Device-specific and contextual patterns of screen use: links to emotional and behavioral outcomes in early childhood

While most research emphasizes the negative impact of screen time duration on child outcomes, fewer studies examine how content, context, and device-specific patterns influence mental health in early childhood. This study explored how characteristics of household screen media use, including dominant content type, device, co-viewing frequency, and age at first exposure, relate to socio-emotional outcomes in children aged 2–6 years. Cross‑sectional baseline data were analyzed from 940 children (mean age = 4.67 years) participating in the ANONYMIZED longitudinal project in Portugal. Parents reported screen use across five devices (television, computer, video games, tablet, and smartphone), content categories (educational, entertainment, communication), co-viewing practices, mealtime and bedtime use, and age at first exposure. Socio-emotional outcomes were assessed using the Strengths and Difficulties Questionnaire (SDQ), and associations were analyzed using multinomial logistic regression, adjusting for child and parental characteristics. Entertainment content was the most frequent type of use (58.5%). Higher television viewing time was associated with conduct problems and abnormal total difficulties (both OR = 1.01, ps < 0.01). Similarly, daily smartphone use was linked to elevated conduct problems and abnormal total difficulties (both OR = 1.01, ps < 0.01). Smartphone use during meals was significantly related to abnormal conduct problems ( OR = 2.66, p < 0.001). Early smartphone exposure (≤2 years) was connected to borderline conduct problems ( OR = 1.66, p < 0.01) and abnormal total difficulties (OR = 2.10, p < 0.01). These findings indicate that, beyond total screen time duration, the specific device-use patterns, early exposure to screens, and certain contexts may play distinct roles in early socio‑emotional development. Interventions may benefit from incorporating these multidimensional factors to better support healthy developmental outcomes.