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Abstract

The rapid integration of digital technology in early childhood education has raised concerns about managing preschool screen time (ST) and its potential harm to children’s health and development. These concerns intensify during crises like pandemics or conflicts, when remote learning becomes necessary. Identifying risk and protective factors related to digital exposure is essential for child well-being. To investigate health risks and protective strategies linked to ST among preschool children during remote learning. A literature review was conducted from 2010 to 2025 using scientometric databases. Studies on health effects of digital exposure in early childhood were included. The review was illustrated with findings from our study of 1312 parents of preschoolers aged 4 to 6, which explored the relationship between ST and mastery of learning programs. Excessive ST was associated with reduced physical activity, irregular sleep, emotional difficulties, and delayed language acquisition. Higher ST was also linked to lower odds of completing the preschool learning program. Effective protective strategies included structured routines, parental co-viewing, and limiting passive ST. Reducing parental technoference emerged as a protective factor. Contextual factors such as socioeconomic disparities and caregiver digital literacy influenced outcomes. Remote learning presents both challenges and opportunities for preschoolers. While excessive screen use and parental technoference can negatively impact health and learning, evidence-based strategies, such as co-viewing, regulated content, and mindful parental engagement, can help reduce harm. Developing health-informed digital practices in early education is critical in times of crisis.

Keywords

preschool children early childhood development remote learning screen time technoference parental co-viewing protective factors risk factors public health

Remote learning during crises now extends to preschool education, requiring increased public health attention and evidence-based guidance.

Excessive screen exposure in early childhood is associated with poorer learning outcomes, language delays, reduced attention, disrupted sleep, emotional dysregulation, and long-term challenges in social interaction and emotional connectedness.

Prolonged passive screen time increases risks of physical health issues such as obesity and myopia, while limiting real-world exploration and play.

Parental technoference, which is disrupted interaction caused by adult device use, further weakens emotional bonding and behavioral regulation.

Active, co-viewed, and developmentally appropriate digital engagement can support learning when combined with daily routines and mindful parental presence.

Introduction

Digital education has expanded significantly in recent years due to the COVID-19 pandemic, global transitions to online learning, and, in Ukraine, the ongoing military conflict. While remote learning offers continuity and emotional support for children in crisis situations, its application to preschool-aged children (2-6 years) presents distinct challenges.^1-4 At this developmental stage, children have limited attention spans, immature executive functions, and require hands-on, socially interactive, and emotionally responsive learning environments.¹

International guidelines from the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend limiting screen time (ST) to a maximum of 1 h per day for children aged 2 to 5 years. They emphasize the importance of high-quality content and active parental involvement.^1,5-7 These recommendations are grounded in mounting evidence linking excessive screen exposure to a range of negative outcomes.^3,5-18 Neuropsychological research suggests that early and prolonged screen exposure may impair attention regulation, memory consolidation, and fine motor development.^{9,12,14,16-18} It is also associated with reduced physical activity, language delays, behavioral issues, and disturbed sleep.^12,13,15-18 Recent studies highlight broader health concerns, including mental health difficulties, ADHD-like symptoms, and increased risks of obesity and myopia.^10,16,18

In addition to children’s screen time, parental technoference, disruptions in parent-child interactions due to parental device use, has emerged as a critical factor influencing child well-being.^7,8,19 It undermines the warmth of parent-child bonds and negatively affects children’s emotional and cognitive development.¹⁹

Despite these concerns, many countries, including Ukraine, have implemented or are experimenting with remote preschool learning. This has occurred both during the pandemic and in response to infrastructure disruptions and safety risks caused by war. However, evidence-based guidelines for remote learning in early childhood remain scarce, particularly in non-Western contexts.²⁰

The balance between educational needs and health risks in digital environments is difficult to define without empirical data.^3,4,10 Since distance learning involves extended screen time (ST) for both educational and social activities, it is essential to assess the health effects of this exposure. Current research indicates that ST is characterized by rapid information intake while increasing overall screen use. Reviewing studies conducted before the era of fast-paced content may therefore provide more meaningful insights into which aspects of distance learning require sustained focus.

This study aims to bridge the gap in understanding the impact of ST on the health of preschoolers in a distance learning context. We present a hybrid publication that combines a narrative review of the international literature on the subject with original data from a multicenter cross-sectional study involving 1312 preschool children aged 4 to 6 years in Ukraine. This study aimed to investigate whether screen duration affects preschool children’s cognitive engagement in learning tasks. Additionally, we provide practical recommendations for implementing remote learning for preschoolers in a health-informed manner.

Materials and Methods

Narrative Review

We conducted a narrative literature review of publications from January 2010 to April 2025 via the following databases: PubMed, Scopus, Web of Science. The search strategy combined terms such as “preschool children,” “screen time,” “remote learning,” “digital media,” “sleep,” “cognitive development,” “language development,” “visual health,” and “emotional behavior.” Boolean operators (AND/OR) were applied.

Inclusion criteria:

- Peer-reviewed articles published in English and Ukrainian between 2010 and 2025.

