Guideline Recommendations and Estimates of Excessive Screen Time in Children

Abstract

Even though digital media use in early childhood has increased, compliance estimates vary depending on the screen time guideline applied. This study compared Portuguese, World Health Organization, and American Academy of Pediatrics recommendations within the same population, and examined factors associated with exceeding age-specific limits. Baseline data from 940 children aged two to six years (mean 4.67 ± 1.03; 52.8% boys) were analyzed. The mean daily screen time was 126 minutes. The exceedance prevalence and severity were classified according to each framework. Most children exceeded recommendations across all systems, with highest prevalence and severity under the Portuguese Society of Neuropediatrics, followed by the American Academy of Pediatrics and the World Health Organization. Despite systematic reclassification across guidelines, consistent determinants emerged: earlier age at first exposure (ORs ranging between 0.93 - 0.98), child Internet use (non-use: ORs between 0.06 - 0.38), higher maternal screen time (ORs between 1.02 - 1.04), and bedroom device access (ORs between 0.17 - 0.50) were associated with higher odds of exceeding limits. Parental awareness of recommendations was generally high, but quantitative restrictions were less consistently implemented. The findings suggest that prevalence estimates strongly depend on the guideline framework applied, while family-level determinants of excessive exposure remain stable across classification systems.