Background Digital media has undergone explosive revolution with the advent of portable gadgets and instant internet access. Early exposure and excessive screen use has negative influences across domains of early child development and also causes behaviour problems. There is paucity of data in our population with regard to the impact of latest technology gadgets as well as screen addiction.

Objectives Estimate the exposure and addiction of screen media among children in a developing country and its influence on early child development and behaviour.

Methods We included 613 children between 18 months and 12 years who visited the paediatric out-patient department for a well or a sick visit. Children with already diagnosed developmental delays and neurodevelopmental disorders were excluded. Their media exposure was analysed along with Problematic Media Use Measure Short Form (PMUM-SF) for addiction. They were screened for behaviour problems using the Child Behaviour Checklist (CBCL) for 1.5 to 5 years and Strengths and Difficulties Questionnaire (SDQ) for those beyond 5 upto 12 years. Those under five years were also subjected to a developmental screening using Ages and Stages Questionnaire (ASQ3).

Results The most common gadget used was television followed by smartphones. Median average daily screen time was 1.6 hours( inter-quartile range 1–3 hours). Female gender (OR 0.26 (95% CI 0.11 – 0.63); p=0.003) and children with average daily screen time of less than two hours [OR 0.092 (95% CI 0.018 – 0.48); p=0.003) had lesser chance of having concerns in the communication domain. Female gender also had less chance for pervasive developmental problems. Children with no physical activity (OR 8.5 (95% CI 1.48 – 48.57); p=0.016) use of tablet gadget (OR 3.1 (95% CI 1.07 – 9.02); p=0.037) and those with average daily screen time of greater than two hours (OR 3.95 (95% CI 1.34 – 11.67); p=0.013) had more chance of affective problems in the under five age group. Below average school performance, median average daily screen time of children, watching handheld video games, and parental concerns about child’s media use with regard to addiction, exposure to violence, adult content and bad language, were found as significant predictors for screen addiction. Increased screen time and media addiction were significantly associated with concerns in communication, problem-solving and personal-social domains, as well as various behaviour problems. The most common device associated with addiction was tablet in the under five age group whereas it included smartphones, computer and video games in the older age group.

Conclusions We conclude that paediatricians should look into media use among children in their regular visit and formulate regional media guidelines for children to enhance digital literacy. This study done prior to the coronavirus disease (COVID) era, can serve as a baseline to assess further increase in screen time during the current COVID pandemic.