- Studies involving children aged 2 to 6 years.

- Research examining associations between ST and developmental or health outcomes (cognitive, behavioral, emotional, physical, or sleep-related).

Exclusion criteria:

- Articles focusing on ST unrelated to learning or media exposure (eg, telemedicine, parental use only).

- Nonhuman research, conference abstracts, editorials, or nonpeer-reviewed sources.

Reference lists of key papers were screened for additional eligible studies. Preference was given to recent large-scale studies, systematic reviews, and those with clear outcome measures.^{3-5,8-10,13-30}

Empirical Findings

Design and Participants

In the spring of 2012, we conducted a survey of parents of preschool children aged 4 to 6 years regarding their children’s daily routines. A total of 1312 questionnaires were included in the analysis (50.5% boys). The parents completed daily diaries over 7 consecutive days, which are provided in the Supplemental Materials (Supplemental file 1). The diaries were pilot tested on a focus group (n = 20) and demonstrated excellent reliability, with ICC values ranging from 0.82 to 0.95 in a test-retest procedure conducted over a 1-week interval.

This multicenter study involved respondents from 4 regions of Ukraine. All kindergartens were publicly owned and operated under a unified educational standard. Kindergarten educators, trained by our staff during a 1-day seminar, worked directly with the parents. The questionnaire included items about children’s daily routines as well as their learning process.

Given the hybrid nature of this article, we used a small subset of this database to illustrate the impact of ST duration on the acquisition of the educational program.

Data Processing

Trained research assistants manually reviewed and processed the individual logs. The quantitative values (eg, bedtime) were transformed into categorized intervals (eg, “Before 21:00”). The total daily ST was calculated by summing the time spent watching television, playing games, and using electronic devices for educational purposes. A binary variable was generated for screen time: 1 = “≤1 h/day”; 0 = “>1.1 h/day”. The outcome variable was cognitive engagement in learning tasks (1 = yes; 0 = no).

Cognitive engagement was measured via a binary variable defined by the response to the following question: “Does the child understand the educational material taught at kindergarten?” The response options were “yes” and “no.”

Statistical Analysis

Descriptive statistics were calculated for key variables. Logistic regression was performed with cognitive engagement as the dependent variable. The independent variables included screen time, sex, residential status (urban/rural), and sleep duration (in minutes). Odds ratios (ORs) with 95% confidence intervals (CIs) are reported. Model performance was evaluated via receiver operating characteristic (ROC) curve analysis, and the threshold with the best balance of sensitivity and specificity was identified.

All statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 26.0³¹ and verified using R software, Version 4.3.1.³²

Results

The literature consistently indicates that excessive screen time in preschool-aged children is associated with adverse developmental and health outcomes. These include reduced language development,^4,9,13,14,21 impaired executive functioning and attention regulation,^2,3,15,22-25 increased risks of overweight and myopia,^{3,10,27,29,30} emotional dysregulation and social difficulties,^12,18,19,30 and disrupted sleep patterns^3,5,6,12 (Table 1). In addition, studies highlight distinctions between active and passive screen time that influence developmental trajectories.^26-29

Table 1.

Summary of Literature Review Findings.

Health domain	Impact of excessive screen time	Protective factors	Key references
Language development	Reduced verbal expression and vocabulary acquisition	Parental co-viewing; high-quality educational media	Brushe et al,⁴ Kim and Chung,⁹ Rayce et al,¹³ Hutton et al,¹⁴ Linebarger and Vaala,²¹ Swider-Cios et al,²² Clemente-Suárez et al,²³ Gaudreau et al,²⁴ Nivins et al,²⁵ Panjeti-Madan and Ranganathan³⁰
Executive functioning & attention	Impaired attention regulation and cognitive flexibility	Interactive content; screen time limits	Lakicevic et al,² Muppalla et al,³ Bustamante et al,¹⁵ Swider-Cios et al,²² Sweetser et al²⁶
Physical health (weight, vision)	Increased risk of overweight and myopia	Physical activity; limited daily exposure	Muppalla et al,³ Devi and Singh,¹⁰ Bozzola et al,²⁷ Byrne et al,²⁹ Panjeti-Madan and Ranganathan³⁰
Emotional & social behavior	Higher levels of emotional dysregulation and social withdrawal	Parental involvement; media literacy	Brushe et al,⁴ Kim and Chung,⁹ Liu et al,¹² Charan et al,¹⁸ Argyriadi et al,¹⁹ Panjeti-Madan and Ranganathan³⁰
Sleep	Delayed sleep onset, reduced duration, circadian rhythm disruption (e.g., melatonin suppression)	Avoiding screens before bedtime; sleep-friendly routines	Muppalla et al,³ Brushe et al,⁴ Madigan et al,⁵ World Health Organization,⁶ Liu et al¹²

Meta-analyses and large-scale surveys have shown that only 24% to 36% of children under 5 meet ST recommendations.^4,5,11 Parental co-view and interactive digital content can reduce certain risks, although potential long-term effects on brain development remain under investigation.^4,14,23

The main key points identified are presented in Figure 1.

