To explore the perceptions, challenges and strategies of caregivers in managing screen time among children younger than 5 years in the urban and rural areas of Tamil Nadu, India.

Qualitative study using focus group discussions (FGDs).

Rural Health and Training Centre in Vayalanallur, Thiruvallur district and Urban Health and Training Centre, Thiruvanmyur in Chennai district, Tamil Nadu, India.

54 caregivers (27 rural, 27 urban, 46 mothers, 6 grandmothers, 2 fathers) of children younger than 5 years whose screen time exceeded WHO age-specific recommendations participated. Six FGDs were conducted, each with 8–10 participants.

FGDs were conducted in familiar community locations near the participants’ homes to ensure comfort and accessibility. The audio recordings were transcribed verbatim in Tamil and translated into English and analysed using inductive thematic analysis. Coding was manually performed by two independent researchers.

Six major themes emerged: (1) circumstances leading to screen exposure, (2) perceived advantages, (3) perceived disadvantages, (4) challenges in reducing screen time, (5) methods adopted to reduce screen time and (6) strategies for sustaining reduction. Safety concerns, lack of play space and the need to manage household chores were commonly cited reasons for screen use. Although most caregivers were aware of the potential harms, screens were often used to feed or pacify children. Emotional resistance from children, inconsistent family norms and grandparents’ screen use were common barriers. Caregivers employed strategies, such as limiting access, engaging in outdoor play and enrolling children in structured activities. Urban–rural differences were minimal, and thematic saturation was achieved after six FGDs.

Caregivers face multiple, structural and family level challenges in managing screen time among young children. Awareness and interventions need to be tailored to address family dynamics, caregiver fatigue and lack of alternatives. Health providers, community workers and policymakers should collaborate to offer structured support, promote screen-free engagement and ensure child-friendly spaces in urban and rural communities.

To estimate the prevalence of sleep problems among children aged 2–5 years residing in South India, assess its association with screen time and identify a predictive screen time threshold.

Population-based cross-sectional study.

Field practice areas in rural and urban centres of a medical college in South India.

In total, 523 children aged 2–5 years were selected by simple random sampling.

Sleep problems were assessed using the validated bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity of sleep and snoring sleep screening tool. Sociodemographic and behavioural factors, including screen time, were also examined. The optimal predictive screen time cut-off was identified using receiver operating characteristic (ROC) analysis.

Sleep disturbances were reported in 39.6% of children (95% CI 35.5% to 43.8%). The most common sleep problems were irregular sleep (22.2%), bedtime resistance (20.8%) and night awakening (19.9%). Multivariate logistic regression showed strong associations between sleep problems and screen use in bed (adjusted OR (AOR) = 3.8; 95% CI 2.4 to 6.1), excess screen time (AOR=3.3; 95% CI 1.8 to 6), smaller family size (AOR=3.1; 95% CI 1.5 to 6.1), reduced physical activity (AOR=2.6; 95% CI 1.6 to 4.2), shorter birth spacing (AOR=1.8; 95% CI 1.1 to 2.8), lower socioeconomic status (AOR=1.8; 95% CI 1.2 to 2.8) and maternal screen time>2 hours/day (AOR=1.6; 95% CI 1.04 to 2.6). ROC analysis identified ≥2.4 hours per day of screen time as the optimal threshold for predicting sleep problems (area under the curve=0.800; sensitivity, 73.9% and specificity, 77.2%).

In this large population-based study, two of the five preschool children experienced sleep problems, with excess screen time, particularly screen use in bed, being the key contributing factor. This is one of the few Indian studies to establish an ROC-derived screen time threshold for identifying sleep problems. These findings can guide targeted parental advice and early preventive strategies to promote healthy sleep in preschool children.

The prevalence of food allergies, particularly IgE-mediated allergies, is rising in developed countries, with cashew nut allergy emerging as a significant public health concern due to its potential for severe anaphylaxis and frequent association with atopic disorders. Cashew nuts are among the most common allergens in Europe and Australia, often involving cosensitisation with pistachios, hazelnuts and other allergens. Diagnosis relies on clinical history, measurement of specific IgE (sIgE) levels, skin prick tests (SPT) and oral food challenges (OFCs). Current management strategies focus on allergen avoidance and emergency interventions, whereas oral immunotherapy (OIT) represents a promising approach to desensitisation. Recent studies, including the NUT CRACKER trial, have reported high desensitisation rates with cashew OIT, although these are associated with a risk of adverse events. This study introduces a novel randomised controlled trial aimed at evaluating the efficacy and safety of cashew immunotherapy in children.

This randomised, open-label, parallel-group trial, with a 2:1 allocation ratio, will be conducted at the Department of Paediatric Pneumology and Allergology, Medical University of Warsaw, Poland. Thirty-nine children, aged 4–17 years, with confirmed IgE-mediated cashew allergy via open OFC will be enrolled. Participants in the experimental group will undergo OIT, which involves gradually increasing doses of cashew protein up to a maintenance dose of 1200 mg. The duration of OIT will range from 12 to 60 weeks, depending on individual baseline tolerance. The control group will receive standard management, including strict cashew avoidance and emergency response strategies to accidental exposure, for 1 year.

The primary endpoint is to determine the proportion of participants tolerating a 4043 mg dose of cashew protein at the study’s end in the OIT group compared with the control group. Secondary outcomes include evaluating the safety profile of OIT, assessing changes in laboratory markers such as sIgE and IgG4 levels for cashew and the major cashew allergen Ana o 3, analysing basophil activation test responses and measuring changes in SPT wheal diameter at baseline and study completion.

The study has been approved by the Ethics Committee of the Medical University of Warsaw (approval number: KB/267/2023). Study findings will be published in peer-reviewed journals and presented at international conferences.

NCT06328504.