How much screen time should kids get?
SINGAPORE - Even though most parents believe it is unhealthy for children to be glued to a screen, they often leave them in front of the television or with an iPad or phone in return for some peace and quiet.
But parents need not feel too guilty - new guidance on children's screen time from Britain suggests that the evidence of harm from screen time is often overstated.
The Royal College of Paediatrics and Child Health (RCPCH) said earlier this month that it would not recommend any age-appropriate time limits because there is not enough evidence that screen time harms a child's health at any age.
Instead, it recommends that families negotiate screen time limits with their children based on their needs. Parents should decide how much is enough.
However, the college did recommend that children refrain from using digital devices in the hour before bedtime because of evidence that they can harm sleep.
The guidelines can seem conservative because many parents often limit their children's screen time.
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In the United States, the American Academy of Pediatrics recommends age-appropriate time limits.
An RCPCH spokesman said it could not find consistent evidence for any specific health or well-being benefits of screen time.
"Although there are negative associations between screen time and poor mental health, sleep and fitness, we cannot be sure that these links are causal, or if other factors are causing both negative health outcomes and higher screen time," he said.
BUT IT CAN BE PROBLEMATIC
Medical experts, however, warned that the lack of solid evidence does not mean that excessive screen time is not harmful.
Problems arise when screen time displaces physical activity and face-to-face social interaction and affects sleep and school performance.
"There's still some controversy, but the overall consensus is that excessive screen time is not recommended, especially for young children," said Dr Ong Say How, a senior consultant and chief of the department of developmental psychiatry at the Institute of Mental Health.
He added: "Some kids do not shower or eat late into the night despite pleas from their parents. They also sacrifice their sleep and we know that Singapore kids are sleep-deprived."
In recent years, the scientific literature supporting the connection between tech use and symptoms has been growing, said Dr Gary Small, a psychiatry professor and director of the University of California, Los Angeles' Longevity Centre.
"Our group did a study showing that pre-teens who went for five days without television, computers or smart phones had significant improvements in emotional and social intelligence," he said.
Studies have also linked excessive screen time to other negative effects such as poorer memory.
"The main fear with the increasing use of digital devices is that it will compromise time spent on physical or outdoor activities, sleep and human interaction with other children or adults in a typical 24-hour period," said Dr Wendy Liew, a paediatrician, with a special interest in neurology, at SBCC Baby & Child Clinic.
BE MINDFUL OF DIGITAL MEDIA USE
Dr Yang Linqi, a paediatrician at Thomson Medical Centre, said the new British guidelines builds on the current thinking that screen time should be controlled, but counters that not all screen time is bad.
She said the guidelines are catered towards older children and young persons, and are not relevant to younger infants and toddlers.
Dr Ong said, as a guide, a child aged below 18 months should not be exposed to screen time, as he is still learning basic skills like toileting and eating.
Older children can have limited screen time, though screen time should not prevent a child from exploring his environment and getting new experiences, he said.
"Children are also developing their fine motor and language skills, and screen time is not going to help in those areas," he added.
"Face-to-face interaction is still the preferred way of social engagement. It is when you activate more of your learning as you use more skill sets - motor, physical, social skills," said Dr Ong.
Dr Small said moderation is key.
"One important principle to keep in mind is that when we spend a lot of time on a particular mental task, the neural circuits controlling that task strengthen," he said.
"However, when we spend too much time on a particular task such as video gaming, it is likely that we neglect other mental tasks like conversations and physical exercise, and the neural circuits controlling those tasks weaken."
WHAT PARENTS CAN DO
Parents need to supervise their children when it comes to screen time.
"The brain of a child is like a sponge. A young and immature child may not be able to discern what is real and what is not, what is right and what is not right," said Dr Ong.
Limits should be enforced from young, so that the child knows he does not have free access to digital media. "You can't take for granted that he will know when to stop," he said.
Dr Lim Boon Leng, a psychiatrist at Gleneagles Hospital, said a common mistake parents make is in allowing very young children free rein over the usage when they are in pre-school and limiting them once there is academic stress.
"Having control over screen time from day one is important in getting the child to accept that he or she needs guidance over it."
Also, parents should teach their children how to protect themselves online, such as not disclosing personal data, said Dr Ong.
"Parents can engage with their child on social media and, in the process, interact and guide them online," he said.
"Parents should be better informed about digital media. Very often, they are clueless about digital media, and hence, the child gets a free hand in how to do it, and that's when it can get out of control. "
Dr Liew said what is most important is how parents are going to guide their children in the use of digital media.
