Asociación entre el uso de medios electrónicos, hitos del desarrollo y lenguaje en infantes

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Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166 151
https://doi.org/10.16888/interd.2022.39.3.9
Association between electronic media use,
development milestones and language in infants
Asociación entre el uso de medios electrónicos, hitos del desarrollo
y lenguaje en infantes
Maian Stamati1, Lucas G. Gago-Galvagno2, Stephanie E. Miller3, Angel M. Elgier4,
Rocío A. Hauché5 & Susana C. Azzollini6
1Universidad Abierta Interamericana, Argentina.
https://orcid.org/0000-0001-6276-6413. E-mail: maistamati@gmail.com
2Universidad Abierta Interamericana, Universidad de Buenos Aires, Consejo Nacional de
Investigaciones Cientícas y Técnicas (CONICET), Argentina.
https://orcid.org/0000-0001-5993-3866. E-mail: lucas.gagogalvagno@hotmail.com
3University of Mississippi, United States.
https://orcid.org/0000-0001-9691-5499. E-mail: semille5@go.olemiss.edu
4Universidad Abierta Interamericana, Universidad de Buenos Aires, Consejo Nacional de
Investigaciones Cientícas y Técnicas (CONICET), Argentina.
https://orcid.org/0000-0002-6110-5151. E-mail: amelgier@gmail.com
5Universidad Abierta Interamericana, Universidad de Buenos Aires, Argentina.
https://orcid.org/0000-0001-8821-115X. E-mail: hauche.rocio@gmail.com
6Universidad Abierta Interamericana, Universidad de Buenos Aires, Consejo Nacional de
Investigaciones Cientícas y Técnicas (CONICET), Argentina.
https://orcid.org/0000-0002-3192-5087. E-mail: susana1060@yahoo.com.ar
Se agradece a la Universidad Abierta Interamericana (UAI), Universidad de Buenos Aires
(UBA), y al Consejo Nacional de Investigaciones Cientícas y Técnicas (CONICET) por
haber subsidiado este trabajo.
Universidad Abierta Interamericana (UAI), Universidad de Buenos Aires (UBA),
Consejo Nacional de Investigaciones Cientícas y Técnicas (CONICET)
Buenos Aires, Argentina
Resumen
En los últimos años, el uso de medios elec-
trónicos ha aumentado en la infancia temprana
debido al creciente acceso a las pantallas y a
la situación de aislamiento ocasionado por
la pandemia de COVID-19. Por otro lado,
durante la primera infancia, las habilidades de
lenguaje y motrices son fundamentales para
el desarrollo de otras habilidades cognitivas,
y se asocian con el rendimiento académico
y habilidades sociales posteriores durante
la niñez y adolescencia. Por ende, se vuelve
fundamental estudiar cómo el contexto de
estimulación en el hogar, especícamente
el uso de pantallas, se asocia con estas habi-
lidades importantes en los primeros años de
vida. Si bien existen investigaciones sobre las
asociaciones del uso de pantallas con habili-
dades cognitivas tempranas, son escasas las

Stamati, Gago-Galvagno, Miller, Elgier, Hauché & Azzollini
Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166152
que indagan este fenómeno en el ámbito lati-
noamericano, y nulas las que lo realizaron en
el actual contexto de pandemia. El objetivo
de esta investigación fue describir el uso de
medios electrónicos (i. e., TV, teléfono celular
y tablet) y su asociación con el lenguaje y los
hitos del desarrollo en los primeros años de
vida. Los participantes fueron 253 cuidadores
primarios de infantes de Latinoamérica (68.8
% de Argentina, y 31.2 % de otros países
de la región) con edades entre 2 y 48 meses
(M = 30.17 meses, SD = 10.82, femenino =
124), reclutados vía web a través de mues-
treo no probabilístico de tipo intencional y
por bola de nieve. Se utilizaron los reportes
de los padres sobre el uso de medios electró-
nicos (i. e., tiempo de uso, edad de inicio y
tipo de contenido), los hitos del desarrollo
motor y del lenguaje, el Inventario de Desa-
rrollo de Habilidades Comunicativas (CDI)
(i. e., densidad léxica y uso de oraciones) y la
Encuesta Permanente de Hogares (EPH) para
evaluar las variables sociodemográcas. Los
resultados mostraron que, en promedio, los
infantes comenzaron a usar pantallas durante
el primer año de vida en un promedio de una
hora por día, con la televisión como el medio
más utilizado y la visualización de videos la
actividad que más realizaban. El número de
horas de uso de dispositivos se asoció posi-
tivamente con la densidad léxica y el uso
de oraciones: a más horas de uso, mayor
cantidad de palabras y oraciones reportadas.
