Orange City Hospital & Research Institute

Screen Time: Boon Or Bane Of 21st Century?

Dr. Pallavi Bapat Pinge

(Developmental And Behavioural Pediatrician)
Orange City Hospital and Research Centre, Nagpur

21st century, year 2020, and we are living in the digital world. If we have a look at our homes andcount the number of appliances and technology-based devices that we need from start of the day till bedtime- we will be amazed to see our dependence on technology!! We have TV, that too ‘smart’ ones for news, entertainment, we have laptops and desktops for ‘work from home’, school and college projects, we have internet to browse and search about everything and anything! We also have smart phones which are an all in1 package-we set alarms, we make video calls, we watch web series on OTT platforms, we are on social media, we have apps for music and radio, we pay bills, get appointments and even attend official meetings on these smart phones! Not only this, we have mobile games, pubG, play station, videogames, nursery rhymes and songs and so many entertainment options for our kids of all ages !!

Undoubtedly, being in this world of technology is indeed very opportune times for all of us! But, as they say anything in excess is harmful….so is this Digitalization! And here comes the demon of excess digitalization- it’s called ‘Screen time’. Some of you must have heard about it, some of you know about it, but are not acquainted with the term- Screen time!!So, what is this screen time? Screen time/Digital screen exposure is the amount of time spent by an individual using a digital/electronic media i.e. a device with a screen such as a smart phone, tablet, computer, television, video games or wearable technology. ‘Digital media’ refers to content transmitted over the Internet or computer networks on all devices, unless particular ones are specified. So, are we having lots of screen time or digital media exposure? Yes, absolutely- because we all are on atleast one of these screens –all the time!! And now the most important question- are we exposing our children to screen time?? Yes…we are!! What is the youngest age at which these kids are exposed to screen time? Have you noticed around you? I have seen as young as 4 month old babies being shown mobile songs and videos by their parents!! Many houses have habit of keeping the TV on all the time, in such houses babies as young as 2months are exposed to this background TV!! So, what are the possible reasons-for introducing these small little dumplings to these screens?? There are many reasons.For Feeding- yes! We expect a 15 month old to sit at one place and finish of his or her meal in 10-15 minutes just like us!! But this toddler who has recently learned to toddle around is more interested in exploring the surroundings!! And so, we give this little one, a mobile video to watch, and then just feed the baby hurriedly!! What a relief! So yes- we use while feeding. Then, we use screens as a babysitting tool! In nuclear family settings as well as in joint families where we have forgotten our age old songs and rhymes to engage our kids, we have forgotten to play with our own kids, we are short of ideas to engage our kids, and we are busy ourselves on our screens-either for work or our entertainment; giving an Ipad/tablet or a mobile with your child’s favourite cartoon to watch is the easiest option to keep him/her engaged! So yes- screens are a babysitting tool! Then, for entertainment- kids now a days are so well acquainted with the touch screen and all other technicalities of the gadgets, that they know how to download a game, how to play it etc. So, gadgets are used for playing video games and mobile games!! Also, many informative apps are available for kids of all ages, which are used by parents to teach their children alphabets, numbers, and even learning apps which help in understanding concepts through audiovisuals!!

There are other reasons also, like to prevent a tantrum, or to end a tantrum; to distract a child from an unwanted demand, or the last resort to keep the child busy ,so that you can do your daily chores!!! !!! So, yes we use screens for our children for various reasons! But, are we heading in the right direction in terms of amount of screen exposure for our kids?? Is your child being exposed to screen excessively?? What is excessive screen time exposure?? How to keep a check on that? Are there any potential benefits? Does screen time have a bad impact on your kid? Does this problem exist in India? Many of us might have the misconception that this is a problem of western world- we don’t have it! To understand this, I would like to shed light on the magnitude of this problem! SO, in high income countries like US and UK, in a study it was found that 66-70% of children in the age group of 2-5 years had more than 2hours of screen time daily! Whereas ,in middle income countries like Thailand, Malaysia, India, nearly 40% of 0-2 year old children spent more than 2 hours/day on screens!!SO, the problem is of equal magnitude everywhere! It has also been observed that screen time exposure increases in weekends compared to weekdays because of greater availability of time and lack of schedule! So, holidays, summer vacations and weekends are more likely to increase the habit of watching screens!! In a study done in Malaysia, 25.7% of urban population had more than 2 hours of screen exposure; where as 32.7% of the rural population had more than 2 hours of screen time exposure! Thus, screen time exposure is prevalent in rural as well as urban areas equally and hence the problem of excess screen time exists in urban as well as rural population!! TV still dominates total screen time and increases with age. Many children accumulate screen time at home and in child care, from a variety of screens that are easily transportable. And the range of exposure to screens is from 2-4 hours/day to more than 15 hours/week irrespective of age!! And hence, people busy in their phones during meals, children occupied with smart phones during metro or train travels or parent and child both engrossed in individual screens while waiting for an appointment at a doctor’s clinic are now-a-days regular scenes unfortunately!! Now let’s focus on the effects of this screen time exposure on children! Early exposure to screen i.e. within 5 years of age can be formative. It can be habit-forming, and early overexposure increases the likelihood of overuse in later life. Also, establishing healthy routines with respect to media use is easier in early childhood than later on. And screen use tends to increase over time to include more entertainment than exclusively educational viewing.

