36-95 min/d]).

Male, %

Time spent on both handheld devices and personal comput-

NR
91
52
59
47
50
83
48
33
48

48
47

ers increased by approximately 45 min/d on both types of de-

vices, corresponding to a moderate to large effect size (hand-
held device k = 20 [mean, 44 min/d; 90% CI, 11-77 min/d];
personal computer k = 13 [mean, 46 min/d; 90% CI, 12-81 min/
d]). Moderator analyses also revealed that changes in total daily
SES
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR

screen time were larger for sample estimates in which the data
were reported retrospectively (116 min/d; 90% CI, 95-137 min/d;
k = 36) rather than longitudinally (65 min/d; 90% CI, 50-80
2516
1237

1711

1537

2426

1793
No.a
Table 1. Characteristics of the Included Studies (continued)

267

147

131

103
47

54

min/d; k = 51). Both estimates were in the range of moderate

effect sizes.
Moderator analyses (Table 2) signaled possible increases
Netherlands
Netherlands
South Korea

South Korea

in television viewing, video gaming, and social media use.

Hong Kong
Argentina
Germany
Portugal
Country

Changes in daily screen time were also possibly larger for

Global

China
Israel
India

sample estimates with higher baseline (pre–COVID-19) screen

time levels, sample estimates of recreational screen time,
sample estimates representing children and adolescents with
weight-related medical diagnoses, and sample estimates based
Schnaiderman et al,66 2021

Shoshani and Kor,68 2021

on parental reports. However, sampling uncertainty in each of

Ten Velde et al,69 2021
Schmidt et al,67 2020

these outcomes was too large to be definitive (ie, 90% CIs in-
Welling et al,14 2022
Saxena et al,65 2021
Rebelo et al,25 2021
Ribner et al,64 2021

Zhang et al,72 2021

Xiang et al,70 2020
Yum et al,71 2021

cluded a wide range of trivial values). Sampling uncertainty

Seo et al,24 2021

for the remaining moderators shown in Table 2 (ie, sex, re-

gional and seasonal characteristics, studies of samples with
Source

clinical diagnoses, and studies conducted over different du-

rations) should be interpreted as unclear.

jamapediatrics.com (Reprinted) JAMA Pediatrics Published online November 7, 2022 E5

© 2022 American Medical Association. All rights reserved.

Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
 Research Original Investigation Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic

Figure 2. Contributing Studies for Change in Screen Time Before and During the COVID-19 Pandemic

Mean change in screen

Source time, min (90% CI)
Morrison et al,15 2021 –15 (–29 to –2)
Welling et al,14 2022 –9 (–125 to 108)
Burkart et al,37 2022 20 (16 to 23)
Shoshani and Kor,68 2021 20 (10 to 30)
Delisle Nyström et al,60 2020 30 (11 to 49)
Ostermeier et al,61 2021 30 (22 to 38)
Kim et al,47 2021 40 (30 to 51)
Ribner et al,64 2021 47 (46 to 48)
Eales et al,41 2021 50 (25 to 74)
Ghanamah and Eghbaria-Ghanamah,42 2021 54 (27 to 81)
Okely et al,61 2021 57 (45 to 69)
Nathan et al,58 2021 57 (29 to 85)
Schmidt et al,67 2020 59 (55 to 64)
Ma et al,51 2021 61 (31 to 90)
Ten Velde et al,69 2021 61 (38 to 84)
Ng et al,59 2021 69 (42 to 96)
Aguilar-Farias et al,34 2021 83 (59 to 108)
Peddie et al,63 2021 84 (44 to 124)
Hossain et al,43 2021 85 (35 to 134)
Jáuregui et al,45 2021 95 (88 to 102)
López-Gil et al,49 2021 100 (97 to 103)
McArthur et al,4 2021 102 (99 to 105)
Medrano et al,54 2021 108 (55 to 161)
Rebelo et al,25 2021 119 (61 to 177)
Mohan et al,56 2021 120 (70 to 170)
Garcia et al,26 2021 120 (77 to 164)
Beck et al,35 2021 132 (67 to 197)
Mirhajianmoghadam et al,55 2021 138 (99 to 177)
Moore et al,57 2021 138 (101 to 176)
Hu et al,44 2021 141 (100 to 182)
Xiang et al,70 2020 144 (77 to 210)
Cardy et al,38 2021 159 (147 to 171)
López-Bueno et al,50 2020 167 (160 to 174)
Maltoni et al,53 2021 174 (89 to 259)
Schnaiderman et al,66 2021 180 (105 to 255)
Cheng et al,40 2021 206 (167 to 246)
Zhang et al,72 2021 266 (134 to 398)
The studies are presented in order
Pietrobelli et al,16 2021 292 (210 to 373)
of smallest to largest change in
Pooled change
screen time. The square data markers
Minutes 84 (51 to 116)
indicate the degree of change, with
Standardized units 0.8 (0.5 to 1.1)
the lines through the markers
–200 –100 0 100 200 300 400 indicating 90% CIs. The diamond
Mean change in screen data marker indicates the overall
time, min (90% CI) pooled effect based on the
included studies.

