Pediatricians Rethink Screen Time Policy for Children – Wall Street Journal

All screens are not created equal.

In a nod to the changing nature of digital media and technology, the American Academy of Pediatrics announced this month that it is starting the process of revising its ironclad guidelines for children and screens.

For more than 15 years it has advised parents to avoid screen time completely for children under the age of 2, and to limit screen time to no more than two hours a day for children older than 2.

“In a world where ‘screen time’ is becoming simply ‘time,’ our policies must evolve or become obsolete,” the AAP’s media committee wrote in an article published this month in the publication AAP News, which circulates to the academy’s 64,000 members.

Ari Brown, lead author of the article and chair of the AAP committee that’s been investigating children’s media use, noted that the 2011 statement on media use for children under age 2 was being written and published at about the same time as the first generation iPad came out. “It literally felt outdated before we even released it,” Dr. Brown said. “Technology moves faster than science can study it, so we are perpetually behind in our advice and our recommendations.”

Experts are convening now and hope to be more expansive in their next set of guidelines, which they aim to have out in fall 2016. “All technology is not the same, all media is not the same,” said Dr. Brown. “There’s consumption, and there’s creation, and there’s communication. So if you’re looking at children under 2, there’s a big difference between endless hours of watching cartoons on YouTube and videochatting with Grandma.”

A 2013 survey by Common Sense Media, in San Francisco, found that 38% of children under the age of 2 had used a mobile device. (Count my 2-year-old among them. By 18-months her favorite pastime was talking to Siri on my iPhone.)

“Some of the traditional recommendations, like discouraging all screen time before age 2, just don’t fit with reality circa 2015-2016,” said James Steyer, chief executive of Common Sense Media, which rates all media content for parents.

In May, the AAP convened a symposium with top researchers and experts in the field of media use and children. Among the studies presented was research showing that when English-speaking 9-month-olds watched a Mandarin teacher on a television screen, there was no benefit, as measured by change in brain activity. When the teacher was in the room, there was a lot of change.

Other studies have highlighted the value of back-and-forth communication for children’s learning. Children between the ages of 24 months and 30 months learned as many new words from a teacher via videochat as they did with live presentation. “The more screen media mimics live interactions, the more educationally valuable it may be,” said Dr. Brown.

Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, has advocated for rethinking the AAP guidelines for more than a year.

One of the authors of the current guidelines, Dr. Christakis penned a controversial editorial in JAMA Pediatrics last March stating it was time to revise the current guidelines. His recommendation is that interactive media for children under 2 years is acceptable for 30 to 60 minutes a day.

“The reality is we have to explore how to judiciously use these newer interactive technologies which are clearly very different from traditional, passive media,” he said.

Is reading a book with a child on an iPad any different from reading a physical book, Dr. Christakis says. “The real value of reading to a child isn’t anything magical about the book… The book is providing a platform for a parent and child to interact. The real question is, Does the device promote that kind of back and forth or not? It certainly could. It’s all about how it’s used and how it’s structured.”

And then as a child develops and begins to engage in independent play, Dr. Christakis adds, is an iPad worse than other toys? The studies haven’t been done, he said, but he suspects it isn’t any worse.

Dr. Christakis’s research has found that children brought to the lab to play with blocks showed greater brain engagement, as measured by cortisol levels, than when watching Baby Einstein DVDs. Now he is conducting similar experiments with children from the ages of 18 months to 24 months that compares their experience with DVDs and with educational iPad apps.

Rachel Barr, an associate psychology professor at Georgetown University, has been studying how 2½- to 3-year-olds do puzzles, comparing regular magnet puzzles with puzzles on a computer touch screen.

She has found that children can learn in either format but there is a “transfer deficit,” meaning that they might excel in one context but when asked to switch to the other there is a lag in performance. “Applying things from one context to another is difficult,” she said.

She has also learned that if children don’t have someone showing them how to do the puzzle, such as how to drag the pieces on screen, their performance plummets.

One area of research involving media and screens that has recently become robust is the detrimental impact of background television, Dr. Barr said.

“Background TV actually disrupts the children’s activities—their play, the parent-child interactions, and it’s related to poorer executive functioning,” she said. “When it is on, play is not as complex, and that’s a really important part of how a child develops.”

Dr. Barr said parents need guidelines to be told what they can do, not just what they can’t do. “I don’t think there’s a bright line at age 2,” she said. “Development is a gradual process.”

Claire Lerner, senior parenting adviser for Zero to Three, a nonprofit that promotes healthy early development, is a co-author with Dr. Barr of research-based guidelines on screen time. The goal of the 2014 paper, she said, was to give parents some guidance on what they should think about when it comes to screen time. Parents need to be mindful that screen time is age- and content-appropriate.

A television show like “Arthur” is a great show, she said, but too complicated for a 2- or 3-year-old to understand. “It needs to be something that reflects their world, something that they’ve experienced,” she said.

Screen time can be enhanced by making it interactive, she said. Talk to your child about what they’re watching, expand on it by putting a physical object that they are viewing into their hands.

No matter how high the “quality” of screen time, it should be still be limited to 60 to 90 minutes a day, Ms. Lerner said.

She advises parents not to use screens as a way to calm a child—which she says she sees increasingly in her private practice as a clinical social worker.

Donald Shifrin, a clinical professor of pediatrics at the University of Washington School of Medicine in Seattle, says it is common for parents to try to distract children with screens during doctor visits. He has seen parents give young children a smartphone after a vaccination, for example. “Often times I say something like, ‘I think a hug would be terrific right now,’ ” says Dr. Shifrin, who is also on the AAP committee reviewing children’s media use and was chairman of the May symposium.

He said parents have to be involved in the content their children are using online, and aware and vigilant about how much time the child is using it. The AAP recommends that parents enforce tech-free zones for the whole family, such as mealtimes and bedtimes. “We want to show toddlers to teens that we don’t have to be defaulting to our screens at every moment,” Dr. Shifrin said.

Write to Sumathi Reddy at sumathi.reddy@wsj.com