Scary Screen-Time

So you’ve heard about ‘screen-time’, but how much do you know about it and the effect it has on your little ones’ development? How much is too much? We hope this article will shed some light on this topic for you.

Basic Development

According to Piaget, children learn and develop through active participation, observation and exploration of the environment. As discussed in our previous post on development (https://babytherapy.org.za/play-and-active-experimentation-the-building-blocks-of-development/), children develop through four basic stages namely the sensory-motor stage (0 – 2 years), the pre-operational stage (2 – 7 years), the concrete operational stage (7 – 11 years) and the formal operational stage (12 years and up).

In order to understand the effect that the lack of appropriate stimulation can have on development, it is important to understand the effect of active, unstructured play and stimulation on the development of a child. In this post, we focus our attention on the effect of screen-time on Piaget’s first two stages of development.

How Does The Screen Influence Development?

One of the key points of Piaget’s theory is that learning is an active process. In recent times, screen-based media has greatly altered the way in which children learn, explore their environment and interact with each other – while their neural organisation has remained the same (1).

Digital media is freely available, and children are exposed to screens daily (2). However, as early childhood is marked by cortical brain development it is probable that excessive screen-time can lead to undesirable neural changes similar to those of addictions (3). As children learn through cause and effect and repeat pleasant actions, they are more easily prone to addiction, training their brains to rely on the stimuli of screens.

Parents may feel that the presence of a screen during daily routines, like feeding and bath time, may assist in the swift completion of routines (4). This, however, interferes with the essential socio-emotional skills-building process which occurs naturally between a parent and a child.

The seemingly positive result that a parent thinks they have gained by distracting a child, could be a lost opportunity to build trust (2). A parent could manage their child’s emotions as well as teach self-modulation during this time by comforting them in a soothing voice, using facial expressions and a gentle touch.

Television time is related to delayed language and executive functioning, poor health and obesity, attention difficulties as well as affecting physical activity (5, 6).

A study by Roman and colleagues (2017) links delays in early socio-emotional skills as well as delays in language and cognition to the interruption of parent and child interactions caused by electronic screens. Early socio-emotional development forms the foundation for later mental health, and the use of screens could have detrimental effects on the mental health of children.

Toddlers and Screen Time

The American Academy of Paediatrics provides the following statement:

“Unstructured playtime is more valuable for the developing brain than any electronic media exposure. If a parent is not able to actively play with a child, that child should have solo playtime with an adult nearby, to allow them to think creatively, problem-solve, and accomplish tasks.”

Effect On Sleep

Sleep plays an important role in neuro-development as well as cognition, especially in the years which form the foundation of neural development (7). Inadequate sleep damages the neuro-behavioural and cognitive functions, behaviour, learning, health and well-being of a child. The following are the effects of screens on sleep and related development:

• Due to the probability of touch screens, most children have access to these devices at bedtime. Such devices have harmful effects on the quality and quantity of sleep (8).
• Screen-time may lead to a later bedtime, decreasing sleep duration (7, 8).
• Screens make falling asleep more difficult as the media content may, and is designed to, raise physiological and psychological stimulation. This affects the quality and quantity of sleep (4, 5).
• Circadian rhythm (a person’s innate sleep-wake cycle) is influenced by the blue light of screens which leads to suppression of melatonin (the hormone which helps to control sleep patterns) (4, 7).

Effect On The Developing Brain

Broad exposure to digital platforms could affect brain development and language acquisition (9). Excessive exposure to screens during childhood is associated with:

• Grey and white matter atrophy (wasting/degenerating brain matter).
• Lower cortico-striatal connections, which are involved in developing appropriate goal-directed behaviour as well as understanding what actions to take in order to attain the desired outcome.
• Increased cortical thickness only in non-language areas, which accompanies lower intelligence and language difficulties (1, 3).

Pre-schoolers And Screen-Time

Physical activity in the early years may influence children’s higher order cognitive progress, which in turn affects self-regulation (10). It is suggested that self-regulation skills, self-control and reward processing skills are developed during early childhood. Lower social interaction and cognitive effort in early childhood could have consequences on later activities that necessitate self-regulation. Therefore, too much early screen-time may deflect the academic path of a child.

