Parental use of mobile screens and interaction with children. A systematic review
Systematic review
|Published
The Norwegian Institute of Public Health was commissioned to systematically review research on the consequences of parental use of mobile screens (smart-phones, tablets) when interacting with children 0-6 years old.
Key message
Most young people and adults are today frequent users of smart-phones. The term “technoference” describes how technology interferes with and interrupts relations. The Norwegian Institute of Public Health was commissioned by the Norwegian Directorate of Health to systematically review research on the consequences of parents’ use of mobile screens (smart-phones, tablets) when interacting with children 0-6 years old, on outcomes such as parents’ sensitivity, interaction with the child, attachment and development. Through searching for literature in databases and several other sources, we identified ca. 10 000 references, and reviewed 83 studies in full-text. We included 15 experimental studies and 5 naturalistic observational studies. We assessed risk of bias, and our confidence in the documentation in the 15 experimental.
- In four experimental studies of breastfeeding situations the authors reported varied results, and the evidence is very uncertain.
- In nine experimental studies of different play and interaction situations, the authors reported more consistent results and the evidence suggests negative short-term consequences on parents’ sensitivity and responsivity, the child’s stress and negative emotionality, and interaction in general.
- In two studies of learning situations the authors reported varied results, and the evidence is very uncertain.
- In five naturalistic observational studies of interplay on playgrounds, cafes and similar, authors reported some associations between parents’ use of mobile screens and lower responsivity and lower probability of interaction, but in these studies, we cannot rule out that there are other factors that influence both phone use and interplay.
Even though the results in this review show some possible short-term consequences, the research question is answered to a limited degree only. There is a need for more research with a longer timeframe.
Summary
Introduction
The vast majority of young people and adults in Norway today have access to and are frequent users of a smartphone. Parents’ use of a smartphone or tablet when interacting with children is thus very likely. We need evidence about whether the use of these digital tools lead to changes in the relationship parent-child or in children's development. The Norwegian government's escalation plan for children and young people's mental health 2019-2024 points out that extensive use of digital tools (e.g., smartphones) by parents can affect the interaction between parents and children, an interaction that is «crucial for the child's physical, mental, intellectual and psychosocial development». Early interaction with parents shapes the child's attachment, in which the child has his or her primary needs covered and is held and comforted. Attachment is the psychological bond between the child and the primary caregivers and forms the basis for future relationships.
Purpose
The National guideline for child and youth health centers 0-5 years have a strong recommendation that parents should receive guidance on general parent-child interaction in all consultations in the child and youth health centers program. In the child and youth health centers program, «parents’ use of mobile devices and social media» is mentioned as a topic for parent counselling at the regular meetings when the child is 4 weeks, 6 months, 2 years, and 4 years. The evidence to date came from a 2017 review article that supports the recommendation on parents’ use of mobile devices with a broad, psychological understanding of interaction and attachment. The review also found that there was a lack of knowledge about whether parents' mobile phone use has possible harmful effects for the child. The Norwegian Directorate of Health therefore wants a thorough review of the literature about parents' use of digital technology and interaction with children in the short and long term.
Method
We performed a systematic review on the consequences of parents' use of digital devices on their interaction with children, children's attachment and children’s development. The inclusion criteria were:
- Population: parents and children 0-6 years
- Exposure: parents' use of mobile devices (smartphone, tablet) when interacting with children
- Comparison: restricted or no use of mobile devices
- Outcomes: stress in children, interaction between parents and children, parents' attention to the child, joint attention in parents and children, parents’ responsivity, parents’ emotional availability, children’s attachment and children’s emotional and cognitive development
- Study design: studies with control conditions, that is, randomized or non-randomized studies with control group, interrupted time series, longitudinal/ cohort studies and within subjects studies (studies that compare the participants with themselves by having several phases in the experiment)
We were to first search for systematic reviews, and if none was found, we were to search for primary studies.
Results
Through literature searches in databases and several other sources, we identified 10,000 references and read 83 studies in full text. We included a total of 20 studies: three randomized controlled trials, twelve within-subjects studies and five naturalistic observational studies (studies from playgrounds, cafes and such).
Due to limited time, we only performed risk of bias appraisals on 15 experimental studies. Of these, five studies had a low risk, six had a moderate risk and four studies had a high risk of bias. As we could not combine the results in meta-analyses, we used an adapted GRADE method (Grading of Recommendation, Assessment, Development and Evaluation) to assess the certainty of evidence.
We grouped the included studies according to the situation and purpose of the contact: breastfeeding situations (four studies), play situations (nine studies) and learning situations (two studies). These studies were conducted in a laboratory or at home under controlled conditions. In addition, there were the five naturalistic studies.
All 20 studies measured consequences in the short term, what happens in the situation itself when a parent uses the mobile phone while spending time with children.
- In four experimental studies of breastfeeding situations the authors reported varied results, and the evidence is very uncertain.
- In nine experimental studies of different play and interaction situations, the authors reported more consistent results and the evidence suggests negative short-term consequences on parents’ sensitivity and responsivity, the child’s stress and negative emotionality, and interaction in general.
- In two studies of learning situations the authors reported varied results, and the evidence is very uncertain.
- In five naturalistic observational studies of interplay on playgrounds, cafes and similar, the authors reported some associations between parents’ use of mobile screens and lower responsivity and lower probability of interaction, but in these studies, we cannot rule out that there are other factors that influence both phone use and interplay. As we have not assessed the quality of these studies, we are unable to discuss the confidence in the results.
Discussion
The 20 included studies answer the research question only partially. The studies present snapshots, that is what happens in the interaction in the very short term when a parent or caregiver uses mobile screens in certain situations. The outcomes that are measured are related to interaction here and now, parents' communication and response as well as the child's communication and emotional expression. We thus know very little about the long-term consequences of parents' use of digital technology on the child's attachment and the emotional and cognitive development.
The literature (e.g., systematic reviews) conducted on this research question before, include cross sectional and qualitative designs and conclude that there are associations between parents' use of mobile screens and interaction with children. Two new, Nordic cross-sectional studies also found associations between parents' use of mobile screens and interaction with children and children's cognitive and emotional development, but here too we cannot rule out that there are underlying factors (confounding factors) that affect both the use of mobile screens and the child's behavior and development – as parents' general style towards the child. Inferences of a casual relation (the use of mobile phone causes X outcome) warrant further research.
Conclusion
Our results provide some support in guiding parent’s cautious use of digital screens while in the presence of their children. Based on the evidence it is however difficult to conclude on the consequences of this habit. The research question is thus answered partially. There is a great need for further research with a longer time perspective. It may also be valuable to systematically summarize findings from studies with other types of designs to gain a broader understanding of the phenomenon of interest.
