Associations Between Caregiver Smartphone Use in a Child's Presence and Motor Skills and Executive Function in Preschoolers: SUNRISE International Study

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Abstract
Background: The preschool years are a crucial period for development. Stable environments and responsive caregivers support children's cognitive and motor development, two interrelated and essential domains. Caregiver smartphone use in front of children may reduce attention and responsiveness, which have been negatively associated with young children's health and development. We examined associations between the frequency of caregiver smartphone use in a child's presence and motor skills and executive functions, and whether these associations vary by country income level. Methods: We analysed cross‐sectional data from 27 countries participating in the SUNRISE International Study. Caregivers reported the frequency of smartphone use in the child's presence across five scenarios: mealtime, playtime, travel, walk and bedtime routines. Children's motor skills were assessed using four established tests. Early Years Toolbox games were used to assess children's visual–spatial working memory and inhibition. Mixed‐effects linear regression models were used to assess the associations, including interaction terms to test variation by country income level. Models were adjusted for the child's sex, age, daily screen time, time spent outdoors, sleep duration and the caregiver's highest level of education. Results: The analytical sample included 2232 preschoolers (mean age = 4.2 ± 0.6 years, 50.9% girls). In fully adjusted models, the frequency of caregiver smartphone use in a child's presence was not associated with gross motor skills, fine motor skills, visual–spatial working memory or inhibition (all p > 0.05). Results did not differ by country income level. Conclusions: Findings suggest that the frequency of caregiver smartphone use in a child's presence alone may not be associated with performance on motor skills and executive function. There is a need for more sensitive measures that capture the frequency, duration and context of interruptions and more longitudinal studies that examine motor development and cognition. Future research should also account for socioeconomic and demographic diversity, environmental factors and cultural context when assessing such associations.

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