Figure 1.

The impact of excessive screen time on health risks in preschoolers.^{4-7,11,12,15,25-27}

Additionally, emerging evidence suggests that technoference, defined as the disruption of parent-child interactions due to adult screen use, may further exacerbate emotional and behavioral challenges in young children (Figure 2).

Figure 2.

Invisible interruptions: how technoference shapes childhood.

Recent studies show that parental technoference is not merely a background behavior but a distinct risk factor for child development. These disruptions can lead to increased irritability, attention-seeking behaviors, and difficulties in emotional regulation, particularly when children perceive digital devices as competing for parental attention.^16,19 Technoference also undermines everyday caregiving routines and safety monitoring.

Given its impact, it should be considered a separate digital exposure variable alongside screen time in models of early childhood health.

Empirical Findings

The average daily ST in the total sample was 63.8 min (SD = 56.2), with boys and girls averaging 67.8 min (SD = 58.6) and 59.7 min (SD = 53.5), respectively (F = 6.7; P = .010). The proportion of children aged 4 to 6 years with STs exceeding 1 h per day was 49.3% for boys, 40.4% for girls (χ² = 10.4; P = .001), and 44.9% in the overall sample. Table 2 presents sample characteristics stratified by sex, including qualitative and quantitative data.

Table 2.

Demographic Profile and Screen Time Patterns (N = 1312).

Variables	Respondents	Boys		Girls		Total
Variables	Respondents	n	%	n	%	n	%
Qualitative data
Place of living	Urban	207	47.1 ± 2.4	233	53.0 ± 2.4	440	33.5 ± 1.3
Place of living	Rural	458	52.5 ± 1.7	414	47.5 ± 1.7	872	66.5 ± 1.3
χ²/P		χ² = 3.5; P = .061
Sleep	1.0 h and less	588	51.1 ± 1.5	563	48.9 ± 1.5	1151	87.7 ± 0.9
Sleep	Hour and more	77	47.8 ± 3.9	84	52.2 ± 3.9	161	12.3 ± 0.9
χ²/P		χ² = 0.6; P = .439
Screen time	1.1 h and more	336	55.7 ± 2.0	267	44.3 ± 2.0	603	46.0 ± 1.4
Screen time	1.0 h and less	329	46.4 ± 1.9	380	53.6 ± 1.9	709	54.0 ± 1.4
χ²/P		χ² = 11.3; P = .008
Successful education¹	No	66	62.3 ± 4.7	40	37.7 ± 4.7	106	8.1 ± 0.8
Successful education¹	Yes	599	49.7 ± 1.4	607	50.3 ± 1.4	1206	91.9 ± 0.8
χ²/P		χ² = 6.2; P = .013
Quantitative data
Sleep duration, min/day		665	556.9 (24.8)³		558.6 (24.7)		557.8 (24.8)
F/P		F = 1.6; P = .208
Screen time, min/day		665	67.8 (58.6)	647	59.7 (53.5)		63.8 (56.2)
F/P		F = 6.7; P = .010
Including
TV, min/day		665	41.7 (31.1)	647	39.2 (30.5)	1312	40.4 (30.8)
F/P		F = 2.2; P = .141
Video games, min/day		346	28.0 (27.5)	313	24.9 (24.7)	659	26.5 (26.2)
F/P		F = 2.3; P = .126
DL², min/day		259	29.6 (29.3)	219	25.2 (22.7)	478	27.6 (26.5)
F/P		F = 3.3; P = .072

Successful education refers to how effectively children comprehend and retain knowledge.

DL is developmental learning denotes learning activities using electronic screen devices.

Values are presented as the mean (standard deviation).

The composition of STs between boys and girls did not differ significantly and consisted of 73.4% television viewing, 16.2% video gaming, and 10.4% developmental learning activities (Figure 3).

Figure 3.

Composition of screen time in preschool children stratified by sex, %.

The largest share of ST was allocated to television viewing (73.4%), with video gaming and developmental activities accounting for 16.2% and 10.4%, respectively. Girls spent a slightly greater proportion of their ST watching television (Figure 3), whereas boys had higher proportions engaging in video games and developmental activities; however, these differences were not statistically significant (P > .1).

Children residing in rural areas had significantly lower average STs (53.5 min, SD = 34.8) than did their urban counterparts (84.3 min, SD = 80.0; F = 94.4; P < .001).

Children who successfully acquired the educational program had an average ST of 54.3 min (SD = 35.2), whereas those with learning difficulties averaged 172.2 min (SD = 111.4).

Among children with more than 1.1 h of screen exposure per day, 10.05% reported not assimilating educational material in kindergarten, whereas among those with less than or equal to 1 h, only 3.24% reported doing so. The relationship was statistically significant (χ² = 24.98, df = 1, P < .001), and a weak but significant positive correlation was found (Spearman’s ρ = .139, P < .001).

