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Could I have a word?: Developmental screen time

NOTE: “Could I have a word?” are short articles with information from scientific research within the last 5 years.

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Introduction


When I published “Children and Screen Time,” it led to an interesting conversation with a friend. He brought up some great points: not all screen time is the same, the term “screen time” itself is vague, and exposure to technology at a young age fostered skills in him that prepared him for the 21st century workplace. He also mentioned how he has used technology with his own young son. He said, “...when my little guy says ‘Dad, how do frogs eat?’ and I can pull up an educational kids’ video that not only shows him [the answer] but also educates him on the life cycle of a frog, I think that’s rad.”


This conversation led me to reflect on the potential benefits of screen time for children.

I thought about another friend who used to work in a children’s hospital. She worked with children who spent months or even years in treatment. For those children, remaining connected to family and friends was critically important for their well-being. So, my friend fought to acquire technology that brought joy into their daily lives while also connecting them to family, friends, and other patients. Didn’t these children benefit from screen time?


I also thought about my own youth. After a typical small town childhood, sudden loss and serious illness hit my family like a tempest. During my teenaged years, video games were a way to connect with my friends every day. Plus, while I was immersed in virtual worlds, I experienced relief from the difficult reality of life. Once I had grown up and found independence, I established a more balanced relationship with games and faced the difficulties of my earlier years with the help of friends and a counsellor. Didn’t I benefit from screen time?


Now I see that writing just one article about screen time is a disservice. We already know that there are risks associated with excessive screen time for young children. Now, I want to investigate the question “what are the potential benefits to screen time for children?” Knowing the answer to this question can help us to maximize the benefits and minimize the risks to support the healthy development of our children. Then, we can truly call our children’s technology use “developmental screen time.”


There are Different Kinds of Screen Time


Just as my friend said, “screen time” is a vague term that encompasses many different kinds of activities. A group of Australian researchers identified five types of screen time:

  • educational (e.g. online classes, using learning apps),

  • interactive (e.g. playing video games, browsing the internet),

  • passive (e.g. watching TV, watching online videos),

  • social (e.g. chatting with colleagues, friends, or family online), and

  • other [6].

It is reasonable to expect that each of these different kinds of screen time might have different effects on a child. For instance, passively watching the TV might have different effects on development than interactively learning French on an app.


Furthermore, the activity level within each kind of screen time may vary. For example, some apps and video games (interactive screen time) involve exercise or walking around in nature. However, other video games involve sitting in a chair while you collect digital herbs for hours. Given that one of these activities is sedentary while the others involve physical activity, we could also expect them to have different effects.


An Australian study followed 4013 children for four years [6]. These children were 10-11 years old at the start of the study and 14-15 years old at the end. The researchers tracked the effects of different kinds of screen time on health-related quality of life, physical health, school achievement, and socio-emotional outcomes. Here is what the research found:

  • Educational screen time had a positive effect on school achievement and no negative effect on other outcomes.

  • Interactive screen time had a positive effect on school achievement but had a negative effect on all other outcomes.

  • Passive screen time had a negative effect on all outcomes.

  • All effect sizes were small.

The Australian researchers noted the small effect that all kinds of screen time had, whether positive or negative and stated, “High levels of concern about children’s screen time... may be unwarranted” [6].


Although the effects of screen time on the children in this study were small, these children were already school age when the study began and were adolescents by its ending. By comparison, a Canadian study (which I cited in “Children and Screen Time”) showed significant negative effects in all outcomes for children ages 3 to 6. In short, the age matters when it comes to screen time.


Age Matters


There are many different terms that refer to different age groups during childhood. Some common terms include:

  • infant (under 1 year),

  • toddler (1-3 years),

  • preschool age (3-5 years),

  • school age (6-12 years),

  • preadolescence” (10-13 years), and

  • adolescence (10-19 years generally, but there are many definitions).

These terms are imprecise and sometimes the years overlap. This is because all children develop in their own way, at their own speed, as determined by the interaction of many different influences. Plus, cultural, social, legal, political, and temporal factors also play into the definition of these terms. It’s complicated!


Despite this complication, it is agreed upon by the American Academy of Pediatrics, the Canadian Paediatric Association, and the World Health Organization that children ages 0-2 (zero to two) should spend no time on screens at all [2, 3].


What about preschool and school age children, or preadolescents and adolescents? At this time, the research is not so sharply defined. There are not single studies that answer a research question such as “How do the different kinds of screen time affect developmental outcomes for infants, toddlers, preschool age children, school age children, preadolescents, and adolescents?” For this purpose, different kinds of research are needed, such as a systematic review or meta-analysis.


For a systematic review, the researcher(s) take all the current studies on a topic and they review them, then summarize these results. A meta-analysis is like this, but the researcher(s) also use a statistical analysis to transform all the different data into one overall trend. Both methodologies are useful for understanding a big topic such as “effects of screen time on children.” Both methodologies are also very intensive and time-consuming.


The good news is that large organizations such as the American Academy of Pediatrics, the World Health Organization, and the Canadian Paediatric Society have conducted this kind of research in order to understand the risks and potential benefits of screen time and to make recommendations for caregivers.


Know the Risks


The Canadian Paediatric Society states, “There are no proven benefits of media exposure for infants and toddlers, and some known developmental risks” [3, p.482]. Research on the risks of excessive screen time agrees in many areas. The risks outlined by the Canadian Paediatric Society are shown in Table 1. There may be other risks that are not listed here.