Además, cuanto más tardía era la edad de
inicio de uso de dispositivos, más bajas eran
las puntuaciones en los informes lingüísticos
e hitos posteriores del desarrollo motor y del
lenguaje. Los tamaños del efecto para estas
asociaciones fueron de bajos a moderados, lo
que indica que otras variables podrían estar
contribuyendo al desarrollo de estas habili-
dades cognitivas. No se encontraron diferen-
cias en las capacidades motrices y del lenguaje
en función del tipo de contenido del disposi-
tivo. Tampoco se observaron diferencias en el
uso de pantallas en función del género de los
infantes, la edad y las variables sociodemográ-
cas, lo que podría indicar, tal como demos-
traron investigaciones anteriores, que durante
el aislamiento por COVID-19 el uso de los
medios electrónicos fue constante, indepen-
dientemente del contexto del hogar. Los resul-
tados indican que el uso excesivo de pantallas
podría afectar, tanto de forma positiva como
negativa, algunas habilidades tempranas,
aunque es necesario investigar el contexto
en el que se utilizan. Especícamente, para
futuras investigaciones sería importante: (a)
trabajar con díadas de cuidadores-infantes,
para evaluar cómo los comportamientos
parentales moderan las asociaciones entre uso
de pantallas y cognición infantil; (b) realizar
estudios longitudinales; y (c) evaluar estas
variables en diferentes provincias del país
y regiones de Latinoamérica, para estudiar
cómo las idiosincrasias culturales modulan el
uso de estos dispositivos.
Palabras clave: medios electrónicos, hitos del
desarrollo, lenguaje, cuidadores, infantes
Abstract
The use of electronic media has increased
in early childhood. During early childhood,
language and motor skills are important for
the development of other cognitive skills.
Therefore, it becomes essential to study how
the use of screens is associated with these
important skills in the rst years of life. The
objective of the following research was to
describe the use of electronic media (i. e.,
TV, cellphone and tablet) and its association
with language and developmental milestones
in the rst years of life. Participants were 253
primary caregivers of infants between 2 to
48 months (M = 30.17 months, SD = 10.82,
female = 124). Parental reports of infant
media use, motor and language development
milestones, the MacArthur-Bates Commu-
nicative Development Inventory (CDI) and
the Permanent Household Survey (EPH) for
sociodemographic variables were used. The
results showed that, on average, infants began
to use screens during the rst year of life at

Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166 153
https://doi.org/10.16888/interd.2022.39.3.9
an average of one hour per day with TV as
the most used medium and video viewing as
the activity they did the most. The number of
hours of devices usage was positively asso-
ciated with lexical density and sentence use.
Furthermore, starting device use at a later age
was associated with lower scores in language
reports and later milestones of motor and
language development. No dierences were
found based on the type of device content and
sociodemographic variables. Results indicate
that the excessive use of screens could aect
some early skills, although it is necessary to
investigate the context in which they are used.
Keywords: electronic media, development
milestones, language, caregivers, infants
Introduction
From the rst years of life, development
is modulated by a variable environment indi-
rect to the infant’s life (e. g., culture, access to
education, public policies), within an imme-
diate context (e. g., stimulation at home,
parental styles). During development, these
dierent levels of analysis are interrelated
(Bronfenbrenner, 1986; Vygotsky, 1929) and
contribute to dierences in infant’s cognitive
development from the rst years of life (Gago
Galvagno et al., 2019, 2020a, 2020b; Luo et
al., 2019; Tamis-LeMonda et al., 2019) sugges-
ting these factors are a very important issue to
consider when promoting public policies that
favor ontogenetic development (Yoshikawa
et al., 2018). The purpose of this study is to
examine how a particular element of the imme-
diate context related to stimulation at home
–electronic media use– relates to cognitive
development in developmental milestones in
language, motor skills and sociodemographic
during the rst 4 years of life.
Language and motor skills during the
rst years
Developmental milestones in early child-
hood refer to foundational acquisitions. These
are explained as the progress of each infant
in dierent areas and describe observable
behaviors in the daily life of a child (Pauen,
2012). During development, the acquisition of
the dierent milestones is not carried out in
a rigid way. On the contrary, there is a wide
variation in the time that each new skill is
achieved that is impacted by the genetic and
the social environment (Arteaga et al., 2017;
Bedford et al., 2016).
Meeting each developmental milestone
enables children to perform progressively
more complex and sequential activities. The
early acquisition of both motor and language
developmental milestones are essential,
since they are associated with greater achie-
vements in early cognitive skills and later
academic performance, and their delay could
be related to the presence of developmental
disorders (Arnett et al., 2020; Murray et al.,
2007; Taanila et al., 2005). Early motor miles-
tones are typically focused on gross and ne
motor development; gross motor develop-
ment is comprised of the control of the head,
torso, legs, and movement, including balance,
jumping, throwing and catching. Fine motor
development is comprised of hand-body
coordination, and holding and manipulating
objects.
Regarding language, verbal communica-
tion can be one of the most important develop-
mental milestones for parents, with children’s
rst word usually spoken at the end of the rst
year of life. Babies usually start by saying
single words, then two-word sentences, and
later three-word sentences, until nally they
can form more complex sentences (Cohen
& Billard, 2018; Lahrouchi & Kern, 2018).
Children acquire around ve words daily.
Around two years of age, the linguistic explo-
sion takes place, in which children pronounce
around fty words, though there is variation
in the time and extent of this explosion (Bates
& Carnevale, 1993; Hirsh-Pasek et al., 2015).
