Assessment of Digital Overload, Sleep Quality, and Emotional Regulation as Markers of Vulnerability in Child Development

Abstract

Introduction: The increasing use of smartphones, tablets, video games, and other forms of digital media has significantly changed children's daily habits. Excessive or inadequately regulated exposure to technology has been associated with changes in sleep, attention, behavior, emotional regulation, and cognitive performance. However, these factors are often assessed separately, making it difficult to understand how they interact during child development. Identifying patterns that combine digital exposure, sleep quality, and emotional functioning may represent a relevant approach for the early recognition of children with greater functional vulnerability.

Objective: To analyze the available evidence on the use of cognitive fatigue, decision-making overload, and digital behavioral or physiological signals as potential markers of vulnerability in mental health, with an emphasis on anxiety, depression, psychological stress, and functional impairment.

Methods: This is an integrative literature review conducted using the PubMed, Scopus, and Virtual Health Library (VHL) databases. The descriptors "Screen Time," "Digital Media," "Children," "Sleep Quality," "Emotional Regulation," "Child Development," "Behavior," and "Mental Health" were used in combination with the Boolean operators AND and OR. Studies published between 2020 and 2026, available in English, Portuguese, or Spanish, that investigated children and presented associations between digital media exposure and outcomes related to sleep, cognitive development, emotional regulation, behavior, or mental health were considered. Case reports, letters to the editor, editorials, and studies without a direct relationship to the pediatric population were excluded.

Results: Available evidence suggests an association between greater exposure to digital media and reduced sleep duration or quality, changes in attention and executive functions, difficulties in emotional regulation, and certain behavioral problems. The strength of these associations appears to vary according to age, duration and timing of exposure, content consumed, family context, and individual characteristics of the child. Sleep disturbances may constitute an important intermediate mechanism, as digital exposure, particularly close to bedtime, may interfere with sleep patterns and consequently affect cognitive and emotional functions. Joint assessment of these domains may provide more comprehensive information than isolated analysis of screen time.

Conclusions: Digital overload represents an increasingly relevant environmental factor for children's health and development. Integrated assessment of digital exposure, sleep quality, and emotional regulation may contribute to the identification of vulnerability patterns and the development of individualized preventive strategies.