Logistic regression analysis revealed that children who exceeded 1.1 h of ST per day were 3.33 times more likely to be reported as not assimilating educational material in kindergarten (OR = 3.33, 95% CI: 2.03-5.47, z = 4.76, P < .0001). This association remained significant even after controlling for other factors.

Table 3 presents the coefficients from both the unadjusted and adjusted logistic regression models. The unadjusted model revealed that each 1-min decrease in ST per day increased the odds of successful acquisition of the educational program by 2.5% (OR = 0.975; 95% CI: 0.972-0.979). The adjusted odds ratio indicated a 2.2% increase per minute (OR = 0.978; 95% CI: 0.974-0.982).

Table 3.

Logistic Regression Model Coefficients.

Variables	B	Standard error	Vald	P	Exp (B)	CI
Unadjusted model
Screen time	−0.02	0.002	153.1	.001	0.975	0.972-0.979
Intercept	4.75	0.25	360.9	.001	115.705
Adjusted model
Urban/rural	−1.147	0.274	17.6	.001	0.318	0.186-0.543
Sex	0.560	0.271	4.3	.038	1.751	1.030-2.976
Sleep	−0.007	0.005	1.9	.161	0.993	0.983-1.003
Screen time	−0.022	0.002	113.3	.001	0.978	0.974-0.982
Intercept	8.360	2.975	7.9	.005	4271.262

In addition to the effect of ST, the covariates sex (OR = 1.751; 95% CI: 1.030-2.967) and place of residence (OR = 0.318; 95% CI: 0.186-0.543) were significant in the model. The model correctly classified 95.9% of the cases. The model demonstrated strong predictive ability (Model χ²(4) = 289.51, P < .001). The area under the ROC curve (AUC) was 0.941, indicating excellent discriminative power. The optimal cutoff point provided a sensitivity of 0.89 and specificity of 0.87.

Discussion

Our literature review presents evidence suggesting that excessive ST may be associated with various developmental challenges in early childhood. These include potential language delays, difficulties in attention and executive function, emotional dysregulation, behavioral issues, sleep disturbances, and an increased likelihood of obesity and myopia.^{3-6,9-12,21,23,27,30,33-37}

Our data analysis indicated that each additional minute of screen exposure was linked to a decrease in the odds of cognitive engagement of more than 2.2% (OR = 0.978; 95% CI: 0.974-0.982). These findings align with existing research showing that children exceeding the recommended daily ST are at greater risk of learning difficulties. While the observed effect size is modest (r = .14), the consistent results across both adjusted and unadjusted models highlight the potential negative cognitive implications of excessive ST. Our study also found that exceeding 1 h of screen time per day triples the likelihood of academic failure (OR = 3.33, 95% CI: 2.03-5.47).

The relationship between ST and health is believed to stem from both physiological factors, such as melatonin suppression and sedentary behavior, as well as a decrease in engaging, health-promoting activities in children’s daily routines.^{3-6,10,12,30-34} These activities include physical exercise, interactive play, reading, and emotionally rich interactions between adults and children. Additionally, unsupervised or passive screen use, especially with dynamic or algorithm-driven content, may further hinder preschool children’s ability to regulate attention, verbal reasoning, and emotional stability.^{10-12,14,30,34-36}

Recent developments in digital technologies have prompted research into the effects of both active and passive STs.^{26,30,34,35,38} Understanding this distinction is crucial for evaluating their impact on children. International recommendations from the WHO and AAP limit ST to no more than 1 h per day for children aged 2 to 5 years, with at least 70% of that time devoted to active, co-viewed, or interactive content.^{3,6,10,12,26,30,34,36,39} This means that digital time should ideally involve communication, learning, or regulated physical activity.

These guidelines also reflect the developmental characteristics of preschoolers and their attention capacity. Children aged 2 to 3 years can concentrate on a single task for approximately 5-10 min, whereas those aged 4 to 5 years can sustain attention for 10-15 min, potentially extending to 20 min with adult involvement. Therefore, a single video lesson, whether exercise, story, or logical game, should not exceed 15 min for 2- to 3-year-olds and should be limited to 20 min for older preschoolers.

On the basis of our analysis of the literature on ST among preschool children aged 4 to 6 years, particularly during the 2010 to 2015 period, and supplemented by more recent meta-analyses, excessive screen exposure clearly continues to pose a significant developmental risk. Studies from this earlier period, as well as subsequent systematic reviews such as the 2024 meta-analysis,^{3,5,8-10,12,30,34-36,40,41} demonstrate that a large proportion of children aged 2 to 5 years exceed the recommended daily ST limit, often without parental supervision or age-appropriate content.

Recent research has highlighted that technoference, the interruption of interpersonal interactions by digital devices, affects not only the quality of parent-child bonding but also children’s emotional regulation.¹⁹ When parental attention is diverted to screens, children may perceive it as emotional neglect, which can trigger irritability, crying, aggression, and attention-seeking outbursts.^16,19 These reactions reflect deeper disruptions in attachment and trust-building processes.^16,19,42,43 Moreover, children may internalize the message that devices are more important than their presence, undermining the development of self-worth and social responsiveness. This dynamic reinforces the need for intentional digital boundaries within family routines.

