Screen Time Exposure in Children Under Five Years in India: Magnitude, Consequences and the Case for a Nurse-Led Preventive Response: A Narrative Review

Abstract

Background: The first five years of life are critical for neurodevelopment, with outcomes strongly influenced by responsive caregiver interactions. Screen exposure is increasingly common among Indian children, often beginning in infancy. Objective: To synthesise evidence on the prevalence, determinants and consequences of screen time among Indian children under five, examine caregiver knowledge and mediation practices, and identify nursing contributions to prevention. Methods: A narrative review was conducted using PubMed, Scopus and Google Scholar to identify literature published between 2015 and 2025 using terms related to screen exposure, early childhood, India and caregiver practices. World Health Organization and Indian Academy of Pediatrics guidelines were also consulted. Studies were selected based on relevance without formal systematic criteria or meta-analysis. Findings: Screen exposure among Indian children under five frequently exceeds recommended limits, with a reported pooled estimate of 2.22 hours daily. Guidelines recommend no screen exposure below 24 months and a maximum of one hour daily for children aged 24–59 months. Exposure is associated with parental education and occupation and is reinforced by screen use during feeding, emotional soothing and bedtime. Reported consequences include delayed expressive language, reduced attention, disturbed sleep, decreased physical activity and behavioural difficulties. However, evidence is predominantly cross-sectional. Caregiver awareness of age-specific recommendations appears limited, while randomised evidence suggests that structured parental education can reduce exposure. Conclusion: Excessive early screen exposure is a prevalent and modifiable concern in Indian child health. Nursing practice can address this gap through routine screening, age-appropriate anticipatory guidance and substitution-based counselling during immunisation, growth monitoring and Anganwadi visits. Integrating these strategies into existing services may strengthen caregiver awareness, promote healthier media habits and support early childhood development.