This cross-sectional study investigated whether caregiver-reported daily screen time is associated with language development in toddlers aged 12 to 42 months, measured with the Bayley-4. Receptive language was the primary outcome; expressive language, cognitive, and motor scaled scores were secondary. The study was conducted at the pediatric outpatient clinics of a tertiary care city hospital in Türkiye.
This observational, cross-sectional study examined the association between caregiver-reported daily screen time and language development, assessed with the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4), in children aged 12 to 42 months attending the pediatric outpatient clinics of a tertiary care city hospital in Türkiye. The primary outcome was the Bayley-4 Receptive Communication scaled score; the Expressive Communication scaled score was the principal secondary outcome, and Cognitive, Fine Motor, and Gross Motor scaled scores were examined to assess domain specificity. Daily screen exposure was recorded on a four-level ordinal scale (0-30, 30-60, 60-120, and more than 120 minutes per day). The study was approved for children aged 1 to 4 years (12 to 48 months); enrollment was restricted to 12 to 42 months because the Bayley-4 normative range ends at 42 months, so children aged 43 to 48 months could not be scored against the instrument norms. No intervention was assigned; screen exposure was observed, not manipulated.
Study Type
OBSERVATIONAL
Enrollment
153
Caregiver-reported total daily screen media exposure recorded on a four-level ordinal scale (0-30, 30-60, 60-120, and more than 120 minutes per day) using a structured questionnaire administered at the study visit. No exposure was assigned, allocated, or manipulated by the investigators. Applies to Cohorts 1-4.
A single standardized developmental assessment administered to each participant by one certified child development specialist in a dedicated, distraction-free examination room with the caregiver present, per Bayley-4 protocol. Mean administration time was 60-90 minutes. Receptive Communication, Expressive Communication, Cognitive, Fine Motor, and Gross Motor scaled scores were recorded. Applies to Cohorts 1-4.
Kayseri City Hospital, Pediatric Outpatient Clinics
Kayseri, Turkey (Türkiye)
Bayley-4 Receptive Communication Scaled Score
Receptive Communication subscale scaled score of the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4), administered once per participant by a certified examiner. Scaled scores are reported on the Bayley-4 normative metric (population mean 10, standard deviation 3). Higher scores indicate stronger receptive language performance.
Time frame: At enrollment (single cross-sectional assessment)
Bayley-4 Expressive Communication Scaled Score
Expressive Communication subscale scaled score of the Bayley-4, administered once per participant by a certified examiner, reported on the Bayley-4 normative metric (population mean 10, standard deviation 3). Higher scores indicate stronger expressive language performance.
Time frame: At enrollment (single cross-sectional assessment)
Bayley-4 Cognitive, Fine Motor, and Gross Motor Scaled Scores
Cognitive, Fine Motor, and Gross Motor subscale scaled scores of the Bayley-4, administered once per participant by a certified examiner and reported on the Bayley-4 normative metric (population mean 10, standard deviation 3). These non-language domains were recorded to characterize the domain specificity of the exposure-outcome association.
Time frame: At enrollment (single cross-sectional assessment)
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