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. 2022 Dec 19;8(12):e12489. doi: 10.1016/j.heliyon.2022.e12489

The impact of media on children during the COVID-19 pandemic: A narrative review☆

M Mesce a, A Ragona a, S Cimino a, L Cerniglia b,∗
PMCID: PMC9762042  PMID: 36568660

Abstract

Although mobile technologies are a fundamental part of daily life, several studies have shown increased use of electronic devices, TV, and gaming during childhood in conjunction with the COVID-19 pandemic. The virus affected almost every country, causing uncertainty about the future, social isolation, and distress. This narrative review has searched the scientific literature in the field focusing on children. A non-systematic literature review was conducted in May 2022. Various databases were employed to conduct the document research for this paper, such as “Google Scholar”, “PubMed”, “Web of Science”. Keywords for the search included “screen time”, “media”, “digital use”, “social media”, “COVID-19”, “pandemic”, “lockdown”, “children”, “effect of media on children during COVID”. It was found that both children and adolescents seem to have used technologies to confront struggles provoked by COVID-19, such as the onset or exacerbation of symptoms of anxiety, depression, and attention-deficit/hyperactivity disorder. However, moreover, other studies have suggested that increased media use can have positive effects on children depending on usage and monitoring by the parents.

Keywords: Media, Children, COVID-19, Narrative review

Media; Children; COVID-19; Narrative review.

1. Introduction

1.1. Background: children and media

Earlier literature has pointed out that media, particularly the Internet, affect individuals' health, interpersonal relationships, concerns and opinions, and sleep (Do et al., 2020; Tran et al., 2017, 2020; Zhang et al., 2017). Particularly for children, media contribute to daily life throughout development (Calvert and Valkenburg, 2013): today's children are born and grow involved in media, as brilliantly described by the expression "digital natives" (Prensky, 2001). Mobile technologies are a gateway to a wide range of information: their continued modernization, such as electronic tablets and smartphones, allows children and adolescents to be connected to media and move between them 24/7: youths can use their mobile phones to text or call one another, watch online television programs or movies, play online games, or use mobile apps (Calvert, 2015).

Digital progress has supplied more innovative educational opportunities and easier access to information and communication (Chauhan et al., 2021). Therefore, the digital age has fundamentally changed the lives of children, affecting their learning, social relationships, play, and overall development. At the same time, there are concerns about the possible harm caused by the excessive use of digital technology (Huber et al., 2018; Przybylski et al., 2020) that could even result in a full-blown Internet addiction (Mak et al., 2014).

There is significant literature highlighting the various problems that may result from excessive exposure to digital media, and the concerns are specific to each age group, from infants to adolescents (Chonchaiya et al., 2011; Heffler et al., 2020; Srisinghasongkram et al., 2021).

Previous studies suggest that children's cognitive, behavioral, and emotional development might be impaired by exposure to digital media early in life, as it narrows their interests and limits areas of exploration and learning. This makes it difficult for kids to involve themselves in non-electronic tasks, decreases play time with other children, and thus impairs the development of imaginative skills, creativity, and social skills. Digital media also impairs children's maturation of language, attention, reading, and reasoning (Chonchaiya et al., 2011; Heffler et al., 2020), the latter of which is also hindered by the many behavioral problems that can develop, like hyperactivity and inattention, aggression and conduct problems (Srisinghasongkram et al., 2021). All of this has a huge negative effect and involves several areas of the individual: cognitive (intellectual) disorders, lack of attention, poor school performance, impulsivity, and poorer logical reasoning (Srisinghasongkram et al., 2021).

A recent publication (Stiglic and Viner, 2019) showed moderately convincing support for a correlation betwixt display time and depressive symptomatology and weak evidence for an association betwixt screen time and behavior problems, anxiety, hyperactivity, inattention, decreased self-esteem, and decreased psychosocial well-being in young children.

Another serious consequence is cyberbullying: children may be bullied and exposed to traumatic and pornographic/sexually explicit images. All of these may develop further adverse psychological implications (American Academy of Pediatrics, 2016).

1.2. The impact of the COVID-19 pandemic

At the end of 2019, Coronavirus Disease 2019 (COVID-19) was first reported in China; it is a severe infectious disease with high contagiousness and rapid transmission rate, affecting the entire world population and causing various inconveniences in daily life (Phelan et al., 2020). Several studies have shown that the policy of social isolation to control the circulation of COVID-19 did carry a complex influence on psychological well-being (Chen et al., 2020; Duan et al., 2020; Lee et al., 2021; Xie et al., 2020).