Note: all data from [3] unless otherwise stated.


Know the Potential Benefits


In addition to these known risks, there may also be some benefits to screen usage. Just like my friend suggested, screens may be usable in a way that helps children to learn or teach important skills. Technology can also help young people stay connected during periods of separation and stress, such as the children whom my friend worked with in the hospital, or even my young self.


Researchers have noted how important technology has been in during the COVID-19 pandemic. They state that screen time has helped to keep children connected to friends, family, and school during lockdowns [4, 5]. Online classes have allowed school children, as well as adults in college and university, to continue learning even while schools were closed.


The COVID-19 pandemic also saw the greatest movement from in-person to online or video counselling and psychotherapy services ever [7]. Without screen time, many vulnerable children and adults would not have been able to meet with their mental healthcare providers.


Other research on the potential benefits of screen time is still inconclusive. This means that more research is needed to confirm the results. Read Table 2 with a critical eye and check it against your own experience.

Note: all data from [3] unless otherwise stated.


Consult Expert Recommendations


Before looking at the recommendations made by the Canadian Paediatric Society's Digital Health Task Force [3], it is important to remember that recommendations are not prescriptions.


Recommendations are guidelines; prescriptions are rules to be followed. A doctor recommends you go for a walk every day to stay healthy. The same doctor prescribes insulin so you do not go into diabetic shock.


In the context of children and screen time, every caregiver has the autonomy to raise their child the way they believe is best, so long as it is not abusive nor neglectful. The expert recommendations given below can help guide the decisions caregivers make about their children's technology use. These recommendations can help us all to avoid or mitigate the risks and maximize the potential benefits of screen time. Ultimately, we may all choose differently.


Be Mindful

  • Assess your own screen habits first – “how am I using it? how much am I using it? when am I using it? why am I using it?”

  • Coach children to recognize and question advertising; stereotyping; and messages about body image, disability, gender, race, religion, sexuality, violence, and so on.

  • Remind yourself: excessive screen time = lost learning.

Minimize Screen Time

  • 0 screen time under 2 years.

  • <1 hour/day of screen time from 2 to 5 years.

  • Avoid screens at least 1 hour before bed.

  • Avoid sedentary screen time with children younger than 5 years.

  • Maintain daily screen-free time (especially meals and book reading).

Mitigate Risks

  • Be present and engaged when screens are used.

  • Curate: be aware of the content your children use and prioritize age-appropriate, educational, and interactive programming.

  • Use strategies to teach calming, self-regulation, and limit-setting while your child is using technology. This could be an opportunity to learn!

Model Healthy Screen Use

  • Choose healthy alternatives to screens such as active, creative, hands-on, outdoors, and reading activities.

  • Turn off devices during family time (especially meals).

  • Turn off screens when they are not in use and avoid background TV.

Use Practical Strategies

  • Choose together/Choose purposefully: “Let’s watch or play this thing at this time for this reason.”

  • Combine touch screen play with active, creative, and imaginative play.

  • Co-Play/Co-View: connect with your child over what you are playing or watching. Make it into a bonding experience.

  • Create a Family Media Plan [1].

  • Do not use smart phones as a distraction or reward unless necessary [3].

  • Do not make a “phone sandwich” (adult---phone---child). That’s just rude.

Conclusion


There is such a thing as "developmental screen time." We can use technology to enhance our children's curiosity and desire to explore and learn. We can use technology to connect with the people we care about when they are far away and when they are sitting right beside us. We can use technology to improve access to education and mental healthcare. Yes, excessive screen time is harmful, but screen time itself is not necessarily detrimental.

Caregiver involvement in children's screen time is critical. We need to develop our awareness and understanding of the kinds of screen time, how it affects children of different ages, and the risks and potential benefits. With this knowledge and the guidance of expert recommendations, we are better prepared to ensure the time our children spend on technology supports their healthy development.

References


[1] American Academy of Pediatrics. (n.d.). Family media plan. https://www.healthychildren.org/English/media/Pages/default.aspx#home


[2] American Psychiatric Association. (2020). What do we really know about kids and screens? Research by psychologists and others is giving us a better understanding of the risks and potential benefits of children’s and teens’ use of digital devices. https://www.apa.org/monitor/2020/04/cover-kids-screens


[3] Canadian Paediatric Society. (2017). Screen time and young children: Promoting health and development in a digital world. Paediatrics & Child Health, 461-468.


[4] Fry, C. (2021). Sleep deprived but socially connected: Balancing the risks and benefits of adolescent screen time during COVID-19. Journal of Children and Media, 15(1), 37-40.


[5] Nagata, J. M., Magid, H. S. A., & Gabriel, K. P. (2020). Screen time for children and adolescents during the coronavirus disease 2019 pandemic. Obesity, 28(9), 1582-1583.


[6] Sanders, T., Parker, P. D., del Poro-Cruz, B., Noetl, M., * Lonsdale, C. (2019). Type of screen time moderates effects on outcomes of 4013 children: Evidence from the Longitudinal Study of Australian Children. International Journal of Behavioural Nutrition and Physical Activity, 16, 117).


[7] Smith, K., Moller, N., Cooper, M., Gabriel, L., Roddy, J., & Sheehy, R. (2021). Video counselling and psychotherapy: A critical commentary on the evidence base. Counselling and Psychotherapy Research, 22(1), 92-97.

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