The development of this statement was made possible through an unrestricted grant from TELUS. This statement was reviewed by the Community Paediatrics Committee, the Early Years Task Force and the Mental Health and Developmental Disabilities Committee of the Canadian Paediatric Society. It was also reviewed by representatives of the College of Family Physicians of Canada. Special thanks are due to Professor Mary L. Courage, of Memorial University of Newfoundland and Labrador, to Dr Claire M. A. LeBlanc, with McGill University Health Centre, and to Dr Mark Tremblay, of the Healthy Active Living and Obesity Research Group (HALO), for their reviews and feedback. Thanks also to Jennie Strickland, for statement drafting, and to Jessie McGowan, for reviewing the literature.
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But parents and health providers remain concerned. Children in 1970 began watching TV at 4 years old, according the American Academy of Pediatrics. Today, tots as young as 4 months are already tapping tablets. And these digital natives are spending seven hours a day on TVs, computers, smartphones and other electronic devices by the time they reach school. This digital shift has happened so quickly that the studies are still just scratching the surface of what the long-term impact could be.
“We sat with him and played educational apps, and at age 4, he skipped preschool and went straight into kindergarten, which I attribute in part to the iPad,” South, 36, told Moneyish. “But he (7) and my daughter (4) have become obsessed. It’s so easy for them to zone out on it - just as it is for adults - and now when they wake up in the morning, it’s the first thing they try to grab.”
What amount of screen time is appropriate for children? How do you know how much screen time to allow and what to limit? Here are some recommendations from the American Academy of Pediatrics and the Canadian Paediatric Society:
Children who spend more time engaged with screens are less able to accomplish age-appropriate life skills such as tying their shoes, riding a bike, or swimming. Preschool children who are exposed to more screen time than playtime are less likely to be able to build with blocks.TheTelegraph, http://www.telegraph.co.uk/education/educationnews/10767878/Infants-unable-to-use-toy-building-blocks-due-to-iPad-addiction.html
Tables 2 and 3 show the associations of screen time, self-reported vigorous physical activity and objectively measured physical activity with self-reported measures of mental health status, i.e. symptoms of anxiety, depression, and somatic complaints (Table 2) and self-esteem and life dissatisfaction (Table 3). After adjustment for potential confounders (sex, maternal education and percentage body fat), reporting less screen time was associated with a significantly lower risk of reporting symptoms of depression (RR = 0.33, 95% CI = 0.14–0.76), anxiety (RR = 0.44, 95% CI = 0.23–0.84), low self-esteem (RR = 0.31, 95% CI = 0.15–0.66) and life dissatisfaction (RR = 0.38, 95% CI = 0.20–0.72). Self-reported vigorous physical activity showed similar associations (Tables 2 and 3), but objectively measured physical activity was not associated with any of the mental health outcomes (despite being positively correlated to self-reported vigorous physical activity (see S1 and S2 Tables). The relative risk of reporting somatic complaints was marginally lower for those reporting lower screen time (RR = 0.55, 95% CI = 0.29–1.03) but this outcome was unrelated to both self-reported vigorous physical activity and objectively measured physical activity (Table 2).
Participants were asked the following question: „How often, per week, do you perform physical activity that makes you breathe more rapidly or sweat? The variable was scored on a six-point Likert scale, with the following response options: 1 = “never”, 2 = “less than once a week”, 3 = “once a week”, 4 = “2–3 times a week”, 5 = “4–5 times a week”, 6 = “almost every day”. For analysis, the variable was recoded using the following two categories: Less frequently = “less than 4 times a week” and more frequently = “4 times a week or more”, based on international physical activity guidelines stating that children and adolescents should participate in vigorous-intensity physical activity at least 3 days a week .
The researchers found that girls were more prone than boys to spending significant lengths of time on social media — at 13, about one in two girls spent more than an hour on these sites every day, and the gap held throughout later years of adolescence. And as their social media use increased throughout adolescence, their well-being declined. Well-being was measured by how happy they are with their lives, plus any emotional and behavioral problems they have.
Four hundred and eleven tenth-grade students (age 15–16 years, 47% boys and 53% girls) from six elementary schools in metropolitan Reykjavik, Iceland, were invited to participate in the study; 315 (79%) of which agreed to participate. Non-participation was mainly due to absence from school during measurement days and lack of interest in the study. Data collection was performed between mid-April and early June of 2015. Participants provided information regarding their background, health and lifestyle by answering a tablet-based questionnaire (in Icelandic) administered at school under the supervision of research team members. The questionnaire addressed age, sex, maternal education (as a proxy for socioeconomic status), participation in screen-based activities, weekly frequency of vigorous physical activity, symptoms of mental health problems (depression, anxiety and somatic complaints), self-esteem and life satisfaction. Objective measurements of free-living physical activity, weight, height and body composition were also performed. Written informed consent was obtained from all participants and their guardians. Strict procedures were followed to ensure confidentiality. The research project was approved by the Icelandic Data Protection Authority and the National Bioethics Committee as well as the Icelandic Radiation Safety Authority.
