By Richard Turner, MD – MMH Pediatrics 
Screen time has become a huge topic in pediatrics, with both potentially positive and negative effects. Because this topic is a lot to wrap our heads around, we will discuss it in three parts:
Part I: How Does Screen Time Affect Infant and Toddler Development?
Part II: How Does Digital Media Use Affect School-aged Children and Adolescents?
Part III: How Does Screen Time Affect Physical Wellbeing?
Part I:
Our modern digital age of cell phones, gaming, take-out TV (the ability to stream our favorite shows anytime, anywhere), and instant access to our work, family and friends has provided us with advantages unknown to previous generations. But with these advantages comes the discovery of risks and unintended negative consequences, particularly when it comes to our children.
It’s important to understand children under two years old have immature and quickly-developing brains. As a result, infants and toddlers have immature symbolic, memory and attentional skills and can’t learn well from digital devices. They have difficulty transferring what they have learned from two-dimensional media forms and translating it to the three-dimensional real world. To learn effectively, infants and toddlers need hands-on exploration and trial and error with real, tangible objects and situations. They need direct social interaction with trusted caregivers in order to maximize their learning, speech and overall development. In other words, infants and very young children are unable to apply what they learn from media sources, but thrive when taught by direct interaction with, and demonstration by, trusted caregivers.
A study conducted by Dr. Mathilda van den Heuvel at The Hospital for Sick Children in Toronto, Ontario, Canada, found mobile media device use is associated with expressive speech delays in 18-month-old children. She and her colleagues found that children who use a mobile media device (iPad, cell phone, etc.) for 30 minutes a day, show more than double the increased risk in parent-reported speech delays.
An additional study, titled ‘The Impact of Background Television on Parent-child Interaction,’ published in the Child Development journal found these findings (increased risk for developmental delay), are at least in part, due to decreased exposure to verbal and play-based interaction with parents and caregivers. When we’re watching (too much) TV, we’re not paying attention to, teaching and interacting with our children. We’re not sparking their imaginations. Simply put, the bottom line is this – the more time parents spend engaged in media, the less time they are engaged with their children – the less time they are talking to their children, actively reading to their children, directly and attentively playing with their children, teaching their children, encouraging them and allowing their imaginations to flourish.
While it may be ‘easier’ to hand your child a device, it is not better. The only way a child learns fine motor, or any other complicated skill, is through practice. If a toddler is not practicing walking, running, fine motor skills, speech/communication, social and problem-solving skills through active engagement and interaction with and active teaching by caregivers, they will be at a significantly higher risk for developmental delays. Media devices do not enhance learning or development – they hinder them.
For these and many other reasons, the American Academy of Pediatrics recommends children under 18 months of age, screen time should be discouraged all together, expect for video-chatting. For children 18 to 24 months old, if media introduction is desired by the parents, only high-quality programming and apps that can be used together should be viewed (because this is how toddlers learn best – direct parent-child interactions and live demonstration). Letting toddlers use media alone should be absolutely avoided.
In children older than 2, including preschool-aged children, media/screen time should be limited to one hour or less per day and should be shared use between toddler and child to foster enhanced learning, more parent-child interaction and limit-setting, not to mention just the sheer joy of playing with your child, watching him or her grow and develop and amaze you with new skills, and building a strong, loving bond to last a lifetime.
Both parents and children should put the devices down. Parents – pick up your children – hold them, hug them, engage them, INSPIRE them! Lift them up to be the very best they can be.