High-dose electronic media use in five-year-olds and its association with their psychosocial symptoms: a cohort study

Niiranen J, Kiviruusu O, Vornanen R, et al. High-dose electronic media use in five-year-olds and its association with their psychosocial symptoms: a cohort studyBMJ Open 2021; 11:e040848. doi: 10.1136/bmjopen-2020-040848


Objectives This study investigated the frequency of electronic media (e-media) usage by preschool children and the risks of high-dose e-media use on young children’s psychosocial well-being.

Design Longitudinal associations between e-media use at 18 months and psychosocial symptoms at 5 years of age were studied, as well as cross-sectional associations between e-media use and psychosocial symptoms at 5 years.

Setting Between 2011 and 2017 in Finland.

Participants Children aged 5 years (n=699).

Primary and secondary outcome measures Children’s psychosocial symptoms were determined at the age of 5 years using the parent-reported questionnaires Five-to-Fifteen (FTF) and the Strengths and Difficulties Questionnaire (SDQ).

Results Based on our results, 95% of the preschool children exceeded the daily recommended use of e-media set by health professionals. Our results indicate that increased screen time at 5 years of age is associated with a risk of multiple psychosocial symptoms (OR 1.53–2.18, 95% CI 1.05 to 3.34, p<0.05), while increased levels of e-media use at 18 months was only associated with FTF peer problems (OR 1.59, 95% CI 1.04 to 2.41, p=0.03). Moreover, high-dose use of electronic games at the age of 5 years seems to be associated with fewer risks for psychosocial well-being than programme viewing, as it was only associated with SDQ hyperactivity (OR 1.65, 95% CI 1.08 to 2.51, p=0.02).

Conclusion Increased screen time has multiple risks for children’s psychosocial well-being. These risk factors seem to be significant in the long term, and are related to problems in children’s socio-emotional development later on. Health professionals and paediatricians have an important role as communicators of the current research results on the safe usage time of e-media for families, and enhancing parents’ skills as regulators of children’s safe e-media use. More research is needed on the family conditions of high-dose e-media users.

Strengths and limitations of this study

  • A major strength of our study is the longitudinal study setting and repeated measurement of e-media exposure.
  • Patterns of children’s e-media use are rapidly changing, and our study offers results on the associations of young children’s e-media usage with their psychosocial well-being based on recent data.
  • Moreover, the sample is based on a representative birth cohort recruited during pregnancy.
  • A limitation of our study is the measurement of e-media use, which was based on parental questionnaires and not logs.
  • Single mothers as well as those with lower education seem to be under-represented in the sample.


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