COVID-19 took place when digitization was now global, in a society where anyone can be connected in any part of the globe (Serra et al., 2021). Millions of children have been adversely affected by it: due to school closures, many youths have been forced to continue their education online and rely on digital media to stay connected with their peers (Gupta and Jawanda, 2020). Consequently, social network use has increased: children spent more time with smartphones, tablets, and computers (e.g., Chen et al., 2021; Dong et al., 2020; Eales et al., 2021; Kamaşak et al., 2022; Serra et al., 2021; Susilowati et al., 2021; Teng et al., 2021).

Internet and social media provided kids and teenagers to remain connected with peers and relatives but also an avenue to confront unavailability of human interactions during COVID-19 and thus adverse emotions (Cauberghe et al., 2021; Götz et al., 2020; Marciano et al., 2021). In compliance with these studies, the Compensatory Internet Use Theory (Kardefelt-Winther, 2014) argues that adverse life events and stressors can provide motivation for anyone to turn to the Internet to mitigate adverse feelings related to these factors.

Nevertheless, it is crucial to consider that during the pandemic internet access was justified by online classes and peer communication, causing possible misuse (Li et al., 2021a).

Because chronic stress during the pandemic can result in adverse emotional disorders, such as depression and anxiety (e.g., Pfefferbaum and North, 2020; Qiu et al., 2020), it has been observed that during the COVID-19 emergency, some people relied on dangerous coping strategies, such as using smartphones more frequently to consult the Internet and social media in order to alleviate pandemic-related anxiety and follow the news (Király et al., 2020).

Indeed, using the Internet as entertainment can be a regular way for infants to discharge emotions and stress and cope with reality (Kwon, 2011); however, excessive media use can lead users, especially children, to be less interested in real life and focus only on what is happening on the Internet (King and Delfabbro, 2014). The World Health Organization (WHO) indicates a limit of 1 h of display time for 5-year-olds as a guideline (WHO, 2019). Nevertheless, parents experienced many pressures related to screens and technologies since before the onset of the pandemic (Radesky et al., 2016). Considering COVID-19, the inability of the majority of families to comply with the instructions on screens has been recognized.

During the pandemic, the news trended mostly negatively (Ogbodo et al., 2020; Robertson et al., 2021; Priest, Sehgal, & Cook, 2020). Exposure to this kind of news, such as increased infections and deaths or the resulting economic crisis, causes stress and anxiety, and even panic attacks, especially among susceptible groups (Scheufele, 1999). In fact, cross-cultural research centered on the moment of isolation found almost 50 percent of the world's infants were frightened by reports of COVID-19 (Götz et al., 2020). Since pandemic-related news on social media channels was frequently misinformative, getting exposed to this could have adverse emotional implications (Gabarron et al., 2021).

In addition, children can be exposed to inappropriate content and cyberbullying: according to a study conducted by Hunduja and Patchin (2020), even in the pre-COVID-19 period, the Internet was seen to expose children to increased cyberbullying, which can result in low self-esteem and even suicide attempts.

Indeed, the increase in media use is one of the most insidious threats of our time, as it has lowered the age of Internet use and awareness, consequently increasing the related risks and dangers. Therefore, the pandemic fueling this condition has left its mark on further development (Kamaşak et al., 2021).

Earlier literature has focused mainly on adulthood (e.g., Wang et al., 2021a; Wang et al., 2021b) or adolescents (Ren et al., 2021), paying less attention to the impact that media has on children, particularly during COVID-19. Therefore, this paper is designed to recapitulate the impact of media on infancy during COVID-19 and its implication on welfare.

2. Method

The methodological approach of the present paper consists of a narrative review (Green et al., 2006; Pan, 2008) and it is a type of interpretive-qualitative publication that does not answer a specific question but aims to discuss the state of the literature on a given issue and increase the scientific community's debate on it (Grant and Booth, 2009).

A non-systematic literature review was conducted in May 2022. Since this was a narrative review, we did not use a risk of bias instrument, as some authors believe that this type of review may or may not include a quality assessment (Grant & Booth, 2009; Pautasso, 2013).

Various databases were consulted in the search for papers, such as “Google Scholar”, “PubMed”, “Web of Science”. Keywords for the search included “screen time”, “media”, “digital use”, “social media”, “COVID-19”, “pandemic”, “lockdown”, “children”, “effect of media on children during COVID”. These keywords were combined with Boolean operators to restrict the results. The studies were filtered by two of the authors (A.R. and M.M.) and the relevant ones were included in this review, while the unrelevant ones were excluded, as shown in Figure 1. Consequent information is summarized in Table 1.

