Prevalence of Screen Time Exposure in Young Children: Is it Possible with a Hospital-based Study?

Sir, I came across the article titled ‘Prevalence and Predictors of Screen Time Exposure in Young Children: A Descriptive, Facility-Based Study’ by Paldiwal et al.[1] and I would like to highlight a few interesting observations. The authors endeavoured to assess screen time in terms of predictors and its prevalence in young children (6 months to 6 years) through a prospective cross-sectional study. They found that more than half of the children had excessive screen exposure, with an average screen time of 100 min. Infants under 1 year had notably high exposure rates (95.1%). However, a closer examination reveals the following concerns: The authors aimed to estimate screen exposure time and associated risk factors among children aged 6 months to 6 years, but the study title suggests ‘prevalence and predictors’, which is confusing. What are the primary objectives of the study? Assuming the study title is appropriate, the chosen study design and setting do not seem suitable. A hospital-based study cannot estimate prevalence accurately.[2] In addition, the sample size calculation is unclear, with an SD stated as 1.7.2, which seems like a typographical error. Sample size calculation is typically based on the primary objective; hence, the given assumptions would not estimate the prevalence of screen time exposure accurately. It is also unclear why the calculated sample size is 129, yet 418 children were included The authors mention obtaining parental consent, but for this population, assent forms and a participant information sheet (PIS) are necessary. There is no mention of the PIS[3] The inclusion and exclusion criteria are not clear. What about single parents or situations where the mother is working and a guardian or nanny takes care of the children? The authors did not clearly explain the dependent and independent variables[4] Several operational definitions are missing, such as ‘recent typical day’ It is unclear whether the questionnaires used were validated or piloted. What was the validity of the questionnaires? During the consent process, the authors mentioned parents, but the results specifically mention 417 mothers, with no mention of fathers or guardians The authors removed outliers without explaining why or how they validated them. Some outliers represent natural variation in the population and should be kept in the final dataset[5] In the conclusion, the authors state, ‘Efforts should be directed towards raising awareness amongst parents, promoting healthier screen-time practices and fostering outdoor activities’. However, the study does not support these as effective ways to reduce screen time, nor is this discussed in the Review of Literature Sixty percent of study participants were under 3 years of age. How their screen time relates to COVID-19 is unclear, especially since the major impact of COVID-19 was over by 2021. Despite these issues, the study addresses an important and relevant topic. Addressing the above-listed issues would improve the clarity and rigor of the research article.