Kids and Screens: How Pediatricians Can Support Healthy Media Use Choices

A recent presentation by Cori Cross, MD, FAAP, at the 2018 AAP National Conference and Exhibition in Orlando, Florida provided many of the following insights and suggestions around the issue of screen time and today's youth.

It may come as a surprise (or not!) to know that almost half of all 4 year-olds in the U.S. have their own TV, and three-quarters have their own mobile device. Nearly all kids use mobile devices, most before the age of 12 months. And while most children under 2 years old are on screens over 40 minutes a day, less than half of them are read aloud to.

What does this mean for kids today? Are these stats the new norm, or are they indicative of bigger problems?

The answer is not cut and dry. As with anything, there are pros and cons. We’ll explore what screen time means for kids in the U.S. today.

Pediatricians Can Be Early Advocates for Family Screen Time Plans

How soon should pediatricians begin discussing screen time with parents and kids? The answer is: much sooner than you’d think. Decades ago, children didn’t begin watching TV until about 4 years old, and when they did, they watched in a group setting with their families.

Today, many kids begin interacting with mobile devices in their first year, so it’s important for pediatricians to start the conversation in the first few months of a newborn’s life.

Despite these facts, research from Common Sense Media shows that only 20% of parents say they know the AAP recommendations for children’s media use, and 51% say that they are interested in learning about the recommendations. Clearly, the time to educate and provide guidance is now.

What’s Wrong with Too Much Screen Time Anyway?

When it comes to screen time and kids, moderation is key. Too much of anything can be detrimental, including being glued to devices at all hours. However, the suggestion is not to eliminate screen usage entirely - it has its place and can be fine for short periods each day, and a boon for times like travel or when a child is home sick from school.

The idea is not to make absolute rules about using screens, but to make conscious decisions so that screen time is not something that ‘just happens’ unintentionally.

Time spent on screens is also time away from unstructured play, and social play does not have the same benefits as digital play. Social play helps develop the traits needed for success in life, including:

• Creative thinking
• Persistence to task
• Higher-order thinking skills
• Emotional regulation
• Impulse control

Are There Other Negative Effects of Excessive Screen Time?

Too much screen time can have a lasting impact on kids. Some of the effects include:

• Displacement of real world play time and talk time
• Less verbal interaction with parents / potential for reduced exposure to new words
• Distracted parenting due to constant background noise from devices
• Reduced conversation while sharing meals or taking walks
• Increased (attention-seeking) behavioral issues in kids when parents are on devices
• Self-regulation issues (trouble calming down before sleep)
• Trouble sleeping
• Increased potential for obesity issues (both from sleep issues and lack of exercise)
• Less time spent reading books

How Can Pediatricians Support Parents Around Media Use and Screen Time?

A big thing to educate parents on is that not all ‘educational apps’ are truly educational or useful for the stage their child is at. While very young children may appear to be learning from what’s on the screen, they are not truly able to process what they are seeing until they are older. Parents need to be aware of this and decide how soon to expose their children to online learning tools.

Additional tips that pediatricians can share with parents include:

• Set all devices to ‘Do Not Disturb’ or ‘Silent’ during meals and while riding in the car. Use meal times and car rides to talk and interact with each other.
• Start co-viewing together. Rather than everyone being on their separate devices, try watching a movie, video, or TV show together, then promote real-world reinforcement of what you’ve watched by interacting and talking about it after it’s over.
• Decide on a having a certain amount of ‘screen free’ time before bedtime and stick to it. This will help with winding down before sleep.
• Encourage parents to teach their kids good manners regarding media use. For example, emphasize the importance of putting the device down and making eye contact with someone when talking to them.
• Discuss the importance of talking about internet safety with kids. Support parents in discussing cyberbullying, not sharing private or personal information online, and to be aware of talking to strangers online.
• Help families make a plan for exercise and well being. For example, if screen time is allowed at home, it also means at least an hour of physical activity is expected, as well as limiting device usage before bed.
• Suggest that parents and kids come up with their own screen time plan together, and agree to it. They can even write it down on paper and post it somewhere at home where everyone can easily see it and be reminded.
• Refer parents to online resources such as the AAP,  Common Sense Media, and HealthyChildren.org where they can get more information and create their own Family Media Plan.

The best thing pediatricians can do is to educate early and educate often. Well child visits are the perfect opportunity to open up a conversation with parents around media use. Supporting parents and helping them establish guidelines for their children is an important way for pediatricians to advocate for their patients.