Table 1. Characteristics of the included studies.

CI: Confidence interval; aOR: Adjusted odd ratio; OR: Odd ratio; TV: Television; SD: Standard deviation

Authors	Year	Title	Study design	Summary of findings
Sola et al. [18]	2022	Tracking Home Language Production and Environment in Children Who Are Deaf or Hard of Hearing	Cross-sectional	For every hour of electronic media exposure, there were reductions in child vocalizations (β = -0.47; 95% CI: -0.71-0.19), conversational turns (β = -0.45; 95% CI: -0.65-0.22), and language development (β = -0.37; 95% CI: -0.61-0.15).
Putu Dianisa [19]	2023	The relationship between screen time and speech delay in 1-2-year-old children	Cross-sectional study	Children who spent over two hours daily using screens had an increased likelihood of experiencing speech delay (aOR=6.15; (95% CI: 2.84-13.30, p < 0.001). Additionally, being male and belonging to a lower socioeconomic background were also associated with speech delay (aOR = 2.67; 95% CI: 1.72-5.60; p = 0.009 and OR=5.49; 95%CI: 2.04-13.93, p = 0.001, respectively).
Ramelan et al. [20]	2019	The Effect of Gadget Use Intensity towards the Speaking Ability of Early Childhood	Cross-sectional study	60% of parents allowed their children to use gadgets without supervision, while only 40% of parents chose to oversee their children's gadget use. Regarding gadget usage frequency, 70% of children engaged with gadgets daily, while the remaining 30% used gadgets selectively. The results of a simple linear regression analysis indicated a significant correlation between the intensity of gadget usage and the speaking proficiency of young children (p<0.001).
Nugrahaet al. [21]	2019	The effect of gadgets on the speech development of toddlers	Qualitative research design using a phenomenological approach	The findings indicated that electronic gadgets had a negative influence on the development of speech in toddlers compared to other children of the same age without gadgets.
Mustonen et al. [22]	2022	Impact of Home Blood Pressure Data Visualization on Hypertension Medical Decision-Making in Primary Care	Cross-sectional study	As children’s time spent on screen or the mothers' screen time increased, their language skills diminished, even after considering the children's age, maternal education level, and birth order. Additionally, there were cumulative and negative associations with the children's lexical and overall language capabilities.
Al Hosani et al. [23]	2023	Home Monitoring of Blood Pressure: Patients’ Perception and Role of the Pharmacist	Case-control study	Electronic gadgets were used by 90.3% of children with speech and language developmental delays. Children possessing a device had an elevated likelihood of experiencing language development issues (OR = 3.94, 95% CI: 1.97-7.84, p < 0.001). In comparison to early initiation (at 12-24 months of age), the introduction of electronic devices at a later stage (25-36 months) exhibited a positive impact on language development (OR = 0.32, 95% CI: 0.13-0.82, p = 0.017). Moreover, children who spend 3 to 4 hours watching television daily were at an increased risk of language delays (OR = 3.21, 95% CI = 1.66-6.17, p < 0.001).
Varadarajan et al. [24]	2021	Prevalence of excessive screen time and its association with developmental delay in children aged <5 years: A population-based cross-sectional study in India	Population-based cross-sectional study	Increased screen time was associated with developmental delays, particularly in language acquisition and communication. In children aged two years and older, a language delay was significantly positively associated with screen time (aOR = 52.92, 95% CI: 12.33-227.21, p < 0.001). For children below two years of age, a language delay was also associated with screen time (aOR = 20.93, 95% CI: 2.68-163.32, p < 0.01).
van den Heuvel et al. [25]	2020	Mobile Media Device Use is Associated with Expressive Language Delay in 18-Month-Old Children	Cross-sectional study	The study analyzed 893 children (mean age 18.7 months, 54.1% male), with most parents reporting no mobile media device usage (77.6%). Among those with reported usage (22.4%), the median daily use was 15.7 minutes. Expressive speech delay prevalence was 6.6%, while the delay of other communication skills was among 8.8% of children. For device users, each additional 30 minutes daily was linked to increased odds of expressive speech delay (aOR = 2.33, 95% CI: 1.25-4.82).