"For younger children, deciding on the content is important. Sitting with the children and watching together can help them understand what they are seeing," she said.
"Placing consistent limits on time spent and ensuring that this does not impact outdoor activities, sleep and so on is important, and also ensuring human interaction and media-free times such as during meal times."
HOW BAD CAN THE HARM BE?
The overuse of digital devices can lead to behavioural addiction, neglect of school, academic failures and severe family conflicts. It has also been associated with depression, said Dr Lim.
The jury is still out on whether excessive screen time can result in anxiety, depression and other negative psychological effects, considering digital media has not been around for very long, said Dr Ong.
So far, there is "just some hint of association" between excessive screen time and these effects.
Children who are more vulnerable to these effects, such as those with attention deficit hyperactivity disorder (ADHD), should be more careful about such use, said Dr Ong.
ADHD is a mental disorder that involves inattention, hyperactivity and impulsivity.
"There's some concern that excessive gaming can lead to ADHD. For example, if the child has a short attention span, excessive gaming does increase the risks of him developing ADHD," said Dr Ong.
"One thing I would emphasise is that parents need to assess how much screen time impacts their child's behaviour," said Dr Small.
"Some kids are very sensitive while others are not. For a sensitive child, greater monitoring would be needed," he said.
"Also, if a child is doing well in school, spends time offline and has no symptoms, then restriction may not be as important."
Indeed, every child may be impacted by screen time differently.
Said Dr Lim: "While screen time use can be a problem, do not just see it as an enemy but that as parents, we can also utilise it as an incentive and a tool which the family can enjoy together."
PROS AND CONS OF VIDEO GAMES
Playing video games like Warcraft can boost some aspects of cognitive function, such as reaction time, complex reasoning and visual memory, said Dr Small.
"In moderation, video games can be fun and represent another form of social interaction."
It is only when gaming becomes excessive that it may have a negative impact on face-to-face communication skills or emotional and social intelligence; or lead to less time spent on physical exercise, he said.
"We have shown that simply searching online will alter neural networks after just one week, one hour a day.
"All these activities have brain and cognitive effects. The question is whether the effects will be positive or negative, and that depends on the extent of use and the nature of the mental activities involved in the use."
What parents should take note of is the suitability of the games for their child,
Dr Ong said children and young adults are more vulnerable to media influence, unlike adults who are more mature cognitively and have a stronger sense of morals.
"For a child or a young teenager, if he keeps watching violent or sexual scenes, he becomes sensitised to them and may re-enact them in the real world," he said.
"People think that teenagers are mature, but they are not. Studies have shown that your brain is fully mature only in your mid-20s."
Online games may help develop certain skills. "You have better hand-eye coordination and are probably more agile with your fingers, but is there a lot more to it?" said Dr Ong.
In theory, video games can be dispensed with, but many people enjoy them too much, said Dr Small.
The key is to balance screen time with activities away from the screen, such as physical exercise, social interactions and other experiences that support brain health, he said.
A child needs to have recreational activities every day and these should not be restricted to Internet games, said Dr Ong.
Screen time has to be balanced with other forms of social and physical activities, so as to allow the child to learn new skills that the computer cannot teach, he said.
Key recommendations on screen time from the American Academy of Pediatrics (AAP):
• For children younger than 18 months, avoid the use of screen media other than video-chatting.
• Parents of children aged 18 to 24 months who want to introduce digital media should choose high-quality programming and watch it with their children to help them understand what they are seeing.
• For those aged two to five, limit screen use to one hour a day of high-quality programmes. Parents should watch the programmes with children to help them understand what they are seeing and apply it to the world around them.
•For children aged six and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity and other behaviours essential to health.
• Designate media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms.
• Have ongoing communication about online citizenship and safety, including treating others with respect online and offline.
• The AAP has an interactive, online tool for families to create a personalised family media-use plan.
Key recommendations on screen time from the Royal College of Paediatrics and Child Health:
• Families should negotiate screen time limits with their children based on the needs of each child, the ways in which screens are used and the degree to which use of screens appears to displace (or not) physical and social activities and sleep.
• Screens should be avoided for an hour before the planned bedtime.
As a guide to examine their screen time, families can ask these four key questions:
1. Is screen time in your household controlled?
2. Does screen use interfere with what your family wants to do?
3. Does screen use interfere with sleep?
4. Are you able to control snacking during screen time?
