Screen Exposure Of Children Aged 4-6 And Impact On Sleep And Behavior Development In Shandong Province

Objectives To investigate current conditions of screen exposure and its relationship with sleep and behavior development of children aged 4-6 in Shandong,to understand impact of screen exposure on children’s health,to raise people’s awareness of the hazards associated with screen exposure in early life,and to provide basis for formulating public policies,carrying out health education and standardizing family management.Methods From September to October 2018,healthy children in 20 kindergartens of 5cities were randomly selected from 17 prefecture-level cities in Shandong.Information was collected through parents filling out questionnaires,which included personal data,electronic product usage survey in preschool children,children’s sleep habits questionnaire,Achenbach Children’s Behavior Scale(CBCL).Qualified leaders are trained to issue questionnaires and instruct parents to fill out questionnaires.A total of 2500 questionnaires were sent out and 2131 valid questionnaires were collected,with an effective recovery rate of 91.66%.There were 1090 boys and 1041 girls.SPSS 19.0software was used to establish the database and to analysis data.Results 1.The average age of preschool children exposed to electronic products was2.25±0.99 years,and the earliest age was 0.25 years(3 months).53.8% of preschool children’s screen time did not meet the guidelines of American Academy of Pediatrics.Screen time of boys and girls were 1.57±1.37 h and 1.50±1.24 h.There was no significant difference between the two groups(t=1.275,P=0.203).The screen time on workdays was significantly lower than that in weekends(1.40±1.48 h vs 1.88±1.38 h),and the difference was significant(t=-15.411,P < 0.05).Logistic regression analysis of influencing factors for children’screen time showed that medium proportion of milk powder feeding within 4months after birth,frequent access to electronic devices by parents,mother’s education level less than junior high school,high frequency of restriction on children’screen content by parents,long screen time of parents,and long screen time of children before bedtime were risk factors of average daily screen time≥1h,and OR values(95%CI)was1.426(1.087-1.966),3.806(1.904-7.608),2.692(1.397-5.188),1.484(1.167-1.887),1.069(1.033-1.107),2.183(1.740-2.740).Parents’ attitude of prohibiting electronic products is is the protect factor for the average daily screen time≥1h,OR values(95%CI)was 0.452(0.190-1.075).2.67.20% of parents worried about using electronic products to damage children’s eyesight and affect their health;9.30% of parents were afraid of delaying children’s learning time;20.90% of parents thought that children had poor self-control and easily addicted.96.00% of parents accompany children to use electronic products;94% of parents guide children to use electronic products;97.20% of parents restrict children’s screen content;88.80% of parents restrict children’s screen time and 97.10% of parents restrict children to use electronic products.3.Sleeping time of children aged 4-6 years was respectively 9.45±1.72 h,9.23 ±1.02 h and 9.48 ± 1.54 h.The difference was statistically significant(F=5.989,P=0.003).Children with poor sleep quality accounted for 80.90%.Parents non-use of electronic products while children sleeping and long outdoor time weekly were protective factors for poor sleep quality,OR values(95%CI)were 0.366(0.203~1.083),0.973(0.961~0.992).The frequency of children using electronic products before bedtime was 5-7 times,3-4times and 1-2 times per week,and long daily screen time were risk factors for poor sleep quality.,OR values(95%CI)were 1.451(0.872~2.028)、1.919(0.818~2.908)、1.619(1.023~2.123)、1.142(0.998~1.225).4.The detection rate of behavioral problem among children aged 4-5 years was 6.87%.with 48 boys and 82 girls(5.00% vs 8.82%)There were significant differences in the incidence of behavioral problems between boys and girls(χ2 = 10.867,P = 0.001).The top three behavioral problem factors of boys were physical complaint,depression and immaturity,while the top three behavioral problem factors of girls were splitting,compulsion and hyperactivity.Daily screen time ≥1 h and poor sleep quality were risk factors for behavioral problems,OR values(95% CI)were 1.512(1.018-2.258)and 2.344(1.238-4.432).Children did not use electronic products before bedtime was protective factor for behavioral problems,OR values(95% CI)were 0.653(1.283-2.820).Conclusions 1.Excessive screen exposure is common among 4-6 year-old children in Shandong,and shows a younger trend.The influence factors for preschool children’ screen time were feeding method within 4 months after birth,parents’ restriction on children’s screen time and content,mother’s education level,parents’ screen time,screen time of children before bedtime and parents’ attitude of using electronic devices.Parents generally lack awareness of the harmfulness of excessive screen exposure.2.Children’s daily sleep time is lower than the standard of same age group’s sleep time.Children’s poor sleep quality is a serious problem.Children’s weekly outdoor time,frequency of children using electronic products before bedtime,children’s daily screen time,frequency of using electronic products while children sleeping were influence factors for preschool children’ sleep quality.3.The number of girls with behavioral problems was significantly higher than that of boys.Children’s sleep quality,children’s daily screen time,frequency of children using electronic products before bedtime were risk factors for behavioral problems in children.4.It is necessary to improve parents’ knowledge and practice of children’s screen exposure,and take appropriate measures for children’s screen exposure in order to ensure children’s healthy growth.