Ask the Doc: Screen Time

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Approved by the What’s Up Moms Medical Advisory Board

My 3-year old son is obsessed with our ipad. How much screen time is OK?”

Back in the 1970s, children began to regularly watch TV at age 4. Nowadays, they begin interacting with digital media at 4 months of age. Needless to say, we’re living in a whole new world. And the truth is, we don’t really yet know all of the effects our modern, technologically-driven, media-centric lifestyle are having on our children (or us adults). But the American Academy of Pediatrics came out with some helpful guidelines in 2016 based on what we’ve learned so far about the risks and benefits that come with increased media exposure. Their recommendations are:

  • Under 18 months: No media at all (other than video chatting)
  • 18 months – 2 years: High quality programming up to 30 min/day; adults should co-watch with kids and help them understand what they’re seeing
  • 2-5 years: Limit to 1 hour/day
  • 6 + years: Have consistent and clear limits on time spent using media, regulate the types of media and make sure it doesn’t replace adequate physical activity, sleep and other behaviors that are important for good health
  • For all ages: Designate media-free times together, such as dinner and car-rides; designate media-free locations in the home, such as bedrooms

Of course, every family has different considerations, and what is practical will vary. Case in point: My twins didn’t have any screen time until they turned 2.5 years old, while my youngest kiddo said “Daniel” (of Daniel Tiger fame) as one of his earliest words.

We often hear about the negatives of screen-time, like:

  • Increased obesity risk – This is a consistent finding across all age groups (including preschoolers). A large international study with almost 300,000 children and adolescents found that watching 1-3 hours of TV each day led to a 10-27% increase in risk for obesity. There’s generally a strong link between increased media use and decreased physical activity, so every hour spent staring at a screen is an hour less of potential time for active play.
  • Negative effects on sleep – The presence of a TV, computer or mobile device in children’s bedrooms has been associated with fewer minutes of sleep per night. It’s been shown that even babies as young as 6-12 months who were exposed to screen media in the evening hours had significantly shorter nighttime sleep duration compared with those who had no evening screen exposure.
  • Depression and anxiety – This association is tricky. Turns out that how kids use screen time has more impact on whether or not it helps or harms mental health. Social media used in moderation can actually enhance social support and connection. One study showed that older adolescents who used social media passively (by only viewing content) reported declines in well-being and life satisfaction, while those who actively engaged with social media by posting and interacting with others didn’t experience those declines.
  • Poor learning – Evidence continues to show limited educational benefits of media for children younger than two years. Young children typically have difficulty learning from two-dimensional video representations. They need that back-and-forth social engagement to truly learn new words/colors/numbers/etc. While there have been occasional studies that show some educational benefit very early on (such as one in which children as young as 15 months were able to learn sign language symbols after 3 weeks of watching a video 4x/week), when those symbols were taught to children by their parents, they retained more knowledge and memory of those symbols for a longer period of time. Older children are more capable of learning material from educational apps.
  • Aggressive behavior – There have consistently been strong associations documented between violent media content and child aggressive behavior. This is true both for video games and television, movies, etc.

But it’s not all bad! Here’s what we know about some of the benefits:

  • Video-chatting and social bonds – From a very young age, babies are able to create social bonds through video-chatting. Given the benefits of social bonds, especially those with relatives far away, video chats are probably just fine at any age. I remember seeing the strength of those “video-bonds” in action when my usually-slow-to-warm-up twins took off running at the airport in Israel to give their grandparents excited hugs, even though they hadn’t seen them in over a year in “real” life. Even I was surprised at how bonded they already were from a purely video-based relationship!
  • Learning – I know, I just said that media is not helpful for learning in young children. But children preschool aged and older can benefit more from educational programs. High-quality TV programs (i.e. PBS offerings like Sesame Street and Mr. Roger’s Neighborhood) can demonstrably improve cognitive, linguistic and social outcomes for children 3-5 years of age.
  • Building empathy – Just as reading books has been shown to increase empathy with others and can facilitate understanding of other cultures, reading e-books or watching movies can likely do something similar. There’s evidence that being exposed to character-focused media can break stereotypes and help children understand people from whom they differ.
  • Stronger support networks – When I was a resident in pediatrics, I remember marveling at what support the vast online community was able to provide for some of our sickest children, particularly those in the cancer ward who often had extended stays. These teenagers would post blogs and draw great strength from their vast online cheerleading squad.

Clearly there’s a benefit in setting screen time limits for our children. But some say we should stop focusing so much on their screen time and instead turn that focus on ourselves (a psychological selfie, if you will). If you’ve ever noticed that your kids tend to be the most difficult precisely at that moment when you just need to get something done on your computer or phone, you’re probably not imagining it.

Technoference is the term for interference of digital devices on our social interactions and relationships. One interesting study from 2017 looked at 172 dual-parent families, and found that increased technology use in parents was associated with increased hyperactivity, tantrums and sadness in children. When parents are using their screens around children, they naturally have decreased eye contact, fewer spontaneous conversations and less engaged responsiveness. Essentially, there’s an “absent presence;” the parent is there but not there.

Now of course it’s possible (and likely) that parents with particularly “difficult” children are more likely to turn to their screens as a way to relieve stress. Causation goes both ways. But what probably happens is a difficult cycle in which parents use media, kids act out, parents get exhausted and frustrated and turn to more media, causing children to act out even more. I know that for me, reading about this study made a light bulb go off about why my kids seem to be at their worst whenever I’m on-call. Seems that although adults don’t have clear guidelines on screen time limits, we could probably all benefit from more media-free space in our family lives.

Dr. Hovav is a board-certified Pediatrician in CA and Fellow of the American Academy of Pediatrics. She lives in Sherman Oaks with her husband and three young children, boy/girl twins and their wanna-be-a-triplet little brother. She can be found caring for patients in Studio City at Beverly Hills Pediatrics -The Valley.