|Year : 2021 | Volume
| Issue : 2 | Page : 100-105
Screen dependency versus child nourishment among toddlers: A correlational study
Suresh Velumani, Meera Panchal, Bhoomika Patel
Department of Mental Health and Psychiatric Nursing, Sumandeep Nursing College, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
|Date of Submission||05-May-2021|
|Date of Decision||08-Jun-2021|
|Date of Acceptance||30-Jun-2021|
|Date of Web Publication||21-Dec-2021|
Prof. Suresh Velumani
Department of Mental Health Nursing, Sumandeep Nursing College, Sumandeep Vidyapeeth Deemed to be University, Pipariya, Vadodara - 391 760, Gujarat
Source of Support: None, Conflict of Interest: None
Background: Screen viewing has become predominant among children aged under 3 years that causing massive health issues. Nowadays, most of the young kids developed a habit of having food by watching smartphone. Seventy-seven percentage toddlers are using mobile phones every day. Researcher strongly believes that this habit among toddlers is linked, with either overweight or undernutrition. Aim: The present research study aimed to explore the relationship between screen dependency and its effects on child's nourishment. Settings and Design: An explorative-correlational study was carried out on 280 toddlers. Toddlers were selected using quota sampling, and data were collected from areas of Vadodara district. Subjects and Methods: A structured screen dependency questionnaire was used. Subsequently, toddler nourishment was assessed by using Gomez's classification scale. Descriptive and inferential statistics were applied to analyze the data by using SPSS-20 software. Linear regression analysis revealed that toddler nourishment was influenced by the level of screen dependency. Results: The majority toddlers 47.9% (n = 134) were severely dependent on screen, and child nourishment among them resulted that 43.9% (n = 123) were overweight, 2.9% (n = 89) found obese, and 28.2% (n = 79) were belong to malnutrition, the rest were normal. The linear regression analysis showed that screen dependency was significantly correlated with child nourishment beta coefficient (R = 0.321, P = 0.00) at significance of 0.05 level. Conclusions: The present study concluded that there is an influence of screen dependency on child's nourishment. Therefore, the policymakers should also increase the awareness regarding negative impact of screen viewing to the mothers.
Keywords: Child nourishment, correlation, overweight, screen dependency, smartphone, toddlers, underweight
|How to cite this article:|
Velumani S, Panchal M, Patel B. Screen dependency versus child nourishment among toddlers: A correlational study. Indian J Psy Nsg 2021;18:100-5
|How to cite this URL:|
Velumani S, Panchal M, Patel B. Screen dependency versus child nourishment among toddlers: A correlational study. Indian J Psy Nsg [serial online] 2021 [cited 2022 Jul 6];18:100-5. Available from: https://www.ijpn.in/text.asp?2021/18/2/100/332795
| Introduction|| |
Screen time is defined as the time duration spent by the individual on smartphone, tablet, and television. Excessive use of smartphone or viewing digital media is predominantly associated with noncommunicable diseases. It was reported that children below 18 months were clocking up of screen time around 17 h per week.
In recent time, the internet users in India crossed more than 460 million. India is the second largest internet using country, and availability and accessibility of internet become easy since last few years. On the basis of the WHO criteria, it has been mentioned that children aged below 3 are not recommended for using any digital media. However, children who are aged 3–4 years can use digital media not more than 1 h. In contrast, the Indian scenario is quite different from what has been recommended by the WHO.
In addition, the telecom service in India has allowed many operator to own the internet services thereby several video programs are being played in the internet. This has led to screen dependency among the children.
The main childhood problem in India is malnutrition as well as obesity. These issues are mainly due to their attention toward watching digital gadgets during their eating times. The incidence rate of childhood obesity has become high in developing countries.,, It is also observed that children under the age of five have developed a habit of using mobile phone while having food., Viewing smartphone among toddler has become irresistible. Hence, this screen dependency behavior is the main cause of obesity or malnutrition.,
The parents use digital media to prevent children from throwing tantrums while eating food. Since the children are completely getting involved in watching the digital media, they seldom know the amount of food they are consuming. In this situation, most challenging part for parents is to feed the child without using digital media. Therefore, mothers offer digital media despite knowing all the adverse consequences, and take too lightly about their toddlers nutritional status.,
The life of many toddlers has changed under the influence of screen dependency. The recent literature shows that, digital media has a strong influence on child's cognitive development., Literature also suggested that overuse of "screen-time" among children can cause behavioral, mental, physical problems,, delayed speech,, and obesity.