Figure 1.

Figure 1

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Flowchart.

Table 1.

Search strategy.

Database Keywords Population
Google Scholar,
PubMed,
Web of Science 		Screen time, media, digital use, social media, COVID-19, pandemic, lockdown, children, child, effect of media on children during COVID. Children between 2-13 years
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As for the eligibility criteria, we considered the age group 2–13 years, and papers that did not treat the main theme of the age group were discarded. Only studies published between 2020 and 2022 were considered. Since limiting the inclusion of studies by the language of publication is a widespread practice in reviews (Stern and Kleijnen, 2020), we chose to follow this line: articles published not in English were not considered in the present paper. Also, some thesis dissertations (n = 2) were included. We examined each publication's title and abstract using our focus as a guide.

3. Results

This manuscript aimed to summarize the evidence on the influence of media on children during COVID-19 and its impact on well-being. Table 2 provides a brief description of the selected studies.

Table 2.

List of selected publications: Author/Year; Title; Main Issues and Measures.

Author/Year Title Highlighted issues Measures
Adachi, M., Takahashi, M., Shinkawa, H., Mori, H., Nishimura, T., & Nakamura, K. (2022) Longitudinal association between smartphone ownership and depression among schoolchildren under COVID-19 pandemic Smartphone, COVID-19, Depression, Schoolchildren, Screen time An ad hoc questionnaire was developed for the present study; Patient Health Questionnaire for Adolescents (PHQ-A; Johnson et al., 2002).
Camerini, A. L., Albanese, E., Marciano, L., & Corona Immunitas Research Group. (2022) The impact of screen time and green time on mental health in children and adolescents during the COVID-19 pandemic Screen time, green time, mental health, child, COVID-19 An ad hoc questionnaire was developed for the present study; Corona Immunitas Ticino (CIT; West et al., 2020).
Chen, C. Y., Chen, I. H., Pakpour, A. H., Lin, C. Y., & Griffiths, M. D. (2021). Internet-related behaviors and psychological distress among schoolchildren during the COVID-19 school hiatus. COVID-19; problematic gaming; problematic social media use; problematic smartphone use; psychological distress; school hiatus An ad hoc questionnaire was developed for the present study; Internet Gaming Disorder Scale-Short Form (IGDS-SF9; Yam et al., 2019); Bergen Social Media Addiction Scale (BSMAS; Ibidem); Smartphone Application-Based Addiction Scale (SABAS; Ibidem); Depression, Anxiety, Stress Scale-21 (DASS-21; Wang et al., 2016).
Chen, C. Y., Chen, I. H., Hou, W. L., Potenza, M. N., O'Brien, K. S., Lin, C. Y., & Latner, J. D. (2022) The Relationship Between Children's Problematic Internet-related Behaviors and Psychological Distress During the Onset of the COVID-19 Pandemic: A Longitudinal Study addictive behaviors, COVID-19, Internet, pandemic, psychological distress, social media, video games Depression, Anxiety, Stress Scale-21 (DASS-21; Wang et al., 2016); Smartphone Application-Based Addiction Scale (SABAS; Yam et al., 2019); Internet Gaming Disorder Scale-Short Form (IGDS9-SF; Ibidem).
Cowan, K., Potter, J., Olusoga, Y., Bannister, C., Bishop, J. C., Cannon, M., & Signorelli, V. (2021) Children's Digital Play during the COVID-19 Pandemic: insights from the Play Observatory Digital Play, COVID-19, Childhood, Digital Media An ad hoc questionnaire was developed for the present study for both parents and children.
Eales, L., Gillespie, S., Alstat, R. A., Ferguson, G. M., & Carlson, S. M. (2021) Children's screen and problematic media use in the United States before and during the COVID-19 pandemic Screen media use; problematic media use, COVID-19, children An ad hoc questionnaire was developed for the present study; adapted versions of the Common Sense Census (CSC; Rideout and Robb, 2017); Measure of Problematic Media Use - Short Form (Domoff et al., 2019).
Guo, X., Zhou, Y., Xu, J., Hu, Y., & Liu, Z. (2021) The Association of Maternal
Emotional Status With Child
Over-Use of Electronic Devices During the COVID-19 Pandemic		 COVID-19 pandemic, maternal depression, maternal anxiety, child electronic devices over-use, media, family environment An ad hoc questionnaire was developed for the present study; Self-rating Depression Scale (SDS; Zung, 1965); Self-rating Anxiety Scale (SAS; Zung, 1971); Family Environment Scale (FES-CV; Phillips, 1999).
Hmidan, A. (2022) Screen time use and Children's Mental Health During the COVID-19 Pandemic Parent stress, parenting styles, screen time, behavioral outcomes, education, COVID-19 An ad hoc questionnaire was developed for the present study; Alabama Parenting Questionnaire (APQ; Frick, 1991); Parent Stress Index -Fourth Edition Short Form (PSI-4; Cohen et al., 1983); Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997).