Moreover, contemporary studies examining ST in the context of remote learning may not accurately reflect the current pace and style of digital media consumption.^{30,34,35,39,44-47} Modern children are increasingly accustomed to fast-paced, highly stimulating digital content that significantly departs from traditional media formats. Therefore, the design of remote learning programs must account not only for opportunities for social interaction and play-based engagement^{12,14,30,34,36} but also for attention span, overstimulation risks, and the quality of content delivery.

These findings also raise critical questions about the adequacy of “ST” as a standalone indicator of media exposure in preschool-aged children.^11,29,30 There is growing recognition that this metric may oversimplify the multifaceted nature of early digital engagement.^{1,3,11,29,30,35,36,46-48} Modern platforms depend heavily on fast-paced, highly engaging content, which can both positively and negatively impact cognitive load, attention span, and emotional regulation, regardless of duration.

Our review indicates that parental co-view, the use of interactive formats, and adherence to daily ST limits are among the most promising protective strategies.^{3,4,12,14,30,34,36,37} However, implementation varies widely across settings, particularly in non-Western and crisis-affected regions.^{14,34,38,39,44,45,49} This variation underscores the urgent need for practical, culturally sensitive recommendations and rigorous evaluation of digital learning programs in early childhood contexts.¹

Our findings further support the argument that remote learning during early childhood must be carefully regulated. Although online platforms may offer cognitive stimulation, continuity of care, and emotional scaffolding, particularly during emergencies such as pandemics, unsupervised or excessive screen exposure may undermine these potential benefits.^{3,5,10,12,14,30,34-36,39-41,44,45}

It is essential to recognize that, when utilized thoughtfully, digital tools can play a valuable role in supporting development and learning. Interactive media that are age-appropriate and foster sensorimotor engagement, turn-taking, storytelling, and verbal interactions can enhance early cognitive skills, promote language development, and strengthen parent-child relationships when experienced together.^{12,14,20,28,36}

Additionally, structured digital content, particularly when viewed alongside adults, can offer continuity of care, emotional support, and enriching learning experiences during challenging times or periods of routine disruption. Rather than dismissing digital platforms, early childhood education should seek to cultivate media literacy within families and emphasize the importance of quality over quantity in ST. Reducing parental technoference can further enhance the emotional benefits of shared digital experiences, transforming screen time into moments of connection rather than distraction.

The strengths of our study lie in the integration of a narrative synthesis of the world literature with original empirical data collected from a context that deserves further attention. These data were obtained before the pervasive digitalization and rapid content consumption that characterize our era. Therefore, we believe that using retrospective data to analyze the impact of distance learning on children’s health is a valid approach, as it considers the effects of developmental learning.

While much of the research on the impact of ST on the health of preschoolers has focused on high-income Western countries, our findings from Ukraine provide insight into an Eastern European perspective that is often underrepresented. In this region, differences in access to digital technologies, educational resources, and family practices are quite pronounced compared with those in the West.

The limitations of the empirical section of this study include our reliance on retrospective data collected before the era of global digitalization, changes in content, and the rise of distance learning. As a result, we were unable to fully capture the effects of contemporary information content on the health of preschoolers.

Another limitation was the restricted ability to account for all factors that might influence cognitive ability and the acquisition of the kindergarten curriculum. For future prospective studies, it will be important to include additional indicators of development and behavior, such as morbidity, sleep quality, emotional state, and interactions with peers, parents, and caregivers.

Recommendations and Implications

On the basis of the reviewed literature and our empirical findings, we propose the following recommendations to guide policy, research, and practice in early childhood digital learning:

Daily screen time should be limited to no more than 60 minutes for children aged 2 to 5 years, in accordance with the WHO and AAP guidelines. This includes both educational and recreational screen use.^5,9

Age-appropriate, developmentally tailored content should be ensured, with an emphasis on interactive and visually engaging materials that promote sensorimotor engagement, creativity, and verbal interaction. Parental co-view and active participation are essential for enhancing comprehension, reducing passive consumption, and supporting emotional regulation during and after screen use.^9,14,16

Screen use should be avoided at least 1 h before bedtime to reduce melatonin suppression and support healthy sleep patterns.^5,14

Screen-based learning can be balanced with physical activity and hands-on tasks, such as outdoor play, drawing, building, or storytelling, to support multisensory and motor development.^10,14

Remote learning can be structured into short, modular sessions, ideally lasting no more than 15-20 minutes per activity, especially for children under the age of 5.¹⁶

Remote learning is used as a supplemental, not primary, modality, particularly during crises (eg, pandemics, displacement, temporary closures) or when in-person attendance is not feasible due to chronic illness or other family-related factors.^2,16

In addition to the above recommendations, we have developed a concise handout for parents and caregivers, outlining 7 practical steps to support healthy digital habits and reduce technoference in early childhood (Supplemental File 1, Supplemental Material 2). This material is available as supplementary content and may be adapted for use in educational, clinical, or community settings.