Several researchers have dedicated them-
selves to identifying the content of babies’
rst words and the mechanisms by which they

Stamati, Gago-Galvagno, Miller, Elgier, Hauché & Azzollini
Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166154
are acquired. For example, the rst words of
babies are typically nouns with some arguing
that early noun learning, compared to verbs,
is a universal feature of human language
(Hirsh-Pasek et al., 2015). The vocabulary
and acquisition of grammar rules increases
continuously after the third year (Navarro et
al., 2017). Syntactic development refers to
the rules of language, organization of words,
formation of ideas, meaningful sentences and
understanding of what is said. Further develo-
pment in syntax (i. e., related to grammatical
rules), semantic meaning, and pragmatic
understanding continue to develop across
early childhood and is thought to emerge and
develop within the interactive communicative
context between children and their environ-
ment –especially tied to communication with
adults (Gonzales, 2014; Tomasello, 2000).
Use of screens and associations with
language and motor skills
Electronic media has become an ever-pre-
sent element within children’s indirect and
immediate environments. The Argentinean
Association of Pediatrics said in 2011 that
90 % of parents reported their children were
using some form of touchscreen and have
their own device by the age 3. One third of
infants use electronic media before they even
start walking (Melamuda & Waisman, 2019).
During the COVID-19 quarantine, the use of
screens in Argentina grew by more than 50 %
for both adults, infants and children (Sociedad
Argentina de Pediatría, 2020; Picco et al.,
2020) and the American Academy of Pedia-
trics (2020) stopped advising against its use
with infants under two years of age to focus
more on factors involving the child, context
and content.
In a descriptive parent-report study in
children aged 6 to 36 months old, 69.2 % of
parents allowed infants to use screens. The
mean age of rst use was 11 months and 72.2
% of infants and children used touchscreen
devices 2-3 times a week or more. Consump-
tion time increased with age and male infants
used more screen games than females. The
most common reasons parents cited for
touchscreen use in infants were to learn (73.9
%) and entertain (66.3 %). Finally, parents
had a positive attitude towards the use of these
devices for educational purposes at an early
age (Pempek & McDaniel, 2016). Thus, this
research found that most parents and caregi-
vers do not comply with the recommendations
of national and international health organiza-
tions (American Academy of Pediatrics, 2020),
although it is important to note that screen
use is not consistent across all families. For
instance, less recreational screen consump-
tion is associated with higher levels of mother
education, likely also related to facilitating or
promoting certain family and environmental
dynamics (Melamuda & Waisman, 2019;
Stienwandt et al., 2020). However, it is impor-
tant to note more work and consideration of
other factors and context is needed, as other
studies show conicting results suggesting
parents with a higher education had children
engage in more screen time during quarantine
due to COVID-19 (Aguilar-Farias et al., 2021;
Jauregui et al., 2021).
There have also been a number of studies
examining the links between screen time use
and milestones in language and motor deve-
lopment, and results are equivocal. With
respect to language there has been some work
showing negative associations with screen
use. Zimmerman et al. (2007) evaluated a
total of 1 008 parents of toddlers between 2 to
24 months, who were surveyed by telephone.
They were asked questions about child and
parent demographics, parent-child interac-
tions, and viewing of various types of TV and
DVD/video content. Parents were also asked
to complete the MacArthur-Bates Communi-
cative Development Inventory (CDI). Results
indicated that in children 8 to 16 months of
age, each hour per day of DVD/video viewing
was associated with a 16.99-point decrease in
CDI score. However, among children 17 to 24
months, there were no associations between

Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166 155
https://doi.org/10.16888/interd.2022.39.3.9
any exposure to media and CDI scores.
Other work has shown null or even suggest
positive associations between language and
motor milestones and screen use. In a study
that examined association between the use of
tablets and the achievement of motor miles-
tones and linguistic development of children
between 6 and 36 months it was observed that
the number of users of touchscreens, as well
as the time of use, increased with infants’ age.
Between 6 and 12 months, infants’ use was
approximately 9 minutes per day and toddlers
between 2 and 3 years of age used approxima-
tely 44 minutes per day. Although this study
showed that the use of touchscreens increases
rapidly during the rst 3 years of life (Cristia
& Seidl, 2015), no associations were found
between the use of touchscreens and gross
motor and language milestones, though there
was a negative association between the age
of initiation of use of the rst device (speci-
cally screen scrolling), and achievements
in ne motor skills (Bedford et al., 2016). In
another study with a sample of infants from
Chile, no associations were found between the
amount of time spent on technological screens
and receptive and expressive language scores
during the rst three years of life (Alarcón
et al., 2018). Research has even suggested
a positive association between screen use
and language and motor development. For
instance, Terras & Ramsay (2016) suggest
that, at an early age, touchscreens allow chil-
dren to explore and get in touch with various
content, even before saying their rst words.
It was observed that children who had not yet
developed their motor skills and were not able
to turn on a TV or choose which programs to
watch, used mobile devices to watch videos,
interactive games and other entertainment
(Terras & Ramsay, 2016).
