by Bianca Garilli, ND
Screen time is quickly becoming one of the hottest topics for parents, healthcare practitioners, and educators. How much screen time should children and adolescents be allowed per day? Does screen time include the time spent on laptops to complete homework and reading assignments for classes? At what age should children begin to use screens? When is an appropriate developmental timeframe to buy your child a phone? Does the use of screens increase the risks of behavioral disorders and sleep problems in children and adolescents? The list of questions goes on and on.
Unfortunately, many of the answers to these questions are simply unknown at this time and some, honestly, are personal choices that each family has to make for themselves. Truly, there is no denying that the digital age is here to stay; screens are all around us, from televisions to smart watches, from iPods to smart phones, from tablets to laptops, there is literally a screen for everything. In 2017, 98% of homes in the US with young children had a mobile touch-screen device compared to 2011 when only 52% of households had such technology.1
Globally, the availability and usage of mobile touch-screen devices by children are at astonishingly high rates:1
- In Australia, children under 2 years are reported to have an average weekly screen time of 14.2 hours, while those between 2-5 years old average 25.9 hours
- In France, 78% of children were using a mobile touch-screen device by 14 months of age and 90% of children by 2 years of age
- Across five countries in Southeast Asia, 66% of children between 3-8 years of age are reportedly using their parents’ mobile touch-screen device, while 14% of children already owned their own devices
- In Britain, 21% of children aged 3-4 years of age are reported to own their own device
Interestingly enough, part of the dilemma of creating set guidelines on screen time in children is that there are various groups with sometimes competing and conflicting interests in this subject. Educational and tech focused organizations encourage the use of screen time for educational advantages and for enhanced benefits to long-term career and financial goals as children grow into adults. On the other hand, public health officials warn of the potential detriment to young minds and their still developing behaviors.
What is screen time displacing?
There are a variety of reasons cited by experts for keeping screen time to a minimum, particularly in young children.
Take for example the CDC, which states that children between the ages of 8-10 spend, on average, 6 hours per day in front of screens, including 4 hours of TV viewing.2 In children ages 11-14 this number skyrockets to 9 hours per day with approximately 5 of those being TV watching.2 Finally, in teenagers aged 15-18 the number of hours per day in front of a screen averages 7.5 with 4.5 being in front of a TV.2 These numbers are startling high when one realizes the activities which are NOT taking place when this much screen time is involved.
For instance –
- Mentally and physically supportive health benefits which come from engaging in physical activity such as organized sports, neighborhood pick-up games, the unorganized activities of exploring and using imaginative play alone and in groups, and the quiet, downtime children and adolescents need to regroup and restore their bodies and minds
- Social aspects of cultivating relationships with physically present individuals, learning how to read and empathize with emotional cues and needs, developing problem solving skills alone and in groups
- Interconnectedness and responsibilities that come from supporting the family and local community networks through chores, volunteering, and taking part in events
- Restful sleep and downtime to restore brain and body
- Reading and engaging in learning opportunities not involving screens or directed education/learning
- Mindful, present, and nutritious eating time with family, so as to avoid passive overconsumption of nutrient void foods
All of the above suffer when screen time overtakes the activities of unplugged healthful daily life.
Screen time duration impacts wellbeing
A study looked at the effects of screen time in 40,337 children and adolescents in the US between 12-17 years of age.3 For the purpose of this study, screen time included cell phones, computers, electronic devices, electronic games, and TV. The amounts of time spent on screens was compared to an array of psychological wellbeing measures.3
Results from this study found that the wellbeing of children and adolescents did not differ significantly (except in curiosity) between those spending no time on screens and those spending 1 hour or less per day on screens.3 However, after exceeding 1 hour of screen time, the risks to wellbeing increased– the researchers explained that increased screen time (> 1 hour/day), “was generally linked to progressively lower psychological well-being. In terms of relative risk (RR), high users of screens (≥ 7 hours/day) carried twice the risk of low well-being as low users (1 hour/day).”3 The low wellbeing measures included not staying calm (especially among 14- to 17-year-olds, RR 2.08), not finishing tasks (RR 2.53), not being curious (RR 2.72), and having less self-control and emotional stability.3 High users of screens compared to low users were described as more difficult to care for, while twice as many high (vs. low) users of screens had an anxiety or depression diagnosis.3 It was found that the effects of high screen time use on wellbeing was generally greater in adolescents than in children.3
Beyond psychological wellbeing, increased time spent on screens is also associated with increased risk of cardio-metabolic diseases and being overweight.4 It comes as no surprise that longer duration of reading and doing homework is associated with higher academic achievement.5 High use of screen time has also been linked to worsening sleep patterns in children and adolescents.6 In a review of 67 studies published from 1999 to early 2014, it was found that screen time was adversely associated with sleep outcomes (shortened duration and delayed timing) in children and adolescents in 90% of the studies.6 Knowing that restful and adequate sleep, particularly in children and adolescents, is associated with lower obesity risk, better psychological wellbeing, improved cognitive functioning, and lower risk-taking behaviors, it is important that the detrimental effects that screens have on sleep be minimized in this developing population.7
Managing & modeling healthy screen behaviors
A quick peak at the leading organizations’ recommendations on supporting healthy screen time in children and adolescents reveals similar guidelines across the groups which can be broken into 3 key areas:.
