Screen-based media use and emotional and behavioural problems among children aged 6–7 years: a longitudinal cohort study

Screen exposure in early childhood is prevalent and increasing. However, prior research usually focuses on screen time and health risks, domain-specific exposure of screen and its implications for emotional and behavioural development are unknown. We employed data from 1,049 children in the Ma’anshan Birth Cohort (MABC) to examine, at age 6 years, the domains of screen-based media use (access to screens, frequency of use, content viewed, and co-viewing) measured by the ScreenQ, as well as screen time, in relation to emotional and behavioural problems (EBPs) assessed by the Strengths and Difficulties Questionnaire (SDQ) at ages 6 and 7 years. Gender-stratified analyses were performed to examine whether these associations differed by sex. Longitudinal generalized estimating equations (GEE) models were then used to identify associations of the four ScreenQ domains with EBPs, including main effects and time interactions. In addition, screen time was examined as a secondary exposure. The analytic sample comprised 1,049 children (mean age 5.54 ± 1.16 years; 47.4% female). At age 6, Co-viewing showed the strongest associations with EBPs ( ORs :1.34–1.40), followed by Frequency and Access. Further gender-stratified analyses revealed stronger Co-viewing–EBPs associations in girls at age 6 ( ORs :1.51–1.71). At age 7, none of the four screen-based media use domains exhibited significant associations with EBPs after FDR correction, whether or not stratified by gender. Longitudinal GEE analyses confirmed that these robust age-6 associations gradually attenuated over follow-up. Baseline screen time—whether measured on school days or weekends—was not associated with any EBP outcome after FDR correction. This study identified associations between screen-based media use domains and higher risks of EBPs among children aged 6-7 years. Our findings highlight that screen use domains, rather than screen time, should be emphasized in clinical guidance and public health strategies.