23/03/24, 19:41 Screen time: Implications for early childhood cognitive development - ScienceDirect

Early Human Development

Volume 183, August 2023, 105792

Screen time: Implications for early childhood cognitive

development
Luiza Morrone Gastaud, Jéssica Puchalski Trettim, Carolina Coelho Scholl 1, Bárbara Borges Rubin, Fernanda Teixeira Coelho,
Gabriel Blank Krause, Natasha Mayer Ferreira, Mariana Bonati de Matos, Ricardo Tavares Pinheiro ,
Luciana de Avila Quevedo

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https://doi.org/10.1016/j.earlhumdev.2023.105792
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Highlights

• The negative effects that accompany the early screen exposure are extensive.

• There is a scarcity of studies on the topic in young children.

• Cognitive development was associated with lower maternal education and male
sex.

• Cognitive development was associated with 2 h or more of screen time/day.

Abstract

Background
Exposure and introduction to digital media, especially in children, are a current cause for concern. The negative links
associated with early screen exposure are extensive.

Aims
To evaluate the association between the time of exposure to a screen in children at 18 months of age and cognitive
development in a population-based sample in Southern Brazil.

Study design
This was a cross-sectional study corresponding to the fourth wave of a population-based cohort study with pregnant
women and later, their children living in the city of Pelotas, Southern Brazil.

Subjects

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23/03/24, 19:41 Screen time: Implications for early childhood cognitive development - ScienceDirect

The sample consisted of 470 children who completed the cognitive assessment.

Outcome measures
Cognitive development was assessed using the Bayley Scales of Infant Development - Third Edition (BSID-III). Exposure
to screen time was assessed using a questionnaire completed by the primary caregiver.

Results
Of the total, 58.8 % of the children had ≥1 h of screen time per day and the average on the cognitive scale of the entire
sample was 96.1 (SD = 14.0). Cognitive development was lower in children whose mothers had lower levels of education
(CI 95 % -4.9; −2.1), where boys (CI 95 % 3.2; 8.4) and in children exposed to 2 h or more of screen time/day (CI 95 % -3.6;
−0.5).

Conclusions
Exposure to screens may have a significant negative association with children's cognitive development and, therefore,
we seek to intervene and to give advice to parents and guardians about the true impact of digital media. Further
studies are necessary to consolidate the findings and to disclose information on the topic.

Introduction

Technological advances related to different forms of digital entertainment - television, computer, tablet, video games
and smartphones - are being increasingly introduced into families daily routines and activities. Here, this particular
routine is referred to as screen time [1]. In this context, care and concern about the time spent with digital media arise,
especially with children, in regards to the early exposure and introduction of digital media. The negative associations
that accompany the current culture of early screen exposure are extensive.

Studies that sought the motivation for the use of screens in childhood have identified different reasons ranging from
practicality of entertainment to the idea of it serving as a beneficial stimulus to development [2,3]. As a result, more
attention should focus on the negative impact of prolonged screen time on the children's lives.

The American Academy of Pediatrics and the Brazilian Society of Pediatrics created specific guidelines on the topic.
These associations recommend that children under 2 years of age should not be exposed to screens. After 2 years of age,
the screen time should be limited to 1 h per day up to 5 years of age, followed by schoolchildren with a maximum of 2 h
per day. Moreover, screen use must be avoided during meals and before bedtime. One should also evaluate contents
that are sexually explicit, extremely violent or inappropriate [4].

The first years of life, especially the initial 24 months, are marked by new brain connections and the development of
cognitive, language and motor skills. Thus, the recommendations regarding exposure to screens seek to avoid and, or
minimize possible harmful effects on the child's neuropsychomotor development [5]. Child development is a constant
process based on two aspects: the central nervous system - which in the first months of life has a migratory
proliferative action with neuronal differentiation - and the environment - which, through stimuli and interpersonal
interaction, promotes the enrichment of this dynamic process [6]. According to Piaget, cognitive development is
divided into stages. The first one (from birth to 2 years old) is the sensorimotor stage, which is characterized by actions
related to stimuli, such as touching, looking, listening [7]. Based on this, it is possible to observe that children, when
exposed to digital media, can replace important and beneficial activities for the neuro psychomotor growth and
development with screens.

The fragmentation of the development domains - physical, cognitive, language, motor, psychosocial - is carried out for
the purposes of study and research, since these domains are interconnected throughout life. If there is a delay in one of
these domains, it will influence the progress in other domains of development [8]. Following the same line of reason,
and according to Baltes' lifespan perspective, which characterizes development as lifelong. When changes occur across
lifespan; multidimensional, involves dynamic interaction of biological, psychological and social factors;
multidirectional, in which, according to age, the individual varies the degree of ability to acquire different evolutionary

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23/03/24, 19:41 Screen time: Implications for early childhood cognitive development - ScienceDirect

skills, such as balance, learning a new language, refining of vocabulary; and brain plasticity, which involves the ability
to perfect skills with practice and training [8].