Kamaleddine, A. N., Antar, H. A., Abou Ali, B. T., Hammoudi, S. F., Lee, J., Lee, T., ... & Salameh, P. (2022) Effect of Screen Time on Physical and Mental Health and Eating Habits During COVID-19 Lockdown in Lebanon COVID-19; Screen time; Eating; Sleep; Depression. An ad hoc questionnaire was developed for the present study; Children Sleep Habit Questionnaire-Abbreviated (CSHQ-A; Owens et al., 2000); Preschool Feelings Checklist (PFC; Luby et al., 2004).
Kim, S. J., Lee, S., Han, H., Jung, J., Yang, S. J., & Shin, Y. (2021) Parental Mental Health and Children's
Behaviors and Media Usage during COVID-19-Related School Closures		 COVID-19; School Closure; Parental Mental Health, Children's Behaviors; Media Usage An ad hoc questionnaire was developed for the present study; Children's Sleep Habits Questionnaire (CSHQ; Owens et al., 2000); Behavior Problem Index (BPI; Zill and Peterson, 1986); Patient Health Questionnaire-9 (PHQ-9; Kroenke et al., 2001).
Kotrla Topić, M., Varga, V., & Jelovčić, S. (2021) Digital technology use during the covid-19 pandemic and its relations to sleep quality and life satisfaction in children and parents digital technology, life satisfaction, lockdown, sleep quality An ad hoc questionnaire was developed for the present study.
Li, X., Vanderloo, L. M., Keown-Stoneman, C. D., Cost, K. T., Charach, A., Maguire, J. L., ... & Birken, C. S. (2021b) Screen Use and Mental Health Symptoms in Canadian Children and Youth During the COVID-19 Pandemic specific forms of screen use, depression, anxiety, conduct problems, irritability, hyperactivity, and inattention in children and youth during COVID-19. Multiple ad hoc questionnaires were developed for the present study.
Limone, P., & Toto, G. A. (2021) Psychological and Emotional Effects of Digital Technology on Children in COVID-19 Pandemic digital technology; brain condition; neuropsychological effects; COVID-19 ∗
Marfua (2021) Exploring the Influences of Prolonged Screen Time on the Behavior of Children aging 3–6 years During COVID-19 Crisis Prolonged screen time; Pandemic; COVID-19; Child's behavior; Digital device An ad hoc questionnaire was developed for the present study; Strength and Difficulties Questionnaire (SDQ; Goodman, 1997); Socioeconomic Status Questionnaire (SES).
Sciberras, E., Patel, P., Stokes, M. A., Coghill, D., Middeldorp, C. M., Bellgrove, M. A., ... & Westrupp, E. (2020) Physical Health, Media Use, and Mental
Health in Children and Adolescents With ADHD During the COVID-19 Pandemic in Australia		 ADHD, COVID-19, psychological well-being An ad hoc questionnaire was developed for the present study; CoRonavIruS Health Impact Survey (CRISIS; Nikolaidis et al., 2021); An adapted version of the COVID-19 Pandemic Adjustment Survey (CPAS; Westrupp et al., 2020).
Serra, G., Scalzo, L. L., Giuffrè, M., Ferrara, P., & Corsello, G. (2021) Smartphone use and addiction during the coronavirus disease 2019 (COVID-19) pandemic: cohort study on 184 Italian children and adolescents Smartphone, Addiction, COVID-19, School-age children An ad hoc questionnaire was developed for the present study; Italian Smartphone Addiction Scale Short Version (SAS-SV; De Pasquale et al., 2017).
Shuai, L., He, S., Zheng, H., Wang, Z., Qiu, M., Xia, W., ... & Zhang, J. (2021). Influences of digital media use on children and adolescents with ADHD during COVID-19 pandemic ADHD, COVID-19, Digital media, Mental health Self-rating Questionnaire for Problematic Mobile Phone Use (SQPMPU; Tao et al., 2013); Internet Addiction Test (IAT; Young, 2004).
Swanson, Nolan, and Pelham Rating Scale (SNAP; Zhou et al., 2013); Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000); Adolescent Self-rating Life Events Checklist (ASLEC; Xin and Yao, 2015); the Chinese version of the Family Environment Scale (FES-CV; Tao et al., 2015); Students learning motivation scale (SLMS; Chen and Xu, 2020); Depression self-rating scale for children (DSRSC; Su, 2003); Screening child anxiety-related emotional disorders (SCARED; Wang, 2002); the study also designed the Home Quarantine Investigation of the Pandemic (HQIP).
Werling, A. M., Walitza, S., Grünblatt, E., & Drechsler, R. (2021a) Media use before, during, and after COVID-19 lockdown according to parents in a clinically referred sample in child and adolescent psychiatry: Results of an online survey in Switzerland Screen media use, problematic use of the internet, COVID-19 pandemic, Lockdown, Child and adolescent psychiatry An ad hoc questionnaire was developed for the present study; PUI-Screening Questionnaire for Children and Adolescents (PUI-SQ; Werling et al., 2021b).
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∗