Publication Bias and Outliers
The standardized slope of the regression line representing pub-
lication bias was a trivial effect size (β = 0.09; 90% CI, −0.06
to 0.25) (eFigure in the Supplement). A single outlier was iden-
tified against the weighted threshold of P < .001. The direc-
tion or effect sizes of study outcomes were not sensitive to
the removal of this outlier.
Discussion
This meta-analysis of 46 studies (146 effect sizes) from 29 017
children and adolescents revealed that, on average, screen time
increased by 52%, or 84 min/d (1.4 h/d), during the pan-
demic. Compared with a prepandemic baseline value of 162
min/d (2.7 h/d), this increase corresponds to a daily mean of
246 minutes of screen time per day (4.1 h/d) across all chil-
dren and adolescents during the pandemic. This substantial
change in screen time is more than what can be expected ac-
cording to developmental changes19,20 and time trends.21 Sub-
stantial mean increases were observed in samples examining
changes in recreational screen time alone (increase of 84 min/d)
as well as combined estimates of recreational plus educa-
tional (increase of 68 min/d) screen time from prior to during
the pandemic. As such, changes in screen time estimated in
this study can very likely be associated with the unprec-
edented disruptions of the COVID-19 pandemic. These find-
ings should be considered along with another meta-analysis
suggesting a 32% decrease in children’s engagement in mod-
erate to vigorous physical activity during the pandemic.74
Policy-relevant pandemic recovery planning and resource
allocation should therefore consider how to help children,

E6 JAMA Pediatrics Published online November 7, 2022 (Reprinted) jamapediatrics.com

© 2022 American Medical Association. All rights reserved.

Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
 Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic Original Investigation Research

Table 2. Moderator Results of the Changes in Daily Screen Time Comparing Before vs During COVID-19

Characteristic ka Mean (90% CI), min/db β (90% CI)c

Categorical moderators
Device type or content
Handheld devices 20 44 (11 to 77)d 0.83 (0.21 to 1.45)d
d
Personal computer 13 46 (12 to 81) 0.90 (0.24 to 1.59)d
Television 11 55 (10 to 118) 0.49 (0.09 to 1.05)
Videogaming 9 39 (4 to 73) 0.64 (0.07 to 1.20)
Social media 6 36 (−2 to 75) 0.35 (−0.02 to 0.72)
Age group
Preschool 12 66 (27 to 106) 0.64 (0.26 to 1.02)d
Primary school 49 65 (36 to 95) 0.63 (0.34 to 0.91)d
Secondary school 26 110 (72 to 149) 1.06 (0.69 to 1.43)d
a
The number of independent
Sex
samples used for deriving the
d
Female 15 68 (33 to 102) 0.66 (0.32 to 0.99) estimated mean value.
Male 17 74 (39 to 109) 0.72 (0.38 to 1.05)d b
Mean changes in total daily screen
Difference e
96 f
−6 (−55 to 42) −0.06 (−0.53 to 0.41) time and individual categories of
screen time reported in minutes per
Context
day. Mean values were calculated
Educational and recreational 33 68 (36 to 100) 0.66 (0.35 to 0.97) with the remaining moderators
combined held constant at their mean values.
Recreational 54 84 (50 to 119) 0.82 (0.48 to 1.15) c
Standardized effect sizes were
Differencee 51f −16 (−37 to 4) −0.16 (−0.36 to 0.04) calculated by dividing mean
Design changes by the corresponding SD
for the category of screen time.
Longitudinal 51 65 (50 to 80) 0.63 (0.49 to 0.78)d d
Effect sizes with adequate precision
Retrospective 36 116 (95 to 137) 1.12 (0.91 to 1.32)d at the 90% CI (ie, when the chance
Differencee 38f 51 (26 to 75) 0.49 (0.25 to 0.72)d of an outcome including both
Clinical condition substantial negative and positive
values [ie, values >0.2 and
No 83 76 (44 to 108) 0.73 (0.42 to 1.04) <−0.2 SDs, respectively] was
Yes 4 84 (28 to 139) 0.81 (0.27 to 1.35) less than 5%).
e
Differencee 40f 8 (−39 to 55) 0.08 (−0.38 to 0.53) Differences in estimated mean
Other medical condition changes in total daily screen time
were calculated with sex = female,
No 71 76 (44 to 107) 0.73 (0.42 to 1.04) design = longitudinal, and clinical
Yes 16 112 (67 to 157) 1.08 (0.64 to 1.51) status = no as the reference values.
f
Differencee 60f 36 (−1 to 74) 0.35 (−0.01 to 0.71) The df is reported instead of the
k value.
Continuous moderatorsg
g
Continuous moderators were
Baseline 46 26 (6 to 46) 0.25 (0.06 to 0.44)
analyzed by estimating the
Quality 46 9 (−15 to 32) 0.08 (−0.15 to 0.31) difference in mean changes
Region 46 −5 (−42 to 32) −0.05 (−0.40 to 0.30) between studies with lower (mean,
−1 SD) and higher (mean, 1 SD)
Duration 46 −4 (−32 to 24) −0.04 (−0.31 to 0.23)
values for total daily screen time.73

