When parents talk to sleep consultants about their toddler’s bedtime difficulties, one question should always come up: how much time does this child spend on screens? A 2024 study published in the Journal of Indian Association for Child and Adolescent Mental Health offers concrete numbers that make the connection between screens and child wellbeing hard to ignore.
The study, titled “Behavioral Problems Associated with Digital Screen Exposure in Children Aged 2-5 Years: Cross-sectional Study,” was conducted by Kaur, Gupta, Kiran, Malhi and Grover at the Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India. It examined 400 preschool-aged children and found that nearly 60% exceeded the recommended screen time limit. The children who did were significantly more likely to show emotional and behavioral problems. For sleep consultants, this study offers data that can sharpen the way you discuss screens with families of young children.
How the study was set up
The researchers used a community-based cross-sectional design. They selected 400 families with children aged 2 to 5 years from Chandigarh, a North Indian Union Territory. Sampling followed a multi-stage cluster random approach. Data was collected from October 2017 to March 2018 through face-to-face interviews with primary caregivers in their homes. Children with previously diagnosed chronic or congenital illnesses were excluded.
Three validated instruments were used. The first was the Digital Screen Exposure Questionnaire (DSEQ), an 86-item tool developed and validated by the same research team. It covered sociodemographic information, screen time exposure, the home media environment, physical activity levels, media-related behaviors and parental perceptions about digital screen exposure. The second was the Preschool Child Behavior Checklist (Pre-CBCL), a 100-item standardized tool that measures emotional and behavioral problems in young children. The Pre-CBCL has demonstrated high reliability in Indian settings. The third was the Preschool Physical Activity Questionnaire (PrePAQ).
Excessive digital screen exposure was defined as one hour or more per day. This cut-off follows the recommendations of both the American Academy of Pediatrics (2016) and the Indian Academy of Pediatrics (2020).
The numbers that stand out
The mean age of the 400 children was 3.5 years. The sample was balanced by sex: 51.5% boys and 48.5% girls. The majority of families belonged to above-middle socioeconomic class (55.8%), and 86% of mothers were homemakers.
The headline finding: 59.5% of children had excessive screen time, exceeding one hour per day. Screen time was slightly higher on weekdays (58.5%) than on weekends (56.8%).
Two factors showed a positive correlation with screen time: the mother’s level of education and higher per capita family income. Children who attended daycare centers were more likely to have excessive screen time (adjusted odds ratio = 1.82). Caregivers who themselves spent more than two hours on screens per day also had children with higher screen exposure (adjusted odds ratio = 1.68).
Approximately 15% of children showed borderline or clinical levels of emotional problems as measured by the Pre-CBCL. The study found that specific emotional problems were significantly associated with digital screen exposure among the children studied.
The multivariate analysis identified three significant predictors of increased behavioral problems in children under five: excessive screen time, less time spent by parents with their children and the use of multiple devices.
Why sleep consultants should pay attention to this
This study does not measure sleep directly. It focuses on emotional and behavioral outcomes. So why should sleep consultants read it? The answer is screen time. Sleep consultants routinely advise families on screen use before bed. This study provides data on how widespread excessive screen time is among preschoolers and what it is associated with. It strengthens the evidence base that sleep consultants draw on when they recommend reducing screen exposure in young children.
The study’s finding that 59.5% of preschoolers exceeded the one-hour daily guideline is a number worth sharing with parents. It tells families that this is not just their child; it is a widespread pattern with measurable associations with emotional and behavioral difficulty.
Three things from this study that you can use
The one-hour threshold gives families a clear target. Sleep consultants often hear parents ask, “How much is too much?” This study defines excessive screen time as one hour or more per day for children aged 2 to 5, based on international pediatric guidelines. That is a specific and simple number to communicate. It is not a vague recommendation. It gives families something concrete to work with.
Caregiver screen habits predict child screen habits. The finding that caregivers who spent more than two hours per day on screens were significantly more likely to have children with excessive screen time is worth discussing with parents. Reducing a child’s screen time may require the family to examine its own media habits. Sleep consultants who talk with families about bedtime routines can use this finding to broaden the conversation: it is not just about the child’s screen, but about the screens in the entire household.
Parental time with the child is protective. Less time spent by parents with their children was a significant predictor of behavioral problems in this study. For sleep consultants, this is a data point that supports the broader recommendation of prioritizing direct interaction with young children over screen-based activities.
The home media environment deserves attention
One detail from this study that sleep consultants should take seriously is the role of the home media environment. The DSEQ questionnaire measured not just how many hours children spent on screens, but what the media setup of the home looked like: how many devices were available, where they were placed, whether background television was running, and how caregivers used media around their children.
The finding that the use of multiple devices was a significant predictor of behavioral problems suggests that the number of screens in the home may be as relevant as the total hours of use. For sleep consultants, this opens an opportunity to ask parents about where devices are kept. Is there a television in the child’s bedroom? Is a tablet available at bedtime? Is the television on in the background during the evening routine? These are questions that go straight to the conditions around sleep.
Limitations to be aware of
This was a cross-sectional study, which means it captured a single point in time. It cannot tell us whether excessive screen time causes behavioral problems or whether children who already have behavioral difficulties are given more screen time by caregivers who need a break. Both directions are plausible.
The data was collected in 2017-2018, before the COVID-19 pandemic. Screen exposure among young children has risen sharply since then, so current numbers are likely even higher than the 59.5% reported here. The study was conducted in one Indian city, which means the findings may not apply directly to other populations. All data relied on parent report.
These are real limitations. At the same time, the study’s strengths include its community-based sampling, its reasonably large sample size (400 children), its use of a purpose-built and validated screen exposure questionnaire and its application of a standardized behavioral assessment tool (Pre-CBCL) with demonstrated reliability.
Kaur, N., Gupta, M., Kiran, T., Malhi, P., & Grover, S. (2024). Behavioral Problems Associated with Digital Screen Exposure in Children Aged 2-5 Years: Cross-sectional Study. Journal of Indian Association for Child and Adolescent Mental Health, 20(3), 249–263. https://doi.org/10.1177/09731342241236364