Currently, the use of touch devices in
childhood faces a dilemma. On the one hand,
the promotion of digital technology in chil-
dren has evidence that its use prepares them
for the future, and this is reinforced in times
of the pandemic (Aguilar-Farias et al., 2021;
Ramsay, 2016). On the other hand, pediatric
organizations advocate the minimal use of
mobile devices by young children as a result
of concerns about the eects on physical,
cognitive, emotional, social, well-being, and
developmental health (Desmurget & Harlé,
2012). The data provided shows that society
has been incorporating touchscreens in its
daily life, and this does not exclude children
and newborns. However, the Argentine Asso-
ciation of Psychiatry (AAP) has recommended
that children under 2 years of age do not use
this type of devices. This is because the possi-
bility of receiving commercial advertising or
exposure to violent or pornographic content.
By participating in the networks without any
type of supervision, they can provide inappro-
priate information, be subjected to grooming
or harassment and, in turn, can be actors of
these same actions (Melamuda & Waismanb,
2019).
Present study
There is a clear need for better evidence
to support psychologists and educators in the
role and use of screens during early childhood.
This research is important at a theoretical,
practical, and social level and can lead to a
better understanding of how electronic media,
so present in the daily lives of most children
today, relates to development. The objectives
of the following research were to: (a) describe
the age of initiation of the electronic media
and the hours of daily use by infants from 2 to
48 months; (b) study the relationship between
the age of initiation, the time of use of screens
and the acquisition of the motor and language
milestones; (c) associate electronic media use
and sociodemographic variables. A presence
of use of screens early in this age range that
increased with age, a negative correlation
between time of use of touchscreens with
language measures (i. e., lexical density and
use of sentences) and acquisition of develo-
pmental milestones, and greater amount of
screen use time and earlier initiation in fami-

Stamati, Gago-Galvagno, Miller, Elgier, Hauché & Azzollini
Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166156
lies with a lower educational level and with
less independent types of occupations were
expected. However, given the mixed results it
was also possible that this research would not
nd relations, and this was meant to provide
more data in this area.
Method
Participants
The participants in this study were 310
primary caregivers; 56 were excluded because
their infants were older than 48 months. The
nal sample consisted of 253 primary care-
givers of children from 2 to 48 months (M
= 30.17 months, SD = 10.82, female = 124),
contacted via social media.
The type of sampling was non-probabi-
listic, intentional, and snowballing. The study
was carried out in Argentina, since the fami-
lies lived in this country. Of the total, 68.8 %
children were born in Argentina, and 31.2 %
were foreign nationals, born in Peru, Mexico,
Colombia, Chile, Costa Rica, and Bolivia. As
for caregivers, 73 % were born in Argentina
and the rest were from other Latin American
countries. All families had Spanish as their
native language. Of the total number of care-
givers who completed the survey, the majority
(n = 230) were the mothers of the infants.
Regarding the sociodemographic varia-
bles, the infants’ parents had an average level
of higher education and were professionals
(see Table 1).
To carry out the inferential analysis with
the CDI inventory and the development miles-
tones, a sample of 171 participants was used
(M = 32.26 months, SD = 8.93, female = 87);
139 cases were excluded from the nal sample
because the language measurements were not
for infants younger than 12 months (n = 20),
older than 48 months (n = 56) and because of
prematurity (n = 63).
Measures
Permanent Household Survey (EPH,
INDEC, 2018). Information was collected on
the nationality, age and gender of the child, as
well as the educational level (from 1 = incom-
plete primary school to 10 = complete post-
graduate) and profession (1 = unemployed, 2 =
housekeeper, 3 = not qualied, 4 = operator, 5
= employee, 6 = technician, 7 = professional)
of the mother and father.
Questionnaire on the use of ad-hoc screens.
Information was collected on what type of
touchscreens the infants were using. These
included tablet, TV, and cellphones. It was also
asked how many hours per day they used each
of these devices (1 = does not use, 2 = between
0 and 1 hour per day, 3 = between 1 and 2 hours
per day, 4 = between 2 and 3 hours per day,
5 = between 3 and 4 hours per day, 6 = more
than 4 hours per day), age of initiation of die-
rent activities (i. e., screen scrolling, viewing
a video, play with a device, watch photos) (1
= between 0 and 5 months, 2 = between 6 and
11 months, 3 = between 12 and 18 months, 4
= between 19 and 25 months, 5 = between 26
and 36 months, 6 = does not use) and what
content they consumed (i. e., music, YouTube,
cartoons, news, interactive games, photos,
reading books/stories). A total score of Age of
initiation and Hours of use was calculated by
the average of the starting age of the dierent
activities of the screens and the hours of use of
the dierent screens respectively.
Developmental milestones (Bedford et
al., 2016). To assess developmental miles-
tones, critical milestones from the motor and
language domains were chosen. The seven
questions were as follows: “At what age did the
infant…” and data from motor and language
milestones were used: “sat without support”
and “walked independently”, “picked up a
small object with a clamp, that is, with his
thumb and forenger”, “stacked at least three
small blocks or other small objects”, “said his
rst word”, “said two or more words toge-
ther”, “made a whole sentence, meaningful”.

Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166 157
https://doi.org/10.16888/interd.2022.39.3.9
To reply, the caregiver had to indicate their
response on a Likert scale, with age ranges (0
= between 0 to 5 months, 1 = between 6 and
11 months, 2 = between 12 and 18 months, 3
= between 19 and 25 months, 4 = between 26
and 36 months, 5 = still not performed). Varia-
bles of motor and language developmental
milestones were generated by the average of
each development milestone.
