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Prevalence, patterns and parental perceptions of excessive screen time among children aged 2-4 years: A cross-sectional study from a rural setting of Haryana, India
For correspondence: Dr Mohan Bairwa, Centre for Community Medicine, All India Institute of Medical Sciences, Delhi 110 029, India e-mail: mohanbairwa@aiims.edu
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Received: ,
Accepted: ,
How to cite this article: Singh S, Bairwa M, Haldar P, Nongkynrih B. Prevalence, patterns and parental perceptions of excessive screen time among children aged 2-4 years: A cross-sectional study from a rural setting of Haryana, India. Indian J Med Res. 2026;163:548-54. doi: 10.25259/IJMR_2161_2025.
Abstract
Background and objectives
Excessive screen time in toddlers and preschool-aged children, defined by World Health Organization as daily screen exposure exceeding 60 min, has been extensively studied in urban settings and high-income countries. However, evidence from rural contexts remains scarce. So, the objective of this study was to estimate the prevalence of excessive screen time among children aged 2-4 yr in a rural population of North India and understand related parenting practices.
Methods
A community-based cross-sectional study was conducted in four villages of Haryana, India among 282 children. A pre-tested, semi-structured interview schedule was administered to parents to assess weekly screen time duration and frequency, type of content, context of exposure and parental perceptions. Factors associated with excessive screen time were analysed using Poisson regression to estimate the adjusted prevalence ratio.
Results
The prevalence of excessive screen time was 50.5% [95% confidence interval (CI): 44.5–56.5%]. Screen use was primarily for entertainment (71.1%) or as a parenting tool (50%). Smartphones (75.2%) and televisions (57.1%) were the most commonly used devices. Most children viewed age-appropriate content, predominantly cartoons. A majority of parents perceived screen time as harmful (92%) and had attempted to restrict it (90%). Excessive screen time was associated with earlier age of screen use (<24 months) [aPR 1.4 (1.1–1.8), P=0.004] and use of devices during meals [aPR 1.4 (1.1–1.7), P=0.015 ].
Interpretation and conclusions
Excessive screen time was prevalent among half the rural children. Furthermore, this was associated with earlier exposure and mealtime screen use.
Keywords
Child
Electronic device
Excessive screen time
Screen media
Screen time
Screen use
Children today are increasingly immersed in digital media, driven by academic needs, entertainment preferences and social engagement. Existing evidence shows a 40% rise in daily screen time over four years among young children from United States.1 Longer hours of screen viewing negatively impact sleep, diet, and weight gain.2 Young children are particularly vulnerable to harmful effects due to impact on cognition and development.2 Hence, World Health Organization recommends limiting daily screen time to under 60 min for children aged 2–4 years.3
Estimating burden of excessive screen time is essential for this age group as it has broader impacts on health and development. However, prevalence estimates vary widely, ranging from 11.8% in China4 to over 90% in Australia.5 A meta-analysis of 63 studies found that 64.4% of children aged 2-5 yr had excessive screen use; although findings show considerable heterogeneity.6 These variations may be due to lack of standard, objective, and validated tools for screen time measurement.7
Nonetheless, exposure to devices in young children is ubiquitous and it is likely that exposure among rural children is also high. Globally, evidence for this limited, with a systematic review of 622 articles identifying only four rural studies, all from high-income countries.8 In India, an independent literature search found just one study from an educated rural setting in Tamil Nadu.9
Beyond quantifying prevalence of excessive screen time, it is also important to explore content and context of screen use.8 Parenting practices play a key role in regulating children’s screen time.10 A child’s screen use is also influenced by demography, media access, and socio-cultural environment.11 These factors must be comprehensively investigated to understand screen media use in young children. Hence, this study was conducted to assess the prevalence of excessive screen time, identify patterns, associated factors and parental influences of screen viewing among children aged 2-4 yr in rural Haryana, India.
Methods
This population-based cross-sectional study was conducted in four large villages of Haryana, North India with an average population of ∼9000. These villages were purposively selected from the 29 villages under Ballabgarh Health and Demographic Surveillance System, which covers a total population of around 1 lakh.12
This study was undertaken by the department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India after obtaining ethics clearance from Institute Ethics Committee from July 2022 to June 2024. A written informed consent was taken from one parent of participants. The sample size was calculated considering 69% prevalence of excessive screen time reported from rural Tamil Nadu,9 a 5% significance level and a 7% absolute precision. A design effect of 1.5 was considered to adjust for potential clustering. Taking a 10% non-response rate and 10% untraceable children, the final sample size was 310. From a line list of the 1,787 children aged 24–59 months in the selected villages, 310 were selected using Microsoft Excel-generated simple random sampling. In households with two eligible children, the older child was included. Data was collected in May-June 2023.
