Mobile Screen Exposure and Its Impact on Speech Delay and Behavioural Issues in Children

Background: The increasing use of mobile and digital screens in early childhood has raised major concerns regarding their impact on development. Excessive exposure in infancy and preschool years is linked to impaired cognitive, language, and socio-emotional growth. Global guidelines from the World Health Organization and the American Academy of Pediatrics recommend minimal to no screen use in infancy and restricted, co-viewed exposure for children aged two to five years. Despite these recommendations, screen use continues to rise in low- and middle-income settings, where developmental risks may be compounded by limited parental awareness and fewer structured interventions. Objective: This study aimed to examine the association between daily screen exposure and developmental outcomes, particularly speech delay, sleep difficulties, and eye contact, among young children attending a pediatric outpatient clinic in Peshawar, Pakistan. Methods: An observational cross-sectional study was conducted at the Pediatrics Outpatient Department of the Town Women’s and Children Hospital, Peshawar, from November 2022 to August 2025. A total of 215 children with a median age of 3.5 years (IQR: 3.0–4.5) were included using non-probability consecutive sampling. Data were collected on age, daily screen time, speech status, sleep difficulties, and eye contact using structured proformas. Screen time was quantified in hours per day. Statistical analysis included descriptive statistics, Spearman correlation for the relationship between screen duration and speech severity, and odds ratios (ORs) with 95% confidence intervals (CIs) for associations with sleep and eye contact. Results: All children exceeded the recommended one hour of daily screen time, with a median exposure of 5 hours/day. Speech delay was identified in 204 children (94.9%), slight delay in 7 (3.3%), and no speech in 4 (1.9%). Sleep difficulties were reported in 76 children (35.3%), while 111 (51.6%) demonstrated poor eye contact. Children with prolonged screen exposure (>4 hours/day) had significantly higher odds of sleep difficulties (OR = 2.83, 95% CI: 1.41–5.69) and suboptimal eye contact (OR = 1.59, 95% CI: 1.02–2.48). However, the correlation between screen duration and severity of speech delay was weak and non-significant (Spearman r = –0.087, p = 0.202). Conclusion: The study demonstrated that excessive screen exposure in early childhood was strongly associated with sleep difficulties and reduced eye contact, though no direct correlation with speech severity was established. These findings highlight the urgent need for clinical counseling to delay screen onset, limit daily exposure, and encourage interactive, co-viewed educational content. Balanced strategies are essential to safeguard language, cognitive, and socio-emotional development during critical early years.