Communicative Development Inventory
Form II (Resches et al., 2021). This inven-
tory evaluates the development of language in
children through the reporting of a signicant
caregiver. It is made up of two inventories.
Part 1 (CDI 1, lexical density) measures chil-
dren’s use of words. It includes a vocabulary
list of 23 semantic categories with 699 items.
Parents reported the amount of words their
children know. Part 2 (CDI 2, sentence use)
inquires about the way in which the infant
uses language, specically about the evoca-
tion of past and future events, places or people
that are not present, detaching language from
its immediate context (symbolic competence).
Five questions with examples were asked with
3 options each (0 = not yet, 1 = sometimes, 2
= many times), scoring a total on a scale of 0
to 10 points: (1) “Does the child talk about
past situations?”; (2) “Does the child talk
about objects or people that are not present?”;
(3) “Does the child talk about things that are
going to happen in the future?”; (4) “Does the
child understand when they asked to bring
something from another place?”; (5) “When
pointing to or grasping an object, does the
infant say the name of the person to whom
the object belongs even though that person is
not present?”. For this sample, a Cronbach’s
Alpha of .96 was obtained for CDI 1 and of
.84 for CDI 2. About families not from Argen-
tina (n = 97), a Cronbach’s Alpha of .96 was
obtained for CDI 1 and of .88 for CDI 2.
Procedure
The questionnaire was administered
virtually. Participants completed a Google
Forms that was shared on Facebook, Insta-
gram, and WhatsApp. It could be completed
from a cellphone, tablet or PC.
Before beginning the evaluation, all parti-
cipants completed an informed consent. None
received nancial compensation, and all
completed the scales individually at home.
General objectives of the study were reported,
and participants were invited to participate
anonymously, condentially and voluntarily
to avoid bias in their answers.
All questionnaires were administered in
the same order: rst the EPH was adminis-
tered, then the questionnaire on develop-
mental milestones, followed by the CDI, and
nally the questionnaire on the use of touchs-
creens. The data was collected from March 21
to November 11, 2020.
Data analysis
SPSS software version 26 was used. First,
a pre-processing of the data was carried out to
evaluate the presence of outliers in the sample.
A descriptive analysis was then carried out
on the start and average number of hours of
use of touch devices, lexical density, use of
sentences, developmental milestones, and
sociodemographic variables.
The distribution of the variables was calcu-
lated using the Shapiro-Wilk test and the
homogeneity of variances with Levene test.
Most of the variables presented a non-normal
distribution, so non-parametric tests were
used.
First, a variable description was made. Then,
use of electronic media, CDI scores, develo-
pmental milestones, and sociodemographic
variables were correlated using the Spearman
Rho test. Device use was compared according
to content type and gender of infants using
the Kruskal-Wallis H and Mann-Whitney U
tests respectively. Finally, a multiple linear
regression test was carried out, inserting the
variables of device use as input and those of
milestones and language as outcomes.

Stamati, Gago-Galvagno, Miller, Elgier, Hauché & Azzollini
Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166158
Results
Description of variables
Table 1 summarizes the main descriptive
statistics. On average, infants began to use
screens and carry out activities with them
from the rst year of life. Regarding age of
initiation of dierent activities, only video
viewing average occurrence was before the
rst year. The latest used content was with
tablets, as the activities of zooming to a screen
and playing games with the devices were used
for the rst time at age three or not at all.
About tablets, 76.8 % (n = 238) of the infants
sampled did not use them, and 42.6 % (n =
132) did not use cellphones. The amount of
time of tablet and cellphone use was less than
one hour on average for this sample, with both
variables showing a oor eect reective of
lower scores indicating lack of use (symmetry
> 1.40; West et al., 1999). TV was the most
widely used device with children watching on
average more than one hour per day, and only
12 % of all infants did not use it (n = 37).
Table 1.
