Screen Time Evaluation and Recommendations for Children Mohammad Mertaban Hinesburg Family Practice January 2016 Mohammad Mertaban Hinesburg Family Practice January 2016 Screen Time Evaluation and Recommendations for Children

Why early experiences matter

AAP Guidelines Dilemma 2011 American Academy of Pediatrics Media Guidelines: Children under the age of 2: no screen time. Children above the age of 2: entertainment media for no more than 1 -2 hours per day. 2015 American Academy of Pediatrics Media Guidelines: Optimal media education begins after 2 years of age Loose interim guidelines

Problem US Children/adolescents: more than 7 hours per day with media (more than in formal classroom instruction) 30% of US children play with a mobile device when they still are in diapers 75% of 13- to 17-year-olds have smartphones 24% admit using their phones almost constantly

Another Problem… Survey of 365 pediatricians: 50% recommend limiting media use to 1 to 2 hours per day 50% not interested in learning about media effects on their patients

↑screen time = ↓ activity + ↑ distress

Scottish Health Survey of 1,500 children ages 4 – 12 year and their parents Higher amounts of television/screen viewing time meant lower physical activity rates and increased psychological distress Increased emotional symptoms Increased conduct problems Increased peer relationship problems

Precondition the mind to expect high level of stimulation Prolonged exposure to rapid image change during critical period of brain development Precondition the mind to expect high level of stimulation Inattention in later life Why are there no more explosions happening in front of my face? Why is everything so boring? Why do I have to walk from here to there?

AGE 3 AGE 7 MORE Television MORE likely to have attention problems For each hour per day that a child watches TV, their chances of having attention problems by the time they reach 7 years old increased by 10%. AGE 3 AGE 7 MORE Television MORE likely to have attention problems

Cognitive Stimulation Cognitive Stimulation was defined as someone who had a parent that read to them, how often they took them to the museum, how often they sang to them. Cognitive stimulation REDUCED the change of them having attention problems later in life. Each hour per day of cognitive stimulation reduced the changes of attention problems by 30%. AGE 3 AGE 7 MORE Cognitive Stimulation LESS likely to have attention problems

Should I eliminate screen time all together? NO.

Power Puff Girls Content. Content. Content.

The inventor of reality television…

…and its actually slower than reality

Content viewed at 0-3 and risk of attention problems at school age

Media & Public Health Costs Violence: media violence may be associated with 10% of real-life violence Sex: several studies have linked exposure to sex in the media to earlier onset of sexual intercourse Drugs: witnessing smoking scenes in movies may be the leading factor associated with smoking initiation among youth. Obesity: media currently implicated in obesity epidemic; unclear how Children & Adolescents view about 7,500 food advertisements per year (most fast food or junk food) Media replaces physical activity. Eating disorders: In Fiji, a naturalistic study of teenaged girls found that the prevalence of eating disorders increased dramatically after the introduction of American TV programs.14

Early childhood for children is critical to their development More real time play; less fast-paced media Change the beginning and you change the whole story!

How to Talk to Patients and Children Parenting has not changed – same parenting rules aply Role modeling is critical – limit your own media use We learn from each other – “talk time” Content matters – content is more important than time spent Co-engagement counts – family participation Playtime is important – daily unplugged playtime (esp. for younger) Set limits – reasonable It’s OK for your teen to be online – social media Create tech-free zones – family mealtime Kids will be kids – mistakes and empathy

Resources Zimmerman FJ, Christakis DA. Children’s Television Viewing and Cognitive Outcomes. JAMA Pediatrics. July 2005.