Childhood between the ages of 0-6, where the foundations of the individual’s mental, emotional, social development and personality traits are established, is highly significant. In this period, the parent-child relationship plays an extremely important role on the personality development of child. In addition to the relationship of the parents with the child, it is known that the relationships of the parents with each other have a lot of impact on the child [1]. The most distinctive feature that differentiates the family from other social communities is the depth of communication between the people in the family.

      In the families today, the internet deeply affects the family, family communication and the development of children. Families today are having difficulty in communication and interaction network such as internet, computer, tablet, mobile phone [2]. Although parents and children share the same atmosphere, they may lead separate lives as they waste an important part of their time on these devices. At the same time, these devices can sometimes turn into a shelter to avoid communicative problems and responsibilities. It is a controversial issue whether people dislike being together and this causes addictions like internet, smartphone, etc. or addictions like internet, smartphone, etc. prevent people from being together. It is stated that this is a mutual relationship and a vicious circle occurs [3].

      According to data of Turkey Statistical Institute (TSI) [4] 96.9% of the households in Turkey have a mobile phone or smart phone, 22.9% have a desktop computer, 36.4% have a portable computer. With the rise in the rates of internet use and possession of technological devices, the access of the internet has increased, especially among preschool children compared to previous years [5-8]. The results of the European Kids Online Network study show that the age of children actively using the internet is decreasing [9]. In all European countries, prominent increases have been observed at the rate of children accessing the internet. The generation that communicates with avatars and plays games in the virtual worlds has also been found to increase significantly between the ages of 3-11 [10]. The studies conducted in some countries indicate that interaction with mobile technologies has fallen under the age of 2 [11]. More than a fifth of children aged 3-8 in the UK uses the internet with a tablet for 6-7 hours a week and play 6-7 digital games, one in every five children aged 0-8 in the US uses a mobile device almost every day and the length of using these devices has been found to increase [12]. The families’ use of technological devices with screen as an “electronic nanny” increases the length of time children spend on these devices [13].

      In the reinforcement of many skills, notions and behaviours in the early childhood, technology can be exploited especially in the development of psycho-motor skills, hand-eye coordination and attention [14,15]. However, if it is not used properly, it is known that the proliferation of technology has physically, socially, emotionally and mentally negative effects such as obesity, eye health, loss of social relationship and internet addiction [8,15-19]. The children themselves who need real experiences in real life must observe ordinary interactions. The virtual world created in the technological environment is thought to steal these experiences from children [8]. In the studies conducted, it was stated that the use of technological devices with inappropriate length/frequency led to developmental risks [20], problems with secure attachment and emotional regulation [21,22], physical [23] and mental problems [24] incapability in problem solving, game [25] and social skills [26].

      It is important to be able to use such devices in a controlled way in our lives, which causes disruptions especially in family communication and makes children more easily addicted to them [2]. This study was conducted to reveal the effects of relationships of children, attending a preschool education institution, with their parents on their internet use.

Participants

      This descriptive- correlative study was performed in Zonguldak Central Kindergarten in Zonguldak Provincial Center between 27th March 2018 and 1st June 2018. The population of the research consisted of 183 children aged 4-6 and attending the Central Kindergarten, and their parents. The sample of the study was comprised of 142 parents who agreed to participate in the study and fully filled out the questionnaire forms (78% of the universe was achieved). Since seven parents did not agree to participate in the study and 34 parents did not fully fill out the questionnaire, they were excluded from the study.

Procedure

      Written authority was obtained from Zonguldak Bülent Ecevit University Human Research Ethics Committee (Decree no. 2014/08-13) and Zonguldak Provincial Directorate of National Education (dated 27th March 2018 and numbered 12607291) for the implementation of the study. After the participants were informed about the study, the consent of the parents who agreed to participate in the study was obtained with the Informed Voluntary Consent Form. The data were collected by the researchers through the face-to-face interview method with the parent, the mother or the father, at the entrance and exit time of the school, in the class activities (breakfast, picnic, special day) and after parents’ meeting. On condition that the parents were not available, the questionnaire was sent home with the children and parents themselves were asked to fill out the questionnaire. It took the participants an average of 10-15 minutes to fill out the questionnaire form.

Measures

Personal information form

      It is a form consisting of 18 questions prepared by the researchers via literature in order to get information about children and their parents and to determine the state of the Internet use of children [27-29].

Parent- child internet addiction scale-PCIAT20

      It was developed by Young adapting DSM-IV’s “Pathological Gambling” criteria to determine the views of families about the internet use of their children. It was adapted to Turkish by Eşği [30]. The scale, which is a Likert type, consists of 20 items and four subscales [30]. In the study, the cronbach α values of the subscales of the scale were calculated as 0.78 for Social Abstraction, 0.71 for Dysfunction, 0.76 for Deprivation and 0.89 for Control Difficulty.