Conclusions

This study emphasizes the importance of managing screen exposure for preschool children, especially during remote learning. Our findings reveal a significant correlation between increased screen time and a reduced likelihood of mastering educational content, which aligns with existing evidence on the health risks associated with excessive digital media use in early childhood.

While digital tools can offer valuable support during challenging times, they should be used with careful consideration of age-specific needs, developmental vulnerabilities, and health guidelines. Screen-based learning should focus on interaction, be concise, involve adult participation, and be integrated into a holistic daily routine that includes physical activity, social engagement, and adequate sleep.

Future policies and digital education initiatives should be based on evidence-informed strategies that strike a balance between innovation and the well-being of children. Furthermore, additional research is needed to understand the long-term cognitive, emotional, and social impacts of remote learning on preschool-aged individuals.

Supplemental Material

sj-docx-1-inq-10.1177_00469580251390766 – Supplemental material for Digital Exposure in Early Childhood: Health Risks and Protective Strategies During Remote Learning

Supplemental material, sj-docx-1-inq-10.1177_00469580251390766 for Digital Exposure in Early Childhood: Health Risks and Protective Strategies During Remote Learning by Olena Yelizarova, Tetiana Stankevych, Alla Parats, Viktor Yelizarov, Olha Puzanova, Natalia Lebedynets and Svitlana Hozak in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Footnotes

Acknowledgements

We thank the teachers and respondents who participated in this study, and gratefully acknowledge the assistance of the large language model ChatGPT (GPT-4o, GPT-5, OpenAI) and Copilot (Microsoft), which was used to support the translation and language refinement of the manuscript. All intellectual content and final wording were determined by the authors.

ORCID iDs

Olena Yelizarova

Tetiana Stankevych

Alla Parats

Viktor Yelizarov

Olha Puzanova

Natalia Lebedynets

Svitlana Hozak

Ethical Considerations

The survey was approved by the Bioethics Committee of the SI “O.M. Marzieiev Institute for Public Health.”

Consent to Participate

The participants were informed about the survey’s objectives, confidentiality measures, data usage conditions, and contact information for the principal investigator. All the participants read and signed an informed consent form.

Author Contributions

OY: Conceptualization, methodology, investigation, formal analysis, visualization, writing – original draft. TS: Methodology, Investigation, Project administration, Writing – original draft. AP: Methodology, Investigation. VY: Data curation, Software, Formal analysis, Writing – review & editing. OP: Methodology, Investigation, Writing – review & editing. NL: Methodology, Investigation, Writing – review & editing. SH: Conceptualization, methodology, investigation, project administration, supervision. All authors reviewed the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Clinical Trial Registration

Clinical trial number not applicable.

Supplemental Material

Supplemental material for this article is available online.

References

Raikes

Sayre

Davis

, et al. The measuring early learning quality & outcomes initiative: purpose, process and results. Early Years. 2019;39(4):1-16. doi:10.1080/09575146.2019.1669142

Lakicevic

Manojlovic

Chichinina

Drid

Zinchenko

Author correction: screen time exposure and executive functions in preschool children. Sci Rep. 2025;15:7092. doi:10.1038/s41598-025-91348-7

Muppalla

Vuppalapati

Reddy Pulliahgaru

Sreenivasulu

Effects of excessive screen time on child development: an updated review and strategies for management. Cureus. 2023;15(6):e40608. doi:10.7759/cureus.40608

Brushe

Haag

Melhuish

Reilly

Gregory

Screen time and parent-child talk when children are aged 12 to 36 months. JAMA Pediatr. 2024;178(4):369-375. doi:10.1001/jamapediatrics.2023.6790

Madigan

Eirich

Pador

McArthur

Neville

RD.

Assessment of changes in child and adolescent screen time during the COVID-19 pandemic: a systematic review and meta-analysis. JAMA Pediatr. 2022;176(12):1188-1198. doi:10.1001/jamapediatrics.2022.4116

World Health Organization. Guidelines on Physical Activity, Sedentary Behavior and Sleep for Children Under 5 Years of Age. World Health Organization; 2019. https://www.who.int/publications/i/item/9789241550536

American Academy of Pediatrics Council on Communications and Media. Media and young minds. Pediatrics. 2016;138(5):e20162591. doi:10.1542/peds.2016-2591

Lee

Kim

Shin

Screen time among preschoolers: exploring individual, familial, and environmental factors. Clin Exp Pediatr. 2024;67(12):641-650. doi:10.3345/cep.2023.01746

Kim

Chung

US.

Associations among exposure to television or video, language development, and school achievement in childhood: a prospective birth cohort study. Soc Psychiatry Psychiatr Epidemiol. 2021;56(5):847-856. doi:10.1007/s00127-020-01967-w

10.

Devi

Singh

SK.

