The Impact of Screen Time on Early Development

The Impact of Screen Time on Early Development Courtney Orelup, MSN, RN, CPN Salem State University School of Nursing

Outcomes of this presentation: • Understand the impact of screen time on child development. • Discuss the American Academy of Pediatrics current recommendations on screen time for children age 0 to 5 years old. • Identify online resources that support decreased screen time by children.

Screen use is increasing! • Devices (TV’s/computers/cell phones/tablets) are easier to use • Don’t need as much dexterity, touch screen is intuitive • Infants are able to use • Content created for children is growing • Interactive games (for computers, gaming devices, or via the internet) • Video content (via the internet) • What content do your children use/view? • Content captures children’s attention • Keeps children’s attention, may be seen as positive or productive stimulation • Parents/caregivers view media as a ‘peacekeeper’, safe activity for children while parents are busy • Content on the internet is increasing • Internet use is also increasing at all ages • Younger children use interactive digital games & videos • Older children use social media and video games • Internet connectivity is increasing with the use of mobile devices • More opportunity to view/use content on the internet • Lower cost & ease of use lead to more children having devices • How many devices do you have in your home?

How much time do kids spend on screens? • Data from the American Academy of Pediatrics (AAP) and the National Survey of Children’s Health • National Survey of Children’s health - created & administered by the CDC’s National Center for Health Statistics & the Health Resources and Services Administration (HRSA)’s Maternal and Child Health Bureau • Administered in 2003, 2007, 2011, 2016 • Asked about TV/computer/cell phone use in children • How much time do you or your children spend on screens each day? In 2004 (AAP) • 45% of 12 -17 year olds had a cell phone In 2011 (AAP) • On average, children < 2 years old watched television 1 -2 hours/day • 66% of 0 -3 year olds had a television in their bedroom • 52% of 0 -8 year olds had access to a mobile device In 2013 (AAP) 1 st year the AAP also identified media as TV/cell phone/i. Pads/social media • 75% of 0 -8 year olds had access to a mobile device • 92. 2% of 1 year olds had already used a mobile device • Children age 8 -10 spent nearly 8 hours/day with different media • Children older than age 10 spent > 11 hours/day with different media • 75% of 12 -17 year olds have a cell phone In 2016 (AAP) • 24% of adolescents are ‘constantly connected’ and 50% are ‘addicted’ to their phone • 75% of teens have a cell phone • 76% of teens use at least one social media site

2007 -2016 National Survey of Children’s Health – TV and video game watching http: //www. childhealthdata. org/browse/survey/

2011 -2016 National Survey of Children’s Health – computer and device use http: //www. childhealthdata. org/browse/survey/

NSCH screen time findings trended over time NSCH survey year 2007 2011 2016 Overall change Age group Age 1 -5 Age 6 -17 Age 1 -17 Age 0 -17 TV 1 hour or less per day 37. 7 % 44. 1 % 43. 3% 41. 3 % 41. 8 % 17. 4 % Decrease over time TV 1 -3 hours per day 41. 6 % 39. 3 % 38. 7 % 40. 9 % 40. 3 % 66. 0 % Increase over time TV 4+ hours per day 12. 8 % 10. 5 % 11. 9 % 11. 6 % 8. 5 % Decrease over time Computer/device 1 hour or less per day -- Age 6 -11 37. 1 % Age 12 -17 21. 8 % 40. 4 % 51. 1 % -- 19. 5 % Decrease over time Computer/device 1 -3 hours per day -- 28. 0 % 53. 6% 7. 6 % 23. 1 % -- 52. 2 % Increase over time Computer/device 4+ hours per day -- 1. 9 % 8. 4 % 1. 9 % 11. 2 % -- 11. 3 % Increase over time NSCH did not collect data on computer/device use in children age 1 -5 in 2007, and did not separate out age data in the 2016 survey. In 2016, more children were spending 1 -3 hours per day using a screen (TV, video game, computer, or device) when in previous surveys more children were spending less than 1 hour per day using a screen. Overall, the number of children watching TV for 4+ hours per day decreased, but the number of children using a computer/device for 4+ hours per day stayed steady. http: //www. childhealthdata. org/browse/survey/

2016 NSCH screen time findings. Massachusetts compared to Nationwide TV: In Massachusetts, more children watch TV less than 1 hour per day compared to the national average, however fewer children watch TV 1 -3 hours per day. Computer/device: In Massachusetts, children use computers/devices slightly more than the national average. http: //www. childhealthdata. org/browse/survey/