The displacement hypothesis (11) acknowledges that children traditionally engage in outdoor activities, constructional and object-related play as well as pretend and symbolic play. These activities are vital to the development of cognitive, motor, and perceptual skills.

Recently, however, many children spend less time in active exploration of their environment and are instead spending more time with technology, which has changed the way in which they play (10 – 12). Screen-time deters young children from interpersonal communication and has indirect consequences on children’s social behaviour through their influences on social cognitive development in pre-school (10).

Social cognition, which includes children’s understanding of mind, emotion and empathy have been shown to be a vital predictor of early social behaviour. This leads to young children presenting with more behavioural problems (13).

Screen viewing in preschool children is further linked with poor well-being, eating disorders, reduced sleep duration, developmental delays, attention deficit as well as myopia (3, 4, 6, 13).

What About Baby-Friendly Games?

Although digital media markets proclaim certain programmes as baby-friendly, there are various indicators that unstructured play is has much more benefits.

With regards to language development, the following factors should be considered:

• Baby videos often contain a limited language range and a combination of features which lead to habits that hamper language and vocabulary development, rather than appropriately stimulating it.
• Infants learn less from television than they do from live, face-to-face interactions (14). Consider Piaget’s theory of development:
  • Toddlers learn through the manipulation of objects whereas interaction with a two-dimensional screen limits such exploration (4, 15).
  • Language is improved by social opportunity. Eye contact cannot be learnt through screen-time and requires face-to-face interaction. Eye gaze is also an important factor of joint attention or social interaction in which two people are focussing on the same object. Additionally, conversational turn-taking is developed through interaction between a parent and child.
  • Children under the age of 3 do not learn language through videos as they are attracted to the concrete aspects and cannot understand the abstract and symbolic nature of it.
  • These aspects interfere with the socio-emotional skills-building process (2, 4, 16).

That being said, touchscreens offer a spontaneous and attractive source of sensory- and cognitive stimulation for young children (17). There is an indication that toddlers between the ages of 24 and 36 months learn more from interactive touch screen devices than from passively watching television (5, 15, 18). Additionally, children learn better from characters when they are socially reliant or when they are responsive to the actions and vocalisations of the child. Contingency is essential as it helps the child realise that the character is relevant to them and can be learnt from (18). The interactivity of touch screens may be the one feature that assists children in connecting symbols to real-world referents.

Studies by Axford and colleagues (2018) concluded that targeted applications may support the development of fine motor skills as the games require accurate finger placement, movement, as well as control over the amount of pressure used. This could lead to improvements in precision and control (12, 17).

Access to digital media has also changed the way in which children learn. Schroeder and Kirkorian (2016), show that programmes with an interactive medium allow for feedback and possibility, which allows the child to move at their own pace through explored options. This feedback assists children in learning problem-solving strategies, as the child is immediately informed if their choices are correct or not (19).

E-books are also great to motivate children who are emergent readers or who do not like to read (20). The features they present with assists in adopting a more positive attitude towards literacy. If an e-book is designed to be developmentally appropriate and is carefully incorporated into a curriculum, it could support a child’s literacy development more than a print book (20).

Although active participation in age-appropriate applications may be more beneficial than passive TV watching, unstructured play and stimulation are more effective and appropriate for brain and body development.

Screen-time Guidelines

The American Academy of Paediatrics (21) suggest the following age guidelines when it comes to screen-time:

• Before the age of 18 months, children should only be allowed necessary video-chatting.
• Between 18 months and 2 years, children may watch or use high-quality programs or apps if adults watch or play with them. This ensures that they understand what they are seeing.
• Children aged 2 to 5 years should have no more than one hour a day of screen time with adults watching or playing with them.
• From the age of 6 years, children should have consistent limits on the time they spend on electronic media as well as the types of media used.

Additionally, they suggest that media-free times (dinner and before 8 am) and locations (bedrooms and bathrooms) be maintained. From a young age, it is also suggested that online safety and courtesy be openly discussed.

