Abstract: Problem considered: Excessive screen time poses significant health concerns for school-aged children. However, the relationships between screen time, muscle quality, and sleep patterns in Indian school children remain inadequately understood. This study examined the associations between screen time, sleep quality, and muscle health indicators in urban school-aged children in India. Methods: A cross-sectional study was conducted on 252 children aged 11–13 years conveniently sampled from an urban school. Anthropometric measurements, Screen time, sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI), Muscle Quality Index (MQI) calculated from handgrip strength and BMI, physical activity levels, and cardiorespiratory fitness via 6-min walk test. Results: Higher screen time demonstrated significant associations with multiple adverse health outcomes- Lower physical activity levels, elevated BMI, reduced MQI, and poorer sleep quality. Boys reported higher screen time (7.51 ± 1.98 h) compared to girls (6.8 ± 2.05 h, p = 0.007). Multiple regression analysis revealed that BMI (β = 0.208, p = 0.011), MQI (β = ? 0.263, p = 0.019), and PSQI (β = 0.217, p < 0.001) were significant independent predictors of screen time, together explaining 23.4 % of the variance (R2 = 0.234, p < 0.001). Conclusion: This study demonstrates complex interrelationships between excessive screen time and compromised health outcomes in school-aged children, including deteriorated muscle quality, disturbed sleep patterns, and reduced physical activity. These findings emphasize the critical need for comprehensive interventions incorporating promotion of moderate-to-vigorous physical activity, muscle-strengthening exercises, reduction in recreational screen time, and improvement in sleep hygiene. Future longitudinal research should investigate longterm implications and develop evidence-based interventions tailored to the unique cultural and environmental context of urban India.