There are potential benefits and risks of screen time affecting the development, psychosocial and physical domains of children. Firstly, the risks of screen time are as follows:

1. Development:
For language development, first two years of life are the most crucial yearsfor the child!! The more stimulation child gets in this time, the more diverse is the language development of this child. However, exposing the child during these two years to screens including background TV has a negative impact on the language development. The use and acquisition of new words, developing vocabulary and comprehension of new words is hampered! Why does this happen? Because Babies do not absorb content from TV which is presented to them in 2D format as compared to the 3D format, when we interact with the baby in person. Infants may imitate some of the specific actions seen on the nursery rhymes between 6 and 14 months, they might even remember brief sequences of the rhymes like head, shoulder, knee and toes etc by 18 months, but they actually begin to understand content on these screens by the end of their second year only. So all the nursery rhymes, songs shown to the baby were a waste of precious time which we as parents could have spent in one to one interaction in ‘Motherese’ or ‘Infant directed speech’ i.e. high pitched but slow speech so that the baby absorbs our facial movements when we speak to him or her and learns from that. The infants and toddlers are have difficulty transferring new learning from a 2D representation of screen to a 3D object in real life and hence are unlikely to learn from TV and other screens in this age group. Also, the sound effects and animation can interfere with story comprehension and event sequencing, thus ultimately leading to no benefit to the child’s development. In mobile videos and songs, infants are exposed to too many stimuli like light, sound, movement and hence are unable to grasp anything out of it. Hence, these children exposed to screens at tender ages of 6-18months have the risk of significant language and communication delays! Some red flags in language development, which as parents you can keep a watch on! No cooing responsively by 6months of age- i.e if baby is not responding to your talks with different sounds-; no babbling words like mama dada, kaka etc by 10 months of age, no gestures like waving bye-bye by 12 months of age, no words other than mama dada, not following simple commands and not pointing for wants by 18 month of age. No 2 word sentences by 2 years of age, not showing body parts by 2 years of age and less than 50 words vocabulary by 2 years of age are red flags regarding language development. In such scenario, you need to intervene and take your doctor’s advice. And hence, considering the tremendous impact of screen time on children, World Health Organization and American Academy of Pediatrics have formed Screen Time Guidelines. According to these guidelines, no screen time is recommended up to 2 years of age; and for children 2-5 years of age not more than total 1 hour of adult directed screen time in a day is recommended i.e. screen time with involvement of the parents, thus making it an interactive watching instead of passive viewing. Screen time has a negative impact on the motor development of children too. There is a delay in achieving motor milestones like walking, running, climbing stairs etc because of reduced opportunities for outdoor play or physical activity as the child is engaged more on screens! In older kids, lack of outdoor play shows its impact on the motor coordination refinement of fine motor abilities of the children! Screen time also has negative effect on feeding. Toddlers who are given screens while feeding are just gulping the food while being engrossed in the screen and hence do not have interest in the food- its texture, color, taste etc! Also, the child doesn’t develop understanding of one’s own satiety and hunger as he or she is forced fed while watching videos! Feeding while watching screens also affects the chewing abilities of the child, child just keeps the morsel in his mouth as he/she is engrossed in the video, child has to be reminded to chew and then swallow! If this continues, child becomes dependent on parents for feeding, doesn’t eat Tiffin in school and is lacking self help skills of feeding self! This eventually affects the nutrition of the child! Screen time also affects the cognitive development of the child by altering short term memory skills, reading and math skills. In a study, 4-5 year olds based on the history given by their parents, were divided into two groups- children with more than 1 hour screen time and children with less than 1 hour or no screen time! These children were then given blank papers, colours and some art material and were told to make or draw whatever they liked without any specific guidelines! It was observed that, children with more screen time needed some clues and guidelines to use the given material; thus showing difficulty in using creativity and imaginative thinking. Whereas children with less or no screen time exposure experimented with the given material and used their imagination and creativity to make different drawing and craft items out of it!! Thus it is evident that, screen time has a negative impact on the cognition of these preschool children.

