High-Dose Electronic Media Use Linked to Psychosocial Symptoms in 5-Year-Olds

two girls watching tv
two girls watching tv, leisure, electronic use, e-media use
The researchers’ goal was to study the frequency of electronic media usage by preschool children and the risks of high-dose e-media use on young children's psychosocial well-being.

Study data published in BMJ Open outline the negative psychosocial effects of high-dose electronic media (e-media) use in children. In a large-scale cohort study, nearly all surveyed children exceeded the recommended daily amount of e-media exposure. Significant e-media use was associated with myriad psychosocial symptoms, including attention and concentration difficulty, emotional problems, and issues with peers.

This longitudinal cohort study enrolled parents and their children from the Pirkanmaa Hospital District area in southern Finland. Baseline surveys were completed prenatally at 32 weeks; follow-up surveys were administered when children were 3, 8, 18, 24, and 60 months (5 years) of age. The current analysis used data from the baseline, 18-month, and 5-year time points.

Surveys included the Strengths and Difficulties Questionnaire (SDQ) and the Five-to-Fifteen (FTF) questionnaire, which captured behavior and psychological symptoms in children. Children scoring in the 75th percentile or over in SDQ and FTF subscales were considered to have clinically elevated psychosocial symptoms.

Parents were also asked to report sociodemographic characteristics and estimate their child’s average daily e-media use.

Logistic regression models were used to elucidate the relationship between e-media use and certain psychosocial outcomes. Regression models compared outcomes among children in the 75th percentile for e-media use and children in the lowest quartile.

The study cohort comprised 699 children for whom SDQ or FTF survey data were available. Mean age at follow-up was 5.68 (±0.54) years; 52.4% were boys; and 67.7% were in full-time daycare. The majority of parents (63.4%) had a university-level degree.

At 18 months of age, children spent a reported average of 32.4 (±31.0) minutes per day with e-media devices. At 5 years of age, this figure increased to 114.1 (±50.6) minutes per day. At age 5 years, nearly all children (94.6%) consumed more than 60 minutes of screen media each day.

In unadjusted regression models, increased screen time at age 5 years was associated with multiple psychosocial problems as measured by FTF subscales, including attention and concentration difficulties (odds ratio [OR], 1.88; P <.01), hyperactivity and impulsivity (OR, 1.57; P =.03), internalizing symptoms (OR, 1.75; P =.01), and externalizing symptoms (OR, 1.69; P =.01). Additionally, screen time at age 5 years was also associated with hyperactivity (OR, 2.18; P <.01) and conduct problems (OR, 1.53; P =.03) per the SDQ.

Screen time at age 18 months had less of a negative effect and was only longitudinally associated with increased risk of peer problems at age 5 years (OR, 1.64; P =.03). In models adjusted for age, gender, parental education, and daycare attendance, only the association between screen time at age 5 years and internalizing symptoms remained significant (OR, 2.01; P =.01).

Results from this study underscore the negative effects of high-dose e-media use on the psychosocial well-being of children. While e-media use at age 18 months was not substantially predictive of psychological problems at follow-up, significant cross-sectional associations were observed between screen time and psychosocial symptoms at age 5 years.

The primary study limitation was its use of self-reported questionnaires to measure e-media use, rather than logs or another objective observational measure.

“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,” the researchers wrote. “More research is needed on the family conditions of high-dose e-media users.”


Niiranen J, Kiviruusu O, Vornanen R, Saarenpää-Heikkilä O, Paavonen EJ. High-dose electronic media use in five-year-olds and its association with their psychosocial symptoms: a cohort study. BMJ Open. 2021;11(3):e040848. doi:10.1136/bmjopen-2020-040848