Factors Contributing to Screen Exposure in Preschool Children and Its Associated Outcomes: A Systematic Review

OBJECTIVES: This systematic review aims to synthesise the current evidence on risk and protective factors that lead to prolonged screen exposure, and to identify both adverse and positive developmental outcomes associated with that screen exposure in preschool children. MATERIALS AND METHODS: Following PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Medline, Scopus and Web of Science, including observational studies published from 2017 onwards. A rigorous screening and quality appraisal process was applied using the Joanna Briggs Institute's critical appraisal checklists, resulting in the inclusion of 124 studies. RESULTS: Risk factors were predominantly parent-related (e.g., excessive parental screen use, technoference, absence of screen rules), followed by contextual (e.g., low SES, lower parental education) and child-level factors (e.g., early and unsupervised access to screens). Screen exposure was linked to multiple adverse outcomes across developmental, psychosocial, physical, educational and relational domains (e.g., language delays, cognitive deficits, emotional dysregulation, increased obesity risk and weakened parent-child interactions). Conversely, a smaller subset of studies highlighted protective factors and potential developmental benefits under specific conditions. CONCLUSION: Screen exposure in early childhood is a multifaceted phenomenon shaped by individual, familial and contextual determinants. While excessive and unregulated use poses clear developmental risks, structured and intentional media engagement may support developmental benefits. Future longitudinal and experimental research is needed to clarify causal pathways and inform evidence-based policy and parenting practices.