adolescents, and families to “sit less and play more” to meet
the 24-hour movement guidelines.75
In this meta-analysis, we identified several moderators that
explained existing heterogeneity across studies examining
changes in screen time before vs during the pandemic. Changes
were larger for individuals 12 to 18 years of age (110 min/d) com-
pared with preschoolers (66 min/d) and middle school chil-
dren (65 min/d). Adolescents were more likely than their
younger counterparts to own and access digital devices.76 This
finding could also be explained by the fact that adolescence
is marked by an increased emphasis on both a wider interper-
sonal and virtual peer network as well as the development of
romantic relationships.77 In most circumstances, the social dis-
tancing restrictions implemented during the pandemic pro-
hibited face-to-face social interactions between children and
adolescents from different households, especially early in the
pandemic. Therefore, it is likely that they resorted to and re-
lied on digital devices to stay connected. This finding aligns
with a recent census of screen use among children and ado-
lescents, in which 83% of respondents reported using screens
to stay connected with family and friends.78 Adolescents were
also more likely than younger children during the pandemic
to seek new outlets for creative expression, learning new skills
and building on existing skills in a remote context, much of
which took place on digital devices.78
The estimated mean changes in screen time spent on hand-
held devices (44 min/d) and personal computers (46 min/d)
were particularly marked, whereas changes in television, gam-
ing, and social media were similar. This finding aligns with the
observation that, as devices became a central component of
daily living and interactions during the pandemic—for work,
schooling, learning, socialization, and recreation alike—1 in 5

jamapediatrics.com (Reprinted) JAMA Pediatrics Published online November 7, 2022 E7

© 2022 American Medical Association. All rights reserved.

Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
 Research Original Investigation
parents reportedly purchased new devices for their children,
primarily computers and handheld devices.79 Handheld de-
vices and personal computers also provide access to text mes-
saging, instant messaging, video chatting and sharing, etc,
which children and adolescents are more likely to engage in
to connect with peers.
Although the observed mean values were both moderate
effect sizes, there was a larger range of increases in screen time
estimated when prepandemic screen time data were col-
lected in studies retrospectively (90% CI, 95-116 min/d) rather
than longitudinally (90% CI, 50-80 min/d). Given the unprec-
edented nature of the pandemic as well as the time-sensitive
need to study pandemic-related associations in real time, some
scholars collected pandemic data in a largely pragmatic man-
ner, including the use of retrospective recall of prepandemic
experiences and behaviors. However, retrospective study de-
signs are vulnerable to recall bias.27 For example, parents may
have become more acutely aware of their children’s screen time
during lockdowns, which may have biased their perception of
and ability to accurately recall their children’s prepandemic
screen time. Comparatively speaking, longitudinal designs
are often more methodologically rigorous. As such, within-
person studies of child and adolescent screen time should be
more heavily relied on to inform decision-making regarding
policy and practice given their scope for enhanced precision
of estimation.
Although we examined duration, content, and context of
use in this meta-analysis, we could not examine how chil-
dren and adolescents were using screens (eg, solitary view-
ing, gaming with others, or video chatting). It is possible, for
example, that some youths used screens as a supportive tool
for connecting with peers and other supports during physical
distancing, which could explain their increased use. Children
and adolescents who used screens to coview or connect with
others during the pandemic had half as much screen time as
their peers who viewed screens in a solitary manner.80 Thus,
future research should examine duration of screen time and
its association with whatever devices or platforms children and
adolescents are using, examine how they are engaging with
screens, and determine when and for whom problematic screen
use may develop.81
Studies have found small associations between in-
creased screen use among children and poor mental health both
before (see Eirich et al11 for a meta-analysis) and during the
pandemic82-85; however, the association may be nonlinear. That
is, there is support for an inverted U-shaped association be-
tween screen time and well-being—the “Goldilocks hypoth-
esis”—in which children who receive less than 1 hour of screen
time per day and those who receive high doses of screen time
have been shown to have the poorest psychosocial function-
ing compared with children with moderate screen use.86 Thus,
restricting screens altogether is likely not a feasible or opti-
mal solution to managing children’s and adolescents’ screen
use during the pandemic or afterward. Understanding how
screens have been used during the COVID-19 pandemic, for
better and for worse,87 and determining who is at greatest risk
for sustained problematic outcomes require priority in future
studies. Cohort study designs with repeated measures that can
E8 JAMA Pediatrics Published online November 7, 2022 (Reprinted)
© 2022 American Medical Association. All rights reserved.
Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic
account for changes in screen use and mental health before,
during, and after the COVID-19 pandemic will be particularly
important for this endeavor.
Implications
The observed increase in screen time during the COVID-19 pan-
demic may be temporary and context dependent for some
youths (eg, those isolated during school closures). However,
for others, sustained problematic screen use habits may be
formed. Practitioners working with children, adolescents, and
families should focus on promoting healthy device habits
among youths, which can include moderating and monitor-
ing daily use, choosing age-appropriate programs, and priori-
tizing device-free time with family and friends. Youths should
be prompted to think about how they use screens and whether
they can focus their time on screens to meaningfully connect
with others or as a creative outlet. It is also critical to discuss
balancing screen use with other important daily functions, such
as sleep and physical activity. Last, given that screen use is of-
ten interconnected among family members, that parents’ level
of screen use is strongly associated with children’s screen use,88
and that parents’ stress during the pandemic was associated
with children’s increased duration of screen use,4 it is impor-
tant for practitioners to speak jointly with youths and their
caregivers to effect change in familywide screen use.89
Limitations
This study had several limitations. First, although there was rep-
resentative coverage of various continents in this meta-analysis,
there were no samples from South Africa and limited samples
from South America and the Middle East. Thus, findings may
be relevant only to specific geographic regions of the world. Sec-
ond, no reports of screen time were validated against passive
sensing apps.90 Third, only 1 study explicitly reported that all
participants were engaging in virtual learning, and included
samples were homogeneous in terms of socioeconomic status,
precluding consideration of these variables as potential mod-
erators. Greater diversity in sampling for future research stud-
ies on child and adolescent screen use is urgently needed.