2. Psychosocial Domain:
In today’s world, as we can observe, our own use of mobile technology demands more intense attention than other activities like reading a book or watching TV. In such situations, we are so engrossed in it, that we are unable to engage in one to one interaction with the family members. Smart phones blur the line between work and home life, the time consumed on the devices is unpredictable and responding often requires emotional investment. For parents, shifting attention between screens and family life can be stressful, tiring and reduces their ability to interact ‘in the moment’ with children. When parents and child both are busy in screens, the quality and the amount of parent child interaction decreases leading lower level of involvement of parents and reduced stimulation for the child from parents. There is a strong association between parents’ screen time and that of their children .As parents are also busy in screens, there is lack of positive role model for the children when they are told not to spend time with screens!! Hence, there is chance of increase in conflicts between parents and child and thus increasing negative interactions and affecting family bonding! Screen time does have a bad impact on our sleep too. The amount of time spent viewing screens before bedtime is associated with an increase in sleep problems. The volume of screen time as well as the content is detrimental to sleep patterns. The light exposure on the screens reduces melatonin secretion- the sleep inducing hormone in our body, leading to disrupted sleep, reduced sleep quality and duration. And if a child doesn’t have good sleep, then is likely to have behaviour problems in daytime when awake; thus forming a vicious cycle. Excess of screen time exposure from an early age leads to hyperactivity, inattention, aggressive behaviour and anger outburst. As child spends more time indoors and less with peers and playmates, there is decreased socialization, which leads to lack of social skills too; child doesn’t understand how to behave in social situations, doesn’t learn to agree with disagreements, develops temper tantrums, has difficulty in planning, coordination and execution of thought into behaviours; thus provoking anti social behaviour and leads to social isolation. Excessive screen time leads to rewiring of the still developing brain leading to permanent changes in brain which promote anxiety, fear, depression, addiction, poor mental wellbeing, increased aggression and violent behaviour. A child spending hours on mobile games and videos promoting violence has difficulty in self regulation when moving around real world and dealing with real people and real life situations! This negative impact on the overall development and psycho social wellbeing of the child leads to lack of school readiness in the child impacting his or her school life which can ultimately affect the personality and mental well being of these children as an individual.

3. Physical domain
The effect of screen time on physical domains is a long term consequence, majorly affecting school age children and teenagers. These children along with TV watching, mobile videos are also into gaming and internet usage and thus spend more time with the screens. This leads to decrease in physical activity and they are more likely to turn into a ‘couch potato’. Thus, exposure to screens promotes sedentary behaviours and compromises the much needed physical activity in these fast growing children. Spending time on screens also exposes them to commercial advertisements with alluring depictions of unhealthy foods like chips, chocolate, soda etc, thus encouraging unhealthy snacking habits. This ultimately leads to increased calorie intake which coupled with decreased physical activity increases the risk of obesity. Obesity if present in childhood is likely to continue in adulthood too, thus making prone to hypertension, diabetes and other lifestyle diseases. However, nothing in this world is so bad, that it lacks any benefits or positives! So is the case of screen time too. It has potential benefits in development, psychosocial domain and physical domain of the child; only if used mindfully and in moderation.

1. Development:
Beginning at about 2 years, if child is introduced to well-designed, age appropriate educational programs with specific educational goals, it can provide an additional route to early language and literacy for children. These  quality programmes also foster aspects of cognitive development, like creative thinking and imaginative play. So using applications with interactive media with age appropriate content- where parent can give timely reactions to what a child says or does, can help children retain taught information. Interactive ‘learn-to-read’ apps and e-books can build early literacy by providing practise with letters, phonics and word recognition. However, one needs to keep in mind that the amount of time spent on this is within the recommended limits of 1 hour for children 2-5 years of age. Also, though screens may help with language learning when quality content is co-viewed and discussed with a parent or caregiver, preschoolers learn best from live, direct and dynamic interactions with caring adults.

2. Psychosocial domain:
Quality content can enhance social and language skills for all children aged 2 years and older. Well designed, age-appropriate educational programs and screen activities can be powerfully pro-social, helping children to learn antiviolence attitudes, empathy, tolerance and respect. Appropriately used, screen time can calm a child who is overexcited or distressed (e.g., during a medical procedure). But screen learning can affect behaviour both positively and negatively, so ensuring quality content is crucial.

