Features

Time for a screen break?

14 May 2019

Concerns have been raised that digital devices are now a fundamental part of so many children’s lives, but are there mixed messages around the impact on young people? And how can you help parents navigate the advice? Journalist Georgina Fuller reports.

Egg Timer

In January, leading paediatricians said that parents should worry less about screen use after a review found there was very little evidence to suggest it was harmful in itself (Stiglic and Viner, 2019). The Royal College of Paediatrics and Child Health (RCPCH) published guidance informed by the review – which was co-authored by its president, Professor Russell Viner – stating that anecdotal claims that screen time was ‘toxic’ were unsubstantiated (RCPCH, 2019a). The RCPCH said it was not setting time limits for children because there was not enough evidence that screen time was harmful to children’s health. So far, so clear.

A month later, however, the UK’s four chief medical officers (CMOs) issued guidance as part of a review, saying mobile devices should be banned from the dinner table and at bedtime as part of a healthy approach to using such digital devices, and that children should also take a break from sedentary screen use every two hours (Davies et al, 2019). In the CMOs’ review, which was based on research by University College London, they defined screen-based activities as including watching videos online, social media use, gaming and similar activities.

A series of further events seemed to suggest that regardless of whether screen time in itself was toxic, screen-based activities could potentially have negative effects on young people.

English health secretary Matt Hancock met with bosses at Instagram in February, following the tragic suicide of 14-year-old Molly Russell in 2017. Molly had found images relating to self-harm, depression and suicide on her Instagram account. The Instagram chief Adam Mosseri said soon afterwards that the company would ban all images of self-harm on its site (Instagram, 2019).

In March, the health secretary also said that Instagram and other social media platforms should do more to crack down on ‘damaging’ myths, such as banning harmful hashtags.

Meanwhile, the #NewFilters wellbeing report, by the All-Party Parliamentary Group (APPG) on Social Media and Young People’s Mental Health and Wellbeing concluded in March that the technology industry should be doing more to protect children online (Royal Society for Public Health (RSPH), 2019).

In response, the government published its Online harms white paper on 8 April to set out the responsibilities of online platforms including social media (Department for Digital, Culture, Media and Sport (DCMS), 2019). It is running a public consultation on the white paper for 12 weeks (see its key recommendations below).

Then, on 12 April, the Information Commissioner’s Office (ICO) opened a consultation on 16 standards that ‘online services must meet to protect children’s privacy’, saying they looked forward ‘to participating in discussions regarding the government’s white paper’ (ICO, 2019).

So where does all this leave parents, carers and community practitioners (CPs) when it comes to advising on young people’s screen time, and is social media the main concern?

 

Some clarification please

‘Screen time needs to be built around family activities, not the other way around’

Dr Max Davie, officer for health improvement at the RCPCH, reiterates that there is little to suggest that screen time is bad for children. ‘There is not enough evidence to confirm that screen time is directly harmful to child health at any age,’ he explains. ‘Instead, parents should consider whether their child’s screen use is negatively impacting their wellbeing or other activities such as socialising, good sleep, diet, and exercise. Screen time needs to be built around family activities, not the other way around.’ The RCPCH recommends parents or carers ask the following: 

  • Is screen time in your house controlled?
  • Does screen use interfere with what your family want to do?
  • Does screen use interfere with sleep?
  • Are you able to control snacking during screen time?’

‘If a family can ask themselves these questions and are satisfied with the answers, then they can be reassured that they are likely to be doing as well as they can with this tricky issue,’ says Dr Davie.

Will Gardner, CEO of Childnet International, agrees that it is key that screen time should not be getting in the way of other aspects 
of young people’s lives.

‘At Childnet, we have a really practical “family agreement”, which is a great way for parents to start the conversation on how all the family use the internet and new technologies,’ he says. ‘It’s about encouraging families to talk about the way they use the internet at home, at school or a friend’s house. Children as young as three can help you make the promises and talk about why your family needs them.’ (For specific views on Screen time for under-fives, see below).

For children, for example, an agreement could include not giving away personal information, such as the name of their school and address, online, and not taking their tablet into their bedroom.

When it comes to ensuring screen time doesn’t interfere with sleep, as well as the CMOs’ suggestion to ban phones at bedtime, the RCPCH advises no phones or tablets an hour beforehand, and not to be reliant on devices with ‘night modes’ to do the job of emitting less blue light (RCPCH, 2019a).