How Does Frequent Exposure to Media via Screens Affect Child Development? • Top row focuses on ages 0 to 5 years old • Bottom row focuses on age 6 through adolescence Learning/cognitive development Decreased with TV exposure age 0 -2 Learning/attention issues Decreased learning & attention when on screens AND multitasking Parent/child interactions When a TV is on (even to adult content) children interact with adults less Overweight/obesity Increased BMI is correlated with >2 hours of TV watching/day Sleep issues When there is a screen in the bedroom (any screen), children sleep less Substance use exposure (in content/ads) Exposure to substance use in content and ads increases the chance of a child using the substance Sexual behaviors/sexting Increased TV watching in males and computer use in females lead to increased sexual behaviors Mental health Those with high screen use have high depression rates

Effects of Screen Time on Child Development • Learning/cognitive development • Children 0 -2 who watch TV/videos are at risk for expressive language delays • Associations between excessive TV watching (> 2 hours/day) in early childhood is associated with cognitive, language, social/emotional delays (possibly due to fewer parent -child interactions) • Take-away point: Interactions with real people (not screens) are MOST beneficial for infant & toddler learning • PBS programs (and apps) have been shown to increase cognition and language skills • Face to face communication (even via screens) increases child learning • Learning/attention issues • Using screens while being engaged in other tasks decreases learning & attention span • Take-away point: Keep screens away from structured play activities • sibling

• Parent/child interactions • Children play & interact less with adults when a television is on (even if content is for parents) • Parent background television use distracts from parent-child interactions and play • For every hour of television that a child < 2 years watches alone, this child spends an additional 52 minutes less time per day interacting with a parent or • Take-away point: Don’t keep the television on in the background • Overweight/obesity Both broadcast and interactive media viewing increases snacking Children are exposed to more advertisements for unhealthy foods There is an association with viewing > 2 hours of media/day and obesity In 2 year olds, BMI increased for every hour per week of media consumed A child has a 5 x increased risk of being overweight if they watch 5 hours of television/day, compared to those who watch 0 -2 hours/day • Take-away point: Don’t let children frequently use media and snack at the same time, and keep media viewing to < 2 hours a day • • •

Does media viewed on screens help young children learn? Younger children • Undemonstrated educational effectiveness • Much media content is marketed as educational, but has not been studied • Children 12 -18 months remembered better from a live presentation • Children 0 -2 years who watched television showed no improvement in cognitive development compared with non-viewing children by 3 years of age • Children age 12 months and younger do not follow sequential screen shots or dialogue • Heavy TV/video viewing can increase language delays in children less than 2 years of age • Animation/sounds/tapping/swiping draw attention, but may decrease young child comprehension of content • Most media content focuses on rote material (ABC’s, 123’s) • Children learn social skills, creativity, impulse control from people • Children age 0 -3 show decreased transfer of learning from screens • Older children may learn as well from screens as from 3 D learning though • Take-away point: Investigate producers of content, and view content with young children to help them understand it

American Academy of Pediatrics (AAP) Guidelines Brief history of the AAP guidelines on media use 1999 - Policy statement: Media Education • Committee on Public Education 2001 - Policy statement: Children, Adolescents, and Television • Committee on Public Education 10/17/2011 - Policy statement: Media Use by Children Younger than 2 years • Council on Communications and Media 10/28/2013 - Policy statement: Children, Adolescents, and the Media • Council on Communications and Media • Identified media as TV/cell phone/i. Pads/social media 10/21/2016 - Policy statements: 1) Media and Young Minds (age 0 -5) 2) *Media Use in School-Aged Children and Adolescents (age 5 -18) • Technical report: Children and Adolescents and Digital Media • All from the Council on Communications and Media • *not reviewed in this presentation

Review of the 2016 AAP Guidelines Media and Young Minds (age 0 -5 years) • Infants/Toddlers • Children younger than 2 cannot learn from digital media as they do from caregivers • Main factor that facilitates children’s learning from media is co-viewing with parents and re-teaching content • Avoid digital media use in children younger than 18 -24 months • If parents chose to introduce digital media after 18 -24 months, chose high-quality programming and use media together (co-view and avoid solo use). Video chatting is considered a social activity. • Preschoolers • • Many interactives games & applications (‘apps’) are labeled as ‘educational’ without evidence of efficacy Interactive media (touchscreens, sounds) may decrease child comprehension Heavy media use may increase the risk for obesity More exposure to media and the presence of a screen in the bedroom was associated with fewer minutes of sleep per night Limit screen use to 1 hour per day of high quality programming and co-view Turn off televisions, computers, and devices when not in use Keep bedrooms, mealtimes, and parent-child playtimes screen free Do not use screens 1 hour before bedtime

