The American Academy of Pediatrics just updated its screen time recommendations – and, for the first time, we can actually see and understand the research on which the recommendations are based. They’re a bit more nuanced than the previous versions, so join me as we walk through what the recommendations mean for parents of babies and toddlers – whether or not your children have been using screens until now. We’ll look at the impact particularly of TV on cognitive development, obesity, and prosocial vs. antisocial behavior.

News flash: if you’re not watching and discussing shows WITH your child, he may be learning antisocial behavior from even the most innocuous of PBS programming.

This is the first in a two-part series on screen time. Here we focus on what science says about the impacts on development. In the second part we’ll examine what we can do about mitigating these impacts and on harnessing some of the good that digital media can do for our kids, since they are growing up in a world where the use of digital media is a fact of life.

References

Alade, F., Rasmussen, E., & Christy, K. (2014). The relation between television exposure and executive function among preschoolers. Developmental Psychology 50(5), 1497-1506. Full article available at: https://www.researchgate.net/publication/259845495_The_Relation_Between_Television_Exposure_and_Executive_Function_Among_Preschoolers

American Academy of Pediatrics (n.d.) Media and Children. Retrieved from: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-and-Children.aspx?rf=32524&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

Barr, R. (2013). Memory constraints on infant learning from picture books, television, and touchscreens. Child Development Perspectives 7(4), 205-210. Full article available at: https://www.researchgate.net/publication/259074650_Memory_Constraints_on_Infant_Learning_From_Picture_Books_Television_and_Touchscreens

Beales III, J.H., & Kulick, R. (2013). Does advertising on television cause childhood obesity? Journal of Public Policy & Marketing 32(2), 185-194.

Blankson, A.N., O’Brien, M., Leerkes, E.M., Calkins, S.D., & Marcovitch, S. (2015). Do hours spent viewing television at ages 3 and 4 predict vocabulary and executive functioning at age 5? Merrill-Palmer Quarterly 61(2), 264-289.

Bronson, P. & Merryman, A. (2009). Nurtureshock. New York: Twelve.

Christakis, D.A., Gilkerson, J., Richards, J.A., Zimmerman, F.J., Garrison, M.M., Xu, D., Gray, S., & Yapanel, U. (2009). Audible television and decreased adult words, infant vocalizations, and conversational turns. Archives of Pediatrics and Adolescent Medicine Journal 163(6), 554-559. Full article available at: https://sites.oxy.edu/clint/physio/article/AudibleTelevisionandDecreasedAdultWordsInfantVocalizationsandConversationalTurns.pdf

Gentile, D.A., Coyne, S., & Walsh, D.A. (2010). Media violence, physical aggression, and relational aggression in school age children: A short-term longitudinal study. Aggressive Behavior 37, 193-206. DOI: 10.1002/ab.20380

Halford, J.C.G., Gillespie, J., Brown, V., Pontin, E.E., & Dovey, T.M. (2003). Effect of television advertisements for foods on food consumption in children. Appetite 42, 221-225. DOI: 10.1016/j.appet.2003.11.006

Halford, J.C.G., Boyland, E.J., Hughes, G., Oliveira, L.P., & Dovey, T.M. (2007). Beyond-brand effect of television (TV) food advertisements/commercials on caloric intake and food choice of 5-7-year-old children. Appetite 49, 263-267. DOI: 10.1016/j.appet.2006.12.003

Healthychildren.org (n.d.). Family media plan. Retrieved from: https://www.healthychildren.org/English/media/Pages/default.aspx#home

Janz, K.F., Levy, S.M., Burns, T.L., Torner, J.C., Willing, M.C., & Warren, J.J. (2002). Fatness, physical activity, and television viewing in children during the adiposity rebound period: The Iowa bone development study. Preventive Medicine 35, 563-571. DOI: 10.1006/pmed.2002.1113

Kim, M. (2016, October 25). American Academy of Pediatrics says some screen time is OK for kids under two. Replay available at: https://ww2.kqed.org/forum/2016/10/24/american-academy-of-pediatrics-says-some-screen-time-is-ok-for-kids-under-2/

Mares, M. -L., & Acosta, E. E. (2008). Be kind to the three-legged dogs: Children’s literal interpretations of TV’s moral lessons. Media Psychology 11, 377–399, DOI: 10.1080/15213260802204355