The CMOs also make a number of clear recommendations in their screen-based activities review (Davies et al, 2019). As well as children taking regular breaks from screen time, they include parents talking about sharing photos online with their children, making sure parents and their children are aware of and abide by their school’s policy on screen time, ensuring children put their screens away when they are out and about (especially when crossing the road) and everyone putting digital devices away during meal times and face-to-face conversations.

The CMOs’ report also commends those questions for families produced by the RCPCH to help them make decisions about their screen use (see page 36), indicating that perhaps the two reports aren’t as different as first appeared when reported in the media. In fact, as with the RCPCH report, the CMOs said the research is ‘currently insufficiently conclusive to support UK CMO evidence-based guidelines on optimal amounts of screen use or online activities (such as social media use)’. Furthermore, the RCPCH said they welcomed the CMO report which ‘echoes much of our advice to parents’, and fully supported the CMOs’ proposals to improve the safety and wellbeing of children online (RCPCH, 2019b).

Child clinical psychologist at the University of Southampton Dr Angharad Rudkin believes that while the guidelines from the RCPCH are helpful, they don’t go far enough. ‘While there’s not much research to suggest screen time is harmful, there is not much to suggest it’s beneficial either,’ she notes. ‘So I think we have to err on the side of caution and use screen time as a treat or reward rather than rely on it as a given right.’


Screen time for under-fives

Dr Hayley van Zwanenberg, consultant child and adolescent psychiatrist at the Priory Wellbeing Centre Oxford, says that parents should limit screen time for children under five.

‘If children under five are given access, this should not replace communication with family but should ideally be used in an interactive manner, with carers or parents engaging with the child while using the device,’ she says. ‘If they are using digital games it is advisable that these are educational games and only used for brief periods at a time.’

Dr Zwanenberg recommends limiting screen time to two hours per day for children aged three to five. ‘Children under age two years should ideally have no screen time,’ she notes.

Parenting author Liat Hughes Joshi adds that younger children, especially those under five, don’t need to be online. ‘I think young children really benefit from not being online, and many aspects of multimedia games could damage their growing imagination,’ she says. ‘It’s also difficult to ascertain the quality of what they are watching and learning, especially if they have a tantrum the moment you try and take it away from them.’

The most recent guidelines from the American Academy of Pediatrics (AAP) have a collection of recommendations. The AAP says children aged two to five should have no more than an hour a day of (high-quality) screen time with an adult watching or playing with them.

And just before this journal went to press, the WHO issued guidance saying ‘sedentary screen time’, including computer games, should not happen before a child is two, that the limit for two- to four-year-olds is an hour a day, and that less is better (Roberts, 2019).

However, the UK is not changing its screen time guidelines (Roberts, 2019), because, as stated in this feature, the government says there is insufficient research for setting limits. The RCPCH also notes there has been some controversy with guidelines such as the AAP’s for not being fully evidence-based (RCPCH, 2019a).


Is it Social?

The RCPCH stated that one limitation of screen time research is that much of the literature is based on TV screens rather than mobile phones.

Nonetheless, social media in particular has been flagged up as a potential issue of too much screen use by several bodies.

There seems to be broad agreement among the RCPCH, the CMOs, children’s mental health charities and other experts that while social media can be a force for good, there are potential threats and lots that’s unknown. It’s an area that seems to need more accountability and research.

In fact, the #NewFilters wellbeing report recommended creating a social media health alliance, funded by 0.5% tax on the profits of social media companies. The APPG said social media firms should be funding research, drawing up clearer guidance on social media use and establishing a duty of care policy on all users under 24 (RSPH, 2019).

Most social media companies have already set in place an age restriction of 13 years of age to access and use their services, which the UK CMOs support (Davies et al, 2019).

Meanwhile, the recent government white paper’s key recommendations included establishing a code of practice for social networks and internet companies; fining companies that fail to tackle ‘online harms’, such as child abuse, and holding senior company executives in tech companies liable for any breaches (DCMS, 2019).

Statements from the UK policy heads of Facebook and Twitter indicated they also wanted a safer internet and were happy to engage in next steps, but that a point needs to be reached that preserves free speech and the digital economy (Fox, 2019).

Facebook is currently working with experts to provide guidance to parents through its ‘Parents Portal’, and, back in August 2018, Facebook said it would be introducing a number of new tools to help people manage their time on social media. 

A spokesman said: ‘We know that being a parent can be a difficult job and parents can have a lot of questions about Facebook. We created a guide with links, tips and tricks to help parents get the most out of their experience and help their child navigate their experience’ – see facebook.com/safety/parents

The guide forms part of Facebook’s safety centre, which has information on the tools and resources it offers people of all ages to help them manage their experience on Facebook, including a bullying prevention hub.