Descriptive statistics of measured variables
Measures M (SD) Median 95 % IC Range N
Age (months) 30.17 (10.82) 31.20 [28.87, 31.51] 2-48 253
> 12 months 6.90 (3.06) 7.30 [5.42, 8.38] 2-12 19
12-24 months 19.79 (3.12) 20.50 [19.11, 20.84] 12-24 52
24-36 months 30.26 (3.59) 30.30 [29.56, 30.97] 24-36 101
36-48 months 41.82 (3.58) 42.35 [41.03, 42.61] 36-48 81
Age of initiation average 3.91 (1.06) 3.85 [3.78, 4.04] 1.28-6 253
Cellphone use 3.56 (1.62) 3 [3.36, 3.76] 1-6 253
Tablet use 5.15 (1.41) 6 [4.98, 5.33] 1-6 253
Screen scrolling 3.29 (1.39) 3 [3.12, 3.47] 1-6 243
Viewing a video 2.87 (1.41) 3 [2.69, 3.05] 1-6 243
Play with a device 4.63 (1.53) 6 [4.42, 4.84] 1-6 208
Watch photos 3.30 (1.52) 3 [3.11, 3.50] 1-6 238
Zoom to a screen 4.55 (1.55) 5 [4.34, 4.75] 1-6 218
Use time average 1.99 (0.70) 2 [1.90, 2.08] 1-4.5 253
Tablet use time 1.35 (.74) 1 [1.26, 1.44] 1-6 250
Cellphone use time 1.72 (.82) 2 [1.62, 1.83] 1-6 241
TV use time 2.96 (1.36) 3 [2.79, 3.13] 1-6 250
Language
Lexical density (CDI 1) 171.79 (198.80) 77 [141.78, 201.80] 0-670 171
Sentence use (CDI 2) 3.87 (2.43) 4 [3.50, 4.23] 0-8 171
Motor development
milestones average 3.73(0.49)
3.75 [3.65, 3.80] 1-4.75 171
Sit unsuported 4.28 (.55) 4 [4.20, 4.36] 1-5 171
Walked independently 3.08 (.85) 3 [2.95, 3.21] 0-4 171

Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166 159
https://doi.org/10.16888/interd.2022.39.3.9
Measures M (SD) Median 95 % IC Range N
Raised small object 4.10 (.74) 4 [3.99, 4.21] 0-5 171
Stacked two or more objects 3.47 (.95) 4 [3.33, 3.62] 0-5 171
Language development
milestones average 2.56 (.98) 3 [2.41, 2.71] 0-4.33 171
Said rst words 3.53 (.89) 4 [3.39, 3.66] 0-5 171
Said two or more words 2.43 (1.30) 3 [2.23, 2.62] 0-4 171
Made a meaningful sentence 1.74 (1.39) 2 [1.53, 1.95] 0-4 171
Sociodemographic variables
Mother education 6.49(2.10) 7 [6.20, 6.77] 2-10 253
Parent education 5.83(2.19) 6 [5.53, 6.13] 1-10 253
Mother occupation 4.97(2.27) 6 [4.66, 5.28] 1-7 253
Parent occupation 5.41(1.62) 6 [5.19, 5.63] 1-7 253
Note: CDI: Communicative Development Inventory.
Associations between screen use and
language and motor milestones
Age of initiation for screen use and acti-
vities carried out with the screens. Results
are summarized in Table 2. For language
measured with the CDI, lexical density was
positively associated with a later initiation
age of watching videos. These results indi-
cated that later initiation age with the acti-
vity of watching videos was associated with
higher vocabulary use. In the other hand,
lexical density and use of sentences showed
a negative relationship with tablet use and
zoom to a screen, indicating that a later initia-
tion age with tablets and zooming on a screen
was associated with lower language measures
reports by parents.
Regarding both motor and language deve-
lopment milestones, the age at which the
developmental milestones were reached
was negatively associated with the initiation
age for the dierent screens and with activi-
ties linked to them (i. e., moving/touching,
zooming and playing interactive games),
with moderate eect sizes (.15 < rho < .27).
In other words, as the age of initiation with
screens was delayed, developmental miles-
tones were acquired earlier according to the
parents’ report.
Screen usage time. Positive associa-
tions were found between the sum of hours
of dierent screens and language measures,
with small eect sizes (.21 < rho < .51). This
suggested that as the number of hours of use
of electronic devices increased the scores on
lexical density and sentence use did also. No
general associations were found between each
screen usage and the sum of screen hours with
developmental milestones (p > .05). Only
with the language milestone of saying two or
more words positive associations were found.
Screen initiation and usage links to socio-
demographic variables. No associations
were found between hours of screens use and
age of initiation with respect to sociodemogra-
phic variables (i. e., educational level and type
of occupation of the parents), and neither with
respect to the content (i. e., music, YouTube,
cartoons, news, interactive games, photos,
reading books/stories) they consumed using
the Kruskall-Wallis H test (p > .05). Finally, a
Mann Whitney U test was applied to compare
the number of hours of screen use based on
gender. No evidence was found that suggested
that boys and girls used these devices die-
rently in terms of time (p > .05).

Stamati, Gago-Galvagno, Miller, Elgier, Hauché & Azzollini
Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166160
Table 2.
Associations between the variables corresponding to CDI, use of touch devices and development
milestones
Language CDI Developmental milestones
Lexical
density
Sentence
use
Motor
develop.
milestone
avg.
Language
develop.
milestone
avg.
