Screen time for under 2 years might be okay? What!!!???

I was initially confused by recent headlines such as this reporting that Dr. Dimitri Christakis now says some interactive time on tablets or computers might be okay at young ages. He is one of the authors of the 2011 American Academy of Pediatrics Guidelines that recommended no screen time under 2 years of age, so this seemed at first contradictory. He has previously been on record affirming that television for children under 3 years is very detrimental for their attention span, stating that it permanently damaged their brains. So naturally my first impression was the news must have the angle wrong.

photo source: Shutterstock

Then I was reminded that when those guidelines were written, the scope of screen time availability was much different. The guidelines relied on research done well before iPads or other tablets were readily available. It was a time of flip phones, not smart phones. We have little information on what interactive screen time does for development since it is such a new concept.

Toddlers in my office are often on their parent's smart phone or other device. They scroll through family pictures. They try to match puzzle pieces. They find the letter or count the objects. They watch a movie. Each of these is very different in what the child is exposed to and what they can potentially gain. There are lists of educational games for 2-4 year olds to teach various skills. I suspect if the under 2 year crowd playing e-games is sanctioned officially by the AAP, lists for that age group will develop too.

We really are in infancy stages of learning what kids of all ages can learn from these devices or all the negatives that could be attributed to them. Of course the types of interactions make a big difference in addition to the total amount of time spent on these activities. As Dr. Christakis explains in this TED talk, some screen time is too action packed and fast moving for healthy brain development, encouraging short attention spans and hyperactivity. Children under 3 years have an especially rapidly developing brain, so they are more sensitive to the interactions they have in real life or on a screen. (He starts talking about television at about 5 minutes into the video but I encourage watching all of it, it is that good.) It is still unclear if television actually causes increased risk of ADHD or if children with ADHD are simply more drawn to action-packed television. Interestingly, educational television programs aren't linked to increased risk of ADHD but action packed and violent shows are. In short, any experience we have during our developmental years changes us, we just don't know exactly how influential television and video games are.

Toddlers who interact with a screen are learning hand-eye coordination and cause and effect. Yes, that can be learned the old fashioned way with exploring their world around them, and I encourage that most of it should be learned from playing with real objects. They need human interaction to learn social skills. Screen time can over-stimulate them if the action is too fast-paced, too loud, done in excess, or done at the wrong time (such as bedtime). Most of us know how addictive screen time can be. We can lose track of time as adults and so can toddlers and kids. If kids get frustrated playing (or refuse to turn it off when asked) they might be getting inappropriate or too much screen time. If this happens, stop all screen time for awhile and slowly re-introduce it after screening the games/ shows to evaluate if they are appropriate for your child's stage of development. Just because an older sibling or friend enjoys a show or game doesn't mean your child is developmentally ready for it.

For most families children using screen time is a given, it's not something parents avoid until at least 2 years of age. Regardless of recommendations to have no screen time under 2 years and only up to 10 hours per week for older children, most kids have much more screen time than that. Parents know that screen time is a great behavior motivator. Parents use screen time as a token to get chores done or to behave well. It can afford a parent time to get a few things done while kids are not running around the house. It is an easy way to keep kids occupied when they must sit quietly for a long period.

We still should use screen time wisely and responsibly. It should be age appropriate. Especially for younger children, it should have a learning goal and should not be too fast paced. A great video from CommonSenseMedia.org, Not All Screens Are Created Equal, discusses quality as well as quantity of screen time. I regularly use that site to pre-screen media my children want to watch or play to be sure it is appropriate for my child. I encourage you to do the same.

Playing learning games on a computer or tablet has the potential to be beneficial for children, as long as it is balanced with active play to allow for plenty of exercise. Remember as parents we must put down our devices too! Kids need our attention. If we are hiding behind our smart phone or tablet, we are not focusing on them like we need to. Set aside time just for family and turn off all the electronics. Model the behaviors you want your kids to do. Help toddlers and kids use screen time wisely and appropriately.

Cell Phone and Social Media Etiquette

My family was recently on vacation, so I was in public areas more than normal. To say I was surprised by all the people enjoying their cell phones more than their company is not correct. "Saddened" is a better word. Why do people who are out together spend so much of their time avoiding their friends and family who are with them? It isn't uncommon any more to see a table of people all looking at their smart phones. What is our society coming to? How will our children learn to interact with others appropriately?

