Increased Screentime & its Disturbing Impact on Kids & Adolescents

Parents, Please Don’t Take Your Kid’s Screentime Period as Your Free time

In an Age to Run & Play these Kids are Going Astray with Increased Screentime

21st century is the age of technology and the adorable MTS baby ad (the baby starts using technology right after getting out of the mother’s womb) would be a reality-don’t you think (or rather fear!) so at least in a couple of decades? Kids and adolescents grow up surrounded by digital information and entertainment with the means of computers, tablets, smartphones and televisions. These young people spend more time online rather than spending quality time with family and friends. The digital world is full of amazement and surprises for these kids who love interacting with virtual friends, make friends without inhibitions as they need not bother about their physical appearance and have lots of fun playing games to which they get addicted to in course of time. The world outside is cunning and business minded. It loves to exploit the children’s weaknesses by developing sensational games that kids would love to explore, play repeatedly and finally shell out money purchasing different apps or unlocking levels. The days of football and basketball are fast disappearing as kids lock themselves in their rooms focused on the tablet or laptop for hours together. This indeed raises the concerns of health professionals and parents who are of the concept that prolonged screen time is bad for health especially with the magazines and the media reporting their harmful effects every other day on sleep, diet, social life and family life. But research studies are not many as many of them mostly include negative behavior such as snacking, sedentariness and socioeconomic grouping too as factors in their study.
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We do have evidences that increased screen time is associated with obesity, decreased time available for exercise, increase in energy intake and reduction of metabolic rate. There are also side effects such as irritability, mood disorders and poor cognitive performance all of which affect academic performance. Such factors affect quality of life and there have been several guidelines proposed for reducing screen time-the American Academy of Pediatrics in 2015 recommended limiting screen time for children aged 2-5 years to an hour everyday and for those above 6 years it is up to the parents to rationally decide upon a fixed screen time for their children. The Canadian Pediatric Society too came up with similar guidelines in 2017. While time and again we have been insisting on limiting or preventing infants and toddlers from being introduced to gadgets and technology it is depressing to realize that the use of media has only been rising steadily for the past 5-10 years. Kaiser Family Foundation Studies report in 2010 suggested that behavior of 2,000 8-18-year-old kids showed that most of them spent around 7.5 hours daily on media where around 4.31 hours was spent viewing television, 2.31 hours listening to music, 1.29 hours on computer and 1.13 hours playing video games. Yet another study found that youngsters aged around 18 years spent nearly 40 hours every week accessing Internet from home computers.

In order to exactly find the effect of these things on kids a review of reviews (RoR) was taken on children and young people (CYP).

Review of Reviews 
The review study question was ‘What is the evidence for health and well-being effects of screen time in children and adolescents?’

Based on different criteria finally 13 studies were included in the review-6 of them considered the association of screen time with body composition measures (including obesity), three for diet and energy intake, seven for mental health related outcomes like self-esteem and quality of life, four for cardiovascular risk, four for fitness, three for sleep and one for pain and one for asthma. We will take up each of these one by one.

Body Composition: Most of them were associated with television screentime. Most of the studies unanimously reported increased screen time with increase of overweight/obesity over time. Carsen et al reported that increased adiposity measure was associated with computer screentime in almost 3/4th of the studies but the same team could not find any association between video/videogame screentime and adiposity. In another study Ekris et al reported that across 6971 participants from five prospective cohorts BMI at follow-up was not linked to every added hour of computer viewing. While there is moderate evidence that higher screen time is associated with greater adiposity there is not enough evidence for an association with overall screen time or non-television screentime.

Diet & Energy Intake: Screentime in the absence of food commercials still resulted in elevated dietary intake and television screentime increased the consumption of palatable energy-dense foods while evidences were weak for video game screentime. Costigan et al reported that screentime did not promote healthy eating behavior, Pearson and Biddle showed that television screentime was associated with total energy intake and energy dense drinks. Here again, we have moderate evidence linking screentime with high energy intake and less healthy diet quality.

Mental Health & Well-being: There was moderate association between anxiety and screentime while positive association between screentime and depression. High rates of depression were linked to ≥2 hours of screentime daily. Carsen et al reported that screentime and behavioral problems were positively associated in 24 studies. There was a positive association between screentime and poorer psychological well-being and quality of life.

Physical Health: There was weak association between screentime and cardiovascular risk factor generally. While Costigan et al reported that higher screen time was associated with higher physical activity two other reviews found an inverse association between both. CYP cognition and development were examined in three medium-quality reviews. LeBlanc et al conveyed that there was low-quality evidence that television screentime had negative impact on cognitive development in young children. Many studies acclaimed that there was weak evidence that greater television time was associated with poorer educational attainments.

Sleep: There was weak association between screentime and sleep outcomes in all types of media exposure including computer, video screentime and mobile phone screentime. Pain was studied in very few studies and those showed a weak association between screentime and increase in neck/shoulder pain. Likewise, there was insufficient evidence linking asthma with television screentime.

