A systematic review and meta-analysis found associations between various contexts of screen use in early childhood and cognitive and psychosocial developmental outcomes.

In the study, published in JAMA Pediatrics, investigators from the University of Wollongong conducted a comprehensive search of seven databases from inception to December 31, 2023. They identified 100 observational studies, experimental studies, and randomized clinical trials examining the associations between contextual factors of screen use and cognitive or psychosocial development in 176,742 children aged 0 to 5.99 years.

The meta-analysis employed a 3-level approach using random-effects models. Effect sizes were reported as Pearson correlation coefficients (r). Heterogeneity was assessed using Q, I2, and τ2 statistics.

Among the key findings were:

• Program viewing was negatively associated with cognitive (r = –0.16, 95% confidence interval [CI] = –0.24 to –0.08) and psychosocial (r = –0.04, 95% CI = –0.07 to –0.01) outcomes. There was high heterogeneity for cognitive outcomes (I2 = 96.44%).
• Background television exposure was negatively associated with cognitive outcomes (r = –0.10, 95% CI = –0.18 to –0.02). There was minimal between-study heterogeneity (I2 = 18.9%).
• Age-inappropriate content was negatively associated with psychosocial outcomes (r = –0.11, 95% CI = –0.17 to –0.04). There was moderate heterogeneity (I2 within studies = 47.0%, I2 between studies = 48.0%).
• Caregiver screen use during child routines was negatively associated with psychosocial outcomes (r = –0.11, 95% CI = –0.20 to –0.03). There was moderate between-study heterogeneity (I2 = 49.5%).
• Co-use of screen media was positively associated with cognitive outcomes (r = 0.14, 95% CI = 0.03 to 0.25). There was considerable between-study heterogeneity (I2 = 71.6%).

The study also included narrative syntheses of experimental and randomized clinical trial findings, which generally supported the meta-analytic results. For instance, randomized clinical trials demonstrated the benefits of educational and prosocial content for enhanced literacy and socioemotional competence.

The investigators noted several limitations of the study, including heterogeneity in the operationalization of screen use contexts and measurement of developmental outcomes across studies. Additionally, much of the meta-analytic evidence was cross-sectional with a high risk of bias, limiting causal inferences.

The findings suggested that recommendations for healthy screen use in early childhood should consider contexts beyond simple time limits. The investigators emphasized the importance of encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers, while discouraging background television exposure and caregiver screen use during child routines.

Although effect sizes were generally small (r = 0.03–0.16), they were comparable to previous meta-analyses on screen time and developmental outcomes. The investigators argued that even small effects may have wider public health implications from a population-level perspective, particularly during the sensitive developmental period of early childhood.

This comprehensive review provided nuanced evidence to inform guidelines and recommendations for families, clinicians, and educators regarding early childhood screen use. The investigators underscored that future research should further evaluate specific elements within screen use contexts that may influence children's development.