This paper is a Review.

Several papers selected in this review proved that the pandemic influenced children's habits toward electronic media, such as gaming and time spent on social media or smartphones (Adachi et al., 2022; Camerini & Albanese, 2021; Chen et al., 2021; Chen et al., 2022; Hmidan, 2022; Kim et al., 2021; Marfua, 2021; Sciberras et al., 2022; Serra et al., 2021; Werling et al., 2021a, Werling et al., 2021b).

It is possible to summarize the various contributions in this article by following a few main themes: the psychological and physical outcomes of using and owning technological gadgets during COVID-19 (Adachi et al., 2022; Camerini et al., 2022; Chen et al., 2021; Chen et al., 2022; Cowan et al., 2021; Guo et al., 2021; Hmidan, 2022; Limone and Toto, 2021; Werling et al., 2021a; Serra et al., 2021); behavioral problems related to overuse of media during COVID-19 (Li et al., 2021b; Marfua, 2021); the relationship between eating and sleeping disorders and the use of media during the pandemic (Kamaleddine et al., 2022; Kim et al., 2022; Kotrla Topić et al., 2021); the effect of media in groups of clinical and ADHD children (Sciberras et al., 2022; Shuai et al., 2021).

First, several focused on the outcomes of media on psychological and physical well-being, showing that some aversive outcomes due to the use of smartphones were noticed significantly more often in the study population during COVID-19, compared to the pre-pandemic time. In particular, the study by Serra et al. (2021) revealed a considerable risk of smartphone addiction in the pandemic (31.5 % before vs during the emergency 46.7% were outlined and 27.2% were high risk). Moreover, a study (Adachi et al., 2022) instead focused on smartphone ownership and revealed a dissimilar result on depressive symptoms depending on whether children owned a smartphone or not: those who owned a cell phone had significantly higher and lower rates at the cutoff than expected. Consistent with these results on the effects of media overuse in children during COVID-19, the work of Chen et al. (2021) showed that IGDS, BSMAS, SABAS, depression, anxiety, and stress scores were positively and significantly related. In this study, mediation analyses indicated that social media and smartphone activities were mediators in the association between depression, anxiety, and stress, and increased playtime during school hiatus. In a longitudinal study (Chen et al., 2022) repeated-measures analyses of variance noted a significant difference in mean psychological distress, problematic smartphone use, and problematic gaming. Moreover, other researchers not only gave attention to the emotional state of children but also of mothers, showing that maternal anxiety/depression was related to an overuse of handheld Internet devices, especially smartphones, among infants and children (Guo et al., 2021).

In line with these results, very interesting is Hmidan's (2022) study that explored and demonstrated a significant association between screen time and internalizing behaviors: time spent on the screen was a positive predictor of internalizing behaviors (p < .05). In contrast, no association was noted between screen time and externalizing behaviors.

