Tuesday, January 19, 2016

Screen TimeThis past fall, an announcement from the American Academy of Pediatrics (AAP) indicated that the venerable organization was considering modifying its screen time standards for children. The announcement said, “Scientific research and policy statements lag behind the pace of digital innovation,” and noted that the organization’s screen time policies were written before the rise of the iPad (Brown, Shifrin, & Hill, 2015). This elicited more than a little interest from a digitally focused media. A proliferation of articles celebrated the end of “screen time shame” and the rise of digital parenting, although some scolded the AAP for bowing to cultural pressure to allow more screen time.

The AAP clarified that the announcement was not itself a revision of the standards but an acknowledgement that the standards are in need of review. The organization declared screen time and media a strategic priority and, in late 2015, held a symposium to review their guidelines for children and adolescents. The symposium, Growing Up Digital, is an initial step in a planned revision of the AAP’s recommendations later this year (Kamenetz, 2016; Shifrin et al., 2015).

The AAP’s current guidelines are that television and other entertainment media should be avoided for children younger than 2 years old and that older children and teens should limit screen time to 2 hours per day (AAP, 2015). However, critics feel that these recommendations are no longer realistic in the face of digital media saturation. Is abstinence from screen time realistic for children younger than 2? Can older children navigate a digital world with no more than 2 hours per day of screen time? In a recent interview with NPR, David Hill, chairman of the AAP Council on Communications and Media, noted that AAP recommendations will always follow the science but added, “The question before us is whether electronic media use in children is more akin to diet or to tobacco use. With diet, harm reduction measures seem to be turning the tide of the obesity epidemic. With tobacco, on the other hand, there really is no safe level of exposure at any age. My personal opinion is that the diet analogy will end up being more apt” (Kamenetz, 2016).

How much media are we consuming?

According to a 2013 study by Common Sense Media, children under 8 years old are spending less time with “traditional” media like televisions and video games and more time with digital media on mobile devices. Even so, roughly half of the 2 hours of screen time consumed daily by children in this age group is television viewing time. Nearly three-quarters (72%) of 0- to 8-year-olds have used mobile devices like smartphones and tablets (Rideout, 2013). Older children consume even more screen time: A more recent study by Common Sense Media found that tweens (ages 8–12) use an average of 6 hours’ worth of media daily and teenagers average around 9 hours. As with the younger cohort, traditional media like television viewing, listening to music, and video games dominate this time (Rideout, 2015). This report notes that this digital device time often involves multitasking: “For example, [a teen] may be watching TV while getting dressed or cleaning her room, browsing social media while on the bus to school, and listening to music while working out. This study documents the amount of time young people spend with media, but it does not determine whether the time was spent only with media” (Rideout, 2015).

What are the risks of excessive screen time?

The risks of excessive screen time have been well-studied, although many of the cornerstone studies in this area focus on television viewing rather than the use of mobile media devices like smartphones and tablets. In general, screen time exposure is associated with less physical activity, poorer diet choices, disrupted sleep cycles, and a higher body mass index (BMI). A cross-sectional study of more than 10,000 children 6–9 years old in five European countries found a potential relationship between high screen time exposure and increased consumption of foods high in fat, sugar, or salt (Börnhorst et al., 2015). A similar study of nearly 6,000 children aged 9–11 in countries around the world, including Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States, found that higher screen time and sedentary time exposure were associated with poor weight status and a lack of physical activity (LeBlac et al., 2015). Screen time is positively associated with increased BMI in adolescents, particularly for children who are already overweight or obese (Mitchell, Rodriguez, Schmitz, & Audrain-McGovern, 2013). Excessive afterschool screen time has been associated with poorer diet quality and increased snack portion sizes (Ciccone, Woodruff, Fryer, Campbell, & Cole, 2013). Children with more screen time also have higher obesity and cardio-metabolic risk factors than similar peers with less screen time; these risk factors can be early indicators of metabolic disease (Danielsen et al., 2011; Hardey et al., 2010). Finally, as with adults, screen time may be disruptive to sleep for children, and inadequate sleep is associated with higher levels of obesity (Laurson et al., 2014; Magee, Lee, & Vella, 2014; Shifrin et al., 2015). Even with the evidence above, it is difficult to say exactly how much screen time is excessive screen time and how newer forms of digital media compare with traditional media like television.

