Reducing Screen Time for Healthier Development in Children

1. Building Better Brains and Bodies Through Screen Time Reduction Jean Rystrom, Practice Director – Pediatrics, Kaiser Permanente Northwest EMO November, 2010

2. Take Home Messages • Screen time is associated with many health and developmentrisks • The total number of hours spent watching determines many of the outcomes, and reduction helps • How we can do our best for the kids

3. Possible health effects of screen time: starting with early childhood • Weight • Reading and scholastic achievement and development of the brain • Violence and aggression • Sleep problems • Attention problems • Risk behaviors (older kids): Early sexualization, tobacco and alcohol abuse

4. What is “screen time”? • It’s all screen activities for entertainment: TV, movie, video game, computer game, cell phone game, etc. • The number of hours with the screen means greater exposure to risks and fewer hours for other activities.

5. No guilt!(If you are thinking about your own experiences, remember: you didn’t know what you didn’t know)

6. Part 1: Screen Time Usage

7. Usage: Under age 12 months • The AAP recommendation is no screen time before age 2, but… • By 3 months of age, about 40% of children regularly watched television, DVDs, or videos • The median age for introduction was 9 months • Average 1 hour per day by age 12 months Zimmerman et al, Arch Pediatr Adolesc Med, May 2007

8. School Age • AAP recommendation: no more than 1-2 hours per day, but…. • KFF report “Generation M2” • Increase of over 1 h/day from 5 years previous on total media use • Over 4.5 hours per day screen media • Smart phones….(39% to 66% have them – but this doesn’t count talking or texting)

9. Sleep Focus Create Run Read Explore Cope Interact For every hour watched TV Violence Is Fun/Normal Buy More Talk TV Talk Sit More Eat This Play Imagine

10. Part 2: Weight

11. Screen time and Weight:Possible mechanisms Food advertisements, Product placements, Normative behaviors, and Snacking Very sedentary behavior = = Fewer Calories out More Calories In

12. 167 calories • Additional calories consumed per hour of watching television in teens Wiecha, et al, Arch Pediatr Adolesc Med, April 2006

13. Activity level is very low • 84 Calories per hour to sit quietly • 114 Calories per hour to play cards • 198 Calories per hour to walk (2 MPH) The President’s Council on Physical Fitness and Sport, Exercise and Weight Control (based on 150 pound person)

14. Part 3: Reading, Scholastic Achievement and Brain Development

15. “Educational” Claims • No proof of benefit for baby products • Slows development in language, reading and math • No studies compare to beneficial activities Christakis and Zimmerman, The Elephant in the Living Room

16. Educational Impact • Bedroom TV: lower 3rd grade standardized tests (math, reading, and language arts) • Regression models predicted up to 24% of the variation in scores • 71% had a bedroom TV • TV in bedroom predicts greater viewing time Borzekowski and Robinson, Arch Pediatr Adolesc Med, 2005

17. Long Term Impact 30% lower college degree associated with each additional hour of media watched age 5-15 in longitudinal study Hancox, et al, Arch Pediatr Adolesc Med, July 2005

18. Brain development • Brains are “plastic” – especially young kids (even older adults) • Stimulus influences structure: babies need interaction with all senses during critical periods • Baby videos: little dialogue, short scenes, disconnected images, no interactive practice • No human interaction: babies experience world in relationships

19. Part 4: Violence and Aggression

20. Preschool Aggression • Sustained exposure > 2 hours/day of TV/video from age 30-66 months associated with much higher levels of aggression (also problems with sleep, self control, attention and cooperation). • Content not specified (what is watched) Mistry et al, Pediatrics, October 2007

21. Elementary Bullying Behavior • For every hour of daily TV at age 4, increased chance of bullying age 6-11 • Content not specified (what is watched) Zimmerman, et al, Arch Pediatr Adolesc Med, April 2005

22. Updates 2009/10 • AAP has revised policy statement • “a significant risk to the health of children and adolescents” • “media violence is 1 of the causal factors of real life violence and aggression” • “The debate should be over.” • 3 year olds exposed to more TV have greater risk of aggressive behavior (Manganello and Taylor, Arch Pediatr Adolesc Med, Nov 2009)

23. Part 5: Sleep Problems

24. TV and Sleep • More television viewing among infants and children = more irregular sleep schedules Thompson and Christakis, Pediatrics, October 2005 Owens, et al, Pediatrics, 1999

25. Possible mechanisms • Bedtime resistance • Delay of sleep onset, duration • Melatonin and light • Less relaxed after watching • Anxiety, nightmares

26. Part 6: Attention problems

27. Early childhood 10% increase in symptoms of ADHD at age 7 per hour watched at ages 1 or 3 Christakis, et al, Pediatrics, April 2004

28. Possible factors • Causality may be bidirectional • Brain development: Interaction between genetics and environment may condition risk, severity and progression of attention problems • Conditioning: Frequent edits, pans, zooms, etc. = “rapid distraction” • Displacement: In place of other activities which promote attention • Content may have a role

29. “2nd hand TV” • “Background adult television is a disruptive influence on very young children’s behavior” • Reduced toy play episode length • Reduced focused attention during play • Effects in all ages (12, 24 and 36 months) • They weren’t “watching” much Schmidt et all, Child Development, July/August 2008

30. Part 7: What do we do about it?

31. What children and youth need • As much time as possible for: • Interaction with other humans • Verbal experimentation, with feedback from other humans • Creativity and exploration • Reading and prereading activities • Being physically active

32. Quantity matters • For children under the age of 2, the recommendation from the expert group (American Academy of Pediatrics) is NO screen time at all. • For older children, the Academy recommends no more than 1-2 hours per day of total leisure screen time.

33. What can faith communities do? Educate! • Newsletter and/or materials • Post information on site • Create activities such as • Log sheet • Draw “What do YOU like to DO?” • Do More/Watch Less program • “Get My Life Back” contest • Screen Free Week

34. What can parents do? • Set environment • Keep the TV out of kids’ bedrooms • Place the TV in a less desirable area • Reduce total number of sets • Have TV-free meals • Make new family traditions (walk after dinner) • Set limits – aim for 1 hour a day for older kids • No TV under age 2 • TV only on certain days of the week

35. Part 8: Summary

36. Sleep Focus Create Run Read Explore Cope Interact For every hour watched TV Violence Is Fun/Normal Buy More Talk TV Talk Sit More Eat This Play Imagine

37. What you’ve learned! • Health risks of screen time • Reducing hours reduces risk