Dy et al. [26]	2023	Measuring effects of screen time on the development of children in the Philippines: A cross-sectional study	Cross-sectional study	Screen time exceeding two hours was associated with a decrease in receptive and expressive language scores. A high likelihood of excessive screen time was observed in children whose parents watched television for over two hours (OR = 4.19, 95% CI: 2.46-7.13, p < 0.001), spent more than two hours browsing the web (OR = 1.75, 95% CI: 1.07-2.88, p = 0.027), and engaged in social media for over two hours (OR = 1.84, 95% CI: 1.15-2.95, p = 0.012). Findings also revealed higher odds of excessive screen time among children who watched TV alone compared to those who watched TV with a parent or adult (OR = 8.56, 95% CI: 1.14-64.07, p = 0.037).
Salunkhe et al. [27]	2021	Influence of Electronic Media on Speech and Language Delay in Children	Cross-sectional study	Speech and language delays were observed in 28.4% of children who spent more than three hours using media.
Acebedo et al. [11]	2020	Impact of the Use of Media Devices within the Family Context on the Language of Preteens	Transversal design	The findings indicated reduced language scores in preteens with increased access to media devices who used them more often and engaged in fewer conversations with their parents. Similarly, preteens who utilized media devices for communication exhibited lower language scores compared to those who used them for educational purposes or learning. These outcomes remained consistent across different socioeconomic backgrounds, sexes, ages, and family languages.
Vrinda et al. [28]	2021	Impact of Screen Time on Communication in Toddlers: A Parental Awareness Survey	Cross-sectional study	The majority (88.5%) of parents acknowledged being conscious of the consequences of increased screen time for children. Visual issues ranked as the primary concern among the outlined effects, while speech delay was the least reported problem. Of all parents, 84% believed that excessive screen time was linked to attention problems, and 93.8% felt that screen time should be limited. However, 56% were unaware of any established guidelines in this regard.
Aziz et al. [29]	2023	Impact of screen exposure on language development among toddlers and preschoolers in Nineveh province	Cross-sectional study	Among the observed cases, 94.9% experienced delayed speech development, while the remaining experienced complete speech loss. A significant correlation was observed between speech delay and screen usage in both groups, particularly those who initiated screen exposure before 24 months of age (P= 0.02) and spent at least four hours daily engaging with screens (P=0.01). Those who spent more hours per day on screens had considerably lower concentrations (p=0.01). After abstaining from these devices for six months, an improvement in speech was noted in 36.7% of cases.
Sundqvist [30]	2021	Growing Up in a Digital World - Digital Media and the Association With the Child’s Language Development at Two Years of Age	Cross-sectional study	The child's language skills were positively correlated with the practice of engaging in reciprocal interactions. The vocabulary and grammar skills showed negative associations with the use of devices by parents during their daily interactions with the child, as well as the extent to which the child watched TV. Additionally, the child's development of practical communication skills had a positive association with parents incorporating devices into child routines, and it was also positively correlated with parents engaging in media activities together with children. In this case, girls had a stronger performance in pragmatic development.
Asikainen et al. [31]	2021	Exposure to electronic media was negatively associated with speech and language development at 18 and 24 months	Prospective cohort	Long periods of exposure to electronic media for both children and parents were associated with a decrease in the child's expressive vocabulary. Our findings revealed that extended screen time (OR = 1.69) and prolonged TV usage (OR = 1.73) were associated with a reduced vocabulary in 18-month-old children. Similarly, increased parental screen time (OR = 2.16) and less frequent shared reading sessions (OR = 0.65) were both associated with a smaller vocabulary in 24-month-old children.
Venker et al. [32]	2022	Electronic Toys Decrease the Quantity and Lexical Diversity of Spoken Language Produced by Children With Autism Spectrum Disorder and Age-Matched Children With Typical Development	Case-control study	For both children with autism spectrum disorder (ASD) (p = 0.025) and typically developing (TD) children (p = 0.004), the average count of child utterances per minute was significantly reduced during electronic toy play compared to traditional toy play. Similarly, the mean number of distinct words per minute was significantly lower during electronic toy play in both children with ASD (p = 0.021) and children with TD (p = 0.005).
Madigan et al. [15]	2020	Associations Between Screen Use and Child Language Skills: A Systematic Review and Meta-analysis	Systematic Review and Meta-analysis	Increased screen usage duration (hours per session) was associated with reduced language proficiency (r = −0.14; 95% CI: −0.18−0.10). On the other hand, enhanced screen quality, like educational programs (r = 0.13; 95%CI: 0.02-0.24, and joint usage with parents (r = 0.16; 95%CI: 0.07-0.24), was associated with stronger child language abilities. Beginning screen usage at a later age was correlated with improved child language skills (r = 0.17; 95%CI: 0.07-0.27) compared to early-age usage.