Cognitive development encompasses activities related to perception, attention, memory, reasoning and imagination,
among others [9,10]. In the cognitive domain, the child's learning and memory develop from the first weeks after birth,
and a gradual understanding of language occurs. Around the second year of life, children acquire the ability to use
symbols, make simple representations, as well as solve easy problems [8]. When analyzing these developmental
milestones, it is important to consider the influence of media in this early period of life - considering that children
exposed to screens tend to engage in less thinking and problem solving, since cartoons and related activities do not
interact with the child.

Another possible mechanism that explains the impact of screen exposure on child development refers to the cognitive
processes involved in forming executive functions up to two years of age. The executive function includes crucial
abilities such as working memory, impulse inhibition, attention, and reasoning flexibility. Its development depends on
integrating several sources of sensory information [11]. Considering this, the fast-paced nature of media editing on
screens could impact the sensory information pathways and, in turn, the initial development of the executive function,
particularly in the area of attention [12].

Thus, we hypothesized that screen exposure would have a negative impact on cognitive development. Therefore, the
objective of this study was to assess the association between screen time and cognitive development of children at
18 months of age.

Section snippets

Material and methods

This was a cross-sectional study linked to a population-based cohort study, where the baseline was conducted
between the years 2016 and 2018. The initial sample was composed of women up to 24-weeks pregnant, who were
randomly selected from the census sectors in the urban area of Pelotas, a city in Southern Brazil. According to the 2010
Census of the Brazilian Institute of Geography and Statistics (IBGE), the urban area of Pelotas contains 488 census
sectors. Out of these, 244 (50 %) were…

Results

A total of 470 children completed the cognitive assessment in the present study. Table 1 shows the sample distribution.
Most mothers had 13 years of schooling or more (31.0 %), were working (62.7 %) and were from the socioeconomic class
C (middle class) (53.2 %). For children, 51.3 % were female and 13.5 % were premature, 66.7 % did not attend daycare,
59.6 % had at least one sibling, 56.8 % had restless sleep, 63.5 % always needed their parents to go back to sleep and
33.0 % of children had…

Discussion

Our results indicated that children aged 18 months who were exposed to digital media for 2 h or more a day had lower
scores in cognitive development compared to infants who had an exposure of less than 2 h. Although the consequences
to the development of children exposed to screens are still unclear, some studies already indicate some impairment in
the subjects [16].

Similarly, a recent study that evaluated 47 children aged 3 to 5 years in hospitals and primary care clinics in the United
States…

CRediT authorship contribution statement

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23/03/24, 19:41 Screen time: Implications for early childhood cognitive development - ScienceDirect

Luiza Morrone Gastaud - investigation, formal analysis, writing - original draft, writing - review & editing, final
approval. Jéssica Puchalski Trettim, Carolina Coelho Scholl, Bárbara Borges Rubin, Fernanda Teixeira Coelho -
conceptualization, investigation, writing - review & editing, final approval. Gabriel Blank Krause, Natasha Mayer
Ferreira - investigation, writing - review & editing, final approval. Mariana Bonati de Matos – conceptualization,
writing - review & editing, final approval. …

Funding

This work was supported by the National Council for Scientific and Technological Development (CNPq/Brazil) [Process
401726/2015-0 APP/Call 47/2014], the Bill & Melinda Gates Foundation, and the National Institute of Science and
Technology (INCT-DCEN). The sources of funding had no involvement in the study design, in the collection, analysis
and interpretation of data, in the writing of the manuscript, and in the decision to submit the manuscript for
publication.…

Ethics approval

All participants signed an informed consent form, authorizing their participation and that of their children in the
study. This study is part of a larger study that was approved by the Research Ethics Committee of the Catholic
University of Pelotas (CAAE 47807915.4.0000.5339, protocol 2.289.620) and the work has been carried out in
accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments
involving humans.…

Declaration of competing interest

None.…

Acknowledgements
We acknowledge the Bill & Melinda Gates Foundation, the Conselho Nacional de Desenvolvimento Científico e
Tecnológico (CNPq) and the Instituto Nacional de Ciência e Tecnologia (INCT) for their financial support. We are also
grateful to all the dyads who kindly participated in the study.…

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Cited by (0)

1 Present address: Postgraduate Program in Epidemiology, Federal University of Pelotas (UFPel), R. Mal. Deodoro, 1160 – Zip code 96020-220 –
Pelotas/RS – Brazil.

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