1. Model appropriate screen behavior. Modeling appropriate screen behavior begins with parents, guardians, caretakers, and educators. The authors in a BMC Obesity publication concluded that, “Mothers’ and fathers’ media parenting practices were associated with children’s screen time. Interventions aimed at reducing children’s screen time should address both mothers’ and fathers’ media parenting practices.”8 Screen time habits discussed in this article included, among other factors, screen use by parents during meal times.8
2. Limit screen time and limit to age-appropriate content. The American Academy of Pediatrics recommends the following guidelines:9
- For children younger than 18 months, avoid use of screen media other than video chatting. Parents of children 18-24 months of age who want to introduce digital media should choose high-quality programming, and watch it with their children to help them understand what they are seeing.
- For children ages 2-5 years, limit screen use to 1 hour/day of high-quality programs. Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
- For children 6 years and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity, and other behaviors essential to health.
Some researchers and practitioners recommend limiting screen time to 2 hours/day after age 5, not including educational screen time such as what is used for school, studying, and work-related screen interactions.10
3. Encourage face-to-face interactions and physical activity on a regular basis. Be intentional about daily “screen-free” time, particularly during mealtime, conversations, play time, family time, and bedtime. Support daily exercise for all children and adolescents being especially cognizant that sedentary screen time does not become a part of a child’s habits before the age of 5.11
- Straker L et al. Conflicting guidelines on young children’s screen time and use of digital technology create policy and practice dilemmas. J Pediatr. 2018;202:300–303.
- CDC. Screen time vs lean time. https://www.cdc.gov/nccdphp/dch/multimedia/infographics/getmoving.htm. Accessed December 18, 2018.
- Twenge JM et al. Associations between screen time and lower psychological well-being among children and adolescents: Evidence from a population-based study. Prev Med Rep. 2018;12:271-283.
- Braig S et al. Screen time, physical activity and self-esteem in children: the Ulm birth cohort study. Int J Environ Res Public Health. 2018;15(6):E1275.
- Carson V et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab. 2016;41(6)3:S240-265.
- Hale L et al. Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Med Rev. 2015;21:50–58.
- LeBourgeois MK et al. Digital media and sleep in childhood and adolescence. Pediatrics. 2017;140(2):S92–S96.
- Tang L et al. Mothers’ and fathers’ media parenting practices associated with young children’s screen-time: a cross-sectional study. BMC Obes. 2018;5:37.
- American Academy of Pediatrics. AAP announces new recommendations for children’s media use. https://edubirdie.com/articles/american-academy-of-pediatrics-announces-new-recommendations-for-childrens-media-use/. Accessed December 18, 2018.
- Mayo Clinic. The Mayo Clinic Minute. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-how-much-screen-time-is-too-much-for-kids/. Accessed December 18, 2018.
- Canadian Paediatric Society, Digital Health Task Force. Screen time and young children: promoting health and development in a digital world. Paediatr Child Health. 2017;22(8):461–468.
Bianca Garilli, ND, USMC Veteran
Dr. Garilli is a former US Marine turned Naturopathic Doctor (ND). She works in private practice in Northern California and consults with naturopathic and Functional Medicine leaders, including the Institute for Functional Medicine and Metagenics. She is passionate about optimizing health and wellness in individuals, families, companies and communities- one lifestyle change at a time. Dr. Garilli has been on staff at the University of California Irvine, Susan Samueli Center for Integrative Medicine and is faculty at Hawthorn University. She is the creator of the Military and Veteran Health Initiative and is the current Past-President of the Children’s Heart Foundation, CA Chapter.