The following link is also available to help you plan your family’s screen-time:

https://www.healthychildren.org/English/media/Pages/default.aspx

References

1. Horowitz-Kraus T, Hutton JS. Brain connectivity in children is increased by the time they spend reading books and decreased by the length of exposure to screen-based media. Acta Paediatrica. 2017.
2. Raman S, Guerrero-Duby S, McCullough JL, Brown M, Ostrowski-Delahanty S, Langkamp D, et al. Screen Exposure During Daily Routines and a Young Child’s Risk for Having Social-Emotional Delay. Clin Pediatr (Phila). 2017;56(13):1244-53.
3. Simonato I, Janosz M, Archambault I, Pagani LS. Prospective associations between toddler televiewing and subsequent lifestyle habits in adolescence. Preventive Medicine. 2018;110:24-30.
4. Radesky JS, Christakis DA. Increased Screen Time: Implications for Early Childhood Development and Behavior. Pediatric clinics of North America. 2016;63(5):827-39.
5. Anderson DR, Subrahmanyam K. Digital Screen Media and Cognitive Development. Paediatrics. 2017;140(Suppl 2):S57-s61.
6. Bernard JY, Padmapriya N, Chen B, Cai S, Tan KH, Yap F, et al. Predictors of screen viewing time in young Singaporean children: the GUSTO cohort. Int J Behav Nutr Phys Act. 2017;14(1):112.
7. Bathory E, Tomopoulos S. Sleep Regulation, Physiology and Development, Sleep Duration and Patterns, and Sleep Hygiene in Infants, Toddlers, and Preschool-Age Children. Curr Probl Pediatr Adolesc Health Care. 2017;47(2):29-42.
8. Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS. Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis. JAMA Pediatr. 2016;170(12):1202-8.
9. Zimmerman FJ, Christakis DA, Meltzoff AN. Associations between media viewing and language development in children under age 2 years. The Journal of paediatrics. 2007;151(4):364-8.
10. Cliff DP, McNeill J, Vella S, Howard SJ, Kelly MA, Angus DJ, et al. The Preschool Activity, Technology, Health, Adiposity, Behaviour and Cognition (PATH-ABC) cohort study: rationale and design. BMC paediatrics. 2017;17(1):95.
11. Strasburger VC, Jordan AB, Donnerstein E. Children, adolescents, and the media: health effects. Pediatric clinics of North America. 2012;59(3):533-87, vii.
12. Axford C, Joosten AV, Harris C. iPad applications that required a range of motor skills promoted motor coordination in children commencing primary school. Australian occupational therapy journal. 2018.
13. Tansriratanawong S, Louthrenoo O, Chonchaiya W, Charnsil C. Screen viewing time and externalising problems in pre-school children in Northern Thailand. Journal of child and adolescent mental health. 2017;29(3):245-52.
14. Zack E, Gerhardstein P, Meltzoff AN, Barr R. 15-month-olds’ transfer of learning between touch screen and real-world displays: language cues and cognitive loads. Scandinavian journal of psychology. 2013;54(1):20-5.
15. Kirkorian HL, Choi K, Pempek TA. Toddlers’ Word Learning From Contingent and Noncontingent Video on Touch Screens. Child Dev. 2016;87(2):405-13.
16. Hanvey K, DeBold L. Preschool television programmes: analysis using SmartSound IQ data logging. Cochlear implants international. 2015;16 Suppl 1: S26-9.
17. Bedford R, Saez de Urabain IR, Cheung CH, Karmiloff-Smith A, Smith TJ. Toddlers’ Fine Motor Milestone Achievement Is Associated with Early Touchscreen Scrolling. Frontiers in psychology. 2016;7:1108.
18. Sheehan KJ, Uttal DH. Children’s Learning from Touch Screens: A Dual Representation Perspective. Frontiers in psychology. 2016;7:1220.
19. Schroeder EL, Kirkorian HL. When Seeing Is Better than Doing: Preschoolers’ Transfer of STEM Skills Using Touchscreen Games. Frontiers in psychology. 2016;7:1377.
20. Zucker TA, Moody AK, McKenna MC. The Effects of Electronic Books on Pre-Kindergarten-to-Grade 5 Students’ Literacy and Language Outcomes: A Research Synthesis. Journal of Educational Computing Research. 2009;40(1):47-87.
21. Pediatrics AAo. American Academy of Pediatrics Announces New Recommendations for Children’s Media Use. 2016.