So far no studies regarding the screen dependency and its relation to the nutrition of the toddlers have not been carried out study has carried out. Therefore, the present research was carried out to find the intensity of relationship between screen dependency and child's nourishment.
| Subjects and Methods|| |
An explorative, correlational design was employed. To calculate the sample size, power analysis was done and the result of the power analysis was found very reliable (95%). The study was approved by SVIEC, SVDU (Ref: SVIEC/ON/nursbnpg18/B19028-01.05.19). The work was conducted in a city, namely Vadodara. The participants were approached during their free time. Each of them was informed about intention of study, and obtained written consent and assent were taken with the guaranty of their anonymity and confidentiality of data. A survey was conducted in a 643 residence in urban area to identify the number of eligible toddlers. After interacting with parents regarding the usage of digital media, 302 toddlers were shortlisted who are actively using the digital media. Subsequently, toddler's nourishment was evaluated by standard scale of Gomez calculation. From the pool of 302, a total of 280 toddlers were selected by using simple random sampling technique (Lottery method). Importantly, the following inclusion and exclusion criteria were used to select the participants.
- Infants who did not receive exclusive breastfeeding for 6 months and preterm and low birth weight babies were excluded
- Toddlers who are having nutritional deficiency, congenital disorders, and intellectual disabilities are being excluded
- Normal toddler was selected by using anthropometric measurement
- Mother or family caretaker who is actively involved in caring and who gave consent were included.
A screen dependency assessment questionnaire was developed and validated in vernacular language. The questionnaire consists of 20 items. All the items were measured on 5-point Likert scale (from 0= "never," 1= "sometimes," 2= "often," 3= "very often" to 4= "always"). All the questions are intended to check the screen dependency during meal time among toddlers. Questionaries' as follows: (1) Does your child refuse to take meal in absence of mobile, TV, tablet, and/or IPad? (2) While you prepare your child to take meal, does he stubbornly demand a mobile phone? (3) At the time of taking meal, does your child take mobile by himself/herself? (4) While taking meal, is your child continuously gaze at the mobile/TV screen? (5) If you offer food to your child without mobile, does he/she may not take meal adequately? (6) Is your child not positive enough toward food, when he is not offered a mobile while taking meal? (7) Does your child show his/her like and dislike toward food, when he is offered a mobile phone? (8) Does your child show anger if you don't play his/her favorite video on mobile while eating? (9) Does your child show temper tantrums, in absence of mobile while taking meal? (10) When you does not allow your child to watch mobile while taking meal, does he/she spit out bolus? (11) Does your child get too busy watching mobile, such that he/she would not respond to anybody else while eating? (12) Does your child instead of chewing food, keep focusing on mobile screen by keeping bolus in mouth for a long time? (13) Does your child while looking at mobile, swallow food without proper chewing? (14) Does your child behave abnormally when a mobile is snatched away while eating? (15) Does your child not take complete meal and run away, if mobile is dead in middle of feeding? (16) Looking at a mobile phone does your child waste (OR take) lot of time while eating? (17) Does your child get upset with the interruption of advertisements on video while eating? (18) Does your child get irritate while eating, without being waited during buffering of video going on? (19) Does your family face problems with your child, when gone out for dinner and an internet is not available? (20) Having full stomach, still does your child continue taking food? The total score was calculated by summing up answers given to the questions. Reliability of screen dependency assessment questionnaire was measured by an intraclass correlation which was used to find the reliability, the value found to be 0.78, its indicated good reliability. The validity of this questionnaire was re-examined by 5 specialists in field of psychiatric nursing.
