This is the first in a series of blogs about children and technology.
We’ve wanted to write about this subject for the past two years. It has become painfully clear to us that electronics/screen time (TVs, computers, tablets, and smart phones) has become a major concern as pediatricians. The effect it’s having on kids and adolescents is staggering. A typical day in our office will involve evaluations for ADHD, learning difficulties, anxiety, depression, sleeping problems, and extreme behaviors.
We’ll go ahead and call it an EPIDEMIC.
Most parents today grew up with electronics, including smart phones while they were in high school. It is a big part of who they are and their way of life. Consequently, they introduce screens to their children at young ages. Kids will often see their parents in front of screens. No one is to blame. Technology moves lightning fast. It moved so fast that science got a late start and is now telling us there are inherent dangers in what we are doing.
Let’s start with some science first:
When every finger swipe brings about a response of colors and shapes and sounds, a child’s brain responds gleefully with the neurotransmitter dopamine, the key component in our reward system that is associated with feelings of pleasure. Dopamine hits in the brain can feel almost addictive, and when a child gets too used to an immediate stimuli response, he/she will learn to always prefer smartphone-style interaction – that is, immediate gratification and response over real world connection. This is a mild version of the dangerous cycle psychologists and physicians see in patients with drug and alcohol addictions.
The Critical Period
Between birth and age three, our brains develop quickly and are particularly sensitive to the environment around us. This is called the critical period in some circles because the changes that happen become the permanent foundation upon which all later brain function is built.
A child needs specific stimuli from the outside environment for the brains neural network to develop normally. Spend too much time in front of a screen and development becomes stunted. Their social skills (frontal lobe) can be effected as well. Empathy, the near-instinctive way you and I read situations, get a feel for other people, can be dulled, possibly permanently. Heavy parent use of mobile devices is associated with fewer verbal and nonverbal interactions between parents and children.
AAP recommendations for children younger than 2 years were based on research on TV and videos, which showed that in-person interactions with parents are much more effective than video for learning of new verbal or nonverbal problem- solving skills. Before 2 years of age, children are still developing cognitive, language, sensorimotor, and social-emotional skills, which require hands-on exploration and social interaction with trusted caregivers for successful maturation. Therefore, adult interaction remains crucial for toddlers to learn effectively from digital media.
For example, from 12 to 24 months of age, toddlers can begin to learn novel words from commercially available “word learning” videos, but only if their parents watch with them and reteach the words, essentially using the videos as a learning scaffold to build the language skills. In fact, recent reviews of hundreds of toddler/preschooler apps labeled as educational have demonstrated that most apps show low educational potential, target only rote academic skills (eg, ABCs, colors), are not based on established curricula, and include almost no input from developmental specialists or educators.
An additional concern is that the formal features (ie, bells and whistles) that are designed to engage the child in an interactive experience may actually decrease the child’s comprehension or distract from social interaction between caregivers and children during use.
Here are some troubling numbers:
In 2011, 52% of children zero to eight years of age had access to a mobile device. By 2013, this access had increased to 75% of 0- to 8-year-olds.
A large international study (2013) with almost 300,000 children and adolescents found that watching between 1 and 3 hours of TV a day led to a 10% to 27% increase in risk of obesity.
(It should be noted that TV viewing in children has decreased dramatically in the past two years with content moving to smart phones and tablets)
Here are some frequently heard comments from our parents:
“Sometimes I just need to get things done.”
YES! Sometimes we parents need to get stuff done and cannot supervise our kids like we would like to. We like to think of these as worst case scenarios, not something we do regularly. Don’t forget that engaging even our youngest toddlers in household responsibilities early on results in benefits for the entire family in the long run. Yes, it requires a lot of work up front, but it will be worth it
“He focuses better on the TV or tablet than on anything else.”
Digital content can be very stimulating. However, evidence shows that digital media is likely harmful to attention and executive function. See this article about a study that was published in Pediatrics in 2011. This may be one of the factors as to why ADHD numbers have significantly risen over the past decade.
As a child spends more time in front of a screen, their frontal lobe has a harder time turning on when acknowledging a spoken voice, looking at books, or picking up visual clues. It prefers the digital or electronic format.
“I don’t really have a strict limit because we only use educational media.”
Even the AAP distinguishes between quality digital media and media that should be avoided, such as violent or fast-paced media. This doesn’t mean that “educational” shows/apps don’t count. Kids need time to engage in unstructured play. They need to be read to, talked to, and engaged with. They also need regular physical activity and adequate sleep.
