Screen Time, Digital Content Quality, and Parental Mediation as Predictors of Linguistic and Pragmatic Development: Implications for Pediatric and Preventive Health

<b>Background/Objectives:</b> Although numerous studies have examined associations between screen time and early language development, less is known about how screen exposure interacts with developmental stage, digital content quality, and parental mediation across childhood and adolescence, particularly with respect to pragmatic communication. This study aimed to address these gaps by examining the joint associations of screen time, content composition, and parental mediation with multiple linguistic and pragmatic domains across a broad age range. <b>Methods:</b> A cross-sectional study was conducted with 286 Romanian participants aged 5-19 years, grouped into four developmental stages. Measures included daily screen time, proportion of educational versus recreational content, parental mediation practices, and standardized assessments of vocabulary, verbal fluency, grammatical competence, and pragmatic communication. Analyses included descriptive statistics, Pearson correlations, 4 × 3 factorial ANOVAs (age group × screen-time category), and multiple linear regression. <b>Results:</b> Higher levels of screen exposure were consistently associated with lower performance across all linguistic and pragmatic domains (r = -0.19 to -0.28, all <i>p</i> < 0.01). Participants viewing >2 h/day showed significantly weaker outcomes than those with ≤1 h/day, particularly in semantic and phonemic fluency and pragmatic communication (<i>p</i> < 0.001). Educational content correlated positively with linguistic scores, whereas recreational content showed negative associations. Parental mediation emerged as a significant positive predictor. In the regression model (R² = 0.42), age (β = 0.47), parental mediation (β = 0.21), and educational content (β = 0.18) predicted better linguistic performance, while screen time (β = -0.29) predicted lower performance. <b>Conclusions:</b> The findings indicate that associations between digital media use and linguistic and pragmatic performance vary across developmental stages and contextual factors. Rather than screen time alone, digital content quality and parental mediation are associated with differences in communicative performance. These results highlight the value of a nuanced, developmentally informed perspective when considering children's digital media environments.