The global growth of electronic media usage among children has caused concerns regarding screen time (ST) impact on child development. No previous population-based studies have evaluated ST and child development in India. This study aimed to determine the burden of ST, associated sociodemographic factors, and its impact on domains of child development. A population-based cross-sectional study was conducted in the field practice area of rural and urban health centers in Tamil Nadu, India. A total of 718 children (396 rural and 322 urban) were selected, using a cluster random sampling method. ST estimates were obtained from parents/guardian after a 7-day observation period. The Communication DEALL Developmental Checklist was used to assess child development. The mean ST was 2.39 hours/day (95% confidence interval [CI]: 2.23–2.54), and the prevalence of excessive ST was 73% (95% CI: 69.2–76.8). Excessive ST was significantly associated with the mothers’ ST, screen usage at bedtime, birth order (in children < 2 years), and attending school (in children ≥ 2 years). Increased ST was significantly associated with developmental delay, in particular, in the domains of language acquisition and communication. In children aged ≥ 2 years, a delay in ≥ 3 domains was associated with ST (adjusted odds ratio [AOR] = 17.75, 95% CI: 5.04–62.49, p < 0.001), as was language delay (AOR = 52.92, 95% CI: 12.33–227.21, p < 0.001). In children aged < 2 years, a delay in ≥ 2 domains was associated with ST (AOR = 16.79, 95% CI: 2.26–124.4, p < 0.001), as was language delay (AOR = 20.93, 95% CI: 2.68–163.32, p < 0.01). A very high prevalence of excessive ST was identified, with a significant association with developmental delay in children. There is an urgent need to include education on ST limits at the primary healthcare level.

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Assessment of communication skills in children with autism spectrum disorder (ASD) is challenging in an unfamiliar clinical environment due to their limited verbal output and inadequate motivation to communicate. To analyze whether the communication sample recorded at clinic represents the child’s competence and performance, this study compared caregiver–child interaction in 24 to 48 months old children with ASD ( n = 10, M = 38.2 months) at clinic and home. The 30-minute caregiver–child interaction at clinic and home was video recorded and analyzed for frequency of pragmatic acts (initiations and responses) and duration of joint engagement. Results indicated that children initiated and responded more at home than at clinic, whereas caregivers initiated and responded more at clinic. The study provides evidence that communication profile of children with ASD in multiple environments needs to be considered for obtaining representative and reliable communication sample for child-centered assessment and intervention.