“We believe there is a clear need for Apple to offer parents more choices and tools to help them ensure that young consumers are using your products in an optimal manner,” read the letter written by Jana Partners LLC and the California State Teachers' Retirement System, which together own a reported $2 billion stake in Apple.
Increased screen time is displacing face-to-face interactions with family members.Common Sense Media. Zero to eight: Children’s media use in America 2013; A Common Sense research studyPagani LS, Lévesque-Seck F, Fitzpatrick C. Prospective associations between televiewing at toddlerhood and later self-reported social impairment at middle school in a Canadian longitudinal cohort born in 1997/1998. Psychol Med 2016;46(6):3329-37. High levels of screen time at age 2 are associated with social isolation, aggression, and antisocial behaviors in middle childhood.
"The key to digital media use and happiness is limited use," said the study’s lead author and San Diego State University professor Jean Twenge, in the report. "Aim to spend no more than two hours a day on digital media, and try to increase the amount of time you spend seeing friends face-to-face and exercising--two activities reliably linked to greater happiness."
Physical activity may have positive effects on mental health in adolescents via physiological, biochemical and psychological mechanisms . It may improve mental health by having beneficial effects on body composition [40,42] and levels of mood-regulating neurotransmitters in the brain . Regular physical activity may also promote mental health by improving self-esteem, self-efficacy and cognitive and psychological function, reducing distress [20,55], and increasing social interaction and support [55,57,58]. Increased screen time has been associated with poorer mental health among adolescents [21,22,37], potential mechanisms underlying such associations include: 1) negative effects of sedentary behavior on body composition ; 2) psychosocial and psychological effects, as media use via the internet provides adolescents with diverse opportunities for comparing themselves with others. Discrepancies between these publicized ideals and the self could cause social pressure and mental health problems ; 3) screen time may negatively affect sleep , which might have unfavorable effects on mental health ; 4) screen time may displace physical activity , resulting in loss of beneficial effects of exercise on mental health.
Recent studies confirm a strong association between parents’ screen time and that of their children , raising concerns that increasing media presence is displacing quality (face-to-face) parent–child and family interactions . A recent study of smartphone use in fast-food restaurants observed that as time spent by parents on their phones increased, so too did the likelihood of children acting out to gain attention, often leading to negative interactions . Another study found that parents who allow 1- to 4-year-old children to use their smartphones frequently also report offering the phone to reward or distract more often. Consequently, their children ask for the phone—and become upset if refused—more often .
Global self-esteem was assessed using the Rosenberg Self-Esteem Scale . The scale consists of 10 statements, each rated as positive or negative, with four response options: 0 = “strongly agree“, 1 = “somewhat agree“, 2 = “somewhat disagree”and 3 = “strongly disagree“. A score ≥ 15 points reflects a greater level of self-esteem. The Rosenberg scale has been widely used for evaluating self-esteem of young people, and its reliability and validity are well documented .
Information for parents is available at www.caringforkids.cps.ca
Free-living physical activity was objectively measured using small (3.8 cm x 3.7 cm x 1.8 cm) and lightweight (27 g) triaxial raw signal accelerometer-based Actigraph activity monitors (model GT3X+ ActiSleep, Actigraph Inc. Pensacola Florida). Each participant was asked to continuously wear the monitor on his/her non-dominant wrist for 7 consecutive days. A minimum of 3 valid schooldays and 1 valid non-schoolday was set as an inclusion criterion. Days with a wear-time of ≥ 14 h from 12 midnight to 12 midnight the following day were considered valid. Raw triaxial data (in milliG‘s) sampled at 80 samples per second (Hz) were reduced to the vector magnitude of activity counts over 60 s epoch and averaged over all valid days using Actilife software from Actigraph (Pensacola, FL, USA; version 6.13.0) and customized programs in Matlab (The Mathworks, Natick, MA, USA; version R2013a). Participants were categorized as having higher and lower levels of objective total physical activity, using the group median value as a cut-off.
Participating in vigorous physical activity at least 4 times/week was associated with reduced risk (42–69%) of reporting the various mental health problems examined in our study (excluding somatic complaints). Previous findings on the impact of vigorous physical activity on mental health in youth have been mixed, perhaps due to variations in participant age and methodologies to evaluate physical activity and mental health outcomes . In a study on Chinese college students , depression and anxiety were not found to be associated with frequency of physical activity alone, but were negatively associated with a measure that also accounted for intensity and duration of the activity. Further, self-reported vigorous or moderate-to-vigorous physical activity in adolescents was not found to be associated with symptoms of depression and anxiety [23,24] or low self-esteem . Life satisfaction was, however, associated with self-reported physical activity in Iranian youth , and quality of life was related to self-reported weekly frequency of moderate-to-vigorous physical activity in the study by Iannotti et al. .