Conclusions
The COVID-19 pandemic led to substantial changes in daily rou-
tines of children and adolescents. This systematic review and
meta-analysis revealed that their screen time during the pan-
demic increased by 52% compared with prepandemic baseline
estimates, which is greater than what would be expected based
on age changes and time trends. Recovery initiatives should
focus on promoting healthy device habits among children and
adolescents, including moderating daily use, monitoring con-
tent, and promoting the use of screens as a creative outlet and
to meaningfully connect with others. Cohort study designs with
repeated measurement of screen time that can account for
developmental change, as well as preexisting risks and stable
contextual factors or vulnerabilities, are needed to disentangle
the associations of the COVID-19 pandemic with the screen time
and mental health outcomes of children and adolescents.
jamapediatrics.com
 Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic
ARTICLE INFORMATION
Accepted for Publication: August 10, 2022.
Published Online: November 7, 2022.
doi:10.1001/jamapediatrics.2022.4116
Author Contributions: Drs Madigan and Neville
had full access to all of the data in the study and
take responsibility for the integrity of the data
and the accuracy of the data analysis.
Concept and design: Madigan, Eirich, Neville.
Acquisition, analysis, or interpretation of data:
All authors.
Drafting of the manuscript: Madigan, Eirich, Pador,
Neville.
Critical revision of the manuscript for important
intellectual content: Eirich, McArthur, Neville.
Statistical analysis: Eirich, Neville.
Administrative, technical, or material support:
Madigan, Eirich, Pador.
Supervision: Madigan.
Conflict of Interest Disclosures: None reported.
Additional Information: Data extracted from
included studies, data used for the meta-analysis,
and SAS mixed-model code are available on
reasonable request to the corresponding author.
REFERENCES
1. Racine N, Hetherington E, McArthur BA, et al.
Maternal depressive and anxiety symptoms before
and during the COVID-19 pandemic in Canada:
a longitudinal analysis. Lancet Psychiatry. 2021;8
(5):405-415. doi:10.1016/S2215-0366(21)00074-2
2. Pierce M, Hope H, Ford T, et al. Mental health
before and during the COVID-19 pandemic:
a longitudinal probability sample survey of the
UK population. Lancet Psychiatry. 2020;7(10):
883-892. doi:10.1016/S2215-0366(20)30308-4
3. Racine N, McArthur BA, Cooke JE, Eirich R,
Zhu J, Madigan S. Global prevalence of depressive
and anxiety symptoms in children and adolescents
during covid-19: a meta-analysis. JAMA Pediatr.
2021;175(11):1142-1150. doi:10.1001/jamapediatrics.
2021.2482
4. McArthur BA, Racine N, Browne D, McDonald S,
Tough S, Madigan S. Recreational screen time
before and during COVID-19 in school-aged
children. Acta Paediatr. 2021;110(10):2805-2807.
doi:10.1111/apa.15966
5. Vanderloo LM, Carsley S, Aglipay M, Cost KT,
Maguire J, Birken CS. Applying harm reduction
principles to address screen time in young children
amidst the COVID-19 pandemic. J Dev Behav Pediatr.
2020;41(5):335-336. doi:10.1097/DBP.
0000000000000825
6. McArthur BA, Browne D, Tough S, Madigan S.
Trajectories of screen use during early childhood:
predictors and associated behavior and learning
outcomes. Comput Human Behav. 2020;113:106501.
doi:10.1016/j.chb.2020.106501
7. Trinh MH, Sundaram R, Robinson SL, et al.
Association of trajectory and covariates of
children’s screen media time. JAMA Pediatr. 2020;
174(1):71-78. doi:10.1001/jamapediatrics.2019.4488
8. Carter B, Rees P, Hale L, Bhattacharjee D,
Paradkar MS. Association between portable
screen-based media device access or use and sleep
outcomes: a systematic review and meta-analysis.
jamapediatrics.com
© 2022 American Medical Association. All rights reserved.
Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
JAMA Pediatr. 2016;170(12):1202-1208.
doi:10.1001/jamapediatrics.2016.2341
9. Pearson N, Braithwaite RE, Biddle SJH,
van Sluijs EMF, Atkin AJ. Associations between
sedentary behaviour and physical activity in
children and adolescents: a meta-analysis. Obes Rev.
2014;15(8):666-675. doi:10.1111/obr.12188
10. Madigan S, McArthur BA, Anhorn C, Eirich R,
Christakis DA. Associations between screen use
and child language skills: a systematic review and
meta-analysis. JAMA Pediatr. 2020;174(7):665-675.
doi:10.1001/jamapediatrics.2020.0327
11. Eirich R, McArthur BA, Anhorn C, McGuinness C,
Christakis DA, Madigan S. Association of screen
time with internalizing and externalizing behavior
problems in children 12 years or younger:
a systematic review and meta-analysis. JAMA
Psychiatry. 2022;79(5):393-405. doi:10.1001/
jamapsychiatry.2022.0155
12. Adelantado-Renau M, Moliner-Urdiales D,
Cavero-Redondo I, Beltran-Valls MR,
Martínez-Vizcaíno V, Álvarez-Bueno C. Association
between screen media use and academic
performance among children and adolescents:
a systematic review and meta-analysis. JAMA Pediatr.
2019;173(11):1058-1067. doi:10.1001/jamapediatrics.
2019.3176
13. Radesky J, Hiniker A, McLaren C, et al.
Prevalence and characteristics of manipulative
design in mobile applications used by children.
JAMA Netw Open. 2022;5(6):e2217641.
doi:10.1001/jamanetworkopen.2022.17641
14. Welling MS, Abawi O, van den Eynde E, et al.
Impact of the COVID-19 pandemic and related
lockdown measures on lifestyle behaviors and
well-being in children and adolescents with severe
obesity. Obes Facts. 2022;15(2):186-196.
doi:10.1159/000520718
15. Morrison SA, Meh K, Sember V, Starc G, Jurak G.
The effect of pandemic movement restriction
policies on children’s physical fitness, activity,
screen time, and sleep. Front Public Health. 2021;9:
785679. doi:10.3389/fpubh.2021.785679
16. Pietrobelli A, Fearnbach N, Ferruzzi A, et al.
