Digital screen exposure in infants, children and adolescents: a systematic review of existing recommendations.

Objectives: This review aimed to synthesise existing recommendations - issued by either United Nations agencies, scientific societies, governmental health authorities, non-profit organisations, or others - on digital screen exposure in infants, children, and adolescents. Study design: Systematic review. Methods: A wide search strategy was utilised - including digital databases (PubMed, EMBASE, Web of Science), Google, ChatGPT, reference lists from and grey literature -up to July 2024. Identified documents were categorized by type, issuing institutions, audience, publication year, and age groups. A synthesis of recommendations on screen time quantity was provided, comparing recommendations from the World Health Organization (WHO) with those from other institutions/bodies. Results: Out of 85,425 records retrieved, 41 documents were identified. Of these, 23 were published by scientific societies, 13 by government/health authorities, two by the WHO, and three by non-profit organisations. In relation to digital screen quantity, most documents aligned: i) for children under 2 years, most documents recommended zero exposure (n = 20/22); ii) for children aged 2-5 years, the majority recommended limiting screen time to 1 h per day (n = 17/21); iii) for children over 5 years and adolescents, the most permissive guidelines suggested a maximum of 2 h per day (n = 8/10). Existing recommendations were either equally strict or more restrictive than WHO guidelines. In regard to the quality of digital screen exposure, 10 key points emerged, along with additional guidance for parents, schools, healthcare professionals, researchers, and industry. Conclusions: There is consensus on the need to limit the quantity of digital screen time for infants, children and adolescents and to ensure good quality exposure. This alignment provides a strong basis for governments and other bodies to agree on local recommendations, as well as strategies to improve their implementation in practice.