Description of study tool
A semi-structured questionnaire was developed based on literature review and formative research in the study area. The tool demonstrated good 2-week test–retest reliability for average screen time [intraclass correlation coefficient 0.92; 95% confidence interval (CI): 0.84–0.96; P<0.001] and moderate correlation with a 7-day prospective diary (correlation coefficient 0.44; 95% CI: 0.32–0.55; P<0.001). The questionnaire was pre-tested among 20 participants and administered in local language, Hindi.
Screen time was measured through caregivers’ recall of frequency (daily exposure instances) and duration of their child’s individual device use, assessed separately for weekdays and weekends. Daily screen time was estimated by averaging the weekly total. Other components assessed included content, context of exposure, background exposure, parental screen time, parenting practices, perceptions, and socio-demographic details. The questionnaire and diary against which it was validated are included in Supplementary Material.
Data analysis
Data was analysed using Stata v15 (StataCorp, College Station, TX, USA). Descriptive analysis was conducted for prevalence of excessive screen time. Factors associated with outcome were examined using prevalence ratios. Variables with P<0.25 in univariable analysis were entered into the multivariable model. Log-binomial regression was initially attempted but not converge; therefore, Poisson regression with robust standard errors was applied to estimate adjusted prevalence ratios (aPRs). Collinearity was assessed via variance inflation factor (VIF), with variables >10 dropped.
Results
Socio-demographic characteristics
282 participants aged 2-4 yr were recruited for the study. The respondents were mothers, who were primary caregivers of 84% of the participants. Table I provides socio-demographic details of the participants. The median age of mothers and fathers was 27 [Interquartile range (IQR) 25–30] and 30 yr (IQR 28–33), respectively. Median years of schooling were 10 (IQR 7–15) for mothers and 12 (IQR 9–15) for fathers. Most fathers (94.6%) were employed, and 87.1% of mothers were homemakers.
| Study parameters | Frequency | Percentage |
|---|---|---|
| Age (in months) | ||
| 24-35 | 106 | 37.6 |
| 36-47 | 83 | 29.4 |
| 48-59 | 93 | 33.0 |
| Gender | ||
| Male | 131 | 46.5 |
| Female | 151 | 53.5 |
| Primary caregiver | ||
| Mother | 236 | 84.0 |
| Grandmother | 28 | 10.0 |
| Aunt | 11 | 3.9 |
| Others | 6 | 2.1 |
| Family type | ||
| Joint | 180 | 63.8 |
| Nuclear | 44 | 15.6 |
| Three generation | 58 | 20.6 |
| Birth order of child | ||
| Eldest sibling | 121 | 42.9 |
| 2nd order or more | 161 | 57.1 |
| Number of siblings | ||
| None | 50 | 17.7 |
| ≥ 1 | 232 | 82.3 |
| Children aged 2-4 yr in household* | ||
| 1 | 136 | 48.2 |
| 2 or more | 146 | 51.8 |
*other than index child
Screen use among children
Almost 90% (n=251) of participants used screen-based devices, mostly television and smartphones. The prevalence of excessive screen was 50.5% (95% CI: 44.5-56.5%). The median daily screen time was 64.6 (IQR 20-140) min. The intraclass correlation coefficient (ICC) for average screen time across villages was 0.036, indicating limited village-level variation in screen time. In addition, about half (51.9%) of the participants had background screen exposure (i.e, the time a child spends in a room with a device switched on, without actively watching it, with an exposure of 60 (IQR: 30-120) min.
Patterns of screen use
Availability and access
Almost all households (99.3%) owned at least one screen-based device. Figure 1 summarises the household availability of devices. The median age of screen exposure onset was 24 months (IQR 18, 36 months). Around 27% of children began using screens before 2 yr of age; 32% of children had a television placed in the room where they slept and 20% of the children attended childcare centres with a television.
- Availability of devices with screens in the household (n=282).