Effects of COVID‐19 lockdown on lifestyle behaviors
in children with obesity: longitudinal study update.
Obes Sci Pract. 2021;8(4):525–528. doi:10.1002/
osp4.581
17. UNESCO. Framework for reopening schools
supplement: from reopening to recovery—key
resources. March 2021. Accessed February 8, 2022.
https://www.unicef.org/media/94871/file/
Framework%20for%20Reopening%20Schools%
20Supplement-From%20Reopening%20to%
20Recovery-Key%20Resources.pdf
18. Rideout VJ, Robb MB. The Common Sense
Census: Media Use by Kids Age Zero to Eight.
Common Sense Media; 2020.
19. Rideout VJ, Robb MB. The Common Sense
Census: Media Use by Tweens and Teens. Common
Sense Media; 2019.
20. Bucksch J, Sigmundova D, Hamrik Z, et al.
International trends in adolescent screen-time
behaviors from 2002 to 2010. J Adolesc Health.
2016;58(4):417-425. doi:10.1016/j.jadohealth.2015.
11.014
(Reprinted) JAMA Pediatrics Published online November 7, 2022
Original Investigation Research
21. Sigmund E, Sigmundová D, Badura P, Kalman M,
Hamrik Z, Pavelka J. Temporal trends in overweight
and obesity, physical activity and screen time
among Czech adolescents from 2002 to 2014:
a National Health Behaviour in School-aged
Children study. Int J Environ Res Public Health. 2015;
12(9):11848-11868. doi:10.3390/ijerph120911848
22. DiBartolo PM, Grills AE. Who is best at
predicting children’s anxiety in response to a social
evaluative task? a comparison of child, parent,
and teacher reports. J Anxiety Disord. 2006;20(5):
630-645. doi:10.1016/j.janxdis.2005.06.003
23. Fang K, Mu M, Liu K, He Y. Screen time and
childhood overweight/obesity: a systematic review
and meta-analysis. Child Care Health Dev. 2019;45
(5):744-753. doi:10.1111/cch.12701
24. Seo HR, Jung HS, Jung DS, Choi JW, Jo SH.
Acute impact of the coronavirus disease outbreak
on behavioral patterns and emotional states of
pediatric psychiatric patients and caregivers in
Daegu, South Korea. Psychiatry Investig. 2021;18
(9):913-922. doi:10.30773/pi.2021.0127
25. Rebelo AT, Pinto DH, Cunha R, et al. Impact of
one-year pandemic on children with autism
spectrum disorder. Cogent Med. 2021;8:2002558.
26. Garcia JM, Lawrence S, Brazendale K, Leahy N,
Fukuda D. Brief report: the impact of the COVID-19
pandemic on health behaviors in adolescents with
autism spectrum disorder. Disabil Health J. 2021;14
(2):101021. doi:10.1016/j.dhjo.2020.101021
27. Coughlin SS. Recall bias in epidemiologic
studies. J Clin Epidemiol. 1990;43(1):87-91.
doi:10.1016/0895-4356(90)90060-3
28. Covidence. Covidence systematic review
software. Accessed March 6, 2022. https://www.
covidence.org
29. National Heart, Lung, and Blood Institute.
Study quality assessment tools: quality assessment
tool for observational cohort and cross-sectional
studies. Updated July 2021. Accessed January 15,
2021. https://www.nhlbi.nih.gov/health-topics/
study-quality-assessment-tools
30. Yang M. A Review of Random Effects Modelling
in SAS. Centre for Multilevel Modelling; 2003.
31. Cohen J. Statistical Power Analysis for the
Behavioral Sciences. 2nd ed. Lawrence Erlbaum;
1988.
32. Hopkins WG, Marshall SW, Batterham AM,
Hanin J. Progressive statistics for studies in sports
medicine and exercise science. Med Sci Sports Exerc.
2009;41(1):3-13. doi:10.1249/MSS.
0b013e31818cb278
33. Cumming G. The new statistics: why and how.
Psychol Sci. 2014;25(1):7-29. doi:10.1177/
0956797613504966
34. Aguilar-Farias N, Toledo-Vargas M,
Miranda-Marquez S, et al. Sociodemographic
predictors of changes in physical activity, screen
time, and sleep among toddlers and preschoolers
in Chile during the COVID-19 pandemic. Int J
Environ Res Public Health. 2021;18(1):176.
doi:10.3390/ijerph18010176
35. Beck AL, Huang JC, Lendzion L, Fernandez A,
Martinez S. Impact of the coronavirus disease
2019 pandemic on parents’ perception of health
behaviors in children with overweight and obesity.
E9
 Research Original Investigation
Acad Pediatr. 2021;21(8):1434-1440. doi:10.1016/j.
acap.2021.05.015
36. Brzęk A, Strauss M, Sanchis-Gomar F,
Leischik R. Physical activity, screen time, sedentary
and sleeping habits of Polish preschoolers
during the COVID-19 pandemic and WHO’s
recommendations: an observational cohort study.
Int J Environ Res Public Health. 2021;18(21):11173.
doi:10.3390/ijerph182111173
37. Burkart S, Parker H, Weaver RG, et al. Impact of
the COVID-19 pandemic on elementary schoolers’
physical activity, sleep, screen time and diet:
a quasi-experimental interrupted time series study.
Pediatr Obes. 2022;17(1):e12846. doi:10.1111/ijpo.
12846
38. Cardy RE, Dupuis A, Anagnostou E, et al.
Characterizing changes in screen time during the
COVID-19 pandemic school closures in Canada
and its perceived impact on children with autism
spectrum disorder. Front Psychiatry. 2021;12:702774.
doi:10.3389/fpsyt.2021.702774
39. Chen IH, Chen CY, Pakpour AH, et al.
Problematic internet-related behaviors mediate
the associations between levels of internet
engagement and distress among schoolchildren
during COVID-19 lockdown: a longitudinal structural
equation modeling study. J Behav Addict. 2021;10
(1):135-148. doi:10.1556/2006.2021.00006
40. Cheng HP, Wong JSL, Selveindran NM,
Hong JYH. Impact of COVID-19 lockdown on
glycaemic control and lifestyle changes in children
and adolescents with type 1 and type 2 diabetes
mellitus. Endocrine. 2021;73(3):499-506.
doi:10.1007/s12020-021-02810-1
41. Eales L, Gillespie S, Alstat RA, Ferguson GM,
Carlson SM. Children’s screen and problematic
media use in the United States before and during
the COVID-19 pandemic. Child Dev. 2021;92(5):
e866-e882. doi:10.1111/cdev.13652
42. Ghanamah R, Eghbaria-Ghanamah H. Impact of
COVID-19 pandemic on behavioral and emotional
aspects and daily routines of Arab Israeli children.
Int J Environ Res Public Health. 2021;18(6):2946.
