The Association Between Early Screen Exposure and Expressive and Receptive Language Development in Children Under Five:
A Literature Review
Asma Syeda *1, Nauman Ismail 2
*Correspondence to: Asma Syeda. School of Medicine, University College Cork.
Copyright
© 2026: Asma Syeda. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 30 July 2026
Published: 01 September 2026
DOI: https://doi.org/10.5281/zenodo.22268823
Background: Language development during the first five years of life is an important marker of early neurodevelopment and supports later communication, learning and social interaction. As screen exposure through television, smartphones, tablets and other digital media has become increasingly common in early childhood, concerns have been raised about its possible effect on expressive and receptive language development. This literature review aimed to evaluate current evidence on the association between early screen exposure and language outcomes in healthy children aged five years and under
Method: A structured literature search was conducted using PubMed, Web of Science and Google Scholar. Primary studies were included if they assessed screen exposure and reported language related outcomes in healthy children aged five years and under. Studies involving older children, reviews, meta-analyses or irrelevant outcomes were excluded. Ten primary studies were included and synthesised narratively by screen duration, expressive and receptive language outcomes, content quality and caregiver engagement.
Results: Higher screen exposure was commonly associated with weaker language outcomes, including weaker expressive vocabulary, increased risk of speech delay, poorer receptive language scores and lower communication scores. The association appeared strongest when screen use was prolonged, solitary or not accompanied by caregiver interaction. Some studies suggested that joint media engagement may be less harmful and may support vocabulary development in certain contexts.
Conclusion: Excessive and solitary screen exposure appears negatively associated with early language development. However, most studies were observational and relied on parent-reported screen use, so causation cannot be established. Further longitudinal research using objective screen-time measures is needed.
Introduction
Language development during the first five years of life is a central indicator of early neurodevelopment, shaping how children communicate, learn, form relationships and engage with the world around them.[1] This period is particularly important because early language skills support later social participation, educational progress and emotional development. Expressive language refers to the ability to communicate through sounds, words, gestures and sentences, while receptive language refers to the ability to understand communication through auditory and visual cues.[2] Delays in either domain are clinically important as early language difficulties may be associated with poorer educational attainment, social development and quality of life[1,2]. Understanding the factors that influence early language development is therefore an important clinical, educational and public health issue.
In recent years, screen exposure through television, smartphones, tablets and other digital media has become increasingly common in early childhood, making it a growing global public health concern. This has raised concern about whether frequent or early screen use may negatively influence expressive and receptive language development. Several studies have reported associations between higher screen exposure and weaker language outcomes in young children. For instance, Rayce et al.3 found that mobile screen use of one hour or more per day was associated with weaker language development scores and higher odds of both expressive language difficulties and language comprehension difficulties. However, other studies suggest that the relationship is more complex and that screen exposure may not always be harmful. Alroqi et al.[11] suggested that the impact of screen exposure on language development may depend on screen quantity, content and context, including the child’s age and whether caregivers actively engage with the child during screen use. These differing findings highlight the complexity of the relationship between early screen exposure and language development, making it an area of ongoing debate.
Despite growing research in this area, important gaps remain. Much of the evidence focuses on overall screen time or general language delay, without clearly distinguishing between expressive and receptive language outcomes. This distinction is important because a child’s ability to understand language and their ability to produce language may be affected differently by screen exposure.[1] In addition, studies vary in how they define and measure screen exposure, with some focusing on television viewing, mobile device use or total daily screen time. Many studies rely heavily on parent-reported screen exposure and observational designs, making it harder to establish causation between screen exposure and language development.[3,4,6]
Therefore, this literature review aims to evaluate the current evidence on the association between early screen exposure and expressive and receptive language development in children under five. The paper’s objectives include summarising key studies examining screen exposure and early language outcomes, comparing findings related to expressive and receptive language, and exploring whether screen duration, age of exposure, content quality and caregiver engagement influence this relationship. The review will focus specifically on expressive and receptive language outcomes and will not examine broader developmental outcomes such as sleep, attention, behaviour or social-emotional development, except where directly relevant to language development.
Methods
A structured literature search was conducted to identify primary research studies examining the association between early screen exposure and expressive and/or receptive language development in young children. The review initially focused broadly on screen exposure and language development during early childhood. However, the initial search retrieved a wide range of articles involving different age groups, developmental outcomes and forms of screen exposure. Therefore, the focus was narrowed to healthy children aged five years and under. To ensure that the evidence reflected contemporary patterns of digital media use, only studies published from 2010 onwards were included.
