Building Better Brains and Bodies Through Screen

Time Reduction

Jean Rystrom, Practice Director – Pediatrics, Kaiser Permanente Northwest

EMO November, 2010

Take Home Messages

Screen time is associated with many

health and development risks The total number of hours spent

watching determines many of the outcomes, and reduction helps

How we can do our best for the kids

Possible health effects of screen time: starting with early childhood

Weight Reading and scholastic achievement and

development of the brain Violence and aggression Sleep problems Attention problems Risk behaviors (older kids): Early

sexualization, tobacco and alcohol abuse

What is “screen time”?

It’s all screen activities for entertainment: TV, movie, video game, computer game, cell phone game, etc.

The number of hours with the screen means greater exposure to risks and fewer hours for other activities.

No guilt! (If you are thinking about your own experiences, remember: you didn’t

know what you didn’t know)

Part 1: Screen Time Usage

7

Usage: Under age 12 months

The AAP recommendation is no screen time before age 2, but…

By 3 months of age, about 40% of children regularly watched television, DVDs, or videos

The median age for introduction was 9 months Average 1 hour per day by age 12 months

Zimmerman et al, Arch Pediatr Adolesc Med, May 2007

8

School Age

AAP recommendation: no more than 1-2 hours per day, but….

KFF report “Generation M2”• Increase of over 1 h/day from 5 years

previous on total media use• Over 4.5 hours per day screen media• Smart phones….(39% to 66% have them –

but this doesn’t count talking or texting)

Focus

Cope

For every hour watched

Read

Run

Talk

TVTV

Talk Create

Imagine

Play

BuyMore

EatThis

Violence Is Fun/Normal

SitMore

Explore

Interact

Sleep

Part 2: Weight

Screen time and Weight:Possible mechanisms

MoreCalories

In

Fewer Calories out

Food advertisements,Product placements,Normative behaviors,

and Snacking

Very sedentary behavior

==

12

167 calories

Additional calories consumed per hour of watching television in teens

Wiecha, et al, Arch Pediatr Adolesc Med, April 2006

13

Activity level is very low

84 Calories per hour to sit quietly 114 Calories per hour to play cards 198 Calories per hour to walk (2 MPH)

The President’s Council on Physical Fitness and Sport, Exercise and Weight Control (based on 150 pound person)

Part 3: Reading, Scholastic

Achievement and Brain Development

15

“Educational” Claims

No proof of benefit for baby products

Slows development in language, reading and math

No studies compare to beneficial activities

Christakis and Zimmerman, The Elephant in the Living Room

Educational Impact

Bedroom TV: lower 3rd grade standardized tests (math, reading, and language arts)

Regression models predicted up to 24% of the variation in scores

71% had a bedroom TV TV in bedroom predicts greater viewing time

Borzekowski and Robinson, Arch Pediatr Adolesc Med, 2005

Long Term Impact

30% lower college degree associated with each additional hour of media watched age 5-15 in longitudinal studyHancox, et al, Arch Pediatr Adolesc Med, July 2005

Brain development

Brains are “plastic” – especially young kids (even older adults)

Stimulus influences structure: babies need interaction with all senses during critical periods

Baby videos: little dialogue, short scenes, disconnected images, no interactive practice

No human interaction: babies experience world in relationships

Part 4: Violence and Aggression

Preschool Aggression

Sustained exposure > 2 hours/day of TV/video from age 30-66 months associated with much higher levels of aggression (also problems with sleep, self control, attention and cooperation).

Content not specified (what is watched)Mistry et al, Pediatrics, October 2007

Sustained exposure > 2 hours/day of TV/video from age 30-66 months associated with much higher levels of aggression (also problems with sleep, self control, attention and cooperation).

Content not specified (what is watched)Mistry et al, Pediatrics, October 2007

Elementary Bullying Behavior

For every hour of daily TV at age 4, increased chance of bullying age 6-11

Content not specified (what is watched)

Zimmerman, et al, Arch Pediatr Adolesc Med, April 2005

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Updates 2009/10

AAP has revised policy statement “a significant risk to the health of children and

adolescents” “media violence is 1 of the causal factors of

real life violence and aggression” “The debate should be over.”

3 year olds exposed to more TV have greater risk of aggressive behavior (Manganello and Taylor, Arch Pediatr Adolesc Med, Nov 2009)

Part 5: Sleep Problems

TV and Sleep

More television viewing among infants and children = more irregular sleep schedules

Thompson and Christakis, Pediatrics, October 2005

Owens, et al, Pediatrics, 1999

Possible mechanisms

Bedtime resistance Delay of sleep onset, duration Melatonin and light Less relaxed after watching Anxiety, nightmares

Part 6: Attention problems

Early childhood

10% increase in symptoms of ADHD at age 7 per hour watched at ages 1 or 3

Christakis, et al, Pediatrics, April 2004

Possible factors

Causality may be bidirectional Brain development: Interaction between

genetics and environment may condition risk, severity and progression of attention problems

Conditioning: Frequent edits, pans, zooms, etc. = “rapid distraction”

Displacement: In place of other activities which promote attention

Content may have a role

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“2nd hand TV”

“Background adult television is a disruptive influence on very young children’s behavior” Reduced toy play episode length Reduced focused attention during play Effects in all ages (12, 24 and 36 months) They weren’t “watching” much

Schmidt et all, Child Development, July/August 2008

Part 7: What do we do about it?

What children and youth need

As much time as possible for: Interaction with other humans Verbal experimentation, with feedback from

other humans Creativity and exploration Reading and prereading activities Being physically active

Quantity matters

For children under the age of 2, the recommendation from the expert group

(American Academy of Pediatrics) is NO screen time at all.

For older children, the Academy recommends no more than 1-2 hours per day of total leisure screen time.

What can faith communities do? Educate!

Newsletter and/or materials Post information on site Create activities such as

• Log sheet• Draw “What do YOU like to DO?”• Do More/Watch Less program • “Get My Life Back” contest• Screen Free Week

What can parents do? Set environment

Keep the TV out of kids’ bedrooms Place the TV in a less desirable area Reduce total number of sets Have TV-free meals Make new family traditions (walk after dinner)

Set limits – aim for 1 hour a day for older kids No TV under age 2 TV only on certain days of the week

Part 8: Summary

36

Focus

Cope

For every hour watched

Read

Run

Talk

TVTV

Talk Create

Imagine

Play

BuyMore

EatThis

Violence Is Fun/Normal

SitMore

Explore

Interact

Sleep

What you’ve learned!

Health risks of screen time

Reducing hours reduces risk