The obtained data were analyzed using SPSS-20 software (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp). More specifically, descriptive statistics (percentage, mean, standard deviation) were used to describe the sample characteristics, the level of screen dependency, and degree of child nourishment. Moreover, spearman's correlation coefficient was used to explore a possible relationship between screen dependency and child nourishment. Finally, the impact of relationship between two variables was assessed using linear regression analysis. Chi-square test used to find the association between characteristics of toddlers with both screen dependency and child nourishment. The level of significance was set at P < 0.05.
| Results|| |
Two hundred and eighty toddlers were participated in the study for final analysis [Table 1]. Majority of toddlers 28.9% (n = 81) aged between 31 and 36 months and 52.1% (n = 146) were boys. Among the respondents, about 42.5% (n = 119) were having single child. Nearly more than 50% were living in a joint family (55.7% [n = 156]). Majority 63.2% (n = 178) of the mothers were housewife and graduates. About 47.9% (n = 134) participants monthly income is between 30,000 and 45,000.
The result pertaining to screen dependency [Table 2]revealed that nearly half of the toddlers 47.9% (n = 134) were severely dependent on screen. About 34.3% (n = 96) of them were found to be moderately dependent and 17.9% (n = 50) were found to be mild dependent.
The degree of child-nourishment of screen dependent toddlers [Table 3] revealed that 14.3% (n = 40) and 13.9% (n = 39), respectively, were belong to 1st- and 2nd-degree malnutrition. One-fourth of the participants 25% (n = 70) were normal, and 43.9% (n = 123) were overweight and 2.9% (n = 89) found obese.
Level of screen dependency predicts degree of child nourishment with beta coefficient of 0.321 at a significance level of 0.05 [Table 4]. The results revealed that screen dependency has an influence on child nourishment.
|Table 4: Linear regression analysis between screen dependency and child nourishment (n=280)|
Click here to view
The [Table 5] depicts that there is no significant association based on sociodemographic variable with incidence of screen dependency which was found through Chi-square test. However, a significant association found between child nourishment and employment of mother. This result revealed that children of working mother's may at risk of developing nutritional disorders.
|Table 5: Association of screen dependency and child nourishment with their sociodemographic variable (n=280)|
Click here to view
| Discussion|| |
The present study aimed to explore the relationship between screen dependency and its effects on child's nourishment. In the present time, Turkey children aged between 1 and 5 are using digital media more than a recommended hour by the World Health Organization. In addition to that Indian parents are nurturing screen addiction in toddlers' parents who provide smartphone or digital gadgets to toddlers while feeding them. This habit can not only make them sedentary also push them in digital addiction, childhood obesity leads to high cholesterol. Previous literature about higher prevalence of screen dependency showed that 71% of toddlers were accessed to touch-screen devices for about 15 min per day. A similar result was observed in the review conducted in Madrid. Whereas, in support to our study, a review conducted in France showed that 56% of toddlers watch screen at the time of taking meal. Screen viewing habits were observed from the early age of toddler in Maryland. However, the prevalence of higher media viewing in early childhood was also demonstrated in an epidemiological study conducted in Brazil.
Based on Gomez's classification scale assessment, 2.9% of the toddlers were obese, 43.9% overweight, and 28.2% were underweight. According to the Indian report screen time often coincident with meal time leads to overeating in children, and the average age of screen viewing has fallen over the past decades from 3 to 5 years to 12–18 months.
As per the objective of the present study, linear regression analysis used to explore the correlation between screen dependency and toddlers nourishment (R = 0.321) shown a significant positive correlation, which suggested that screen viewing had strong influence on child's nourishment. Numerous studies were found supporting in the favor of positive association between toddler's screen viewing duration with adiposity., Besides, it was suggested in a review conducted in Nottingham, that eating while screen viewing had positive association with overconsumption of meal, leading obesity among children. In addition, previous studies have indicated that screen viewing in children had significant association with overweight and obesity.,, Although in controversy, literatures showed no significant association between screen viewing and child's nutritional status.,
Based on the Chi-square test, found that working (employed)mothers of toddler's are more potential to have either malnutrition or obesity, while Hachi Jain Taran conducted a study in Indore, India, suggested that there is an adverse effect on children health those mothers are working. This result revealed that children of working mother's may at risk of developing nutritional disorders.
