IMPACT OF EXCESSIVE SCREEN EXPOSURE BEFORE AGE TWO ON IMMUNE AND NEUROBEHAVIORAL DEVELOPMENT: A MULTIDIMENSIONAL SYSTEMATIC REVIEW

Abstract

Background: Excessive screen exposure in children under 24 months has raised significant concerns regarding its effects on neurobehavioral and immune development. Objectives: To systematically synthesize evidence on the multidimensional impact of early and excessive screen exposure on language, cognitive, attentional, social, sleep, immune, and neuroimaging outcomes in children aged 0–24 months. Methods: A systematic search of MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library was conducted. Studies published between 2000 and 2023 enrolling children under 24 months were included. Risk of bias was assessed using the Newcastle-Ottawa Scale and AMSTAR-2. Results: Twelve studies were included (n>16,000 children). Mean screen exposure ranged from 1.7 to 3.1 hours/day, with 57–79% of children exceeding WHO/AAP guidelines. Language delay was associated with screen exposure with odds ratios of 1.8 to 2.7. Elevated pro-inflammatory cytokines (IL-6, TNF-α) and cortisol were documented in high-exposure groups. Sleep duration reductions of 0.7 1.6 hours/night were consistently observed. White matter structural differences were identified by neuroimaging. Conclusions: Early excessive screen exposure is consistently associated with adverse neurobehavioral and immunological outcomes in infants and toddlers. Adherence to existing guidelines and caregiver education are strongly supported by the available evidence.