COVID-19 and children's screen time in Ceara, Brazil: a repeated cross-sectional survey

In the present study, we assessed changes in screen time exposure among 3-6-year-old children in Ceara, Brazil, in 2017 and in 2020 during the pandemic. We analyzed data from a state-wide repeated cross-sectional survey. The COVID impact research was conducted by phone interviews. American Academy of Pediatrics (AAP) and World Health Organization (WHO) guidelines were used to define elevated screen exposure. During the COVID-19 pandemic, the proportion of children with screen exposure above recommended levels was 96.8% among 3-4-year-old and 84.2% among 5-6-year-old children. There was a significant increase in proportion of 3-4-year-old children with elevated screen time (risk difference 15.8%; 95% confidence interval (CI): 12.3-19.2; p-value < 0.001). Children participating in remote learning activities had significantly lower television time with a mean difference of -0.8 hours daily (95% CI -0.3 - -1.3; p-value: 0.003) as compared to children not participating in remote learning. The necessary COVID-19 response measures appear to increase screen time among 3-6-year-old children in Ceara, Brazil. Interventions to reduce excess screen time, potentially participation in remote early learning activities should be developed and evaluated in Brazil. Prior State of Knowledge: The necessary COVID-19 response measures appear to increase sedentary time in children in developed countries. Novel contributions: COVID-19 response measures (social distancing and school closures) appear to increase screen time among 3-6-year-old children in Ceara, Brazil. In addition, children participating in remote learning activities had significantly lower television time than children not participating in remote learning. Practical implications: Public health officials should engage in helping support parents by creating safe areas for children to increase physical activity and reduce screen time, monitoring/setting limits on screen time that does not promote learning, and counsel and promote parents to be creative to engage children at home in active play during the COVID-19 pandemic.