Instagram (owned by Facebook) also offers a guide for parents about how Instagram works, as well as tools to help with safety – see wellbeing.instagram.com/parents

Dr Davie at the RCPCH says it’s worth remembering that online communication and interaction is a genuine source of comfort and connection for lots of young people. ‘For instance, children who are feeling worried or depressed may find comfort in technology as they can reach out and connect with a supportive friend or community,’ he says. ‘On the other hand, there is no substitute for face-to-face interaction when it comes to learning to communicate.’

 

How to navigate

Dr Rudkin says she is seeing lots of parents who don’t know how to manage their children’s screen time. A recent parenting survey supports this: almost half of the parents in the poll of 805 admitted they use the TV, tablets and phones as a ‘digital babysitter’ (Care.com, 2019).‘I think we have to bring it back to basics and remember that our kids’ brains are wired to develop and learn through social interaction, so spending time online does not help with this,’ Dr Rudkin notes.

Liat Hughes Joshi, author of How to unplug your child, says that CPs should not necessarily demonise screens or technology per se. But she also spells out an important distinction: ‘Screens are part of all our lives but they’re not life itself,’ she says. ‘Adults should embrace the good that technology can bring, but make sure that unproductive screen time is monitored and kept under control.’

When it comes to playing games on digital devices – can this be seen as harmless fun, helpful even, or should it be avoided? Andy Robertson, author of Taming gaming and manager of Family Gamer TV, thinks that it’s much better for CPs to advise parents to play games with their children rather than try and isolate themselves from them.

‘Games by themselves aren’t necessarily good or bad, it’s how they are played and the context which they are played in,’ he says. (See panel on page 36 for games with under-fives).‘It’s about having conversations with your children and connecting with them by playing games with them,’ he continues. ‘Lots of parents think their children won’t want to play with them but actually, in my experience, they love it if you take an interest in what they are doing.’

Girls are twice as likely to show signs of depressive symptoms linked to social media use compared with boys at age 14

In fact, Andy believes that by playing these games with children you can help teach them to self-police the time they spend online, look subjectively at the people they interact with and take the taboo out of it.


Mobile view

Given the high ownership of mobile phones among young people, surely phone providers have a responsibility to help parents monitor children’s usage? Most of the mobile phone networks offer various tools to help parents (see Resources below).  

Helen Lamprell, general counsel and external affairs director for Vodafone UK, has a similar message to other expert bodies on how young people should make the most of modern technology: ‘It’s all about balance,’ says Helen. ‘Digital technology can offer exciting learning and development opportunities but it is important that this doesn’t interfere with young people’s schoolwork, their mental health, family time or other extracurricular activities.’

Vodafone offers a number of tools to help parents, including SecureNet, which helps to manage and monitor family devices and online activity. ‘We also work with digital family experts Parent Zone and the Vodafone Foundation on Digital Parenting, a resource that gives parents the knowledge and tools they need to have important conversations with their children about the digital world, including screen time.’


Next steps

The CMOs recommend taking a precautionary approach with screen time for children – balanced against the potential benefits they can gain from screen-based activities – and say that more research is needed to understand the relationship between screen-based activities and young people’s mental health. They have advised that the UK Council for Internet Safety (UCIS) should work with the RCPCH over the next 12 months so that the UCIS expands and updates its framework that equips children for digital life.

The CMOs also said that the Department for Education (England) must move swiftly to introduce compulsory ‘relationships education’ in primary schools and that health education should include guidelines on internet safety and online harm. They recommended the relevant bodies in Wales, Northern Ireland and Scotland, introduce similar guidelines. The technology industry – which includes producers of phones and tablets as well as online services such as social media platforms and apps – has a duty of care to its users and needs to use clear terms that children can understand, they said. The CMOs also support the government’s intention to legislate and set clear expectations of the technology industry.

Ultimately, young people today are the first generation to experience the digital evolution from their early years. While screen time in itself might not prove to be exceptionally harmful and it may help provide children with different ways to learn and develop, if it prevents them from playing outside and with each other or learning through social interaction, it may well prove to be detrimental. Which is perhaps why, despite all the voices, and the work yet to be done, there seems to be broad agreement on the importance of balance.  