This research shows that increased screentime was positively linked with a variety of health harms for CYP having strongest evidence for adiposity, unhealthy diet, depressive symptoms and quality of life.

Association between screen time & psychological well-being
We have a study where the effects of screentime on psychological well-being was specifically measured on 44,734 children and adolescents 2 years of age and older in the US in the National Survey of Children’s Health (NSCH) conducted in 2016. All the children were between 2 and 17 years of age and were grouped into four categories: Preschoolers 2-5 years old (9361), elementary schoolers 6-10 years old (10,668), middle schoolers 11-13 years old (7555) and high schoolers 14-17 years old (12,753). Two questions on screentime were asked to caregivers (who are the participants here):
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1. On any weekday, how much time does (child’s name) spend in front of the TV watching TV programs, videos or playing video games
2. On an average weekday, how much time does (child’s name) spend with computers, cell phones, video games and electronic devices doing things other than schoolwork?
   
   

For each of the questions, the choices given were recorded to none=0, less than an hour=0.5, an hour=1, h=2, h=3, h=4 and for any more hours h=5. The total number of hours spent watching TV/playing video games and the time spent on social media was calculated and recorded into 8 different categories: None (no screen time), <1 h (0.01 to 0.99), 1 h (1.00 to 1.49), 2 h (1.50 to 2.49), 3 h (2.50 to 3.49), 4 h (3.50 to 4.49), 5 h (4.50 to 5.49), 6 h (5.50 to 6.49) and 7 h or more (6.50 and higher). Results showed that:
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1. Daily screen time amounted to around 3.20 h a day which increased gradually in the case of elderly children with most of the time spent on electronic devices.
2. More increase in screentime happened between elementary school and middle school. By the time these kids reached high school (ages 14 to 17) most of the adolescents spent around 4h 35 min daily with either electronic gadgets or viewing the television.
3. Until under an hour of screentime viewing, well being did not differ between those not having any screentime and those viewing it for less than an hour daily but after that for every increase in screentime it was linked to lower psychological well-being.
4. In terms of relative risk (RR), increased screentime (7+ h/day) increased the risk of lower well-being by two folds exposed as not staying calm, not finishing tasks, not being curious and arguing too much with caretakers.
5. Increased use of screentime made it difficult for the caretakers to take care of such kids
6. Even those who moderately (4 hours/day) used screens had lower well-being than low users (1 h/day). Among high schoolers those who moderately used screentime were 78% not likely to be curious, 60% more likely to not stay calm when exposed to stressful situations, 66% to leave tasks incomplete and 57% likelier to argue with their caregivers.
7. High schoolers (14-17-year old children) who spend moderate hours on screentime were twice likelier to suffer from anxiety and depression comparatively but the same was not true among 11-13-year old kids
8. More the use of screentime less is the ability of children to control their temper, stay calm when excited or switch between tasks smoothly without anger or anxiety
9. Preschoolers with moderate screentime were also lower in well-being than those at low levels of use
   
   

Game Skills are Better than Life Skills
Studies show depressing results in terms of life skill development in children. More number of children between 2 and 5 years of age could use technology in a better way than demonstrate skills such as riding a cycle, swimming or tying their shoelace. Lack of enough playtime with traditional toys such as building blocks showed that language development is affected greatly. When toddlers (between 18 and 30 months of age) played building blocks with their caretaker, these toddlers showed improved language scores comparatively. Also, children who view television are captured by the attractiveness of the visual images and colors but mostly forget to pay attention to the storyline thereby failing to learn much from these fictional TV episodes.

More time spent viewing per day at ages one and three were associated with attention problems at age seven. Excessive use of television, video games and computer was linked to excess use of tobacco and cigarettes, early sexual debut, sleep deprivation especially when there is a television set in the bedroom (these kids score 7-8 points lower in math tests compared to those without a TV in the bed room), violent behavior not only that’s physical but also verbal, depressive symptoms and anxiety. A study from UCLA showed that screentime was associated with identifying emotional cues of individuals. Study compared a group of people in a nature camp who went without screentime for five consecutive days to another group who were bound to attend the camp later. The first group of people displayed improved emotional cognitive abilities just five days after the camp. The increase in screentime impairs social skills and affects the ability of people to understand emotions of other people.

Screentime definitely impairs social development, emotional intelligence, cognitive improvements and overall quality of life. Kids lose the personal touch with other individuals and fall in love with the virtual world ignoring the presence of the people around him/her. It is 100% essential to control screen time in children and help them enjoy a better quality of life.
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Research
Effects of screentime on the health and well-being of children and adolescents: https://bmjopen.bmj.com/content/9/1/e023191
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Association between screentime and lower psychological well-being among children and adolescents: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214874/

The impact of media use and screen time on children, adolescents and families: https://www.acpeds.org/the-college-speaks/position-statements/parenting-issues/the-impact-of-media-use-and-screen-time-on-children-adolescents-and-families

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