Sedentary behavior and early childhood health: associations between screen exposure, body mass index, and foot arch structure in preschool children.

Early childhood is a critical developmental period during which behavioral and anthropometric characteristics associated with child health begin to emerge. In recent years, screen exposure and sedentary behaviors have attracted increasing attention because of their potential associations with physical activity patterns, growth indicators, and musculoskeletal health outcomes in children. However, their relationships with foot arch categories during early childhood remain insufficiently explored. This analytical cross-sectional study aimed to examine the associations between screen exposure, body mass index (BMI) percentile, and foot arch categories in preschool children. The study included 509 children aged 5-6 years attending four public preschools in Çanakkale, Türkiye. Foot arch profile was assessed using a podoscope and classified according to the Staheli Arch Index and Jack test. Screen exposure was evaluated based on parent-reported daily duration categories, and BMI percentiles were calculated using World Health Organization reference standards. Multinomial logistic regression analysis was conducted to examine associations between screen exposure, BMI percentile, and foot arch categories after adjustment for age and sex. The findings indicated that both screen exposure and BMI percentile were significantly associated with specific foot arch categories. More consistent associations were observed particularly in the rigid flatfoot category, where higher screen exposure and higher BMI percentile were more frequently observed. However, the relatively small number of participants in the highest screen exposure category should be considered when interpreting these findings. Overall, the findings suggest that screen exposure and BMI percentile may be associated with specific foot arch categories during early childhood. Although causal interpretations cannot be made due to the cross-sectional design, the findings may contribute to the growing literature examining behavioral and anthropometric characteristics associated with musculoskeletal indicators in preschool children. Further longitudinal and intervention-based studies are needed to clarify the direction and underlying mechanisms of these associations.