The hazards of excessive screen time: Impacts on physical health, mental health, and overall well-being. J Educ Health Promot. 2023;12:413. doi:10.4103/jehp.jehp_447_23

11.

McArthur

Volkova

Tomopoulos

Madigan

Global prevalence of meeting screen time guidelines among children 5 years and younger: a systematic review and meta-analysis. JAMA Pediatr. 2022;176(4):373-383. doi:10.1001/jamapediatrics.2021.6386

12.

Liu

Riesch

Tien

Lipman

Pinto-Martin

O’Sullivan

. Screen Media overuse and associated physical, cognitive, and emotional/behavioral outcomes in children and adolescents: an integrative review. J Pediatr Health Care. 2022;36(2):99-109. doi:10.1016/j.pedhc.2021.06.003

13.

Rayce

Okholm

Flensborg-Madsen

Mobile device screen time is associated with poorer language development among toddlers: results from a large-scale survey. BMC Public Health. 2024;24(1):1050. doi:10.1186/s12889-024-18447-4

14.

Hutton

Dudley

Horowitz-Kraus

DeWitt

Holland

SK.

Associations between screen-based media use and brain white matter integrity in preschool-aged children. JAMA Pediatr. 2020;174(1):e193869. doi:10.1001/jamapediatrics.2019.3869

15.

Bustamante

Fernández-Castilla

Alcaraz-Iborra

Relation between executive functions and screen time exposure in under 6 year-olds: a meta-analysis. Comput Human Behav. 2023;145:107739. doi:10.1016/j.chb.2023.107739

16.

Megari

Smyrli

Neuropsychological status from preschool age up to adolescence: evidence from typical children and children with disabilities. In: Sofologi

Katsarou

Efthymiou

eds. Exploring Cognitive, Psychosocial, and Psycholinguistic Dynamics Across Childhood and Adolescence. IGI Global; 2025;23-44.

17.

Smyrli

Megari

Neuropsychological development and assessment from infancy to adolescence. In: Sofologi

Katsarou

Efthymiou

, eds. Clinical Applications of Pediatric Neuropsychology From Infancy to Adolescence. IGI Global; 2025;23-42.

18.

Charan

Kalia

Khurana

Narang

GS.

From screens to sunshine: rescuing children’s outdoor playtime in the digital era. J Indian Assoc Child Adolesc Ment Health. 2024;20(1):11-17. doi:10.1177/09731342241229845

19.

Argyriadi

Katsarou

Patelarou

, et al. Digital stress scale (DSC): development and psychometric validation of a measure of stress in the digital age. Int J Environ Res Public Health. 2025;22(7):1080. doi:10.3390/ijerph22071080

20.

Taylor

Sala

Kolak

Gerhardstein

Lingwood

Does adult-child couse during digital media use improve children’s learning aged 0–6 years? A systematic review with meta-analysis. Educ Res Rev. 2024;44:100614. doi:10.1016/j.edurev.2024.100614

21.

Linebarger

Vaala

SE.

Screen media and language development in infants and toddlers: an ecological perspective. Dev Rev. 2010;30(2):176-202. doi:10.1016/j.dr.2010.03.006

22.

Swider-Cios

Vermeij

Sitskoorn

MM.

Young children and screen-based media: the impact on cognitive and socioemotional development and the importance of parental mediation. Cogn Dev. 2023;66:101319. doi:10.1016/j.cogdev.2023.101319

23.

Clemente-Suárez

Beltrán-Velasco

Herrero-Roldán

, et al. Digital device usage and childhood cognitive development: exploring effects on cognitive abilities. Children. 2024;11(11):1299. doi:10.3390/children11111299

24.

Gaudreau

King

Dore

, et al. Preschoolers benefit equally from video chat, pseudo-contingent video, and live book reading: implications for storytime during the Coronavirus pandemic and beyond. Front Psychol. 2020;11:2158. doi:10.3389/fpsyg.2020.02158

25.

Nivins

Sauce

Liebherr

Judd

Klingberg

Long-term impact of digital media on brain development in children. Sci Rep. 2024;14:13030. doi:10.1038/s41598-024-63566-y

26.

Sweetser

Johnson

Ozdowska

Wyeth

Active versus passive screen time for young children. Aust J Early Child. 2012;37(4):94-98. doi:10.1177/183693911203700413

27.

Bozzola

Irrera

Hellmann

Crugliano

Fortunato

Media device use and vision disorders in the pediatric age: the state of the art. Children. 2024;11(11):1408. doi:10.3390/children11111408

28.

Hirsh-Pasek

Zosh

Golinkoff

Gray

Robb

Kaufman

Putting education in "educational" apps: lessons from the science of learning. Psychol Sci Public Interest. 2015;16(1):3-34. doi:10.1177/1529100615569721

29.

Byrne

Terranova

Trost

SG.

Measurement of screen time among young children aged 0–6 years: a systematic review. Obes Rev. 2021;22(8):e13260. doi:10.1111/obr.13260

30.