Less screen time (below the group median of 5.3 h/day) and more frequent vigorous physical activity (≥4x/week) were each associated with reporting fewer symptoms of depression, anxiety, low self-esteem, and life dissatisfaction. No significant associations were observed between objectively measured physical activity and mental health outcomes. Interactive regression analysis showed that the group reporting both less screen time and more frequent vigorous physical activity had the lowest risk of reporting symptoms of depression, anxiety, low self-esteem, and life dissatisfaction.
This article was originally published on Jan. 10, 2018 and has been updated with new research.
3Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, Ulm University, Eythstraße 24, 89075 Ulm, Germany; ed.mlu-nim@tdnarB.einahpetS (S.B.); ed.mlu-nim@hcstibaW.nitraM (M.W.)
We know that screen time has a significant impact on today’s children. However, parents can follow these simple tips to ensure the most appropriate exposure to screens that will provide optimal outcomes for their children:
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Children who watch a lot of television in early years are at a higher risk of becoming overweight.Courage ML, Setliff AE. When babies watch television: Attention-getting, attention-holding, and the implications for learning from video material. Developmental Review 2010;30(2):220-38. Children who watch just 1 hour per day of TV are 50 percent more likely to be overweight than children who watched less.Shenouda N, Timmons BW. Preschool focus: Physical activity and screen time. Hamilton, Ont. Child health and exercise medicine program. McMaster University, Issue 5, January
Research suggests that staying glued to screens could be making teens more depressed. A recent study from San Diego State University analyzed data from the Monitoring the Future survey, which asked more than a million eighth, 10th and 12th graders about how much time they spend on smartphones, tablets and computers. It also quizzed them on their face-to-face interactions and their overall happiness. And it found a correlation between increased screen time and increased unhappiness in the kids addicted to their devices, compared to the teens who spent more time on non-screen activities like sports, reading newspapers and magazines and IRL social interactions.
Competing interests: The authors have declared that no competing interests exist.
Apple has responded to the recent backlash by promising to do more. “We have new features and enhancements planned for the future, to add functionality and make these tools even more robust,” Apple added in its statement to Moneyish. “We are committed to meeting and exceeding our customers’ expectations, especially when it comes to protecting kids."
Self-esteem And Screen Time
Reports of less screen time and more frequent vigorous physical activity were associated with lower risk of reporting mental health problems among Icelandic adolescents. Those who reported a combination of engaging in less screen time and more frequent vigorous physical activity had the lowest risk, suggesting a synergistic relationship between the two behaviors on mental health outcomes. Our results support guiding youth towards more active and less sedentary/screen-based lifestyle.
Dividing the participants into four subgroups based on both self-reported screen time and vigorous physical activity (Table 4) revealed that those reporting both less screen time and more frequent vigorous physical activity had a significantly lower risk of reporting symptoms of depression (RR = 0.06, 95% CI = 0.01–0.41), anxiety (RR = 0.16, 95% CI = 0.06–0.45), low self-esteem (RR = 0.16, 95% CI = 0.05–0.48) and life dissatisfaction (RR = 0.30, 95% CI = 0.15–0.61) compared with those reporting both greater screen time and less frequent vigorous physical activity, after adjusting for sex, maternal education and percentage body fat. A significantly lower risk of reporting life dissatisfaction was also found for those reporting having both less screen time and less frequent vigorous physical activity compared with those reporting more screen time and less frequent vigorous physical activity. No associations were observed between the combined screen time-vigorous physical activity subgroups and their reported somatic complaints.
Received: November 10, 2017; Accepted: April 10, 2018; Published: April 26, 2018
“I sat down with them to watch ‘Screenagers’ [the 2016 documentary delving into how technology impacts kids’ development and self esteem] and they got the message. My 14-year-old went off of Snapchat for a month,” said Dr. Lindholm. “But I still find things, like one kid posting a video of herself dancing in a towel on Snapchat, or making stupid poses she’s seen grown women doing. And it’s daunting.”
Excessive screen time in children is tied to a host of diseases, which includes insulin resistance and cardio-metabolic diseases. A study published in the BMJ was able to link screen-based sedentary behaviour to adiposity (increased body fat) and insulin resistance. It concludes by saying that reducing screen time could help in preventing type 2 diabetes in children.
Screen time can pose many negative risks to children’s health and overall development. However, there are ways for parents to promote a healthier family lifestyle and manage their children’s screen time. Remember to find the balance between screen time and activities that are crucial to learning and development such as physical activity, outdoor play, creativity, sleep, and face-to-face interaction.
Data Availability: All relevant data are within the paper and its Supporting Information files.
4Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Steinhövelstraße 5, 89075 Ulm, Germany; firstname.lastname@example.org