In the second place, on behavioral problems, two studies (Li et al., 2021b; Marfua, 2021) found a worsening in children's conduct during COVID-19 concerning media usage. The study by Li and colleagues (2021) showed that in younger children, higher time spent using TV or digital media was associated with higher levels of behavior problems and hyperactivity/disattention (Li et al., 2021b). In the same paper (Li et al., 2021b), was found that in older children (M = 11.3 +/- 3.3 years) more time spent using digital media or watching TV was connected with higher levels of depression, irritability, inattention, and hyperactivity; more time spent in online learning was linked with higher levels of depression and anxiety; higher levels of video-chatting time were associated with higher levels of depressive symptoms (Li et al., 2021b). Marfua (2021) noted that 55% of mothers reported a change in their children's behavior because of the long time spent on screens during the spread of COVID-19: children shower overactivity, attention problems, reduced interest in learning, showed aggressive attitude, were unable to control emotion and began to hide information (ibidem). In addition, a significant correlation was also found: the prosocial behavior of children decreases in relation to higher screen time (ibidem). The correlation between conduct, hyperactivity, peer relationship, and screen time was non-statistically significant.

Other studies have given importance to the adverse effects of screen time on physical health during the COVID-19 pandemic, such as eating habits, physical activities, and sleep. In particular, some studies focused on unhealthy eating habits. One study (Kamaleddine et al., 2022) conducted a logistic regression analysis using food consumption while using media devices as a dependent variable. The significant independent variables that predicted children's habit of eating foods while using electronic devices were total time spent on screen ≥2 h, time spent on smartphone screen ≥2 h, sleep problems, the ownership of technological device, and not eating unhealthy foods (ibidem). Another study (Kim et al., 2022) that seems to confirm this result states that during the closure of school children gained weight, have done less sport, and have suffered increased exposure to screens. This study also observed that children's sleep problems were associated with time spent on tablets and smartphones, but not their frequency. In line with these results the study of Camerini et al. (2022) emphasized a reduction in the time that children have spent outdoors (green time) and an increase in media time with an overall reduction in children's health.

The work of Kotrla Topić et al. (2021) concerns sleep. In this study, sleep quality was investigated independently for three age groups of children (attending kindergarten, lower, or upper elementary school grades); in all three age groups, parents reported that their children had a good or very good sleep quality. The findings showed a significant negative association between sleep quality and age (partial r = -0.213, p < 0.001). For children, partial correlations were calculated between parents' ratings of sleep quality and digital technology usage, and the effect of age was controlled for. Researchers found a significant negative correlation between sleep quality and smartphone use in leisure time, implying that those who most frequently used smartphones for leisure time had poorer sleep quality.

An interesting study by Werling et al. (2021a) focused on a clinically referred sample and conducted a repeated-measures analysis of gaming time, finding that the primary outcome of gaming over time and the game interaction divided by gender were significant. A pairwise comparison showed that after the lockdown, female patients reported a play time similar to the pre-pandemic, but this did not occur in male patients. Planned contrasts disclosed significant differences in time spent on social media from T1 to T2 and T1 to T3. The pairwise comparisons revealed significant differences between time spent on social media from T1 to T3 in girls but not in boys. According to the results of this study, during the lockdown, the negative effects of using devices on family quality of life have intensified. In the last two weeks, these negative outcomes seem to have returned to normal levels for most parents. Taken together, however, according to parents' perceptions, the lockdown appears to have had very little effect on problem behaviors and specific risks related to the media usage. Parents were requested to indicate if the intensity of the main psychopathological problem had varied since January 2020 and during the lockdown. Most replied that there had been no significant change, meanwhile an increase in problems was referred by an average percentage of parents (37.7%) and a worsening by 21.2%. Statistical comparison between groups concerning estimated screen time in patients with worsened, unaltered, and improved symptoms during the lockdown found noticeable and significant effects. In children between 10 and 13 years with worsening symptomatology, the total time expended on media was significantly higher compared to other groups with no change or improvement in symptoms of the psychopathological disorder. It was also explored if overall time spent on media was correlated with the number of psychopathological disorders reported by parents, the frequency of online school during the lockdown and the frequency of allowed activities outside the home during the lockdown. Neither of these factors had a significant effect on the total time dedicated to media.

Finally, two studies have considered children with ADHD. In the first one (Sciberras et al., 2022), children's stress about COVID-19 was significantly associated with a higher use of social media; the hypothesis of an association between COVID-19 worries and increased gaming has not been confirmed by statistical analysis. Shuai et al. (2021) also focused on children with ADHD: subjects were distinct in ADHD with and without PDMU (problematic digital media use). The ADHD group with PDMU had significantly worse symptoms in attention scores, in oppositional defiant scores, behavioral problems, and emotional difficulties when compared with the ADHD group without PDMU. The children with problematic digital media use presented significantly more impaired executive function on shift, emotional control, initiation, working memory, plan, and behavior regulation index, metacognition than the group without this condition. The total score on the depression self-rating scale for children and the screening child anxiety-related emotional disorders was significantly worse in ADHD with problematic digital media use group compared the other group. The ADHD children in the PDMU group spent more time on screens independently for playing video games than for using social media.