Sit
unsupport
Walk
independent
Raise
small
object
Stack 2+
objects
Say
rst
word
Say 2+
words
Made
sentence
Age of initiation
Avg. across all
devices -.064 -.145 -.359** -.414** -.193* -.121 -.275** -.275** -.165* -.429** -.377**
Cell phone use -.014 -.120 -.217** -.238** -.079 -.060 -.227** -.164* -.159* -.278** -.159*
Tablet use -.181* -.176* -.060 -.185* -.088 -.008 -.078 -.081 -.073 -.248** -.164*
Screen scrolling .106 .037 -.245** -.247** -.166* -.047 -.239** -.117 -.086 -.280** -.231**
Viewing a video .163* .058 -.277** -.154* -.130 -.116 -.242** -.207** -.095 -.226** -.114
Playing with a
device -.096 -.080 -.212* -.509** -.051 -.090 -.181 -.151 -.112 -.464** -.534**
Watch photos .124 -.023 -.364** -.208** -.170* -.130 -.273** -.281** -.093 -.254** -.165*
Zoom to a screen -.185* -.178* -.390** -.396** -.226** -.145 -.220** -.300** -.103 -.390** -.388**
Usage time
Avg. across all
devices .236** .275** .053 .073 .036 .064 -.088 .032 -.067 .095 .087
Tablet .226** .211** -.026 .083 .027 -.093 .011 .051 -.009 .172* .066
Cellphone .153* .206** .011 .133 .041 -.005 -.047 -.047 .027 .167* .089
TV .129 .179* .049 -.009 .008 .110 -.125 .019 -.100 -.044 .044

Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166 161
https://doi.org/10.16888/interd.2022.39.3.9
Contribution of screen use to infant
cognition
Three multiple regressions were performed
on lexical density, sentence use, and motor
and language developmental milestones,
inserting the age of initiation and the sum
of screen time averages as predictors. Table
3 summarizes the results of the regressions.
For the four dependent variables, the general
model was signicant.
Table 3.
Prediction of lexical density, sentence use, and developmental milestones through the use of screens
F B Beta R2
Lexical density 3.491 .040*
Usage time 53.53 .191*
Age of initiation -4.918 -.025
Use of sentences 6.764 .075**
Usage time .721 .210**
Age of initiation -.295 -.123
Motor development milestones 10.07 .107**
Usage time -.022 -.032
Age of initiation -.163 -.335**
Language development milestones 14.08 .144**
Usage time -.006 -.004
Age of initiation -.371 -.380**
Note: CDI: Communicative Development Inventory. *p < .05. **p < .01.
Screens usage time positively predicted the
language outcomes, indicating that as the time
of screen usage increased, so did the lexical
density and the use of sentences. About age of
initiation for the screen devices and activities,
they negatively predicted motor and language
development milestones, with moderate eect
sizes. This indicates that as the age of initia-
tion increased, developmental milestones were
acquired earlier according to the parents’ report.
Discussion
The objective of the present research was
to describe the initiation and hours of use
for electronic devices by infants aged 2 to
48 months, and to associate these variables
with developmental milestones, language,
and sociodemographic variables. The TV
was found to be the most used device and
watching videos was the activity executed the
most. On average infants began to use screens
after their rst year of life and their use time
was on average one hour per day, except for
the TV which was higher. Surprisingly, a posi-
tive association between screen usage hours
and lexical density and sentence use parent
reports was found, although the eect sizes
were small. Further, it is important to note that
some age of screen and activities use initiation
(i. e., tablet use and zooming on a screen) were
negatively associated with language, indi-
cating that delaying screen usage was asso-
ciated with low language report scores, except

Stamati, Gago-Galvagno, Miller, Elgier, Hauché & Azzollini
Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166162
for watching videos, where the longer it was
delayed, the better vocabulary reported scores
were obtained. In addition, negative associa-
tions were found between the age of initiation
of screen use and motor and language deve-
lopmental milestones with moderate eect
sizes for this age range: as the age of initia-
tion with screens was delayed, developmental
milestones were acquired earlier according
to the parents’ report. No associations were
found between developmental milestones and
language outcomes scores with the type of
content that infants consumed on the screens.
Also, no associations between screens and
sociodemographic variables were found (i. e.,
infants’ gender, age, and parental educational
level and occupation). Results demonstrate
several surprising relations suggesting that age
of initiation and usage may not always relate
to negative outcomes in language, and suggest
more work is needed in this area of research.
But the age of initiation could negative relate
with the age that dierent motor and language
development milestones are acquired.
Regarding the descriptive data, although
use time was on average low (one hour) for
the electronic media measure, their age of
initiation was early (from the rst year of life),
which goes against what the dierent pedia-
tric associations recommend during early
childhood (Asociación Argentina de Pedia-
tría, 2019; Melamuda & Waisman, 2019;
Waisman et al., 2018). These results replicate
those carried out in samples from Argentina
(Waisman et al., 2018) and the United States
(McClane & Pempek, 2015), where it was
found that in this age range children used
devices at least one hour per day. This amount
of use may also be reinforced by quarantine,
which could lead parents to use technological
devices as a means of regulating or appeasing
infants during their work routines (Chauhan
et al., 2021; Ribner & McHarg, 2021). On the
other hand, it is necessary to highlight that
the tablet was hardly used at home, and the
device that was used the most was TV. This
could be because TV oer is more varied than
other devices, and, at the same time, it is the
only one that does not require active contact
and interaction on the part of the infant, which
facilitates its use (Melamuda & Waisman,
2019; Ribner & McHarg, 2021).