3. Physical domain:
Children’s screen time does not have to be passive; digital media use can encourage and complement physical activity. Especially after age 3 years, children respond to activity-based programming when it is fun, designed for them and encourages imitation or participation. Active video games can be used to increase light-to-moderate or moderate to-vigorous physical activity in times when going out is not possible. Hence fun, age-appropriate movement and fitness apps (yoga or dance) or console games can be used to integrate more physical activities into daily routines. . Mobile devices with apps for exploring the natural world can enhance outdoor physical activity. Such mobile apps can connect onwith off-screen experiences, foster engagement with caregivers and peers and support active, imaginative play. However, again this has to be within the recommended limits of 1 hour of screen time in a day and should not replace actual outdoor play in gardens and rough housing at homes!

So, while we wish to reap the benefits of screen time , how we can limit the screen time exposure to optimum levels? So, we are going to approach this problem with a 4 pronged approach with the 4 Ms.

1. Minimize
2. Mitigate
3. Mindful use
4. Model

1. Minimize screen time:
Minimizing screen time leaves more time for face to-face interactions, which is how young children learn best.

• Screen time for children younger than 2 years is not recommended. So absolutely no screen time up to 2 years of age. By contrast, they learn intensely through face-to-face interaction with parents and caregivers. Early learning is easier, more enriching and developmentally
more efficient when experienced live, interactively, in real time and space, and with real people. Increase cognitive stimulation and parent child interaction by doing activities using toys, colors, art, games books etc.
• For children 2 to 5 years, limit routine or regular screen time to less than 1 hour per day. Watch with children. Adults can connect what is being viewed with real life, and build language and cognitive skills, such as attention, memory and thinking. Shared screen time also avoids the disadvantages of solitary viewing.
• Ensure that sedentary screen time is not a routine part of child care for children younger than 5 years.
• Maintain daily ‘screen-free’ times, especially for family meals and book-sharing. Avoid screens for at least 1 hour before bedtime, given the potential for melatonin-suppressing effects.

2. Mitigate (reduce) the risks associated with screen time:
When children watch educational, age-appropriate content with an engaged adult, screen time can be a positive learning experience, thus reducing the risk associated with screen time.

• Be present and engaged when screens are used and, whenever possible, co-view with children.
• Be aware of content and prioritize educational, age-appropriate and interactive programming.
• Use parenting strategies that teach self-regulation, calming and limit-setting. Combine touch screen use with creative or active play.

3. Mindful use of screen time:
Children younger than 5 years learn best from live, immersive interactions with family members and caregivers. Given the choice, they will nearly always opt for talking, playing or being read to over screen time in any form. Hence, as parents and caregivers, we need to use screens mindfully.

• Actively enhance—and limit—media encounters by choosing them together and purposefully (‘let’s watch or play this content, at this time, for this reason’).
• Limit screen use in public places and during family routines, such as at meals. Family times are prime opportunities for social learning.
• Select content from quality, non-commercial sources, to minimize exposure to advertising. Pay attention to messages about gender, body image, violence, diversity and social issues when choosing content.
• Help children recognize and question advertising messages, stereotyping and other problematic content.
• Conduct a self-assessment of current screen habits and develop a family media plan for when, how and where screens may (and may not) be used. Like no background TV, no screen time during meals, in bedrooms, and 1 hour prior to sleep. Developing a family ‘media action plan’ can help protect and reinforce quality family time. Setting meaningful limits when children are young and sharing them as a family is far easier than cutting back screen time when children are older. For children—and parents—offscreen time is critical for developing essential life skills such as self-regulation, creativity and learning through physical and imaginative play.

• Remember: too much screen time means lost opportunities for teaching and learning.
• Be reassured that there is no evidence to support introducing technology at an early age. Your child is not missing out anything by being exposed to technology later.

4. Adults should model healthy screen use:
Children younger than 5 years require active play and quality family time to develop essential life skills, such as language, self-regulation and creative thinking. Regardless of age, children should not have to compete with screens for parental attention.

• Choose healthy alternatives, such as reading, outdoor play and creative, hands-on activities.
• Turn off their devices at home during family time.
• Turn off screens when not in use and avoid background TV.

Thus, as we can see, the screen time has its effects on overall development of our children, and whether this is a positive effect or a negative one depends on how we use it!! So let’s use the 4 Ms- Minimize screen time, Mitigate the risks of screen time, Mindful use of screen time and Model good screen use behaviours to tame this demon of ‘screen time’ and make it one of the boons of this digital world!!

Book An Appointment