Content viewed
Most children commonly watch cartoons on television (90.1%). However, smartphone content included cartoons (48.6%), educational (42%), and universal content (43.4%), i.e., designed for all viewers and not specifically for children. These included serials, music videos, gaming, do-it-yourself videos, and short videos. Watching short videos was especially popular on smartphones (24.5%). Educational content included videos for alphabet learning, mathematics, nursery rhymes, or moral stories.
Context of screen time exposure
Parents cited entertainment (71.7%) and education (6%) as common reasons for screen use among children. Screens were also commonly used as parenting tools to calm children (45.8%), keep them occupied (28.3%), or feed them (10.4%). Figure 2 summarises specific contexts of screen exposure among the 251 participants who engaged in screen viewing. Contrary to recommendations, screens are commonly used during meals and at bedtime.
- Distribution of screen use, by specific contexts (n=251*). *the number of children among all interviewed who use screen-based devices.
Parental screen use and parenting knowledge, perception, and practices:
Screen use among parents
Over 80% of fathers and mothers used screens daily, with a median duration of 90 min (IQR: 60–150 min and 60–120 min, respectively). Figure 3 shows the distribution of devices used by participants and their parents.
- Device usage patterns among members of household(n=282).
Parenting knowledge and perception of screen use in children
Although parents were generally unaware of formal guidelines, 22% felt screen time should be limited to one hour, and 30% believed children of this age group should avoid screens altogether. When asked about their perceptions of the effect of screen time on children, 35% of parents considered it useful, primarily for educating their child (32%). However, 92% acknowledged harmful effects of screens on children, including poor vision, cognitive delay, and poor physical health. Concerns also included inappropriate content, academic decline, addiction, and reduced social interaction. Most parents (64%) saw no personal benefit when children were occupied with screens.
Parental supervision of screen-based content
All parents reported monitoring content by keeping the child in the same room or within eyeshot. Figure 4 describes adult co-viewing and verbal interaction with children during device use among all those children who used screen based devices (n=251). Notably, children chose content viewed in 86% of cases.
- Adult supervision of screen-based content (n=251*). *the number of children among all interviewed who use screen-based devices.
Parenting practices to limit screen time and barriers
Most parents (90%) stated they could control their child’s screen time, mainly by restricting screen time or engaging the child in other activities. Some parents (28%) made house rules in an attempt to regulate screen time, mainly by restricting access (11%) or limiting duration (8%). Less commonly (1.3%), parents attempted to be role models and reduced screen time themselves. However, nearly half (45%) accepted facing barriers in controlling the child’s screen time, including the child’s insistence, mealtime dependency, holidays, indulgent relatives or grandparents, and parents’ chores or incomplete tasks.
Predictors of excessive screen time
After adjustment for confounders in the multivariable model, earlier age of screen use (<24 months) [aPR 1.4 (1.1–1.8), P=0.004] and use of devices during meals [aPR 1.4 (1.1–1.7), P=0.015] were significantly associated with excessive screen time. The results are presented in Table II.
| Normal ST, n (%) | Excessive ST, n (%) | cPR* (95%CI) | P value | aPR* (95%CI) | P value | ||
|---|---|---|---|---|---|---|---|
| Socio-demographic factor | |||||||
