Aim This study examined the direct and indirect associations between childhood psychopathology symptoms, screen use, media multitasking and participation in non-digital recreation. Methods Psychopathology symptoms, media use, media multitasking, participation in sports, social clubs and reading/games were reported by 520 parents about their 3- to 11-year-old children. The data were analysed using structural equation modelling. Results There were bidirectional negative associations between sports participation and emotional problems (beta = -0.16, P beta = -0.15, P < .001); attention deficit hyperactivity disorder (ADHD) symptoms were associated with reduced reading/games (beta = -0.14, P = .004). A bidirectional positive association was found between media use and conduct problems (beta = 0.10, P = .015 and beta = 0.14, P = .015). Increased media multitasking was indirectly associated with elevated symptoms of ADHD via a reduction in reading/games (beta = 0.10, P = .026). However, there was no evidence that screen use mediated the associations between psychopathology symptoms and non-digital recreation. Conclusion Depending on the specific psychological difficulties, children are either less likely to participate in non-digital recreation or are more likely to use screen media or multitask with media. Interventions for children, who experience emotional or behavioural difficulties, are needed to improve participation in non-digital recreation.