Electronic searches were carried out using PubMed, Web of Science and Google Scholar. These search engines were selected because they provide access to peer-reviewed literature across medicine, child development and psychology. The initial search term used was “screen time” AND “language development”. This was then expanded using the following keywords in different combinations: “screen time”, “screen exposure”, “digital media”, “expressive language”, “receptive language”, “language development”, “communication delay”, “language delay”, “preschool children” and “children under five”.
The search was carried out in stages. The initial search identified 102 records across the three databases. After 31 duplicate articles were removed, 71 articles remained for screening. The first round of screening was based on the titles and abstracts of the articles. Studies were excluded at this stage if they were not relevant to the review question, focused mainly on children older than five years, did not measure screen exposure, or did not report a language-related outcome. Review articles and opinion pieces were also excluded. Following this initial screening, 19 articles were retrieved for full text assessment.
In the second round of screening full texts were then assessed against predefined inclusion and exclusion criteria. Studies were included if they were primary research articles, published in the English language from 2010 onwards, involved healthy children aged five years and under, measured screen exposure, and reported at least one language-related outcome. Relevant outcomes included expressive language, receptive language, communication delay, language delay or general language development. Studies were excluded if they focused mainly on neurodevelopmental or clinical populations, examined broader developmental outcomes without separately reporting language, did not clearly measure screen exposure, or did not meet the age criteria. After full text screening, 9 further articles were excluded, leaving 10 primary research studies for inclusion in the final review. Figure 1 outlines the search and selection process.
Data from each of the 10 included studies was extracted into a summary table. Extracted information included author and year, study design, participant characteristics, type of screen exposure measured, language outcome measured, main findings and key limitations. These data are presented in Table 1. The rationale for inclusion of each individual study is presented in Table 2. The included studies were then grouped into themes, including screen duration, expressive language outcomes, receptive language outcomes, content quality and caregiver engagement. This thematic approach allowed the evidence to be compared across studies and critically discussed in relation to the aim of the review.
Results
Following the search and screening process, 10 primary research studies examining the relationship between screen exposure and language related outcomes in children under five were included in the review. The included studies used a range of designs, including cross-sectional, longitudinal observational, prospective cohort, national survey and birth cohort follow-up studies. The main characteristics and findings of these studies are summarised in Table 1.
Screen Duration and Language Development
Several studies found that longer daily screen exposure was associated with poorer language outcomes. Rayce et al.[3] in a large cross-sectional study of 31,125 toddlers aged 2–3 years, found that mobile screen use of one hour or more per day was significantly associated with poorer language development scores and higher odds of both expressive language and comprehension difficulties. Similarly, Byeon and Hong[7], in a national survey of 1,778 Korean toddlers, found that watching more than two hours of television per day was associated with a higher risk of language delay, and this risk was seen to increase as TV time increased. Duch et al.[5] also reported that more than two hours per day of television viewing was associated with increased odds of low communication scores.
Expressive and Receptive Language Outcomes
Expressive language was one of the most frequently measured outcomes. Van den Heuvel et al.[6] in a cross-sectional study of 893 children aged 18 months, found that each additional 30 minutes of mobile media use per day increased the odds of parent-reported expressive speech delay. Asikainen et al.[10] in a Finnish birth cohort follow-up study, found that greater child and parental electronic media exposure was negatively associated with expressive vocabulary. Mustonen et al.[8] similarly found that greater child screen time spent alone and greater maternal screen time were associated with poorer lexical and general language abilities.
Fewer studies examined receptive language separately. Rayce et al.[3] found that mobile screen use of one hour or more per day was associated with higher odds of language comprehension difficulties. Dyt et al.[12] in a cross-sectional study of 419 Filipino children aged 24–36 months, found that increasing screen time was associated with lower receptive and expressive language scores, particularly when children watched alone or when parental screen use was high. Alroqi et al.[11] found that joint media engagement was positively associated with receptive and expressive vocabulary in younger toddlers.
Content Quality and Caregiver Engagement
Several studies suggested that the context of screen use was important.[2,8,11] Alroqi et al.[11] found that joint media engagement was positively associated with vocabulary, while greater screen quantity was negatively associated with expressive vocabulary in older toddlers.[11] Mustonen et al.[8] found that solitary screen time was linked with poorer language skills. Brushe et al.[9] in a prospective cohort study of 220 families, found that greater screen time was associated with reduced parent-child verbal interaction, including fewer adult words, child vocalisations and conversational turns. Sundqvist et al.[4] in a longitudinal study of 72 children, found a negative relationship between screen media use and language scores across time points, with screen use at age 2 predicting later language development.