Regarding the links between screen use and
language, these results surprisingly demons-
trate that the amount of time of media use was
associated with higher scores in both lexical
density and use of sentences, with low eect
sizes. Similar positive results were found with
the language development milestone of saying
two or more words. There are several reasons
for these results. For one, results have shown
that when children are younger, they require
the presence of a caregiver when consuming
the screens (Nabi & Krcmar, 2016). A higher
relation between screen use and language could
be because a caregiver was present during the
interaction with the screens. Results could also
be because caregivers reported a greater extent
of watching videos, which could promote
interaction with adults or expand their lexical
density (Ribner & McHarg, 2021; Terras &
Ramsay, 2016). It is also necessary to highlight
that although usage time of devices was asso-
ciated with better language outcomes, age of
initiation with tablet and zooming on a screen
was negatively related. This could be because
these are activities that require the presence of
an adult and an active interaction with the chil-
dren (Bedford et al., 2016). This is reinforced
by the correlation found between a later age of
initiation watching videos and higher reported
language scores. This could be because
watching videos on screens in early childhood
is a passive activity, and promotes the absence
of interactions with adults, or through books
and traditional toys, which reinforces passi-
vity in the infant (Kostyrka-Allchorne et al.,
2017; Waisman et al., 2018). It may be useful
for future works to consider how time engaged
with screens relates to other interactions at
home and how this may change across age.
Regarding developmental milestones,
although no general associations were found
with screen use time there were relations to

Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166 163
https://doi.org/10.16888/interd.2022.39.3.9
age of initiation. Specically, when children
initiated screen use later in life, developmental
milestones were acquired earlier. These nega-
tive associations of screen consumption and
motor and language milestones could be
interpreted with the displacement hypothesis
(Strasburger et al., 2012), which states that
the time a child spends engaged with a screen
limits the time they have to do other activities,
leading to reduced physical activity or face-
to-face communication (Ribner & McHarg,
2021). On the other hand, no associations
were found between these developmental
milestones and usage time, which aligns with
Bedford et al.’s (2016) neutral eects but
goes against their positive results with ne
motor skills, suggesting that the screens could
involve the infants’ motor movement and their
language in an exchange with other adults.
Finally, no associations were found
between the use of devices and sociodemo-
graphic variables such as the educational
level and occupation of the parents and the
age and gender of the infants. This lack of
associations could be interpreted from the
homogeneity of the parent’s sample based
on its characteristics. On the other hand, the
equal use of screens according to the infant’s
gender is consistent with other studies (Lin
et al., 2020; McHarg et al., 2020). However,
the lack of associations with the age of infants
is contradictory with other results found
(McHarg et al., 2020; Melamuda & Waisman,
2019) and counterintuitive. This may be since
on average the use of technologies was low
for this sample due to the age range. In turn,
during the COVID-19 quarantine, the use of
screens was present independently of the age
of the children (Chauhan et al., 2021; Ribner
& McHarg, 2021), which could make the
associations with age disappear.
Conclusion
This research shows the importance of
continued research on this topic since most of
the children in the sample use some type of
touch device, and they use them an average
of one hour per day. Infants likely start to use
screens early in life and the amount of time
of use of electronic media is approximately
one hour per day because: (1) the community
is not aware of the possible negative eects
that these devices can generate on cognitive
development, because of the average time
that children spent with the screens; (2) as a
means of regulate and distract infants; (3) due
to the quarantine condition derived from the
COVID-19 pandemic.
However, arming that the use of screens
in early childhood is associated with the
acquisition of developmental and language
milestones represents the rst step in the study
of this issue in Argentina and other Latin
American countries. Although these results
are not consistent with previous research
on the subject, which states that there is no
evidence to support a negative association
between the age of initiation of use of the rst
touch device and developmental and language
milestones (Bedford et al., 2016; Melamuda
& Waisman, 2019), it is essential to highlight
that these investigations were not carried out
within the local environment. Based on the
results obtained, interventions can be gene-
rated within the area of clinical psychology in
early childhood, giving guidance to primary
caregivers and generating public policies
within the educational eld.
Limitations and future directions
The present study presented a series of
limitations. One of them was that the data
was collected through parental reports, which
could bias the results obtained. In turn, the
type of sampling was non-probabilistic, there-
fore, the results cannot be generalized. In
addition, the questionnaire was not directly
validated for the small part of the evaluated
sample that was not from Argentina. Thirdly,
there was a lack of measurement of parental
activity during the infant’s screen consump-
tion. Finally, having carried out a cross-sec-

Stamati, Gago-Galvagno, Miller, Elgier, Hauché & Azzollini
Screens, development milestones and language in infants. INTERDISCIPLINARIA, 2022, 39(3), 151-166164
tional study does not allow us to visualize
the development trajectories of these skills in
each child.
For future research, it would be benecial
to expand the sample and recruit participants
from dierent provinces of Argentina and other
Latin American countries. Similarly, it would
be recommended to carry out a probabilistic
sampling, based on a direct measurement of
the infants’ behavior. In turn, measure the inte-
ractions of the caregiver-infant dyad during
screen consumption to analyze whether they
mediate the use of the devices and their asso-
ciations with infant cognitive skills. Finally,
carry out a longitudinal study, to be able to
compare the same sample over time and thus
observe the development lines of infants. This
would lead, in a second moment, to generate
specic interventions that consider the deve-
lopment of infants and the incidence of social
and individual factors to promote their cogni-
tion in the rst years of life.
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Recibido: 27 de septiembre de 2021
Aceptado: 10 de agosto de 2022