Background and methodology

Target group: All children born after 01.01.2022 receive the signal sticker from their paediatrician at the early detection examination (U5).

Potential for implementation: The childhood diseases in which the quantity and quality of screen media use play a role result in direct and indirect costs as well as in lifelong psychosocial consequences for the individuals, their families and also for the social security systems. In view of the increasing prevalence estimates, it is to be expected that optimised care in this area will achieve positive clinical as well as economic effects in the long term.

Background: Experts agree that young children spend on average too much time with screen media (1,2) and that the digitalisation trend is strongly increasing (3). Accelerated by the Corona crisis, digital media are taking on an unprecedented role in everyday life. Lessons are being moved to virtual classrooms, kindergarten children follow digital playgroups on the screen, and adults and children alike are more than ever seeking pastimes in digital communication, movies and computer games.

Despite all the blessings we ascribe to digital media, we must not forget that there are also downsidesx, especially for children. Digital screen media have a less favourable effect on the health of young children, who are still developing, than on adults (4,5). Excessive use of digital screens by parents and young children at this stage of life is associated with numerous negative health effects, such as regulatory and attachment disorders (6,7) and developmental disorders of language and cognition (8,9,10). There is much evidence to suggest that the long-term effects of dysregulated screen media use are associated with significant costs to health insurers (11). In contrast, reducing screen media exposure in the early years of life is associated with positive effects in diverse developmental domains, such as fine motor skills (2), attention and social behaviour (12).

In the USA, reducing screen time among children is already a national health goal (13). According to German recommendations (e.g. BVKJ, DGKJ, DGSPJ, BZgA), children under the age of 3 should not be exposed to digital screen media, either actively or passively in the presence of parents using screens. In international comparison, Germany still has a leading restrictive attitude in this respect, and an AWMF guideline on the prevention of dysregulated screen media use in childhood is being developed under the leadership of the applicants (14). In order to implement these recommendations and to really bring them into the awareness of the population, especially of young parents, good and easily understandable information is necessary. This is where the BB3 study comes in. As the world’s largest interventional study to date, it evaluates a complex intervention that can be implemented immediately and cost-effectively as part of the preventive medical check-ups by paediatricians and adolescents.

Methodology: Germany-wide, randomised study of the effectiveness of an intervention for dealing with screen media in routine care at the paediatrician (screening examinations). The randomisation of the clusters is carried out randomly per federal state. The quantitative evaluation of the use of digital screen media in families and general early childhood development will be carried out by means of pre-/post-surveys via the app “Mein Kinder- und Jugendarzt” of the BVKJ. In addition, multicentre, qualitative surveys of practice staff and participating parents will be conducted. As far as possible, the ICD-10 diagnosis data of the participating children will also be evaluated via the Central Institute for Statutory Health Insurance (Zi).

Hypotheses: “Screen free until 3” leads to young parents being better informed and consequently not engaging young children under the age of three with digital devices. This secondarily reduces screen media-associated morbidity, through a reduction in screen time and the resulting improved socio-emotional, language and fine and gross motor development.

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  2. Webster, E. K., Martin, C. K. & Staiano, A. E. Fundamental motor skills, screen-time, and physical activity in preschoolers. J. Sport Health Sci. 8, 114–121 (2019).
  3. Medienpädagogischer Forschungsverbund Südwest. miniKIM2014 – Kleinkinder und Medien, Basisuntersuchung zum Medienumgang 2-bis 5-Jähriger in Deutschland. (2014).
  4. Reckert, T., Schwarz, S., Büsching, U. & Martin, D. ‘Bildschirmfrei bis Drei’: Am Lebensanfang volle Wirklichkeitserfahrung ermöglichen. Kinder- Jugendarzt 51, 195–199 (2020).
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  8. Chonchaiya, W., Sirachairat, C., Vijakkhana, N., Wilaisakditipakorn, T. & Pruksananonda, C. Elevated background TV exposure over time increases behavioural scores of 18-month-old toddlers. Acta Paediatr. Oslo Nor. 1992 104, 1039–1046 (2015).
  9. Madigan, S., Browne, D., Racine, N., Mori, C. & Tough, S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatr. 173, 244–250 (2019).
  10. Tomopoulos, S. et al. Infant Media Exposure and Toddler Development. Arch. Pediatr. Adolesc. Med. 164, 1105–1111 (2010).
  11. Vermont Department of Health. Screen Time & Activity – finding the balance. (2016).
  12. Cheng, S., Maeda, T., Yoichi, S., Yamagata, Z. & Tomiwa, K. Early Television Exposure and Children’s Behavioral and Social Outcomes at Age 30 Months. J. Epidemiol. 20, S482–S489 (2010).
  13. Centers for Disease Control and Prevention (CDC). Chapter 33: Physical Activity (PA). in Healthy People 2020 Midcourse Review 21.
  14. Martin, D. D. Leitlinie zur Prävention dysregulierten Gebrauchs digitaler Bildschirmmedien in der Kindheit – Angemeldetes Leitlinienvorhaben Registernummer 027 – 075.
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