Finding the balance.

If harm reduction is the goal, then how do we reduce the amount of screen time for children and youth while being realistic about the digital age in which we are living? Studies on interventions to reduce screen time have had mixed findings. Having a TV or computer in the child’s bedroom was strongly correlated with excess screen time and poor health outcomes (LeBlac et al., 2015). Other studies have also found a link between childhood obesity and the presence of a television in the child’s bedroom (Wethington, Pan, & Sherry, 2013). However, a systematic review of screen time interventions found only four of the 47 studies reviewed targeted the removal of television from children’s bedrooms. The most successful home- and school-based intervention programs used TV allowance or monitoring devices, based television viewing on achievement of physical exercise goals, set explicit goals for reduced screen time, and had high levels of parental involvement. Counseling by doctors, nurses, and other health providers also helped reduce television viewing time, although this counseling generally took part during a more formal screen time intervention program (Schmidt et al., 2012).

There is no question that children will be exposed to screen time throughout their day and that successful use of digital devices will be an important skill for older children in schools and in their social lives. Indeed, some researchers are pushing back against screen time limits, arguing that when parents take an active role in modeling and using digital media, it helps mitigate negative outcomes and better prepares children for life in a digital world. One researcher found that in contrast with parents who provide no digital guidance and parents who only enforce digital device time limits, parents who play an active role in exposing their children to digital media are more likely to provide guidance on topics like using the Internet responsibly and more likely to interact with their children using technology (Samuel, 2015). Parental role modeling is important in both reducing screen time and increasing physical activity (Xu, Wen, & Rissel, 2015).

Few studies address reducing screen time in very young children (Schmidt et al., 2012), but it is well established that these children (less than 30 months of age) learn best through personal interactions with parents and caregivers and do not learn as effectively from digital media. Older children are more likely to find value in digital media, although experts emphasize that the media must be developmentally appropriate and incorporate active family participation. However, little vetting has been done on programs and applications touted as “educational” (Shifrin et al., 2015). The recent AAP symposium on children and media did note that digital media and gaming can be positive: games can provide interactive learning, teach skills, give children a sense of mastery, and provide education. Particularly for teens, involvement in digital media is a key pillar of social life and engagement with their peer group, even though there are risks, including exposure to bullying and questionable media content (Shifrin et al., 2015).

School and other educational facilities can also reduce screen time (Friedrich, Polet, Schuch, & Wagner, 2014). One role of educators, recommended by the AAP, is to teach digital media literacy and help children learn how to use digital resources safely (Shifrin et al., 2015). Another path, exemplified by policies with strict screen time limits such as the YMCA of the USA’s Healthy Eating and Physical Activity standards, is to reduce or remove screen time in favor of active play and physical activity.

Educators, parents, and child development stakeholders will be watching for the anticipated release of the AAP’s updated screen time standards later this year. Digital media and screen time are here to stay, but with research, we can determine limits that are both safe and realistic. Regardless of the AAP’s updated screen time standards, it will still be true that children and youth need guidance from trusted adults to navigate the digital world and that they need to put down the screens and play actively on a daily basis.

Works cited

  1. American Academy of Pediatrics. (2015). Media and children. Elk Grove Village, IL: American Academy of Pediatrics. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/pages/media-and-children.aspx.
  2. Börnhorst, C., Wijnhoven, T. A., Kunešová, M., Yngve, A., Rito, A. I., Lissner, L., ... Breda, J. (2015). WHO European Childhood Obesity Surveillance Initiative: Associations between sleep duration, screen time and food consumption frequencies. BMC Public Health, 15(1), 1–11. doi:10.1186/s12889-015-1793-3
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  5. Danielsen, Y. S., Júlíusson, P. B., Nordhus, I. H., Kleiven, M., Meltzer, H. M., Olsson, S. G., & Pallesen, S. (2011). The relationship between life-style and cardio-metabolic risk indicators in children: The importance of screen time. Acta Paediatrica (Oslo, Norway: 1992), 100(2), 253–259. doi:10.1111/j.1651-2227.2010.02098.x
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