Child-parent relationship scale-CPRS

      It was developed by Pianta to understand the mother-child relationship. It was adapted to Turkish by Akgün and Yeşilyaprak [31]. The scale consists of 15 items and two subscales [31]. In the study, the cronbach α values of the subscales of the scale were calculated as 0.86 for Conflict and 0.81 for Positive Relationship.

Statistical analysis of data

      Data of the study were analyzed with SPSS 17 package program. Numbers, percentages, arithmetic mean, standard deviation, minimum and maximum values were used to assess data. The Kolmogorov-Smirnov and Shapiro Wilk’s test were used while investigating the situation of variables coming from the normal distribution, and the Pearson Correlation Coefficient was used while examining the relationships between the variables.

      The mean age of the parents was 35.58 ± 5.58 and the number of children they had was 1.74 ± 0.68. The mean age of the children was 5.08 ± 0.73 (Table 1).

Table 1

Table 1: Distribution of the descriptive characteristics of families.

Table 2

Table 2: Distribution of the responses of the parents to the questions of “anxiety”, “internet security application” and “internet use permission”.

      The mean age of children beginning to use the internet was 3.51 ± 0.91 (1-5), and parents let their children use the Internet for an average of 75.46 ± 43.01 (0.00-180.00) minutes per day. 77.4% of the children were using a smartphone, 40.4% a tablet pc and 12.3% a personal computer as a means of connection to the internet.

Table 3

Table 3: Distribution of children’s reactions in cases where internet use is restricted or not allowed.

      The rate of parents anxious about that issue while their children were using the internet was 73.2%, the rate of parents using internet security application was 53.5%. 87.3% of the parents stated that they did not allow their children to use some applications while using the internet (Table 2).

      68.3% of the parents stated that their children gave negative reactions when they limited the internet use of their children or did not allow them to use the internet. 60.8% of children whose internet use was restricted or who were not allowed to use internet by their parents got angry, 56.7% cried and 39.2% shouted as a reaction. 25.8% of the children tried to find a device to use the internet from the individuals other than parents (grandfather, grandmother, etc.) (Table 3).

      While the vast majority of parents (73.2%) allowed their children to use the internet after meals, 22.5% allowed during meals and 21.8% before sleep (Table 4).

Table 4

Table 4: Distribution of the time allowed to children for the internet use.

      Statistically significant relationships were observed at a positive and moderate level between Conflict subscale of CPRS and Social Abstraction (r = 0.368, p <0.01), Dysfunction (r = 0.445, p <0.01), Deprivation (r = 0.333, p <0.01) and Control Difficulty (r = 0.431, p <0.01) subscales of PCIAT20 (Table 5).

Table 5

Table 5: Relationship between subscales of CPRS and PCIAT20.

      Today, the introduction of children with technological devices begins at an early age. The most important problem on this issue is that the use of technological devices in early childhood is not provided in a safe way for children. In this study, the mean age of children beginning to use the internet is 3.51 ± 0.91. Parents give their children an average of 75.46 ± 43.01 (0.00-180.00) minutes of internet use per day. In the studies conducted, it is observed that the rate of internet use has been increasing rapidly, the age of internet use in children has decreased but the length of time has increased [5-9,32,29]. Çelik [29] stated in his study that 57.6% of 4-6 year-old children spent more than two hours on the screen of technological devices on weekdays and 76.3% at the weekends (tablet pc, television, mobile phone, computer [29]). Genç [6] stated in his study that children started using smartphones and tablets before the age of two [6]. In a study conducted in the US, it was stated that 52% of the children between the ages of 0-8 in 2011 used technological devices and this rate increased to 75% with the same research data in 2013 [33]. American Academy of Paediatrics (AAP) [34] warns parents that the children should not look at the screen for more than two hours in a day, and children younger than two years of age should not be exposed to the screen under any circumstances. Since the brain development process of the children is not completed, they cannot adapt to the rapidly changing technology as easily as adults. This situation puts children at many risks [34].

      When the internet connection tools of children were analyzed, it was understood that smartphones (77.4%) were mostly used and they were followed by tablets (40.4%) and personal computers (12.3%). Similar results were found in the studies carried out [32,35,36]. According to data of TSI [4] 96.9% of families have a mobile phone or smartphone, 66% have a portable computer, 22.9% have a desktop computer. It has been observed that the ratio of having internet enabled devices such as smartphones, portable computers (especially tablets) has been rising and the demand for desktop computers has been decreasing nowadays. These studies indicate that as the use of internet-related mobile information technologies at home increases, the use of these technologies in the early childhood period also increases [4].