McClure, E.R., Chentsova-Dutton, Y.E., Barr, R.F., Holochwost, S.J., & Parrott, W.G. (2015). “Facetime doesn’t count”: Video chat as an exception to media restrictions for infants and toddlers. International Journal of Child-Computer Interaction 6, 1-6. DOI: 10.1016/j.ijcci.2016.02.002

McKean, C., Mensah, F.K., Eadie, P., Bavin, E.L., Bretherton, L., Cini, E., & Reilly, S. (2015). Levers for language growth: Characteristics and predictors of language trajectories between 4 and 7 years. PLoS ONE 10(8), 1-21. DOI: 10.1371/journal.pone.0134251

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Read Full TranscriptTranscript

Hello and welcome to the Your Parenting Mojo podcast. Today’s episode is called “really, how bad is screen time for my over two year old?”.

So this episode had some remarkably fortuitous timing – I was actually half way through writing it when the American Academy of Pediatrics updated its guidelines on screen time for children. Cue the scramble to update my research – I was just grateful I hadn’t already recorded and released an episode that became instantly out of date! The old guidelines said that “Television and other entertainment media should be avoided for children under age 2.” In my mind that was a bit of an anemically worded recommendation given that it follows a paragraph stating that “Studies have shown that excessive media use can lead to attention problems, school difficulties, sleep and eating disorders, and obesity. In addition, the internet and cell phones can provide platforms for illicit and risky behaviors.” When I looked around I found that the AAP’s policy had been much more restrictive until just May of last year – it used to recommend that parents avoid screen time completely for children under the age of 2, and to limit screen time to no more than two hours a day for children older than two.

But apparently the AAP realized that 38% of children under age 2 had used a mobile device and 74% of children under two have watched TV before the age of 2. 43% of children under the age of 2 watch TV every day and 18% watch videos or DVDs every day, so clearly parents mostly weren’t following the guidelines, which I’m guessing is what prompted the new guidelines that seem to try to walk a narrow line of recommending less rather than more screen time, but also acknowledging that parents do let their children use these devices in spite of the AAP’s recommendations.

So what do the updated guidelines say? They’re considerably more nuanced than the old ones, which had previously been explained in just a few short paragraphs, and it’s also a bit harder to figure out exactly what the recommendations are because they’re buried below a bunch of preamble BUT I was excited to find that the preamble is fantastically well-referenced, rather than just consisting of a few statements that seemed to appear out of thin air with no basis in any research, which is what the old version seemed like. So here’s the really important stuff: For children younger than 18 months, discourage use of screen media other than video chatting. The scientists who wrote the recommendations cite a study showing that even parents who tended to adhere strictly to the previous “avoid screen time for under twos” statement would permit the use of video chatting, and while there’s no evidence of benefit from video chatting there’s no evidence of harm either, so given that video chatting tends to be a social interaction – which is usually associated with cognitive development – researchers seem to be sort of assuming that video chatting is probably OK. I heard an interview on NPR with one of the lead authors of the guidelines a couple of weeks ago and she said they are designed to be “realistic and broadly applicable,” which seems to account for the use of the word “discourage” when describing screen media use for under 18 month olds – the researchers don’t want to encourage anyone to introduce screens before age 18 months, but they also don’t want to alienate the parents who do decide to do it.

Alright, so for the 18-24 month olds, again, there’s no pressure to introduce screens but if you do use them, the researchers advise using them as a teaching tool and as an activity you do together, not as something you use to help them calm down or something to keep them occupied. The idea behind not using media to calm them down and avoid tantrums is that using media as a calming strategy could lead to problems with limit-setting if children don’t learn to develop their own emotional regulation and always look to devices to help them calm down. The researchers cite the websites Common Sense Media, PBS Kids, and Sesame Workshop as examples of quality programming.

In children older than two years, the recommendations say that parents should limit media to one hour or less per day of high quality programming. The limit addresses the idea that children need other activities in their lives as well, and that screen time can displace these activities if children are on their devices for too long. Again, the ideal is for high-quality children’s programming that you watch together rather than it being a solo activity. Parents may need to help children understand what they’re watching, and help them apply what they learn to the world around them – so if you watch a program on bugs and then you go out and look for bugs, you could talk about what you learned in the program that can help you understand the bugs in real life. Children may not understand the things they see in two-dimensional environments as much as they do if someone explains it to them – the same holds true for books as well as TV, but because a parent is usually reading the book the child gets a chance to ask questions which improves their understanding. Parents should also monitor what children are doing on their devices, test apps before the child uses them, and engage in conversation about the child’s screen time.

