Factors influencing screen time in children aged 0–4 years old: a convergent parallel mixed-methods study

Abstract Background Young children are spending more time on screens at increasingly younger ages, with many exceeding current screen time recommendations. This mixed-methods study aimed to identify factors influencing screen time in children aged 0–4 years. Methods As part of the My Little Moves study, we conducted a convergent parallel mixed-methods approach, incorporating a qualitative and quantitative sub-study. In the qualitative sub-study, we examined parental perspectives on which factors influence young children’s screen time through focus group sessions. During these sessions, parents brainstormed on factors they considered to influence young children’s screen time, first individually and thereafter in a group discussion. A thematic analysis using an inductive approach was used to identify categories of parent-perceived factors. In a separate quantitative sub-study, we collected parent-reported data on parental (e.g., rules around screen time) and environmental factors (e.g., play equipment) through online questionnaires, as well as parent-reported data on children’s screen time through the My Little Moves app, at two timepoints. Robust linear mixed model analyses were used to examine longitudinal associations between factors and screen time. Results In the qualitative sub-study, 22 parents listed 46 factors, which were categorized by researchers into: 8 child-related factors, 19 parent-related factors, and 16 environmental factors. The most frequently mentioned factor was screen use as an instrument to distract or occupy the child. In the quantitative sub-study, complete data were available for 107 children at timepoint 1 (mean age 21.3 ± 12.1 months) and 75 children at timepoint 2 (mean age 28.1 ± 10.6 months). Child age (β = 0.32; 95% CI = (0.22, 0.41)) and the parenting practice of using screen time to control or reward the child’s behavior (β = 0.26; 95% CI = (0.16, 0.37)) were the only factors significantly associated with screen time, both with a moderate effect size. Conclusions Findings from this study suggest that parental use of screen time to distract, reward, or control children’s behavior contributes to increased screen time in 0–4-year-old children. These practices could be targeted to reduce screen time in early childhood.