Panjeti-Madan

Ranganathan

Impact of screen time on children’s Development: cognitive, language, physical, and social and emotional domains. Multimodal Technol Interact. 2023;7(5):52. doi:10.3390/mti7050052

31.

IBM Corp. IBM SPSS Statistics for Windows, Version 26.0. IBM Corp; 2019.

32.

R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2023. https://www.r-project.org

33.

Morrison

Meh

Sember

Starc

Jurak

The effect of pandemic movement restriction policies on children’s physical fitness, activity, screen time, and sleep. Front Public Health. 2021;9:785679. doi:10.3389/fpubh.2021.785679

34.

Ponti

Screen time and preschool children: Promoting health and development in a digital world. Paediatr Child Health. 2023;28(3):184-192. https://academic.oup.com/pch/article-abstract/28/3/184/7163632

35.

Egan

Beatty

To school through the screens: the use of screen devices to support young children’s education and learning during the COVID-19 pandemic. Ir Educ Stud. 2021;40(2):275-283. doi:10.1080/03323315.2021.1932551

36.

Pardhan

Parkin

Trott

Driscoll

Risks of digital screen time and recommendations for mitigating adverse outcomes in children and adolescents. J Sch Health. 2022;92(8):765-773. doi:10.1111/josh.13170

37.

McIver

LSB

. Beyond the Screen: Impact of Screen Time on Children’s Cognitive Development. Doctoral dissertation, Regent University. 2025. https://search.proquest.com/openview/f617f1543c0932e10f64648d5d12f4e1/1?pq-origsite=gscholar&cbl=18750&diss=y

38.

Kovacs

Starc

Brandes

, et al. Physical activity, screen time and the COVID-19 school closures in Europe – an observational study in 10 countries. Eur J Sport Sci. 2022;22(7):1094-1103. doi:10.1080/17461391.2021.1897166

39.

Sajwani

Qawas

Al Ali

, et al. The effect of lockdowns and distant learning on the health-related behaviours of school students in the United Arab Emirates. BMC Primary Care. 2022;23(1):253. doi:10.1186/s12875-022-01856-y

40.

Arippin

NFA

Mahmud

Abdul Rahman

Aliy-Yuin

KYA

Swee Ching

H. Abdul Mumin

. Parents’ knowledge, attitude, and practice on children’s screen time at home and the implications for nurses in promoting health: a cross-sectional study. Children. 2023;18(3):299-308. doi:10.20473/jn.v18i3.49891

41.

Kołota

Głąbska

Covid-19 pandemic and remote education contributes to improved nutritional behaviors and increased screen time in a Polish population-based sample of primary school adolescents: diet and activity of youth during COVID-19 (DAY-19) study. Nutr. 2021;13(5):1596. https://www.mdpi.com/2072-6643/13/5/1596

42.

Argyriadi

Katsarou

Efthymiou

. Psychosocial adaptation and stress regulation in childhood and adolescence. In: Sofologi

Katsarou

Efthymiou

, eds. Exploring Cognitive, Psychosocial, and Psycholinguistic Dynamics Across Childhood and Adolescence. Pennsylvania (USA): IGI Global; 2025:85-102. doi: 10.4018/979-8-3693-4022-6.ch004

43.

Komanchuk

Toews

Marshall

, et al. Impacts of parental technoference on parent-child relationships and child health and developmental outcomes: a scoping review. Cyberpsychol Behav Soc Netw. 2023;26(8):579-603. doi:10.1089/cyber.2022.0278

44.

Singh

Balhara

YPS

. “Screen-time" for children and adolescents in COVID-19 times: need to have the contextually informed perspective. Indian J Psychiatry. 2021;63(2):192-195. doi:10.4103/psychiatry.IndianJPsychiatry_646_20

45.

Wong

Tsai

Jonas

, et al. Digital screen time during the COVID-19 pandemic: risk for a further myopia boom? Am J Ophthalmol. 2021;223:333-337. https://www.sciencedirect.com/science/article/pii/S0002939420303925

46.

Larsson

Shad

Hulbert

Roueché

Macaulay

Screen-time: ensuring excellence in online teaching. Paediatr Child Health. 2024;34(1):34-40. https://www.sciencedirect.com/science/article/pii/S1751722223001816

47.

Diamantis

Shalit

Katsas

, et al. Improving children’s lifestyle and quality of life through synchronous online education: the nutritional adventures school-based program. Nutr. 2023;15(24):5124. https://www.mdpi.com/2072-6643/15/24/5124

48.

Abou Hashish

Baatiah

Bashaweeh

Kattan

AM.

The online learning experience and reported headaches associated with screen exposure time among Saudi health sciences students during the COVID-19 pandemic. BMC Med Educ. 2022;22(1):226. doi:10.1186/s12909-022-03235-8

49.

Efthymiou

Katsarou

Sofologi

, et al. A systematic review of school-based behavioral interventions and the symbolic labor of inclusion for children with chronic illness. Healthcare. 2025;13(16):1968. doi:10.3390/healthcare13161968

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