Discussion
The main findings of this literature review suggest that screen exposure is negatively associated with both expressive and receptive language outcomes in children under five. This association appears strongest when screen use is prolonged, solitary, or not accompanied by caregiver interaction.[3,5,8,11] Across the included studies, higher daily screen duration was repeatedly linked with weaker expressive language, poorer receptive language scores, or an increased risk of language delay. This pattern was evident in large cross-sectional studies as well as in smaller cohort and observational studies.[3,6,7]
Similar findings were reported across different cultural settings, including Korean toddlers and Saudi Arabian children.[7,11] This suggests that the relationship between excessive screen exposure and poorer early language outcomes is not limited to a certain population, or cultural setting.
A further observation was that expressive language was assessed more frequently than receptive language. Several studies reported that greater screen exposure was associated with weaker expressive vocabulary, increased risk of speech delay, or lower communication scores.[3,9] This is important as it may reflect that expressive difficulties are often more visible to parents and therefore easier to report. Receptive language was examined less often, but the studies that included it also suggested negative associations with higher screen exposure.[3,8,11] This is important because it indicates that screen exposure may affect not only a child’s ability to express themselves, but also their ability to understand language. However, because receptive language outcomes were measured less consistently across the literature, further research is needed to truly determine the strength and nature of this relationship.
Another important theme was that screen exposure should not be considered solely in terms of duration. The context of screen use also appears important. Studies such as Alrouqi et al.[11], Mustonen et al.8, Dyt et al.[12], and Brushe et al.[9] found that solitary screen use and reduced caregiver interaction during screen time were associated with poorer language outcomes. In contrast, joint media engagement was, in some cases, linked with stronger vocabulary development.[11] This suggests that screen exposure may not be uniformly harmful, and that caregiver involvement may influence whether screen use has a negative or potentially supportive role in early language development.
Brushe et al.[9] supports this interpretation by suggesting a possible mechanism for the association between screen exposure and weaker language outcomes. In their prospective cohort study, greater screen time was associated with fewer adult words, child vocalisations, and conversational turns. This suggests that screen use may affect language development by displacing the verbal interaction children need for language learning. Therefore, the concern is not only the duration of screen use, but whether it reduces opportunities for parent-child communication, shared attention, and responsive feedback.[9]
Despite differences between the included studies, several shared limitations were evident. Most studies were observational or cross-sectional, meaning they can identify associations but cannot establish causation.[13] Many also relied on parent-reported screen use, which may be affected by recall bias or inaccurate reporting. In addition, screen exposure was defined differently across studies, including total daily duration, television viewing, mobile media use and co-viewing, making direct comparison difficult.
Another limitation is that screen content was not consistently assessed. This is important as educational, age-appropriate and interactive media may affect language differently from passive or fast-paced entertainment. The context of use also matters, as prolonged solitary viewing differs from brief co-viewing with a caregiver who supports the child’s understanding through conversation.
Age may also influence the relationship between screen exposure and language development. Early childhood includes several stages of rapid language growth, so infants, toddlers and preschool children may not be affected in the same way. Alrouqi et al.[11] suggested that joint media engagement may be positively associated with vocabulary in younger toddlers, while greater screen quantity was negatively associated with language in older toddlers. This highlights the need to consider developmental stages when interpreting the findings.
These findings are clinically relevant in the field of medicine because screen use patterns are modifiable and can be addressed during routine developmental surveillance. Asking about screen duration, solitary viewing and caregiver involvement may help clinicians identify children at increased risk of language difficulties, provide targeted anticipatory guidance, and promote language rich activities such as shared reading, conversation and interactive play.
Overall, the evidence suggests that high screen duration, solitary use and reduced caregiver interaction are associated with weaker language development during early childhood. However, as most studies were observational, this relationship should be interpreted as an association rather than proven causation. Future research should use larger longitudinal designs, objective screen-time measures and clearer assessment of duration, content quality and caregiver involvement. Receptive language should also be studied further, as it remains less explored than expressive language. For parents and clinicians, the findings support reducing excessive screen time, avoiding solitary viewing where possible, and encouraging caregiver and child interaction during media use.
Acknowledgments - I would like to acknowledge the significant help and advice provided by Mr. Simon Smith in the formulation of this topic, as well as in the formatting and structuring of this review. I would also like to thank my parents for their continued support and encouragement.
Declaration - I declare that all the work contained in this review is my own and that it has not been submitted anywhere for any award. Assistance received and other sources of information used, have been acknowledged.
References