4. Discussion

The present study aims to highlight the implication of media use on children during COVID-19. The emergency that the world has faced over the past two years has had serious repercussions in every sphere of human life, affecting the psychological and non-psychological habits and welfare of everyone, regardless of age, putting family relationships and children's social-emotional maturation at risk (Witt et al., 2020). Especially for children and adolescents the crisis has favored increased vulnerabilities and affected the stability of family members (Douglas et al., 2020; Garcia and Duarte, 2020; Wang et al., 2020a; Lee, 2020; Viner et al., 2020).

Considering the 18 selected articles in our review, we can highlight that the issues the authors focused on most are the problematic use of devices in early childhood and the psychological and physical impact that technology can have on children and their mental health. There is no doubt that COVID-19 there was an increase in the time spent at home compared to before the lockdown and so on screens, even for younger children (Kotrla, Varga & Jelovčić., 2021; Andrew et al., 2020; Moore et al., 2020). In fact, the prevalence of technology device use increased significantly during the pandemic due to the lack of outdoor activity and indoor confinement. The increase of technology device employment during COVID-19 has been brought to 15 percent (Ammar et al., 2021) and this has led to dysfunction in normal functioning (Lau et al., 2022). In fact, increased use of technological devices is a prodrome for the eventual onset of sleep disorders, irritability but also Internet addiction, and gaming problems (Mohan et al., 2021). Earlier studies have observed that Internet addiction is significantly correlated with the onset of psychiatric symptoms such as ADHD, depression, and anxiety (Ho et al., 2014).

There is ample evidence that screen overexposure (≥4 h per day) can be a prodrome for major depressive disorder and social phobia in children (Kim et al., 2020), emphasizing the need to restrict children's exposure to screens, regardless of their age (Hmidan, 2022). According to research by Kim et al. (2021), children gained weight during the blockade and engaged in less physical activity and more media use; the most used media was online educational content (97.2%); however, YouTube was found to be one of the most used contents (87.6%) immediately followed by online games (78.3%). This increased use of media and the Internet could lead not only to physical problems but also to internalizing and externalizing symptoms (Hmidan, 2022). In this study, the author noticed a positive correlation between screen time and internalizing behaviors and hypothesized that age-related factors may moderate the strength of the correlation (ibidem).

Another crucial point is that the school hiatus, and consequently the lockdown related to the pandemic, could have caused psychological distress in elementary school children (Chen et al., 2021), and the negative impact can be extended to the problematic use of social media and smartphones. Longitudinal research conducted by Chen et al. (2022) shows that the pandemic has worsened psychological health and increased problematic Internet use in a large sample of schoolchildren increasing digital media-related distress.

In addition, in research conducted by Atia Marfua (2021), mothers noted various behavioral and health concerns in their sons and daughters during COVID-19 related to the prolonged use of screens and technological devices. Other researchers (Li et al., 2021b) found that increased screen use was related to greater rates of psychological health symptoms in children and adolescents during COVID-19, consistent with findings in the pre-pandemic literature (Stiglic and Viner, 2019; Hoare et al., 2016; Suchert, Hanewinkel & Isensee, 2015). In particular, in young children, increased time spent on TV or digital media has proven to be related to conduct issues and hyperactivity/disattention (Cost et al., 2022.; Patterson et al., 2002). Television has had a significant impact during this period of isolation because everyone has it in the home: greater and more constant access to information regarding the pandemic has been positively related to symptoms of anxiety and depression as well as PTSD (Wang et al., 2020b; Xiong et al., 2020). Such negative consequences can strike especially hard with children: in fact, it has been shown that watching television before age 3 can negatively affect children's cognitive functions (Zimmerman and Christakis, 2005).

Gaming has also played a significant role in entertaining children during isolation, even bringing in some cases positive, and non-negative, effects such as improving mental health and helping combat isolation (Barr and Copeland-Stewart, 2022). In fact, video games are functional stress-relieving tools for both children and adults: they are believed to reduce both anxiety and depression and increase other abilities (Bowman et al., 2022; Limone, 2021; Yee and Sng, 2022).

However, Werling et al. (2021) found that although most of the effects due to dysfunctional media use seemed reversible, this was not the case in a clinical champion of young males with psychiatric disorders. It is, therefore, possible to conclude, based on the earlier research cited above, that excessive media use was only temporary in most individuals, however, for those who were already at risk for technological dependence, the lockdown may have exacerbated the problem.