| Caregiver | Mother | 117 (49.6) | 119 (50.4) | 1 | - | - | |
| Other | 22 (49.0) | 23 (51.0) | 1.0 (0.7-1.4) | 0.932 | - | - | |
| Age of the child (yr) | 2 | 67 (63.8) | 38 (36.2) | 1 | 1 | ||
| 3 | 34 (41.0) | 49 (59.0) | 1.6 (1.2-2.2) | 0.002 | 1.2 (0.7-1.9) | 0.599 | |
| 4 | 38 (40.9) | 55 (59.1) | 1.6 (1.2-2.2) | 0.002 | 1.5 (0.9-2.9) | 0.141 | |
| Gender | Female | 75 (49.7) | 76 (50.3) | 1 | - | - | |
| Male | 64 (49.2) | 66 (50.8) | 1.0 (0.8-1.3) | 0.942 | - | - | |
| Number of Siblings | None | 20 (40.0) | 30 (60.0) | 1 | 1 | ||
| 1 or more | 119 (51.2) | 112 (48.8) | 0.8 (0.6-1.1) | 0.112 | 0.8 (0.6-1.3) | 0.449 | |
| Family type | Nuclear | 26 (59.1) | 18 (40.9) | 1 | 1 | ||
| Joint | 113 (47.7) | 124 (52.3) | 1.3 (0.9-1.9) | 0.199 | 0.9 (0.6-1.4) | 0.692 | |
| Parental factors | |||||||
| Parental age (in years) | Mother’s age | - | - | 1.0 (1.0-1.1) | 0.007 | 1.0 (1.0–1.1) | 0.158 |
| Father’s age | - | - | 1.0 (1.0-1.1) | 0.000 | Dropped due to multicollinearity with mother’s age | ||
| Years of schooling | Mother | - | - | 1.0 (0.9-1.0) | 0.077 | ||
| Father | - | - | 1.0 (0.9-1.0) | 0.14 | |||
| Mother’s occupation | Homemaker | 124 (51.0) | 119 (49.0) | 1 | - | - | |
| Employed | 14 (38.9) | 22 (61.1) | 1.2 (0.9-1.7) | 0.135 | 1.0 (0.8–1.3) | 0.885 | |
| Mother’s screen time | ≤1h | 56 (57.2) | 42 (42.8) | 1 | 1 | ||
| >1h | 51 (37.2) | 86 (62.8) | 1.4 (1.1-1.9) | 0.004 | 1.3 (1.0–1.8) | 0.065 | |
| Father’s screen time | ≤1h | 44 (45.8) | 52 (54.2) | 1 | - | - | |
| >1h | 60 (44.4) | 75 (55.6) | 1.0 (0.8-1.3) | 0.835 | - | - | |
| Availability of screen devices | |||||||
| TV in childcare facility | No | 56 (49.1) | 58 (50.9) | 1 | 1 | ||
| Yes | 18 (32.1) | 38 (67.9) | 1.3 (1.0-1.7) | 0.027 | 1.2 (1.0–1.6) | 0.109 | |
| Number of TV sets at home | ≤ 1 | 126 (53.6) | 109 (46.4) | 1 | 1 | ||
| >1 | 13 (28.3) | 33 (71.7) | 1.5 (1.2-1.9) | 0.000 | 1.2 (0.9–1.5) | 0.189 | |
| Age of onset of screen use | ≥24 months | 90 (52.0) | 83 (48.0) | 1 | |||
| <24 months | 19 (25.0) | 57 (75.0) | 1.5 (1.3-1.9) | 0.000 | 1.4 (1.1–1.8) | 0.004 | |
| Context of screen time in children | |||||||
| Use of devices before sleep | No | 75 (52.1) | 69 (47.9) | 1 | 1 | ||
| Yes | 34 (31.8) | 73 (68.2) | 1.4 (1.1-1.8) | 0.001 | 1.2 (0.9–1.5) | 0.25 | |
| Use of devices during meals | No | 87 (54.0) | 74 (46.0) | 1 | 1 | ||
| Yes | 22 (24.7) | 67 (75.3) | 1.6 (1.3-2.0) | 0.000 | 1.4 (1.1–1.7) | 0.015 | |
| Use of devices to calm child | No | 70 (51.9) | 65 (48.1) | 1 | 1 | ||
| Yes | 39 (33.6) | 77 (66.4) | 1.4 (1.1-1.7) | 0.004 | 1.2 (1.0–1.6) | 0.105 | |
| Use of devices for education | No | 83 (48.5) | 88 (51.5) | 1 | 1 | ||
| Yes | 26 (32.5) | 54 (67.5) | 1.3 (1.1-1.6) | 0.012 | 1.0 (0.8–1.3) | 0.729 | |
| Background Screen Time | No | 79 (58.5) | 56 (41.5) | 1 | 1 | ||
| Yes | 59 (40.7) | 86 (59.3) | 1.4 (1.1-1.8) | 0.004 | 0.9 (0.7–1.2) | 0.585 | |
| Parental knowledge, perceptions and practices | |||||||
| Rules regarding screen time | No | 101 (49.7) | 102 (50.3) | 1 | - | - | |
| Yes | 38 (48.7) | 40 (51.2) | 1.0 (0.8-1.3) | 0.876 | - | - | |
| Co-viewing devices with children | No | 49 (43.8) | 63 (56.2) | 1 | - | - | |
| Yes | 60 (43.2) | 79 (56.8) | 1.0 (0.8-1.2) | 0.926 | - | - | |
| Methods used to reduce ST | Restrict time | 88 (50.6) | 86 (49.4) | 1 | - | - | |
| Distract child | 25 (44.6) | 31 (55.4) | 1.1 (0.8-1.5) | 0.426 | - | - | |
*cPR, crude prevalence ratio (univariable analysis); aPR, adjusted prevalence ratio (from multivariable Poisson regression with robust standard errors)
Discussion
This study, conducted in rural India, found a 50.5% prevalence of excessive screen time. In rural Tamil Nadu, this was found to be 69%9 while in urban India the prevalence ranged from 60 to 89.4%.13-15 These findings show that the use of screen-based devices among young children is no longer confined to urban settings.