Resources

Parents and CPs can consult a number of resources if they are concerned about screen time usage or online safety. The final five are suggested by the CMOs’ report:  

  • Find the RCPCH guide for clinicians and parents at bit.ly/RCPCH_screen_time, and the CMOs’ report at bit.ly/CMO_screen_time
  • Advice for setting parental controls on digital devices for all the mobile phone networks and broadband providers can be found in a guide by Internet Matters at bit.ly/parental_controls. Individual guides for parents include, from Vodafone vodafone.co.uk/mobile/digital-parenting, from EE and Internet Matters internetmatters.org/ee, and from O2 o2.co.uk/family
  • The UK Safer Internet Centre has partnered with Childnet International to create specific guidance on Keeping under-fives safe online with guidelines for three- to 11-year-olds at saferinternet.org.uk  
  • The UK Council for Internet Safety has developed a framework to equip children and young people for digital life and guidance for parents on minimising their child’s risk of online harms. See gov.uk/government/organisations/uk-council-for-internet-safety
  • The Professionals Online Safety Helpline (POSH) was set up in 2011 to help all members of the community working with or for children in the UK, with any online safety issues they may face. Call 0344 381 4772.  
  • The UK Safer Internet Centre has also developed a platform where people can report harmful content online if they are not satisfied with the result of their report to social media providers. For illegal content, reports should be made to the police and online to the Internet Watch Foundation. See saferinternet.org.uk and iwf.org.uk
  • 360 degree safe is an online safety self-review for schools at 360safe.org.uk

 


 

References 

Care.com. (2019) Parenting and tech report. See: https://s3.eu-west-1.amazonaws.com/carezen euwprd/pageConfigurator/images/Parenting%20Technology%20Report%20Care.pdf (accessed 29 April 2019).

Davies SC, Atherton F, Calderwood C, McBride M. (2019) United Kingdom Chief Medical Officers’ commentary on 'Screen-based activities and children and young people’s mental health and psychosocial wellbeing: a systematic map of reviews'

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/777026/UK_CMO_commentary_on_screentime_and_social_media_map_of_reviews.pdf  (accessed 16 April 2019).

Department for Digital, Culture, Media & Sport (2019). Online Harms White Paper. See: https://www.gov.uk/government/consultations/online-harms-white-paper (accessed 16 April 2019).

Fox C. (2019) Websites to be fined over 'online harms' under new proposals. See: https://www.bbc.co.uk/news/technology-47826946  (accessed 22 April 2019).

ICO. (2019) ICO launches consultation on Code of Practice to help protect children online.

See: https://ico.org.uk/about-the-ico/news-and-events/news-and-blogs/2019/04/ico-launches-consultation-on-code-of-practice-to-help-protect-children-online/ (accessed 22 April 2019).

Instagram. (2019) Changes we’re making to do more to support and protect the most vulnerable people who use Instagram. See:

https://instagram-press.com/blog/2019/02/07/changes-were-making-to-do-more-to-support-and-protect-the-most-vulnerable-people-who-use-instagram/ (accessed 23 April 2019).

Kelly Y et al. Depression linked to social media twice as high among girls. See: https://www.ucl.ac.uk/news/2019/jan/depression-linked-social-media-twice-high-among-girls-0 (accessed 16 April 2019).  

Ofcom. (2018) Children and parents: Media use and attitudes report 2018. See: https://www.ofcom.org.uk/__data/assets/pdf_file/0024/134907/Children-and-Parents-Media-Use-and-Attitudes-2018.pdf (accessed 23 April 2019).

RCPCH. (2019a) The health impacts of screen time: a guide for clinicians and parents. See: https://www.rcpch.ac.uk/sites/default/files/2018-12/rcpch_screen_time_guide_-_final.pdf (accessed 22 April 2019).

RCPCH. (2019b) RCPCH responds to social media and screen time guidance from Chief Medical Officers. See:

https://www.rcpch.ac.uk/news-events/news/rcpch-responds-social-media-screen-time-guidance-chief-medical-officers (accessed 22 April 2019).

Stiglic and Viner. (2019) Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. See:

https://bmjopen.bmj.com/content/9/1/e023191 (accessed 16 April 2019).

The Royal Society for Public Health. (2019) #NewFilters to manage the impact of social media on young people’s mental health and wellbeing. See: https://www.rsph.org.uk/uploads/assets/uploaded/23180e2a-e6b8-4e8d-9e3da2a300525c98.pdf (accessed 22 April 2019).

Roberts M. (2019) No sedentary screen time for babies, WHO says. See: https://www.bbc.co.uk/news/health-48021224 (accessed 24 April 2019).


 

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