| Conclusions|| |
The present study concluded that there is an influence of screen dependency on child's nourishment (43.9% overweight and underweight 28.2%). These results may have important implications for reducing the incidence of obesity and malnutrition. Researcher strongly assumes that in 2030 in India, around 51%–60% of children are vulnerable to develop nutritional health disorders such as obesity and malnutrition which is caused by screen viewing behavior. Hence, the policymakers must take appropriate action such as guidance and counseling for mothers to create an awareness regarding negative impact of screen viewing on health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hossain FB, Shawon MS, Al-Abid MS, Mahmood S, Adhikary G, Bulbul MM. Double burden of malnutrition in children aged 24 to 59 months by socioeconomic status in five South Asian countries: Evidence from demographic and health surveys. BMJ Open 2020;10:e032866.
Khadilkar VV, Khadilkar AV. Revised Indian Academy of Pediatrics 2015 growth charts for height, weight and body mass index for 5-18-year-old Indian children. Indian J Endocrinol Metab 2015;19:470-6.
Ranjani H, Mehreen TS, Pradeepa R, Anjana RM, Garg R, Anand K, et al
. Epidemiology of childhood overweight and obesity in India: A systematic review. Indian J Med Res 2016;143:160-74.
] [Full text]
Akowuah PK, Kobia-Acquah E. Childhood obesity and overweight in Ghana: A systematic review and meta-analysis. J Nutr Metab 2020;2020:1-11.
Kaur N, Gupta M, Malhi P, Grover S. Screen time in under-five children. Indian Pediatr 2019;56:773-88.
Jusienė R, Urbonas V, Laurinaitytė I, Rakickienė L, Breidokienė R, Kuzminskaitė M, et al
. Screen use during meals among young children: Exploration of associated variables. Medicina (Kaunas) 2019;55:688.
Heilmann A, Rouxel P, Fitzsimons E, Kelly Y, Watt RG. Longitudinal associations between television in the bedroom and body fatness in a UK cohort study. Int J Obes (Lond) 2017;41:1503-9.
Howard JB, Skinner AC, Ravanbakht SN, Brown JD, Perrin AJ, Steiner MJ, et al
. Obesogenic behavior and weight-based stigma in popular children's movies, 2012 to 2015. Pediatrics 2017;140:e20172126.
Tang L, Darlington G, Ma DW, Haines J; Guelph Family Health Study. Mothers' and fathers' media parenting practices associated with young children's screen-time: a cross-sectional study. BMC Obes 2018;5:37.
Goh SN, Teh LH, Tay WR, Anantharaman S, van Dam RM, Tan CS, et al
. Sociodemographic, home environment and parental influences on total and device-specific screen viewing in children aged 2 years and below: An observational study. BMJ Open 2016;6:e009113.
Aishworiya R, Cai S, Chen HY, Phua DY, Broekman BF, Daniel LM, et al
. Television viewing and child cognition in a longitudinal birth cohort in Singapore: the role of maternal factors. BMC Pediatr 2019;19:286.
Ruiter EL, Saat JJ, Molleman GR, Fransen GA, van der Velden K, van Jaarsveld CH, et al
. Parents' underestimation of their child's weight status. Moderating factors and change over time: A cross-sectional study. PLoS One 2020;15:e0227761.
Rodrigues D, Machado-Rodrigues AM, Padez C. Parental misperception of their child's weight status and how weight underestimation is associated with childhood obesity. Am J Hum Biol 2020;32:5 (Volume 32: issue 5):e23393. [doi: 10.1002/ajhb. 23393].
Lin LY, Cherng RJ, Chen YJ, Chen YJ, Yang HM. Effects of television exposure on developmental skills among young children. Infant Behav Dev 2015;38:20-6.
Fancourt D, Steptoe A. Television viewing and cognitive decline in older age: Findings from the English longitudinal study of ageing. Sci Rep 2019;9:2851.
