Association of Screen Time with Suspected Developmental Coordination Disorder in One-Child and Multi-Child Preschoolers

Background: Excessive screen exposure has become a global public health issue. The study aimed to determine the national prevalence of excessive screen exposure of preschoolers and its association with suspected DCD in children with or without siblings.Methods: A retrospective cohort study was conducted with 126 433 children from 551 cities in China. The Little Developmental Coordination Disorder Questionnaire (LDCDQ) was used to assess the motor development of children. Information on screen time in the past year was provided by parents. The mixed and multi-level logistic regression model was used to analyse associations of all screen exposure measurements in the past year with the score of LDCDQ and the risk of suspected DCD.Findings: The prevalence of excessive screen exposure was 67.6% (>1 hour per day) and 28.9% (>2 hours per day) in Chinese preschoolers. One hour’s increase in weekday daily screen time, weekend daily screen time, and screen time before sleep in the past year was associated with a decreased total score of the LDCDQ (β were -0.690, -0.398 and -1.587, p<0.001) and an increased risk of suspected DCD by 15.3%, 9.1% and 46.8% when adjusting for the child, family and maternal health characteristics. Excessive screen exposure decreased children’s total LDCDQ scores by 1.335 (>1 hour vs. ≤1 hour) and 1.162 (>2 hours vs. ≤2 hours) and increased risks of suspected DCD by 44.0% (>1 hour vs. ≤1 hour) and 31.1% (>2 hours vs. ≤2 hours) with statistical significance (each p<0.05). The stratified analysis showed that the association between screen time and LDCDQ score was stronger in children without siblings than in those with siblings.Interpretation: The risk of suspected DCD was highest for screen time exposure before bed compared with average weekday and weekend exposures. Parents should be advised to prevent their children from using electronic screens unsupervised.Funding Information: The study was funded by National Natural Science Foundation of China (81673179), the Science and Technology Commission of Shanghai Municipality (21DZ2202000, 19140903100), Shanghai Municipal Health Commission (2020YJZX0213), and Pudong Municipal Health Commission (PW2020D-11).Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: The study was approved by the Ethics Committee of Shanghai First Maternity and Infant Hospital (KS18156). All information acquired was kept confidential and was only accessible by the researchers.