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In this longitudinal study of 4 cohorts, 2026 children with 6648 observations were included. Compared with children with lower levels of screen use, children with higher levels of screen use had significantly higher levels of mental health symptoms during the COVID-19 pandemic. These findings suggest that policy intervention, as well as evidence-informed social supports, may be required to promote healthful screen use and mental health in children and youth during the pandemic and beyond.