Are play and screen time associated with British preschoolers' mental health? Cross-sectional findings from the British Preschool Children's Play Survey.
In British preschoolers, adventurous play is associated with better mental health outcomes, whereas higher educational screen time was associated with poorer mental health, indicating that adventurous play may benefit preschoolers' mental health or that preschoolers with better mental health are more likely to engage in adventurous play.
Key Findings
Results
Each additional hour per week of adventurous play was associated with lower internalising scores and higher positive affect scores in British preschoolers.
For each additional hour per week of adventurous play, children had lower internalising scores of -0.02 (95% CI: -0.03 to -0.01)
For each additional hour per week of adventurous play, children had higher positive affect scores of 0.04 (95% CI: 0.02 to 0.05)
Associations were derived from linear regression models adjusted for child and parental demographic variables
Sample included 1018 children aged 2-4 years from England, Scotland, and Wales
Results
More hours per day of educational screen time (versus less than 1 hour per day) was associated with higher internalising scores, higher negative affect scores, lower positive affect scores, and higher externalising scores.
The reference category was less than 1 hour per day of educational screen time
Higher educational screen time was associated with higher internalising scores, higher negative affect scores, lower positive affect scores, and higher externalising scores
Associations were identified using linear regression adjusted for child and parental demographic variables
Educational screen time was defined as time spent on educational screen-based activities
Results
More hours per day of recreational screen time (versus less than 1 hour per day) was associated with higher internalising scores and higher negative affect scores.
The reference category was less than 1 hour per day of recreational screen time
Recreational screen time was associated with higher internalising and negative affect scores
Recreational screen time was defined separately from educational screen time
Associations were identified using linear regression adjusted for child and parental demographic variables
Results
Adventurous play moderated the association between higher educational screen time and both internalising scores and negative affect scores.
Interaction terms between adventurous play and educational screen time variables were tested in regression models
Adventurous play moderated the association between higher educational screen time and internalising scores
Adventurous play moderated the association between higher educational screen time and negative affect scores
This finding suggests adventurous play may offset possible negative associations with educational screen time
Methods
The study used a nationally representative cross-sectional sample of 1018 British caregivers of preschool-aged children recruited through YouGov UK.
Original recruitment target was n=1066 caregivers of 2-4 year olds; complete-case valid data were available for n=1018
Age distribution: age 2 n=298 (29%), age 3 n=365 (36%), age 4 n=355 (35%)
47% of children were female; 81% were white
Participants were from England, Scotland, and Wales (Britain)
Mental health was measured using four outcomes: internalising and externalising scores (Strengths and Difficulties Questionnaire) and positive and negative affect scores (Positive and Negative Affect Schedule for Children-P)
Hesketh K, Dodd H. (2026). Are play and screen time associated with British preschoolers' mental health? Cross-sectional findings from the British Preschool Children's Play Survey.. BMJ open. https://doi.org/10.1136/bmjopen-2025-105101