Implications for National Health • Healthy People 2020 objectives • Goals for the health of the U. S. population, by the U. S. Department of Health and Human Services • Category ‘Nutrition and Weight Status & Physical Activity’, objective ‘Physical Activity’ • Focus on increasing the number of children who do not view television, videos, use a computer (for non-school use), or play video or computer games for more than 2 hours a day • Goal of having children age 0 -2 view no television or videos on an average weekday • Don’t specifically mention use of social media or use of ‘other screens’ (cell phones, devices) • No objectives for decreasing screen use under the ‘Maternal Child Health’ category, or under ‘Early and Middle Childhood’ or ‘Adolescent Health’

Objectives for Healthy People 2020 in Physical Activity • PA-8. 1: Increase the proportion of children aged 0 -2 years who view no television or videos on an average weekday • PA-8. 2. 1: Increase the proportion of children age 2 -5 years who view television, videos, or play video games for no more than 2 hours a day • http: //www. childhealthdata. org/browse/healthy-people-2020

Resources for Families American Academy of Pediatrics (AAP) Family Media Use plan Screen topics: • Screen free zones, screen free times, device curfews, choosing media, co-viewing media, online manners, digital citizenship, online safety/privacy Non-screen topics: • Sleep times, exercise times, parent-child play times https: //www. healthychildren. org/English/media/Pages/def ault. aspx#home Centers for Disease Control and Prevention (CDC) National Institutes for Health (NIH) Screen time vs. Lean time • Ensure children have 1 hour of physical activity per day • Limit children’s total screen time to 1 -2 hours per day • Remove televisions from children’s bedrooms • Encourage other types of physical and social activities (team sports) We Can! Screen Time Reduction Curricula • Families Finding the Balance: A Parent Handbook • Parent Tips Sheet • Screen Time Reduction Curricula • We Can! Screen Time Chart https: //www. cdc. gov/nccdph p/dch/multimedia/infograph ics/getmoving. htm https: //www. nhlbi. nih. gov/healt h/educational/wecan/reducescreen-time/tips-to-reducescreen-time. htm

Future Areas of Research • Association between screen time and learning difficulties • Educational efficacy of online content/aps for young children

References • Chassiakos, Y. , Radesky, J. , Christakis, D. , Moreno, M. , Cross, C. , Council on Communications and Media (2016). Children and Adolescents and Digital media, Pediatrics, 138(5). DOI: 10. 1342/peds. 2016 -2593 • Council on Communications and Media (2013). Children, adolescents, and the media, Pediatrics, 132(5), pg. 958 -961. DOI: 10. 1542/peds. 2013 -2656 • Council on Communications and Media (2016). Media and young minds, Pediatrics, 138(5), pg. 3 -6. DOI: 10. 1542/peds. 2016 -2591 • Council on Communications and Media (2011). Media use by children younger than 2 years, Pediatrics, 128(5), pg. 1040 -1045. DOI: 10. 1542/peds. 2011 -1753. • Council on Communications and Media (2016). Media use in school-aged children and adolescents, Pediatrics, 138(5), pg. 3 -6. DOI: 10. 1542/peds. 2016 -2592 • Herrick, K. , Fakhouri T. , Carlson S. , & Fulton J. (2014). TV watching and computer use in U. S. youth aged 12– 15, 2012. NCHS data brief, no 157. Hyattsville, MD: National Center for Health Statistics. • Kremer, P. , Elshaug, C. , Leslie, E. , Toumbourou, J. , Patton, G. , & Williams, J. (2014). Physical activity, leisure-time screen use and depression in children and young adolescents. Journal of Science and Medicine in Sport, 17, pg. 183 -187. DOI: http: //dx. doi. org/10. 1016/j. jsams. 2013. 012 • Moser, A. , Zimmerman, L. , Dickerson, K. , Grenell, A. , Barr, R. , Gerhadrstein, P. (2015). They can interact, but can they learn? Toddlers’ transfer learning from touchscreens and television. Journal of Experimental Child Psychology, 137, p. 137 -155.

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