ImportanceThe multifaceted nature of screen use has been largely overlooked in favor of a simplistic unidimensional measure of overall screen time when evaluating the benefits and risks of screen use to early childhood development.ObjectiveTo conduct a systematic review and meta-analysis to examine associations of screen use contexts in early childhood with cognitive and psychosocial outcomes.Data SourcesPsycINFO, Embase, MEDLINE Ovid, ProQuest, CINAHL, Web of Science, and Scopus were searched from inception to December 31, 2023.Study SelectionA total of 7441 studies were initially identified. Studies were included if they examined associations between a contextual factor of screen use among children aged 0 to 5.99 years and cognitive or psychosocial development. Observational, experimental, and randomized clinical trial study designs were included.Data Extraction and SynthesisAll studies were independently screened in duplicate following PRISMA guidelines. Effect sizes of associations (r) from observational studies were pooled using random-effects 3-level meta-analyses. The remaining study designs were narratively synthesized.Main Outcomes and MeasuresScreen use contexts included content (child directed and age inappropriate), type (program viewing and game or app use), co-use (or solo use), background television, caregiver screen use during child routines, and purpose. Outcomes were cognitive (executive functioning, language, and academic skills) or psychosocial (internalizing and externalizing behavior problems and socioemotional competence).ResultsOverall, 100 studies (176 742 participants) were included, and of these, 64 observational studies (pooled sample sizes ranging from 711 to 69 232) were included in meta-analyses. Program viewing (n = 14; k = 48; r, −0.16; 95% CI, −0.24 to −0.08) and background television (n = 8; k = 18; r, −0.10; 95% CI, −0.18 to −0.02) were negatively associated with cognitive outcomes, while program viewing (n = 6; k = 31; r, −0.04; 95% CI, −0.07 to −0.01), age-inappropriate content (n = 9; k = 36; r, −0.11; 95% CI, −0.17 to −0.04), and caregiver screen use during routines (n = 6; k = 14; r, −0.11; 95% CI, −0.20 to −0.03) were negatively associated with psychosocial outcomes. Co-use was positively associated with cognitive outcomes (n = 8; k = 28; r, 0.14; 95% CI, 0.03 to 0.25).Conclusions and RelevanceFindings show small to moderate effect sizes that highlight the need to consider screen use contexts when making recommendations for families, clinicians, and educators beyond screen time limits; including encouraging intentional and productive screen use, age-appropriate content, and co-use with caregivers.

中文翻译：

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幼儿筛查使用环境以及认知和社会心理结局


重要性在评估使用屏幕对儿童早期发展的益处和风险时，屏幕使用的多方面性质在很大程度上被忽视了，取而代之的是对整体屏幕时间的简单单维测量。目的进行系统评价和荟萃分析，以检查幼儿期屏幕使用环境与认知和社会心理结局的关联。数据来源从建库到 2023 年 12 月 31 日检索了 PsycINFO、Embase、MEDLINE Ovid、ProQuest、CINAHL、Web of Science 和 Scopus。如果研究考察了 0 至 5.99 岁儿童使用屏幕的背景因素与认知或心理社会发展之间的关联，则纳入研究。纳入观察性、实验性和随机临床试验研究设计。资料提取和综合所有研究均按照 PRISMA 指南独立筛选，一式两份。使用随机效应 3 水平荟萃分析合并来自观察性研究的关联效应大小 （r）。其余的研究设计是叙述性综合的。主要结局和措施屏幕使用环境包括内容（儿童导向和年龄不合适）、类型（节目观看和游戏或应用程序使用）、共同使用（或单独使用）、背景电视、儿童日常生活期间照顾者屏幕的使用和目的。结局是认知 （执行功能、语言和学术技能） 或社会心理 （内化和外化行为问题和社会情感能力）。结果总体而言，共纳入 100 项研究 （176 742 名参与者），其中 64 项观察性研究 （合并样本量范围为 711 至 69 232 人） 被纳入荟萃分析。节目观看 （n = 14;k = 48;r，−0。16;95% CI，-0.24 至 -0.08）和背景电视（n = 8;k = 18;r，-0.10;95% CI，-0.18 至 -0.02）与认知结果呈负相关，而节目观看（n = 6;k = 31;r，-0.04;95% CI，-0.07 至 -0.01）、年龄不适宜的内容（n = 9;k = 36;r，-0.11;95% CI，-0.17 至 -0.04）和护理人员在日常活动中的屏幕使用（n = 6;k = 14;r， −0.11;95% CI，-0.20 至 -0.03）与社会心理结局呈负相关。共同使用与认知结局呈正相关 （n = 8;k = 28;r，0.14;95% CI，0.03 至 0.25）。结论和相关性研究结果显示了小到中等的效应大小，这突出了在为超出屏幕时间限制的家庭、临床医生和教育工作者提出建议时需要考虑屏幕使用环境的必要性;包括鼓励有意识和富有成效地使用屏幕、适合年龄的内容以及与护理人员共同使用。