      Parents stated that they were concerned about their children while using the internet and therefore, they were using a security application. In a thesis study which was conducted to ensure the safe use of internet in Turkey, it was found that the proportion of parents using software programs to block the internet websites increased from 33.9% to 40.3% between the years 2010 and 2015 [37]. Zehir et al. [38] reported that 65% of parents whose children were between the ages of 4-6 checked the websites their children were visiting and the games they were playing on the internet. In the same study, the rate of those using a secure internet application or blocking some websites was 29% [38]. In the study conducted by Özyürek [39] with mothers of children aged 36 months and over, it was determined that approximately 75% of children used computes alone without their parental control [39]. Additionally, it was stated that parents’ knowledge on simple filtering, restriction and control mechanisms they could easily use was of great importance and the children in Turkey had the lowest level of internet literacy in the average of Europe [40]. When we examine the results of the study, although the use of internet security application has increased over the years, it is still thought to be insufficient.

      The vast majority of parents stated that they allowed the use of internet after and during meals. In a study conducted in Canada, it was concluded that the habit of screen use during meals increased the length of time spent on the screen both on weekdays and at the weekends [41]. In the study conducted by Gündoğdu et al. [35], it was determined that 86% of the children used a technological device during meals [35]. As supported by the study findings, allowing children to use the internet or screen during meals is thought be for the purpose of distracting and making them finish their meal. In a qualitative study, it was revealed that parents agreed with the idea that technology was a saving tool for feeding their babies [42]. However, the American Academy of Paediatrics (AAP) [34] does not recommend any screens not be used during meals and up to an hour before sleep [34].

      In the study, it was observed that more than half of the children reacted with anger, crying and shouting when the internet use was restricted or not allowed. Similar findings have been obtained in the studies conducted on this issue [35,38,42]. Dealing with a certain behaviour too much, moving away from the real world and maintaining the behaviour that gives pleasure, difficulty in controlling behaviors and symptoms such as anger and restlessness that occur when the behaviour is prevented from being repeated are evaluated within the scope of addiction [43]. It is worrying that children show addictive-like symptoms against internet use during this period. It is known that in order to prevent addiction in the early period, parents should establish rules about children's internet use and be determined to apply these rules. American Academy of Paediatrics (AAP) [34] recommends that parents establish consistent rules for the use of mobile devices [34].

      A positive, moderate and significant relationship was found between the Conflict subscale reflecting the negative relations of the CPRS which evaluated the relations of the parents with their children and the child's problematic internet use (p <0.01). A limited number of studies have been found in the literature examining the relationship between the two variables with a pre-school sample [21]. Studies have been observed to be conducted mostly on school age and adolescent children [22,48,44- 47]. In a study conducted on preschool children between the ages of 3-6, it was observed that the score of safe attachment reduced with the rise in the length of children’s technology use [21]. In a study examining the relationship between the features of the internet use and the parental relations in high school students, students who had weak relations stated after the interviews that they used the internet since they could not share enough things with their families [46]. Balkan [47] detected a negative relationship between the use of computer and family functions in his study, which examined the relationship between computer-internet addiction and family functions among university students [47]. As the studies support, the lack of social needs is tried to be overcome by the children with technological environments today.

      As a result, it is known that preschool period is a critical period in terms of child's self-formation, personality development and socialization [49]. In a family environment where family relations are inadequate, the development of the child is hindered. The child may begin some quests considering that their thoughts and feelings are not important [2,50]. As a basic result of this situation, the needs that cannot be met by family relations are tried to be met by turning to the use of internet (tablet, smartphone, computer etc.). The children may shelter in the internet to meet their emotional needs that they cannot meet with their family members. Therefore, it is significant to develop the communication between the parent and child to reduce the internet use of the child.

Implications for nursing practice

      Communication of parents with each other and their children greatly affects the development of preschool children in particular phone [2]. It is known that excessive use of technological devices affects interpersonal communication, social life, academic success, physical and psycho-social growth and development in parents and children. Increased internet usage time can also cause some health problems. Nurses should be able to provide environments and trainings in which parents can provide information about the extent to which internet use affects their children and family lives and how to deal with problems in this regard. Having knowledge about cognitive development, the nurse should determine training methods taking into account children's developmental characteristics. A nurse in contact with the parent; It should be able to organize training and counseling for every individual in the family about problematic internet use and its effects, and especially reducing their negative effects on child health. Nurses should take precautions by knowing the negative effects of the internet and the health problems caused by it, and develop interventional strategies to prevent problematic internet use [51].