Early-Life Screen Exposure, Sleep Disturbance, and Emotional–Behavioral Problems among Preschool Children: A Cross-Sectional Study
TL;DR
In this sample, screen exposure exceeded recommended limits and was independently associated with poorer sleep and more emotional–behavioral problems, with sleep partially mediating the relationship.
Abstract
Background: Preschool children are increasingly exposed to digital screens during a period of rapid neurodevelopment. Excessive and poorly timed screen use may compromise sleep and contribute to emotional and behavioral difficulties, yet the extent to which sleep links the two remains incompletely characterized. Objectives: To determine the pattern of screen exposure among preschool children, and to examine its association with sleep disturbance and with emotional–behavioral problems, including the mediating role of sleep. Methods: A cross-sectional study was conducted among 384 children aged 3–5 years attending selected outpatient and preschool settings. Screen exposure (duration, timing, device type) was assessed by a structured parent-report questionnaire; sleep was measured with the Children’s Sleep Habits Questionnaire (CSHQ); and emotional–behavioral problems were assessed with the parent-report Strengths and Difficulties Questionnaire (SDQ). Associations were examined using chi-square tests, correlation, and multivariable linear regression adjusted for confounders. Mediation of the screen–behavior association by sleep was tested using the Baron–Kenny approach with bootstrapped indirect effects. Results: Mean daily screen time was 2.6 (SD 1.4) hours, and only 22.4% of children met the recommended ≤1 hour/day. Greater screen time was associated with higher CSHQ scores (poorer sleep; r = 0.42, p < 0.001) and higher SDQ total difficulties scores (r = 0.36, p < 0.001). In adjusted models, each additional hour of daily screen time predicted a 1.9-point increase in SDQ total difficulties (β = 0.31, p < 0.001). Sleep disturbance partially mediated the screen–behavior association, accounting for approximately 38% of the total effect. Evening and pre-bedtime use and mobile-device use showed the strongest associations. Conclusion: In this sample, screen exposure exceeded recommended limits and was independently associated with poorer sleep and more emotional–behavioral problems, with sleep partially mediating the relationship. Interventions targeting the amount and timing of screen use while protecting sleep may support early childhood mental health.