Trends in Screen Time Use Among Children During the COVID-19 Pandemic, July 2019 Through August 2021
Authors: Hedderson Monique M. , Bekelman Traci A. , Li Mingyi , Knapp Emily A. , Palmore Meredith , Dong Yanan , Elliott Amy J. , Friedman Chloe , Galarce Maren , Gilbert-Diamond Diane , Glueck Deborah , Hockett Christine W. , Lucchini Maristella , McDonald Julia , Sauder Katherine , Zhu Yeyi , Karagas Margaret R. , Dabelea Dana , Ferrara Assiamira ,   Environmental Influences on Child Health Outcomes Program, Smith Brian P , Newby Kristen L , Jacobson Lisa P , Parker Corette B , Gershon Richard C , Cella David , Alshawabkeh Akram N , Aschner Judy L , Merhar Stephanie L , Pryhuber Gloria S , Moore Paul E , Lampland Andrea L , Wadhawan Rajan , Wagner Carol L , Hudak Mark L , Mayock Dennis E , Washburn Lisa K , Croen Lisa A , Karr Caherine J , Mason Alex , Lester Barry M , Carter Brian S , Marsit Carmen J , Pastyrnak Steven L , Neal Charles , Smith Lynne M , Helderman Jennifer B , McEvoy Cindy , Tepper Robert S , Kerver Jean , Barone Charles , McKane Patricia , Paneth Nigel , Elliott Michael R , Trasande Leonardo , Sathyanarayana Sheela , Bush Nicole , Nguyen Ruby HN , Barrett Emily S 
Published: February 2023

ImportanceThe COVID-19 pandemic led to widespread lockdowns and school closures that may have affected screen time among children. Although restrictions were strongest early in the pandemic, it is unclear how screen time changed as the pandemic progressed.ObjectiveTo evaluate change in children’s screen time from before the pandemic to during the pandemic, from July 2019 through August 2021.Design, Setting, and ParticipantsThis is a longitudinal cohort study with repeated measures of screen time collected before the pandemic and during 2 pandemic periods. Children aged 4 to 12 years and their parent were enrolled in 3 pediatric cohorts across 3 states in the US participating in the Environmental Influences of Child Health Outcomes (ECHO) Program. Data analysis was performed from November 2021 to July 2022.ExposuresCOVID-19 pandemic period: prepandemic (July 2019 to March 2020), pandemic period 1 (December 2020 to April 2021), and pandemic period 2 (May 2021 to August 2021).Main Outcomes and MeasuresThe primary outcomes were total, educational (not including remote school), and recreational screen time assessed via the ECHO Child Media Use questionnaire. Linear mixed-effects models were used for screen time adjusted for child’s age, number of siblings, sex, race, ethnicity, and maternal education.ResultsThe cohort included 228 children (prepandemic mean [SD] age, 7.0 [2.7] years; 100 female [43.9%]) with screen time measured during the prepandemic period and at least once during the pandemic period. Prepandemic mean (SD) total screen time was 4.4 (3.9) hours per day and increased 1.75 hours per day (95% CI, 1.18-2.31 hours per day) in the first pandemic period and 1.11 hours per day (95% CI, 0.49-1.72 hours per day) in the second pandemic period, in adjusted models. Prepandemic mean (SD) recreational screen time was 4.0 (3.5) hours per day and increased 0.89 hours per day (95% CI, 0.39-1.39 hours per day) in the first pandemic period and 0.70 hours per day (95% CI, 0.16-1.25 hours per day) in the second pandemic period. Prepandemic mean (SD) educational screen time was 0.5 (1.2) hours per day (median [IQR], 0.0 [0.0-0.4] hours per day) and increased 0.93 hours per day (95% CI, 0.67-1.19 hours per day) in the first pandemic period and 0.46 hours per day (95% CI, 0.18-0.74 hours per day) in the second pandemic period.Conclusions and RelevanceThese findings suggest that screen time among children increased during the COVID-19 pandemic and remained elevated even after many public health precautions were lifted. The long-term association of increased screen time during the COVID-19 pandemic with children’s health needs to be determined.