Screen time and sedentary behaviour in the early years (Part 5): Ten recommendations for living in harmony with screens

Dr Breanne Kunstler (BBiomedSci, BHealthSci, MPhysio, PhD).

I have written a series of posts on screen time and the potential effects it might have on the health of our kids. This post will provide a brief summary of those posts and finish with some recommendations for parents on how they can support a healthy relationship between screens and their kids.

Summary of screen time and its potential relationship with poor health

Post 1 provided a brief summary of screen time and the reasons why parents are concerned by it (e.g. cyberbullying). It is recommended that children spend less than an hour using screens daily, but Aussie kids are far exceeding this number. I suggested that there was little evidence to support this 1 hour recommendation at this time.

Posts 2 and 3 involved exploring the potential physical and psychological health effects of screen time on our children. I am confident that high screen time is related to kids having a poor diet, poor heart health, low fitness, depression, anxiety, poor self-esteem and poor pro-social behaviour. I am not so convinced that high screen time is directly related to obesity, as I believe other factors like junk food consumption during screen time might have a large role to play. I am also not convinced that high screen time is related to poor quality of life, sleep and academic outcomes. More high-quality research is needed in these areas.

Post 4 explored parents’ thoughts on screen time and outlined that they believe that there are positives and negatives to screen time. Sometimes screen time is necessary to allow them to do things, like go to the bathroom, but they also believe that sometimes screen time can be detrimental (e.g. causing kids to sleep poorly, which can create daytime sleepiness at school). Overall, what parents do (e.g. using screens themselves) can have a direct relationship on what their kids do.

We can’t avoid screens. They are here to stay so we need to learn how to live in health and harmony with them. I will now attempt to tie everything together by providing some feasible strategies for parents to use to ensure our kids have the best possible relationship with their screens.

Image 1: Love the computer you're with (credit: picsart.com)

What works to reduce screen time?

Parents don’t really know how to effectively reduce their kids’ screen time. Unfortunately, it seems that researchers don’t really know either. Several studies have been done to find the best strategies to reduce screen time, but they only reduce it a little bit (e.g. 8 min/day), which doesn’t justify the time and effort it takes to use them. Behaviour change programs targeting recreational screen time (non-school) in children younger than 13 years old can reduce screen time (TV and other types) by 26.4 min/day. Although this seems like a large amount of time, these improvements aren’t usually maintained once these programs end.

Programs to reduce screen time often try to reduce BMI and weight too. Something as resource intensive as installing standing desks at school, with the intention not only to reduce sitting but to also increase calorie burning, have only resulted in a tiny amount of increased energy expenditure, which is unlikely to have a significant effect on weight. Studies in kids that attempt to reduce screen time and improve weight only see small improvements in BMI (e.g. 0.24-0.89kg/m², which is insignificant). These poor findings are common for interventions targeted at reducing BMI of children by changing their screen time behaviours.

There appears to be some promise in programs that focus on educating and empowering care providers and parents to reduce child screen time. For example, changing policies about staff supervision of media use have lowered the amount of screen time 3 to 5 year old kids have in childcare. Parents who are confident in their ability to reduce kids’ screen time might be very successful at reducing their kids’ screen time. Teaching parents how to help their pre-schoolers achieve a healthy lifestyle might be a very successful way of changing screen time behaviours and, as a result, reducing poor health in childhood. 

Based on this information, I think one of the best things we can do is to empower parents to support their kids to reduce their screen time.

Image 2: Screens are no match for super parents! (credit: twitter.com)

Ten recommendations to empower parents to reduce kids' screen time

I have used the information I have presented in these blog posts, as well as my experiences as a physiotherapist and new mum, to provide ten recommendations.

1. Don’t fret too much about meeting the guidelines of 1 hour per day of screen time. We don’t have any evidence to say that screen time actually causes all the poor outcomes I have written about. Also, the research in the area of screen time and health effects is still developing, meaning we don’t have much high quality evidence to inform the 1 hour guideline just yet. So, by all means play with your kids instead of sticking them in front of a screen, but don’t feel guilty if they are getting more than 1 hour of screen time daily at this point.
2. Encourage healthy behaviours (e.g. outdoor play) by creating opportunities for kids to get active, like taking them to the park or doing another activity of their choice, rather than just discouraging and limiting screen time by removing devices and giving them nothing else to do.
3. Make screen time a social activity. We can’t stop our kids from using screens, so we should make it as social and interactive as possible. Make some time to interact with screens with your kids so that you can talk about the content they are seeing. It’s important to help kids to understand what they are seeing (e.g. violent digital content, content related to "ideal" body image) and talk about how applicable it is in real life – are these socially acceptable behaviours or realistic ideals? What are the real-world harms of behaving this way?
4. Monitor what kids are doing while using screens. Are they eating excessive amounts of junk food? If so, this might increase their chances of obesity. Consider providing healthy after-school snacks that keep kids satisfied until dinner. Better yet, involve them in the preparation to give them something to do.
5. Watch for any changes in mental health, like lack of interest in usual activities. This might be a sign that screen time is negatively affecting your child's mental health.
6. Cease screen time an hour before bed to support good quality sleep. Remove devices from bedrooms of younger kids, but give adolescents the autonomy to learn how to have screens in the room and refrain from using them;
7. Think about other types of entertainment you can use. If you don’t want to use the TV as a digital babysitter then consider other age-appropriate entertainment measures. Hubby and I use the radio instead of the TV, or simply place Abby in her floor gym (affectionately referred to as her "jail") without any other distractions. Use a tablet so you can still watch TV if you’d like to;
8. Support kids to discover activities they like doing. If your kids enjoy cricket, then encourage them to join the local team. They can’t be on their screens while facing a fast ball;
9. Model good behaviours – be the person you want your kids to be. If you use screens, your kids will think that’s normal and will copy you. If you go for a walk after dinner, then your kids will think that’s normal and will copy you. Both of these behaviours are fine to mimic; it's about finding a healthy balance. However, expect that your influence will decrease as the child ages; and
10. Balance the practical and the theoretical. We know what we should do in theory, but we also need to do what we need to do. If that means planting the child in front of Playschool on the TV so you can poo then just do it. Also, remember that your kids probably just want to relax sometimes and watch some TV, just like you do, so give them a break sometimes.

This brings me to the end of a whopping five-part series on screen time and child health. I hope that my posts have been useful to you and have helped you to better understand screen time and its potential effects on health.

Live well, with screens.