As a physician who must take phone calls for work, some of which might be true urgent calls (true emergencies should be called to 911), I still don't answer my phone most of the time. It is okay for people to leave messages. Returning a call after excusing myself from my family or friends within a short time is much more considerate for all involved. I find it beneficial too since I can listen to a message, get my thoughts in order before returning the call, and I have a record of the call to document later in a patient's chart. Most people simply answer a phone call or text because they can. Or they scan a social media site when they should be talking with others face to face.

A friend shared a blog today on her Facebook page that I found interesting and timely. It is from the American Academy of Pediatrics (AAP) Council on Communications and Media (COCM) and had a list of phone etiquette rules for kids. As I read it, I thought of some more rules that could (should, in my opinion) be used by all.

Here are my suggestions. In no particular order:

• It’s okay to let people leave a message. If the phone rings when you are in a conversation, ignore it unless you’re expecting an important call. For routine calls, use a conversation break to excuse yourself and state you need to return a call or text. 
• Important calls still deserve respect. If you are expecting an important call, alert those with you ahead of time that you might need to excuse yourself when your phone rings. This lets them know that you aren’t just taking a routine call when the phone rings and they are still important to you. 
• Go to a quiet place to return calls and texts. This is not only polite to the people in the room, but it also reminds you that there are people who are waiting for you to return. 
• Be with those with you. Make eye contact when you are talking to people. Don’t keep checking your phone ~ it makes it seem like those with you are less important than whatever you are seeing on your phone. Messages will be there later! 
• Limit bragging. Don’t upload and share pictures of everything you do with friends. This might unknowingly hurt another friend’s feelings if they weren’t invited to join. Or friends will get bored and tune you out. 
• No phones at the table. Leave your phone out of sight and on silent when eating. Unless everyone puts their phones in the center of the table with a “No touch” rule, all phones should be hidden and ignored during a meal. Talk to those at the table. Enjoy their company. Most calls can wait a few minutes for you to finish your meal. 
• Keep the noise down. Turn the ringer off when you are in any public place. If you are alone and on your phone, keep your voice to a normal talking level so you don’t disrupt others around you. Better yet – go outside to take a call. 
• Keep phones on silent and put away when at school, work, or in a professional setting (such as at a checkout line at the store or at a doctor's office). It is not only rude, but can get you in trouble with your teacher or boss. It limits the constructive time spent with you by the person you should be giving your full attention to.
• Incriminating or hurtful information doesn't belong. Don’t type, photograph or forward anything you wouldn’t want your parents, boss or principal to see. Remember that once you push send words and pictures will last forever on the web and could be seen by anyone if a friend saves or forwards it. It could come back to haunt you. If you would be embarrassed if your parent, grandparent, or neighbor sees it, don’t do it!
• Get help when needed. If you see something you think could hurt someone, or that indicates someone is hurting, tell a responsible trusted adult. You could save a life! Literally. 
• Don’t measure your value by how many “friends” you have, or all the cool things they seem to be doing. Your life is worth something, but you don’t have to broadcast it to everyone online. 
• Live life! Spend your time actually doing things, don’t waste it watching what others are doing or documenting every little thing you do. 
• Only “friend” people you know in person. Even if they know a friend of a friend, they are not your friend. Be safe and only friend real friends and family. Make your privacy settings private so others who you don't know can't see your posts.
• Never give personal information to people you don't know. Be careful that others might share your posts, so avoid using your team names, school name, and other identifying information. Turn off your camera's GPS if you take pictures that will allow a stranger to know where you are.
• Never share passwords with anyone but your parents. And always let your parents know your passwords. They have your best interests at heart and can help you stay safe online. 
• Never answer a text while driving (or even walking). This really doesn’t need any explanation. Texting distracts you from getting to where you need to be safely. 
• Avoid taking calls when driving. Any distraction to driving is a distraction. The really cool thing with cell phones is that they all have voice mail. That means people can leave messages. And you can call them back from a safe place. Brilliant! If you must take a call when driving, use a hands-free device for added safety. Be aware of state laws restricting some drivers of any phone use.
• Keep phones out of your bedroom. Use a public area of the home to charge phones overnight. This prevents your phone from waking you at all hours of the night. Sleep is important, and just because your friend has insomnia doesn’t mean you need to answer their call!