To the best of our knowledge, this study was the first longitudinal study to investigate the effects of smart device usage and media content exposure on toddlers’ behavioral development with a focus on the moderating influence of mother–child interaction. Our results indicated an association between a considerable increase in the screen time trajectories of children during the ages 1–3 years and a range of behavioral problems at the age of 3 years; this association extended beyond overall screen time, encompassing specific media content, such as game and cartoon media. Notably, these adverse effects became either ameliorated or nonsignificant in children with higher mother–child interaction levels; this finding emphasizes the vital role of mother–child interactions in moderating the negative effects of smart device usage patterns on young children.
Our results contribute to a limited body of research regarding the effects of early smart device usage on internalizing, externalizing, and overall behavioral problems in toddlers. Consistent with the findings of previous studies [39, 40] regarding adverse behavioral effects of smart device usage, our findings suggested that such effects—including those on internalizing behaviors, externalizing behaviors, somatic complaints, social withdrawal, and aggression—were more significant in situations with lower mother–child interaction levels, in which extensive smart device usage tended to amplify behavioral problems. By contrast, higher mother–child interaction levels either alleviated these negative behavioral impacts (e.g., anxiety/depression, somatic complaints, and aggression) or made them nonsignificant (e.g., withdrawal and externalizing behaviors). In general, this study addressed a gap in the literature by empirically investigating and observing the influential role of parent–child interactions in alleviating the negative effects of screen time on toddlers’ behavior, thereby addressing a suggestion from a previous study [16].
Although few studies have focused on the impact of smart device media content on toddlers, the current findings corroborate those of a study regarding traditional media [41]. For instance, toddlers exposed to more educational content under higher levels of parent–child interaction demonstrated significantly fewer somatic complaints, whereas children’s behavior tended to be more aggressive with an increase in exposure to educational content in situations with lower levels of parent–child interaction. Exposure to educational content alongside warm and supportive parenting led to enhanced benefits in the executive functional development of young children [41]. However, an increase in game and cartoon content exposure was associated with an increase in internalizing problems—including anxiety/depression, somatic complaints, and withdrawal—in toddlers, particularly those exposed to poor mother–child interactions. Nevertheless, no such findings were noted in toddlers exposed to higher mother–child interaction levels. Studies have not identified the effects of using smart devices, including gaming consoles and tablets, on children’s behavior [39, 42]; the present results related to the role of mother–child interactions may contribute to relevant clarifications. Nevertheless, in contrast to previous findings regarding the beneficial effects of video chatting [43], we observed that toddlers with greater exposure to communication content, particularly those with lower mother–child interaction levels, tended to exhibit more withdrawal symptoms; this finding warrants further examination.
To explain the pathways underlying the present findings, we, in alignment with attachment theory [23], emphasize the importance of secure, high-quality mother–child interactions to facilitate children's emotional and behavioral development. Through positive interactions to facilitate the establishment of effective parenting practices [44, 45], mothers can play an active role in setting appropriate screen time limits, guiding their children through digital experiences, and participating in media content engagement with their children [45]. Such maternal involvement can lead to a decrease in screen time and can guide children toward beneficial smart device use, such as engagement with educational content [17]. In addition, improved mother–child interactions may encourage other healthy activities, such as socialization and participation in physical activities, as opposed to prolonged usage of smart devices [46]. Furthermore, warm and responsive parenting is a key feature of positive mother–child interactions, which are essential for the development of self-regulation in young children [47]. As a consequence of poor mother–child interactions, children with low self-regulation levels may encounter challenges related to attention control, making them susceptible to distraction from external stimuli, including instant rewards from smart devices [39]. Such increased susceptibility can lead to difficulty disengaging from devices and thus may limit opportunities to engage in other beneficial activities during the crucial developmental stage.
Notably, increased smart device usage in toddlers is currently a major concern, mainly because portable, handheld smart devices are often used for distraction, as rewards, or as a means of parental respite [48]. We observed a notable increase in daily usage, from 60 min at the age of 1 year to 142 min at the age of 3 years, exceeding the recommended screen time for toddlers [4]. By the age of 3 years, children frequently engaged with educational, cartoon, and app content; this finding aligned with those of Radesky et al. related to widespread smart device usage (18). The interactive features and immersive experiences [49] of smart devices can lead to excessive usage in young children [50]. Furthermore, blue light emission from device screens may disrupt sleep patterns, impacting a child’s health and development [51], particularly when used before bedtime [52]. Finally, excessive smart device usage may limit engagement in beneficial activities, such as in-person social interactions [53], and the physical activities necessary for developing visual motor skills [53].
Our study yields several key implications. First, in the current digital era, positive parent–child interactions were observed to provide beneficial adaptation of the inevitable integration of smart devices into the lives of young children. Accordingly, following the American Academy of Pediatrics Family Media Use Plan [4], we advocate the promotion of mother–child interactions to enhance parenting. Moreover, integrating parenting intervention programs [54] into health care and health-care education with a view to enriching parenting knowledge and skills is essential. Approaches to actively engage children during media consumption and to help them contextualize such content are essential [45]; incorporating such approaches into guidelines can help parents navigate challenges related to smart devices, ensuring that health-care practices evolve with every family’s changing needs in the digital age. Second, our results emphasized the importance of both screen time quantity and quality for young children. Although limiting screen time is crucial, the quality of consumed content can also shape the corresponding outcomes. On the basis of the varied impacts of content types on behaviors observed in our study, we recommend a balanced approach to the formulation of guidelines and parenting advice that considers screen time quantity and quality so that early screen usage can be managed effectively.
The current study had several strengths. First, our longitudinal design enabled the assessment of changes in smart device usage and mother–child interactions over time, thereby providing a dynamic, comprehensive understanding of these trends’ evolution during the crucial developmental period (i.e., during 1–3 years of age). Second, our study explored behavioral problems in 3-year-old children across multiple domains to provide related insights with a potentially high impact. These results are particularly relevant considering the vital role of the toddlerhood years in behavioral development and lifelong habit formation, as well as the lack of evidence regarding device usage and screen time. Third, by including paternal variables such as sociodemographic characteristics and depression levels, we were able to enhance the current understanding of family dynamics and their impact on children’s behavioral development and smart device usage.
This study also had several notable limitations. First, our participants were recruited only from medical centers in metropolitan Taipei and primarily included women of relatively high age with relatively high socioeconomic status. This factor may have limited the generalizability of our findings. Second, the use of self-reporting questionnaires may have introduced biases related to social desirability and recall accuracy, particularly in the assessment of mother–child interactions. Mothers may not be fully aware of the nuances or problematic aspects that can lead to disparities between perceived and actual interactions [55]. In addition, maternal mental health problems, including depression, may influence a mother’s perception and reporting of her child’s behaviors and interactions [56]. Finally, we were unable to differentiate between the applications used by the toddlers in this study; in particular, we were unable to stratify the applications, such as YouTube, associated with a risk of exposure to age-inappropriate content or ads. Many apps claim to be educational but lack relevant empirical evidence to support this claim [18]; this feature can create challenges for accurate assessment of their impact on child development.