Association between screen exposure and language development delay during the COVID-19 pandemic for 18–72 months children in China: evidence from a cross-sectional study

The impact of screen exposure on children’s language development has been widely debated. However, some characteristics of screen use, particularly the influence of the pandemic over the past three years have yet to be sufficiently investigated. To examine the association between screen exposure, particularly during the pandemic, and language development delays in children aged 18–72 months. A total of 2100 children who attended the children’s language development clinic at Guangzhou Women and Children’s Medical Center and Yuncheng Street Community Health Service Center in Guangzhou, China, were recruited into the study between January 2020 and September 2023. Children’s demographic and developmental characteristics were obtained through a structured questionnaire, and their language development delays were evaluated through the Sign-Significate Relations (S-S) assessment, which was subsequently validated by the China Developmental Scale for Children method based on the voluntary principle. Multivariate logistic regression models were employed to analyze the association between screen exposure and language development delay. In order to gain further insight, the data was stratified according to whether or not the children had experienced a period of social isolation due to the COVID-19 pandemic, the parenting environment and the quality of screen usage. More than half of the children (53.29%) were exposed to screens for over 1 h daily. After adjusting for potential confounders, a dose-response relationship was observed between children’s daily screen exposure exceeding 1 h and the risk of delayed language development. The stratified analyses confirmed the main findings, revealing stronger associations in children who had experienced at least one period of quarantine, whose primary language spoken at home was Cantonese, whose caregivers had an intermediate personality, whose daily outdoor activities were less than 2 h, who did not have interaction with caregivers during screen time, and who watched educational videos. This study suggested that excessive screen exposure in children was associated with a heightened likelihood of language development delays, especially among children who experienced COVID-19 quarantine with prolonged screen time.