“My kids can’t settle down for the night without having the TV on.”
Results from one study show a relationship between screen time and poor sleep, especially when screens are used in the evening hours. As mentioned above, we are seeing a lot of kids with sleep issues. Some are due to common, age appropriate reasons, but many are due to screen time.
“It helps my child calm down when she gets upset.”
Distraction can be helpful in distressing or painful situations. This is why many children’s hospitals have child life departments available to help during painful or otherwise anxiety provoking procedures. We use virtual reality in our office for vaccines and blood work. However – Using screens to alleviate the discomfort of everyday disappointments or frustrations interferes with our children learning healthy emotional regulation without reaching for an external device.
One reason that children may be less socially engaged during digital play is that gaming design involves behavioral reinforcement meant to achieve a maximum duration of engagement, which may explain why interrupting children’s digital play leads to tantrums.
“The TV is on in the background all day, but they’re not actually watching it.”
However, having the TV on in the background distracts children from their play, interferes with good language exposure, and decreases parent-child interaction, all things that can have an effect on their development. It is amazing what kids pick up from background TV. Yes, my son, at 4 years old, asked me if my heart was healthy enough for sex!
Here are our recommendations for ages 1-5:
1) No screen time for anyone under 24 months of age
Exceptions are video chatting (Facetime) or worst case scenarios (DMV, illness/doctor’s visit, etc.)
2) No screens in bedroom
Having screens in the bedroom was an independent factor associated with obesity. As kids get older, the temptation and addiction will only get worse. This is a place for quiet time, music, drawing, reading, sleeping, etc.
3) For ages 2 through 5 years old: No more than 1 hour a day of quality content.
Use sources like Common Sense Media to help you determine what is quality and what is not. Most evidence now suggests that long amounts of time in front of a screens is more damaging than short exposure (30-45 minutes).
We recommend teaching your kid that screens are an earned privilege not an expectation. It should never be a part of your everyday routine. Kids can look out the window while in the car. They can eat their meal or they can be hangry by their next one.
4) Find apps and games that you can play with your child.
Studies show that retention is much better when educational apps/games are played with a parent vs. alone with a device.
5) Develop a Family Media Use Plan
6) Watch the time YOU spend in front of screens
Try your best to wait until the kids are asleep. If it is work related, let them know.
Finally, we know parenting is the hardest job there is. There is no perfect parent. It is our goal to let you know electronics can be harmful and potentially damaging to a child’s developing brain through the age of 5. Hopefully we have given you some tips on how to safely raise your kids in an electronic/digital world.
 Brown A; Council on Communications and Media. Media use by children younger than 2 years. Pediatrics. 2011;128(5):1040–1045
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Do babies learn from baby media? chat as an exception to media Psychol Sci. 2010;21(11):1570–1574 restrictions for infants and toddlers. Richert RA, Robb MB, Fender JG, Wartella E. Word learning from baby videos. Arch Pediatr Adolesc Med. 2010;164(5):432–437
 Vaala S, Ly A, Levine M. Getting a Read on the App Stores: A Market Scan and Analysis of Children’s Literacy Apps. New York: The Joan Ganz Cooney Center at Sesame Workshop; 2015. Available at www.joanganzcooneycen ter.org/wp-content/uploads/2015/12/. Guernsey L, Levine MH. Tap Click toddlers learn language. Child Dev. Read: Growing Readers in a World of
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 Rideout V. Zero to Eight: Children’s Media Use in America. San Francisco, CA: Common Sense Media; 2013
 Braithwaite I, Stewart AW, Hancox RJ, Beasley R, Murphy R, Mitchell EA; ISAAC Phase Three Study Group. The worldwide association between television viewing and obesity in children and adolescents: cross sectional study. PLoS One. 2013;8(9):e74263
 Michelle M. Garrison, Kimberly Liekweg, Dimitri A. Christakis Pediatrics July 2011, VOLUME 128 / ISSUE 1
Article Media Use and Child Sleep: The Impact of Content, Timing, and Environment
 Hiniker A, Suh H, Cao S, Kientz JA. Screen time tantrums: how families manage screen media experiences for toddlers and preschoolers. In: CHI’16. Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems; May 7–12, 2016; New York, NY. 648–660. Available at: http:// dl. acm. org/ citation. cfm? doid= 2858036.2858278. Accessed May 9, 2016