Screen Time in Pediatrics
Written by Dr. Carly Wilbur, UH Pediatrician and psi Medical Director.
As the COVID-19 pandemic unfolded, many schools and workplaces shifted to an online platform. This necessarily increased the amount of time we all spent using electronic devices to communicate, learn, and connect. While the American Academy of Pediatrics recommended fewer than two hours per day of total screen time prior to the move to remote learning, these guidelines have been updated to reflect the realistic demands of our current digital age.
Not all screen time is bad. The effect it has on the mind and body varies with age, content, timing, and other important factors.
AGE— Screen time for children under two years old is still not encouraged, however during the COVID lockdown, experts modified this recommendation to allow for real-time video chatting so that loved ones could stay in touch. For toddlers, it is advised that only high-quality educational programming be selected, and that parents or caregivers watch alongside younger children so that the experience can be shared and reflected upon together. Solo use of a phone or tablet for viewing in toddlers is not endorsed. For school-aged children, parents must establish clear rules and boundaries, including reviewing internet safety and avoidance of dangerous engagement in social media. For pre-teens and adolescents, this point bears repeating: it is easy for kids at this developmental stage to get swept away in a fad or a scam. They must be told in clear terms that their privacy (ranging from social security number, to home address, to intimate photos) must be prioritized and they are never to engage in behavior that is harmful to themselves (i.e. trending challenges) or others (bullying, trolling).
CONTENT— It is too easy, given the “frictionless interface”, purposely designed to effortlessly slide the user’s attention from one screen to the next, to fall into what’s called an internet rabbit hole. This reference, from Alice in Wonderland, is a metaphor for a method of transporting someone into a surreal and disturbing situation. Clicking on a link located on an age-appropriate site can lead down a road to something unsuitable and traumatizing for younger children. Teenagers and adults can also get caught up in the “gamification” of apps and social media sites, where designers intentionally set up competitive elements to encourage in-app purchases and promote online marketing. This is all to say where you start isn’t always where you land online.
BRAIN CHEMISTRY— Research continues to delve into the effect that screens have on children at a young age. Even in moderation, there are biologic consequences for exposure to the blue light wavelength that screened devices emit. It is surmised that extended exposure can cause long-term damage to the eyes, including macular degeneration, early development of cataracts, retinal toxicity, eye strain, and dry eyes. While an iPad can serve as a great babysitter for a busy parent trying to get dinner ready, inert observation does nothing to further a child’s imagination, encourage creative problem-solving, or develop self-comfort mechanisms. It can serve as a welcome distraction for a hyperactive child, but doesn’t teach them to channel their energy into a productive outcome. Videos of unboxing toys or watching others play video games does not stimulate the imagination. For older children, they should consider whether their screen contact makes them feel better or worse afterward, if it was overall a positive or negative experience. Learning to play guitar or draw calligraphy online and coming away with a new self-taught skill is an entirely different endeavor than passively watching Ninja play Fortnite on Twitch. At nighttime, the effect of the blue light wavelength is magnified. Scientists have discovered that exposure to screens, regardless of the filter applied, suppresses the secretion of melatonin, the body’s naturally-occurring hormone that makes us sleepy. That means that having a TV or phone in the bedroom impedes the circadian nature of the sleep-wake cycle.
SOCIAL INTERACTION— Some screen use encourages social communication, connection, or useful contact, and other screen use does not. Real-time video calls with friends and family, or even judicious use of online gaming with other known players is beneficial. Video chatting throughout the COVID pandemic may have been the only way some grandparents could “visit” with family. It has value when it is used to promote family togetherness, and to prevent social isolation. On the flip side, when screens are prohibited during family dinnertime and bedtime, it encourages in-person intimacy and communication, and protects certain shared encounters that foster emotional closeness and healthy attachment.
Not all screen time is created equal. Using a device to attend classes, learn a new skill, connect with friends and family, or distract an antsy child for a moment is a testament to the ways we put technology to work to improve our lives. But too much screen time can cost us in terms of eye strain, social media addiction, exposure to inappropriate content, disruption of innate sleep chemistry, and exposure to the kind of stressors that contribute to trial-and-error skills-building. Screen time has its role, but it should not replace the need for eating, sleeping, studying, playing, exercising, or interacting with real people. As teachers, parents, and caregivers, we must remain vigilant to these hazards, and set a good example at the dinner table, during bedtime, and any other opportunity when we can to demonstrate good impulse control, put down our screens, and look at each other.