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A family doctor’s rules for toddlers and screen time

toddler with ipad
AP Photo/Gerald Herbert
Short on safety.
Published Last updated This article is more than 2 years old.

I knew it was inevitable, but I was hoping to delay it a bit longer: my son Alex has discovered the digital world. Almost two years old, he’s increasingly fascinated with mommy and daddy’s smartphones, tablets, and laptop computers. As I help him drag Curious George toys on an iPad app to complete a puzzle, I feel a pang of guilt knowing I’m breaking a taboo to have no screen time of any type for any child under two (and two hours maximum total screen time for older children), policies long recommended by the American Academy of Pediatrics (AAP) and the Obama administration, among others.

Am I already ruining his chances to go Ivy League?

This hard and fast two-hour policy, beaten into parents’ brains by their pediatricians, troubles me and many others partly because it was last updated in 2011 before the astounding boom of tablets, smartphones and touch screens among both kids and adults. The policy warnings had focused very reasonably on TV and its clear long-term harms to healthy development in kids under two—especially harmful when passively watching non-interactive, non-educational TV.

But such traditional passive TV watching, while still the dominant form of media consumption for most children, is rapidly becoming meaningless for many. Clearly, an interactive video game that parents and toddlers are playing together or watching family vacation videos on a smartphone can have huge value compared to zombie-like staring at an episode of Spongebob or China’s popular Pleasant Goat (喜羊羊) cartoons—these kinds of shows are shown in studies to harm a young child’s executive functioning, a prefrontal brain skill set including memory, attention, and setting goals.

Not all screens are equal, and guidelines need to be updated to reflect these differences.

The policy also doesn’t reflect the reality on the ground: a recent survey of parents by Common Sense Media shows that toddlers under two are spending almost one hour a day using screen media anyway. This is why, in my own efforts to offer better advice to my patients as well as myself and my wife, I set out to find the most recent research that focuses on digital media with young children.

Teachers are an obvious source to assess what’s working for children’s education. In a Joan Ganz Cooney Center 2013 survey of 694 American teachers of kindergarten to eighth grade, most teachers (74%) reported they were already using digital games as part of their classroom teaching. A great majority (78%) thought that digital games were improving student mastery of basic curriculum (especially math), and 71% agreed that they helped with extra-curricular skills such as critical thinking, collaboration and communicating. Only 21% thought that digital games in classrooms led to behavioral issues.

We often, and by default, assume that video games are inherently antisocial and couldn’t truly be healthy for our society. But much research has shown that many of these games are quite the opposite, actually helping to foster social skills such as empathy, caring, and sharing. I encountered the term “prosocial” quite often in the new research, and I think it’s a powerfully evocative word to help understand digital media’s positive potential.

An impressive study published last August in Pediatrics, surveyed 5,000 children ages 10 to 15 and found that those who played video games up to one hour a day had higher levels of life satisfaction, prosocial behavior, and behavioral control compared to those who played no games. The study also showed that playing too much (more than three hours a day) had the opposite effects. Another main point was that both positive and negative effects were actually quite small.

It’s also helpful, and important, to distinguish between types of screen time. Passive TV watching is clearly the worst type of screen time. An excellent review published last year in British Medical Journal surveyed 11,000 mothers in the UK and compared whether TV and electronic game use in five-year-old children led to behavioral issues when they reached seven. They found that excessive TV (or DVD) watching (over three hours) led to worsening social behavior, conduct, and hyperactivity, compared to light TV watching, under one hour a day. And light video game playing also showed improved social behavior compared to no playing.

I still generally agree with most of the AAP’s family media plan advice, especially no TV ever in bedrooms and no screens at certain times of the day, including during meals, and screen time limits depending on age. With children under two, I definitely believe that screen time should never be spent alone: kids always benefit more from any activity when parents are playing along.

Even more practical advice about which digital media may be helpful or not is in the outstanding website from non-profit Common Sense Media. The site has a handy list of best apps for preschoolers, along with very practical ratings including quality, learning potential, positive role models, ease of play, and consumerism. This is where I discovered highly rated apps like Busy Shapes, which I’ve played with Alex and has positive developmental benefit—but still probably isn’t nearly as beneficial as an old fashioned wooden puzzle set. I tried the e-book version of Dr Seuss’ My ABC Book, but he ignored the lovely rhymes and kept tapping to hear the noises (some, but not all, research does show that e-books are often inferior—as children who focus on the distracting technology absorb and understand less of the story).

For all the redeeming qualities of interactive screen time, however, what is clear to me after all my research is that even a highly-rated app or video games could never be as stimulating or educational as actual 3D games. Stacking, matching, reading books—all of these flat 2D-screens just can’t compare to a pile of crayons, wooden blocks and Legos. But I’ve also decided that Alex, at 21 months, can continue to dabble in some digital media. My wife and I haven’t watched traditional TV in many years and only use it for DVD or ad-free TV shows, and we always keep the kids away from this passive exposure. In all cases, we still limit total time to far below one hour a day, and almost none of it is ever unsupervised.

I think we’re doing a pretty good job in this new digital world. Screens are an ever-rapidly essential and inescapable part of modern and future life, and with a bit of evidence-based guidance, our kids will be just fine.

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