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Pediatricians Elaborate on Screen Guidelines

American Academy of Pediatrics elaborates on official screentime guidelines

screen guidelines for children
Don't let the iPad hijack your child's brain.
Last Monday, the American Academy of Pediatrics released an updated policy statement on screen-time guidelines for children, including the recommendation to make a “family media use plan.” Although the AAP has been criticized (usually by parents or journalists) for its “draconian” recommendations to limit screen time to no more than 2 hours/day for school-age children and teens and to discourage it altogether for children less than two, there’s a growing body of research that support these guidelines. Few parents follow them, and in my experience have never heard them (from their pediatrician or anyone else).

Recently, a large study[1] conducted by Iowa State University followed over a thousand children for 13 months and examined television and video game habits (separately and together). They found screen-time was associated with subsequent attention problems for both television and video games, and, importantly, that children who engaged in more than two hours of daily screen-time were indeed at higher risk for developing attention problems.  Although there are many studies demonstrating screen-time’s health effects[2], this study actually provides support that the “2 hour” rule isn’t arbitrary.  

Let’s go over the recommendations; I’ve added some comments in italics:

  • Keep the TV set and internet-connected devices out the child’s bedroom. This includes iPads, tablets, and smartphones. If families followed this one recommendation, it would eliminate the majority of screen-related issues. Trying to control screen-time with electronic gadgets in the bedroom in nearly impossible. Furthermore, “no electronics in the bedroom” is a standard recommendation for good sleep hygiene—for all of us.

    Recently I asked a family to remove the television and Xbox out of their son’s bedroom. He’d been drawing gruesome pictures at school and telling scary stories that disturbed the other children. We’d already removed all the horror movies and video games, but he continued the behavior and was about to become expelled. Finally, after discussing the subject on multiple occasions over many months, the parents agreed to remove the TV and Xbox out of his room.

    Why is this intervention met with such resistance, even in the face of dire consequences? I suspect it’s become such the norm that the idea seems radical. Regardless, it’s important to appreciate that studies show light-at-night devices are linked to poor sleep[3], depression[4], and impaired cognition[5]. And as you might guess, sleep disturbances in children and teens are at an all-time high.
  • Limit the amount of total entertainment screen-time to less than 1 to 2 hours per day.  If your child is experiencing attention, learning, mood, social, or behavioral issues, I would limit it even further, especially on weekdays. Another good rule is to match each hour of screen-time with an hour of physical activity. (Better yet—an hour of physical activity earns an hour of screens, assuming all homework and chores are done.)
  • Discourage screen media exposure for children less than 2 years of age. I’m more conservative and recommend this for less than three—a lot of the research[6] is done on children three or younger.  
  • Monitor what media your children are using, including websites and social media. This is another recommendation that’s rarely followed. You should have access to your child’s social media accounts and monitor them. Monitoring is a lot easier when the computer can only be used in “family zones” of the house. Additionally, each new iPad, tablet, or smartphone in the home makes monitoring more difficult. Avoid purchasing more devices than you need, and get rid of “extras.”  
  • Coview TV, movies, and videos with children and teenagers. Also, play each video game with your child first before deciding if they are age appropriate/non-violent/etc. Even games meant for younger children are usually quite violent (a teenager first informed me of this and said, “Parents have no idea.” He’s right, and the video game industry banks on this).
  • Model active parenting by establishing a “family media plan”. Enforce a mealtime and bedtime “curfew” for devices, including cell phones.  Establish reasonable but firm rules about cell phones, texting, internet, and social media use.  When I restrict children and teens from their screens as part of treatment, they often complain that their parents continue to text, email, and check Facebook on their phones all evening long. The rationale of “I’m the adult and you’re the child” doesn’t apply here; limiting screens works best when the whole family follows the guidelines. It’s especially critical to turn off phones during dinnertime, which is an important time for the family to connect.  Also, write the rules down and post them in the kitchen or other visible area to keep everyone accountable.

    All children and teens need to hand their phones over before bedtime, and preferably by sundown to limit light-at-night exposure. Do NOT trust that your child or teen won’t use their phone at night (they’ll try to convince you otherwise); they simply don’t have the capacity to self-regulate their use.

If you have tips about managing screens in your household, please share them by commenting. Also, forwarding this article to others (your child’s friends’ parents, teachers, coaches, etc) helps promote awareness at the grassroots level.      

 

[1] Edward L Swing et al., “Television and Video Game Exposure and the Development of Attention Problems,” Pediatrics 126, no. 2 (August 2010): 214–221, doi:10.1542/peds.2009-1508.

[2] Council on Communications and Media, “Children, Adolescents, and the Media,” Pediatrics (October 28, 2013), doi:10.1542/peds.2013-2656.

[3] Takeshi Munezawa et al., “The Association Between Use of Mobile Phones after Lights Out and Sleep Disturbances Among Japanese Adolescents: a Nationwide Cross-sectional Survey,” Sleep 34, no. 8 (August 2011): 1013–1020, doi:10.5665/SLEEP.1152.

[4] Xianchen Liu, “Sleep and Adolescent Suicidal Behavior,” Sleep 27, no. 7 (November 1, 2004): 1351–1358.

[5] Christina J. Calamaro, Thornton B. A. Mason, and Sarah J. Ratcliffe, “Adolescents Living the 24/7 Lifestyle: Effects of Caffeine and Technology on Sleep Duration and Daytime Functioning,” Pediatrics 123, no. 6 (June 1, 2009): e1005–e1010, doi:10.1542/peds.2008-3641.

[6] Council on Communications and Media, “Media Use by Children Younger Than 2 Years,” Pediatrics 128, no. 5 (November 1, 2011): 1040–1045, doi:10.1542/peds.2011-1753.

Victoria L. Dunckley, M.D., is a board-certified child and adolescent psychiatrist specializing in treating children with complex diagnoses and/or treatment-resistant conditions.

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