Outdoor play as a mitigating factor in the association between screen time for young children and neurodevelopmental outcomes

Sugiyama, M., Tsuchiya, K. J., Okubo, Y., Rahman, M. S., Uchiyama, S., Harada, T., … Itoh, H. (2023). Outdoor play as a mitigating factor in the association between screen time for young children and neurodevelopmental outcomes. JAMA Pediatrics, 177(3), 8. http://dx.doi.org/10.1001/jamapediatrics.2022.5356

Suboptimal neurodevelopment outcomes linked to higher screen time among young children may be mitigated by outdoor playYoung children’s screen time has been linked to poor developmental, behavioral, emotional, and academic outcomes in early childhood. To help ensure children’s healthy development, the American Academy of Pediatrics recommends no more than one hour of non-educational screen time a day for children between the ages of two and five years. This study aimed to further clarify the relationship between screen time and young children’s development by examining: (1) screen time at age two years in relation to neurodevelopmental outcomes at age four years; (2) outdoor play time at age two years eight months in relation to neurodevelopmental outcomes at age four years; and (3) if the frequency of outdoor play at age two years eight months influences the link between screen time and neurodevelopmental outcomes.

The research was conducted as a part of the Hamamatsu Birth Cohort Study for Mothers and Children in Japan with 885 young children (from age 2 to 4 years). Questionnaires were completed by parents to assess children’s screen time at age two years and frequency and duration of outdoor play at age two years eight months. Screen time durations of more than one hour per day were classified as higher screen time. Outdoor play time reported as less than six days per week (for a minimum of 30 minutes) was considered infrequent outdoor play. Neurodevelopmental outcomes were assessed with the Vineland Adaptive Behavior Scales (VABS) which was administered through semi-structured interviews with parents when children were age four years. The assessment incorporated measures for “communication (receptive, expressive, and written language skills), daily living skills (skills entailing personal, domestic, and community life), and socialization (interpersonal relationships, play, and coping skills).” Data collected on other potentially influential factors included child’s gender, parental education level, and autism spectrum disorder symptoms. Statistical analysis was conducted to examine the relationships between screen time at age two years, outdoor play at age two years eight months, and neurodevelopmental outcomes (communication, daily living skills, and socialization) at age four years. Analysis also tested for the effect outdoor play had on the relationship between screen time and neurodevelopmental outcomes.

Findings revealed that children with higher screen time (more than one hour a day) at age two years had significantly lower scores for communication and daily living skills at age four years. While children with higher screen time also had lower socialization scores, this relationship did not reach statistical significance. Children with higher screen times were also significantly less likely to frequently play outdoors. Further, children who infrequently played outdoors (less than six days per week) had significantly lower scores for daily living skills and socialization, but not communication. Importantly, lower daily living skills scores were found to be positively influenced by increased time engaged in outdoor play. This finding suggests that while screen time is linked to poorer daily living skills, outdoor play may help improve this outcome for children who engage in higher screen times. Additionally, although a significant relationship was not detected between screen time and socialization, higher socialization scores were found to be significantly related to frequent outdoor play.

The study confirmed that, for young children, higher screen times are linked to suboptimal neurodevelopment, specifically for communication and daily living skills. The study also highlights the potential of outdoor play, which may support neurodevelopment and help young children with higher screen times bolster their daily living skills. Research should continue to examine these relationships with the aim of identifying interventions that can reduce the developmental risks associated with screen time. To support children’s healthy neurodevelopment, it is important to adhere to screen time guidelines that limit young children’s screen use, while also encouraging outdoor play.

The Bottom Line

Suboptimal neurodevelopment outcomes linked to higher screen time among young children may be mitigated by outdoor play