doi:10.3390/ijerph18062946
43. Hossain MS, Deeba IM, Hasan M, et al.
International study of 24-h movement behaviors
of early years (SUNRISE): a pilot study from
Bangladesh. Pilot Feasibility Stud. 2021;7(1):176.
doi:10.1186/s40814-021-00912-1
44. Hu P, Samuels S, Maciejewski KR, et al.
Changes in weight-related health behaviors and
social determinants of health among youth with
overweight/obesity during the COVID-19 pandemic.
Child Obes. 2021;18(6):369-382. doi:10.1089/chi.
2021.0196
45. Jáuregui A, Argumedo G, Medina C,
Bonvecchio-Arenas A, Romero-Martínez M,
Okely AD. Factors associated with changes in
movement behaviors in toddlers and preschoolers
during the COVID-19 pandemic: a national
cross-sectional study in Mexico. Prev Med Rep.
2021;24:101552. doi:10.1016/j.pmedr.2021.101552
46. Jia P, Zhang L, Yu W, et al. Impact of COVID-19
lockdown on activity patterns and weight status
among youths in China: the COVID-19 Impact on
Lifestyle Change Survey (COINLICS). Int J Obes
(Lond). 2021;45(3):695-699. doi:10.1038/s41366-
020-00710-4
E10 JAMA Pediatrics Published online November 7, 2022 (Reprinted)
© 2022 American Medical Association. All rights reserved.
Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic
47. Kim H, Ma J, Lee S, Gu Y. Change in Japanese
children’s 24-hour movement guidelines and
mental health during the COVID-19 pandemic. Sci Rep.
2021;11(1):22972. doi:10.1038/s41598-021-01803-4
48. Kim H, Ma J, Kim J, Xu D, Lee S. Changes in
adherence to the 24-hour movement guidelines
and overweight and obesity among children in
northeastern Japan: a longitudinal study before and
during the COVID-19 pandemic. Obesities. 2021;1
(3):167-177. doi:10.3390/obesities1030015
49. López-Gil JF, Tremblay MS, Brazo-Sayavera J.
Changes in healthy behaviors and meeting 24-h
movement guidelines in Spanish and Brazilian
preschoolers, children and adolescents during the
COVID-19 lockdown. Children (Basel). 2021;8(2):83.
doi:10.3390/children8020083
50. López-Bueno R, Calatayud J, Ezzatvar Y, et al.
Association between current physical activity and
current perceived anxiety and mood in the initial
phase of COVID-19 confinement. Front Psychiatry.
2020;11:729. doi:10.3389/fpsyt.2020.00729
51. Ma D, Wei S, Li SM, et al. Progression of myopia
in a natural cohort of Chinese children during
COVID-19 pandemic. Graefes Arch Clin Exp
Ophthalmol. 2021;259(9):2813-2820. doi:10.1007/
s00417-021-05305-x
52. Maheux AJ, Nesi J, Galla BM, Roberts SR,
Choukas-Bradley S. #Grateful: longitudinal
associations between adolescents’ social media use
and gratitude during the COVID-19 pandemic. J Res
Adolesc. 2021;31(3):734-747. doi:10.1111/jora.12650
53. Maltoni G, Zioutas M, Deiana G, Biserni GB,
Pession A, Zucchini S. Gender differences in weight
gain during lockdown due to COVID-19 pandemic in
adolescents with obesity. Nutr Metab Cardiovasc Dis.
2021;31(7):2181-2185. doi:10.1016/j.numecd.2021.
03.018
54. Medrano M, Cadenas-Sanchez C, Oses M,
Arenaza L, Amasene M, Labayen I. Changes in
lifestyle behaviours during the COVID-19
confinement in Spanish children: a longitudinal
analysis from the MUGI project. Pediatr Obes.
2021;16(4):e12731. doi:10.1111/ijpo.12731
55. Mirhajianmoghadam H, Piña A, Ostrin LA.
Objective and subjective behavioral measures
in myopic and non-myopic children during the
COVID-19 pandemic. Transl Vis Sci Technol. 2021;10
(11):4. doi:10.1167/tvst.10.11.4
56. Mohan A, Sen P, Shah C, Jain E, Jain S.
Prevalence and risk factor assessment of digital eye
strain among children using online e-learning during
the COVID-19 pandemic: Digital Eye Strain Among
Kids (DESK Study-1). Indian J Ophthalmol. 2021;69
(1):140-144. doi:10.4103/ijo.IJO_2535_20
57. Moore SA, Faulkner G, Rhodes RE, et al.
Few Canadian children and youth were meeting the
24-hour movement behaviour guidelines 6-months
into the COVID-19 pandemic: follow-up from
a national study. Appl Physiol Nutr Metab. 2021;46
(10):1225-1240. doi:10.1139/apnm-2021-0354
58. Nathan A, George P, Ng M, et al. Impact of
COVID-19 restrictions on western Australian
children’s physical activity and screen time. Int J
Environ Res Public Health. 2021;18(5):2583.
doi:10.3390/ijerph18052583
59. Ng JYY, He Q, Chong KH, Okely AD, Chan CHS,
Ha AS. The impact of COVID-19 on preschool-aged
children’s movement behaviors in Hong Kong:
a longitudinal analysis of accelerometer-measured
data. Int J Environ Res Public Health. 2021;18(22):
11907. doi:10.3390/ijerph182211907
60. Delisle Nyström C, Alexandrou C, Henström M,
et al. International Study of Movement Behaviors
in the Early Years (SUNRISE): results from SUNRISE
Sweden’s pilot and COVID-19 study. Int J Environ
Res Public Health. 2020;17(22):8491. doi:10.3390/
ijerph17228491
61. Okely AD, Kariippanon KE, Guan H, et al.
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. BMC Public Health. 2021;21(1):940.
doi:10.1186/s12889-021-10852-3
62. Ostermeier E, Tucker P, Clark A, Seabrook JA,
Gilliland J. Parents’ report of Canadian elementary
school children’s physical activity and screen time
during the COVID-19 pandemic: a longitudinal
study. Int J Environ Res Public Health. 2021;18(23):
12352. doi:10.3390/ijerph182312352
63. Peddie MC, Scott T, Haszard JJ. Using a 24 h
activity recall (STAR-24) to describe activity in
adolescent boys in New Zealand: comparisons
between a sample collected before, and a sample
collected during the COVID-19 lockdown. Int J
Environ Res Public Health. 2021;18(15):8035.
doi:10.3390/ijerph18158035
64. Ribner AD, Coulanges L, Friedman S,
Libertus ME; I-FAM-Covid Consortium. Screen time
in the coronavirus 2019 era: international trends
of increasing use among 3- to 7-year-old children.
J Pediatr. 2021;239:59-66. doi:10.1016/j.jpeds.2021.
08.068
65. Saxena R, Gupta V, Rakheja V, Dhiman R,