Finally, the guidelines talk about when devices *shouldn’t* be used – that includes meal times, times when you’re playing with your child (and that goes for parents too). Screens in bedrooms are not recommended, and children shouldn’t use devices within an hour of bedtime.

We’ve generally followed a “no TV” policy with our toddler until she was two. She also isn’t allowed to play with our phones – she doesn’t have any apps on them. She does watch videos with her Dad on his phone; usually videos of herself but there’s also one of our friend’s drone that she is strangely attached to. But that’s five or ten minutes a day on weekends. Recently she had an ear infection and had to stay home from school unexpectedly, so I had to stay with her, and I still needed to get work done. I offered to put on the movie Penguins which she was quite interested in for five minutes, but then she got bored and asked me to turn it off, but then she wanted it on again, and then off again…and for several days afterward she campaigned to watch it. It gave me a taste of what we might be getting into if we started to allow her to watch TV, so we backed off it again and haven’t let her watch it since. But I know some parents approach this differently and do allow TV watching so I wanted to try to understand what really are the impacts of TV on children’s physical and cognitive development? Does some kind of switch flip at age 2 where it suddenly becomes “less bad”? And a neighbor of mine asked whether having TV on all the time as ‘background noise’ might be better than just watching a few shows because then children might get desensitized to it and stop paying attention?

There’s a lot to untangle when it comes to the research on TV viewing in children so let’s dive in.

Cognitive Development

The impact of TV on children’s development may differ at different points in the lifespan, so there may be a “sensitive period” for the effects of TV viewing on children’s cognitive development. Executive functioning is a term that means a set of related skills involving working memory, cognitive inhibitory control, and attentional focusing and flexibility. Now let’s go through what each of *those* mean. Working memory is the way you hold multiple pieces of information in your mind at once and manipulate this information. Cognitive inhibitory control means suppressing dominant information in favor of not dominant information. Attentional focusing and flexibility refer to the ability to focus and shift attention in response to change. I think about this in terms of an example – maybe you’re watching a complicated movie on TV; the kind with multiple plot lines and you’re trying to figure out what’s going on. Your child wakes up upstairs and starts crying quietly. You need to suppress your thinking about the movie to assess the noises you hear from your child and decide whether it’s the kind of crying that needs your attention or not. In making that shift you demonstrated attentional focusing and flexibility. So both executive functioning, which is all of those concepts taken together, plus vocabulary development, are really important in the preschool years because they’re among the strongest predictors of early academic achievement. One study found that watching child-directed programs at ages 2 and 3 was associated with better word comprehension at age 3, but the very same study found that children who viewed more general education programs at ages 2-5 had lower word comprehension at ages 4-7. The authors of another study suggest that children already have to have a good store of vocabulary to be able to pick up new words from watching TV – in other words, they have to understand what they’re watching, which I suppose is why children’s programming is associated with an increased vocabulary but general educational programming isn’t.

The evidence for or against the impact of TV on executive function development seems to be pretty mixed. One study found that children have a shorter focused attention span when a TV is on in the background, even though they didn’t have more episodes of focused attention with the TV off. Four year olds living in homes with more adult television programming were rated as having lower executive functioning skills by their parents than children who lived in homes with less adult TV watching, but children’s programming didn’t seem to have the same effect. And another set of researchers had children wear a digital recorder on random days for up to 24 months, which recorded the amount of TV they watched, as well as the words they said and the words other people said to them. IT turned out that each hour of TV the children were exposed to, even if it was just background noise, was associated with less talking by the child and also less talking by the parents to the child. There are some days where I might wish my daughter didn’t talk as much and this study shows that TV would be a good way to keep her quieter, but at the end of the day the more she talks and the more I talk with her, the better her language development gets. And, finally, a third study found that a greater cumulative number of hours of watching TV, starting to watch TV at a younger age, and watching media that wasn’t explicitly developed for children are all linked with poor executive functioning in preschoolers, although the study authors noted that they were able to show correlation, not causation – they couldn’t prove that watching TV causes these detrimental effects.

Because it seems as though having a TV on or not having a TV on are not the only factors at play here. It’s also important to factor in the extent to which toys and learning materials are available at home, the extent to which parents teach children and provide enrichment, and even...

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