With respect to content, cartoons and educational videos were most viewed on television, as also reported in other studies.15,16 However, on smartphones, 30% of children watched content which required less concentration such as short videos. The effect of early exposure to such content is so far unknown. In our study, 32% of the content viewed by children was educational, much higher than urban Chandigarh (16%),13 but lower than in the United States (40-60%).17 Content was mainly chosen by children themselves, limiting parental discretion and parents’ claim of screening for inappropriate content at all times was probably limited by the social desirability bias.
The Indian Academy of Paediatrics advises against screens during meals, one hour before sleep or as a tool to distract children.18 However, our study found all three practices common. Use of screens during meals and before sleep was found to be associated with higher prevalence of excessive screen time, consistent with findings from India,9,15 Thailand,19 USA,20 Canada21 Australia22 and France.23 The health impacts of various contexts for screen exposure is a grey area in the literature. In addition, background screen time, which negatively affects parent-child interaction and children’s attention,24 behaviour,25 and temperament26 was common, similar to studies from United States,26 Spain,27 and Canada.28 We found a positive relationship between the early onset of screen exposure and excessive screen time, similar to that reported in a study in Turkey.29
Screen devices were commonly used as a parenting tool, reported by half of the participants. In comparison, 95% of caregivers of 15–18-month-old children in Delhi30 and 65.9% of parents in Canada28 use screens to entertain their children. Adult supervision and verbal interaction during screen time were limited in our study, possibly due to the rural setting, whereas higher engagement has been reported in urban India15 and developed countries.16,27 Parental co-viewing with children forms a platform for interaction.
Understanding parents’ perceptions of the effects screen time is key to interpreting attitudes and practices. Only 35% of parents, in our study, perceived any benefit of screen viewing, while 93% believed it to be harmful. Most parents believed they could control their child’s screen time through restricting duration or engaging in other activities. Barriers to this include busy schedules, social pressure, grandparents’ leniency or child’s insistence including refusal to eat without a screen. These findings are comparable to previous research.31,32
This is the first community-based study on screen time in under 5 children of rural North. A reliable questionnaire corelating moderately with a prospective diary was used to estimate screen time. However, due to inability to reach the desired sample size, the prospective diary could not estimate excessive screen time. The questionnaire method used was limited by recall bias. There may have also been an error in estimation of excessive screen time due to misclassification, or self-reporting bias. Causal association for identified risk or protective factors could not be established. Due to these shortcomings, the findings have limited generalisability beyond rural North India.
Screens are an integral part of daily lives, and keeping children away from them is difficult. Based on this research, techniques such as restricting access to screen-based devices, delaying onset of screen time beyond two years, and disallowing use during meals could be helpful in reducing excessive screen time. Further research, including multi-centric cohort and case-control studies, is needed to confirm these findings. Parenting techniques, such as establishing household rules for limiting screen time, restricting content, or engaging children in other activities, may be helpful. It is important to inform parents about the effects of screen time on their children, contexts where screens should not be used, and content suitable for children. Further research is necessary to enhance parenting practices and evaluate their impact on children’s screen usage.
Author contributions
SS: Conception and design of the study, data collection, analysis and interpretation of data, manuscript writing; MB, PH, BN: Conception and design of the study, interpretation of data, manuscript writing. All authors have read and approved the final printed version of the manuscript.
Financial support and sponsorship
None.
Conflicts of Interest
None.
Use of Artificial Intelligence (AI)-Assisted Technology for manuscript preparation
The authors confirm that there was no use of AI-assisted technology for assisting in the writing of the manuscript and no images were manipulated using AI.
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