Bhardawaj A, Vashist P. Lifestyle modification in
school-going children before and after COVID-19
lockdown. Indian J Ophthalmol. 2021;69(12):3623-
3629. doi:10.4103/ijo.IJO_2096_21
66. Schnaiderman D, Bailac M, Borak L, et al.
Psychological impact of COVID-19 lockdown in
children and adolescents from San Carlos de
Bariloche, Argentina: parents’ perspective. Article
in Spanish. Arch Argent Pediatr. 2021;119(3):170-176.
doi:10.5546/aap.2021.eng.170
67. Schmidt SCE, Anedda B, Burchartz A, et al.
Physical activity and screen time of children and
adolescents before and during the COVID-19
lockdown in Germany: a natural experiment. Sci Rep.
2020;10(1):21780. doi:10.1038/s41598-020-
78438-4
68. Shoshani A, Kor A. The mental health effects
of the COVID-19 pandemic on children and
adolescents: risk and protective factors. Psychol
Trauma. Published online December 20, 2021.
doi:10.1037/tra0001188
69. Ten Velde G, Lubrecht J, Arayess L, et al.
Physical activity behaviour and screen time in
Dutch children during the COVID-19 pandemic:
pre-, during- and post-school closures. Pediatr Obes.
2021;16(9):e12779. doi:10.1111/ijpo.12779
70. Xiang M, Zhang Z, Kuwahara K. Impact of
COVID-19 pandemic on children and adolescents’
lifestyle behavior larger than expected. Prog
Cardiovasc Dis. 2020;63(4):531-532. doi:10.1016/j.
pcad.2020.04.013
71. Yum HR, Park SH, Shin SY. Influence of
coronavirus disease 2019 on myopic progression
in children treated with low-concentration atropine.
jamapediatrics.com
 Global Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic
PLoS One. 2021;16(9):e0257480. doi:10.1371/
journal.pone.0257480
72. Zhang X, Cheung SSL, Chan HN, et al.
Myopia incidence and lifestyle changes among
school children during the COVID-19 pandemic:
a population-based prospective study. Br J
Ophthalmol. Published online August 2, 2021.
doi:10.1136/bjophthalmol-2021-319307
73. Gelman A. Scaling regression inputs by dividing
by two standard deviations. Stat Med. 2008;27
(15):2865-2873. doi:10.1002/sim.3107
74. Neville RD, Lakes KD, Hopkins WG, et al.
Global changes in child and adolescent physical
activity during the COVID-19 pandemic:
a systematic review and meta-analysis. JAMA Pediatr.
2022;176(9):886-894. doi:10.1001/jamapediatrics.
2022.2313
75. World Health Organization. To grow up healthy,
children need to sit less and play more. April 24,
2019. Accessed April 24, 2022. https://www.who.
int/news/item/24-04-2019-to-grow-up-healthy-
children-need-to-sit-less-and-play-more
76. Lauricella AR, Cingel DP, Blackwell C,
Wartella E, Conway A. The mobile generation:
youth and adolescent ownership and use of new
media. Commun Res Rep. 2014;31(4):357-364.
doi:10.1080/08824096.2014.963221
77. Urberg KA, Değirmencioğlu SM, Tolson JM,
Halliday-Scher K. The structure of adolescent peer
networks. Dev Psychol. 1995;31(4):540-547.
doi:10.1037/0012-1649.31.4.540
jamapediatrics.com
© 2022 American Medical Association. All rights reserved.
Downloaded From: https://jamanetwork.com/ Academia Espanola De Dermatology Y Venereologia by Nastiti Yusrin Husnati on 11/12/2022
78. Rideout V, Robb MB. The Role of Media During
the Pandemic: Connection, Creativity, and Learning
for Tweens and Teens. Common Sense Media; 2021.
79. Jennings NA, Caplovitz AG. Parenting and
tweens’ media use during the COVID-19 pandemic.
Psychol Pop Media. 2022;11(3):311-315.
doi:10.1037/ppm0000376
80. McArthur BA, Eirich R, McDonald S, Tough S,
Madigan S. Predictors of preadolescent children’s
recreational screen time duration during the
COVID-19 pandemic. J Dev Behav Pediatr. 2022;43
(6):353-361. doi:10.1097/DBP.0000000000001057
81. Christakis DA. The effects of infant media
usage: what do we know and what should we learn?
Acta Paediatr. 2009;98(1):8-16. doi:10.1111/j.1651-
2227.2008.01027.x
82. Li X, Vanderloo LM, Keown-Stoneman CDG,
et al. Screen use and mental health symptoms in
Canadian children and youth during the COVID-19
pandemic. JAMA Netw Open. 2021;4(12):e2140875.
doi:10.1001/jamanetworkopen.2021.40875
83. McArthur BA, Racine N, McDonald S, Tough S,
Madigan S. Child and family factors associated
with child mental health and well-being during
COVID-19. Eur Child Adolesc Psychiatry. Published
online July 24, 2021. doi:10.1007/s00787-021-
01849-9
84. Rosen ML, Rodman AM, Kasparek SW, et al.
Promoting youth mental health during the
COVID-19 pandemic: a longitudinal study. PLoS One.
2021;16(8):e0255294. doi:10.1371/journal.pone.
0255294
(Reprinted) JAMA Pediatrics Published online November 7, 2022
Original Investigation Research
85. Tandon PS, Zhou C, Johnson AM, Gonzalez ES,
Kroshus E. Association of children’s physical activity
and screen time with mental health during the
COVID-19 pandemic. JAMA Netw Open. 2021;4(10):
e2127892. doi:10.1001/jamanetworkopen.2021.
27892
86. Przybylski AK, Orben A, Weinstein N.
How much is too much? examining the relationship
between digital screen engagement and
psychosocial functioning in a confirmatory cohort
study. J Am Acad Child Adolesc Psychiatry. 2020;59
(9):1080-1088. doi:10.1016/j.jaac.2019.06.017
87. Browne D, Thompson DA, Madigan S.
Digital media use in children: clinical vs scientific
responsibilities. JAMA Pediatr. 2020;174(2):111-112.
doi:10.1001/jamapediatrics.2019.4559
88. Madigan S, Racine N, Tough S. Prevalence of
preschoolers meeting vs exceeding screen time
guidelines. JAMA Pediatr. 2020;174(1):93-95.
doi:10.1001/jamapediatrics.2019.4495
89. Marsh S, Foley LS, Wilks DC, Maddison R.
Family‐based interventions for reducing sedentary
time in youth: a systematic review of randomized
controlled trials. Obes Rev. 2014;15(2):117-133.
doi:10.1111/obr.12105
90. Radesky JS, Weeks HM, Ball R, et al.
Young children’s use of smartphones and tablets.
Pediatrics. 2020;146(1):e20193518. doi:10.1542/peds.
2019-3518
E11