Jan 10 2019

Children and Screen Time

Most parents worry about how much time their children are spending in front of computer screens, smartphones, and other electronic devices. This is a reasonable worry – this is a fairly dramatic cultural change, and the experience is different than what most of today’s parents experienced when they were children.

Pediatricians have also been warning about excessive screen time, which has been linked to obesity. But current research and recommendations are getting more nuanced, and pediatric organizations have recently walked back or altered their recommendations.
A recent review published in the BMJ found:

We found moderately strong evidence for associations between screentime and greater obesity/adiposity and higher depressive symptoms; moderate evidence for an association between screentime and higher energy intake, less healthy diet quality and poorer quality of life. There was weak evidence for associations of screentime with behaviour problems, anxiety, hyperactivity and inattention, poorer self-esteem, poorer well-being and poorer psychosocial health, metabolic syndrome, poorer cardiorespiratory fitness, poorer cognitive development and lower educational attainments and poor sleep outcomes. There was no or insufficient evidence for an association of screentime with eating disorders or suicidal ideation, individual cardiovascular risk factors, asthma prevalence or pain. Evidence for threshold effects was weak. We found weak evidence that small amounts of daily screen use is not harmful and may have some benefits.

The evidence is weak, and correlational only. This means we cannot conclude that screen time causes obesity, anxiety, or other issues. It may be, for example, that children who are sedentary for other reasons are both overweight and engage in sedentary activities, many of which involve screen time.
Based on this review, The Royal College of Paediatrics and Child Health said that there is insufficient evidence to conclude that screen time in itself is “toxic.”

The American Academy of Pediatrics has likewise modified their recommendations recently.  Instead of limiting screen time, they encourage parents to make sure children get enough physical activity. The focus is on maximizing physical activity, not limiting screen time. Since there are only so many hours in a day, it is a zero-sum game.

Another recent study looks at parent’s behavior and parenting strategies regarding screen time and overall screen time by their children. The results are a bit mixed, a little different for fathers and mothers, and weekday vs weekend, but a couple patterns emerge.

First, it appears to be a bad idea to use screen time as a punishment or reward. This had the effect of generally increasing overall screen time in children, likely because it makes screen time more alluring – the forbidden fruit. The same, incidentally, is true of sweets – they should not be used as a reward.
These results conveniently dovetail with the above results – if parents don’t focus on the screen time, but rather try to prioritize family time or physical activity, this avoids the unintended effect described above.

The study also showed some effect for parents using devices at the dinner table, and modeling behavior. If parents avoid screens during meals, and instead interact with their children, this may decrease the children’s screen time.

Taking all of this together, where are we? Unfortunately, one conclusion is that we simply do not have enough evidence to make solid recommendations. Most of the evidence is weak, preliminary, and correlational. There is some evidence on which to base recommendations, but clearly more research is needed.

However, it’s unlikely we will get well-controlled data. It’s difficult to force people to use more or less screen time to see what happens. But we can do studies in which parental behavior, for example, is altered to see what effect is has on their children’s screen time.
Otherwise I think the evidence shows that screen time and using computer devices is not “toxic” or something to be stigmatized. It is one more thing that is just part of modern life. But like everything, it should be done in moderation.

Every generation seems to have similar worries about children obsessing on one type of activity or another. There always something ruining “these kids today” – TVs, roleplaying games, video games.

Rather than demonizing one activity, parents should encourage their children to engage in a variety of activities, physical, mental, and social. Fill their day with such activity, and the screen time issue will take care of itself. (But don’t overschedule your kids – that’s a separate issue.)

There is one exception to all this – screen time before sleep. Everyone should avoid screen time in the hour or so before they want to go to sleep, but especially if you have difficulty falling asleep or feel you are not getting enough sleep. The close-up light from screens is especially disruptive to the circadian rhythm, it delays the natural increase in melatonin that is important to regulating the timing of sleep. Essentially, we did not evolve with electricity. We need sunlight during the day, and relatively low light in the evening to help our brain regulate its sleep-wake cycle.
So – no electronic devices in bed is a good rule. Come up with other night-time activities, like reading.

We will adapt as technology changes, and screen time is now an unavoidable part of modern life. As always, scientific evidence is the best guide to how to optimally adapt with the fewest unintended consequences.

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