Rikkers W, Lawrence D, Hafekost J, Zubrick SR. Internet use and electronic gaming by children and adolescents with emotional and behavioural problems in Australia – Results from the second child and adolescent survey of mental health and wellbeing. BMC Public Health 2016;16:399.
McVeigh J, Smith A, Howie E, Straker L. Trajectories of television watching from childhood to early adulthood and their association with body composition and mental health outcomes in young adults. PLoS One 2016;11:e0152879.
Poitras VJ, Gray CE, Janssen X, Aubert S, Carson V, Faulkner G, et al
. Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0-4 years). BMC Public Health 2017;17:868.
van den Heuvel M, Ma J, Borkhoff CM, Koroshegyi C, Dai DW, Parkin PC, et al
. Mobile media device use is associated with expressive language delay in 18-month-old children. J Dev Behav Pediatr 2019;40:99-104.
Madigan S, McArthur BA, Anhorn C, Eirich R, Christakis DA. Associations between screen use and child language skills: A systematic review and meta-analysis. JAMA Pediatr 2020;174:665-75.
Wada K, Yamakawa M, Konishi K, Goto Y, Mizuta F, Koda S, et al
. Associations of cell phone use and screen viewing with overweight in children. Child Obes 2019;15:7, 417-42.
Kılıç AO, Sari E, Yucel H, Oğuz MM, Polat E, Acoglu EA, et al
. Exposure to and use of mobile devices in children aged 1–60 months. Eur J Pediatr 2019;178:221-7.
Ahearne C, Dilworth S, Rollings R, Livingstone V, Murray D. Touch-screen technology usage in toddlers. Arch Dis Child 2016;101:181-3.
De-Sola Gutiérrez J, Rodríguez de Fonseca F, Rubio G. Cell-phone addiction: A review. Front Psychiatry 2016;7:175.
Assathiany R, Guery E, Caron FM, Cheymol J, Picherot G, Foucaud P, et al
. Children and screens: A survey by French pediatricians. Arch Pediatr 2018;25:84-8.
Trinh MH, Sundaram R, Robinson SL, Lin TC, Bell EM, Ghassabian A, et al
. Association of trajectory and covariates of children's screen media time. JAMA Pediatr 2020;174:71-8.
Guedes SD, Morais RL, Santos LR, Leite HR, Nobre JN, Santos JN. Children's use of interactive media in early childhood-An epidemiological study. Rev Paul Pediatr 2020;38:e2018165.
Hu J, Ding N, Yang L, Ma Y, Gao M, Wen D. Association between television viewing and early childhood overweight and obesity: A pair-matched case-control study in China. BMC Pediatr 2019;19:184.
Stiglic N, Viner RM. Effects of screentime on the health and well-being of children and adolescents: A systematic review of reviews. BMJ Open 2019;9:e023191.
Collings PJ, Kelly B, West J, Wright J. Associations of TV viewing duration, meals and snacks eaten when watching TV, and a TV in the bedroom with child Adiposity. Obesity (Silver Spring) 2018;26:1619-28.
Borghese MM, Tremblay MS, Katzmarzyk PT, Tudor-Locke C, Schuna JM Jr., Leduc G, et al
. Mediating role of television time, diet patterns, physical activity and sleep duration in the association between television in the bedroom and adiposity in 10 year-old children. Int J Behav Nutr Phys Act 2015;12:60.
Avery A, Anderson C, McCullough F. Associations between children's diet quality and watching television during meal or snack consumption: A systematic review. Matern Child Nutr 2017;13:01-20.
Saldanha-Gomes C, Marbac M, Sedki M, Cornet M, Plancoulaine S, Charles MA, et al
. Clusters of diet, physical activity, television exposure and sleep habits and their association with adiposity in preschool children: The EDEN mother-child cohort. Int J Behav Nutr Phys Act 2020;17:20.
Chen HJ, Wang Y. Do weight status and television viewing influence children's subsequent dietary changes? A National Longitudinal Study in the United States. Int J Obes (Lond) 2015;39:931-8.
Tahir MJ, Willett W, Forman MR. The association of television viewing in childhood with overweight and obesity throughout the life course. Am J Epidemiol 2019;188:282-93.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]