In addition, our investigation shows that children who engaged more in activities involving screens during the pandemic are more likely to develop higher levels of anxiety and psychosomatic symptoms (Camerini et al., 2022), thus confirming previously observed findings (Ho et al., 2014; Mohan et al., 2021).

A very interesting point to consider is that during COVID-19 infants experienced different age-related challenges (Eales et al., 2021): in particular, while younger children may not need media to stay in virtual contact with peers, older children may have contacts outside the family to maintain (Masten and Motti-Stefanidi, 2020). These researchers, in line with others, cited so far, have also found that in general an improve in children's media use was observed and that older children, in particular, are often left alone with technological devices as they are considered more independent.

Regarding mental health during COVID-19, some studies have found a correlation not only between device ownership and depression in school-aged children (Adachi et al., 2022), but also between maternal symptomatology and excessive use of handheld Internet devices, particularly smartphones, among children (Guo et al., 2021), and this association varies according to the age of the children. This is a crucial point because we need to consider that children's social isolation and the activities, they engage in during the shutdown also affect parents' mental health. Maternal mental state can affect the child in several ways: for example, mothers with internalizing disorders might make excessive use of electronic devices, act as role models for children, or use screen time to replace insufficient maternal companionship (Bjelland et al., 2015; Faltýnková et al., 2020; Wu, 2016) or children may take relief from portable internet devices when the mother is unable to provide emotional support.

However, it is worth noting that the media can further have a beneficial impact: it has been shown that children and adolescents can benefit because social media helps increase communication skills and develop technical skills (Tartari, 2015). During the lockdown, social media shares allowed for similar feelings to be shared: in fact, it was observed that those who perceived they had more support on social media had a better level of mental health (Kaya, 2020; Canale et al., 2022).

Further, COVID-19 allowed new intervention methods for chronic disease management that proved to be extremely useful in that they allowed essential services needed during isolation not to be interrupted (Shamsabadi et al., 2022).

Psychotherapy has also had to adapt to the period of isolation, resorting to the use of virtual platforms. Regarding the treatment of symptoms due to the pandemic, it has been found that cognitive-behavioral therapy via the Internet is the most effective therapy (Ho et al., 2020; Zhang and Ho, 2017).

Overall, therefore, digital technologies can be useful resources in addressing issues posed by COVID-19.

Ultimately, the increased reliance on technology during COVID-19 has a complex impact. Technological devices have indeed provided an escape from loneliness but, at the same time, maybe a prodrome for the development of depression, anxiety, irritability, and sleep problems. This review has some limitations explained below. First, we only included papers published in English; we chose to follow this line due to lack of time and unavailability of language resources, which, as suggested by Neimann Rasmussen and Montgomery (2018), are among the most common reasons for not including languages other than English. Another limitation may be related to the survey methods of the articles included in this manuscript; in fact, in most cases, they are based on parental observation. Since the results of the studies considered refer to a potentially frightening and depressing period for the children, likely, the time spent with the parents, which was greatly increased due to the closure, and the quality of the relationship may also have been affected; this situation could therefore have influenced the parents' ability to observe and, consequently, the results obtained. A controlled type of data collection would be useful to try to isolate possible causal agents.

5. Conclusions

We are aware that COVID-19 sets a unique issue and raises the need to find innovative solutions to the latest problems. We suggest that emphasis and attention be placed on children's psychological health during the pandemic because it is important to limit the negative impact of restrictions on their health to avoid long-term consequences. The family atmosphere plays a key role in promoting dialogue and a protective environment, especially in this period. Parents have a key role in this context and should check their children for negative outcomes of increased technology and media use. An effective strategy might be to limit screen time in favor of more interactive, creative, and in-person games; in addition, it would be helpful to promote time spent outdoors as much as possible, as access to green spaces has been combined with improved psychological health and maturation in infants (Becker et al., 2017; McCormick, 2017; Tremblay et al., 2015). We hope that more in-depth research can be conducted in the future on how the media influenced the well-being of children during the COVID-19 pandemic.

Declarations

Author contribution statement

All authors listed have significantly contributed to the development and the writing of this article.

Funding statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability statement

No data was used for the research described in the article.

Declaration of interest's statement

The authors declare no conflict of interest.

Additional information

No additional information is available for this paper.

Footnotes

☆

This article is a part of the "The effects of media on children during the COVID-19″ Special issue.

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