By Daniel E. Gershon, D.O. and Laura Salitros, D.O. – Lee’s Summit Physicians Group

We recently posted a blog about social media and young children (ages 0-5).  Now we move on to a more challenging situation: media and how it applies to school aged children and adolescents.

When our children are young, they’re more easily entertained by the simple things. As they get older, their interests become much more specific and much more influenced by their peers. Kids start participating in sports, music, theater, cooking, reading, Girl Scouts, Boy Scouts, and many other activities. However, electronics remain a fierce competitor for their attention and time, whether they are participating in these activities or not.

Get Them Involved

The more involved they are, the less idle time they have at home to engage in electronics. This is one of the reasons why pediatricians recommend getting your kids involved in activities outside the school and home.

We worry about kids who have few interests and prefer to stay home. Sadly, there are also many families that do not have the means to allow their kids to participate in organized activities. Because electronics are a very appealing activity that is part of almost every household, they can very quickly become the preferred activity for children.

As parents raising children in this digital age, part of our job is to help them navigate media so they can reap the benefits while also being protected from the risks.  In order to teach our children to use media safely and respectfully, we first need to educate ourselves about what is out there, what the potential risks and benefits are, and what the recommendations are.

What are they watching?

It is important to understand the types of media that kids are consuming. There is broadcast media (TV and movies) and interactive media (social media, video games). In recent years, we’re seeing a shift toward more interactive media. There are many devices that allow us to connect to digital media, perhaps the most important being the smartphone.

Smartphones give kids and teenagers the ability to stay connected constantly. In fact, according to a study published in 2015, about three-quarters of teens have access to a smartphone and one-quarter of teens describe themselves as being “almost constantly” online (Lenhart A. Teens, Social Media & Technology Overview 2015. Washington, DC: Pew Internet and American Life Project; 2015).

So what exactly are the risks?

Addiction

If you read our last blog, we discussed how electronics cause DOPAMINE to be released. This neurotransmitter creates a similar response to the one seen from a cocaine high on a functional MRI of the brain. When the reward pathways become overused, the brain craves more and more dopamine. As we are seeing more addictive behaviors related to screens, the medical community has needed to respond. The most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has even added Internet Gaming Disorder as a diagnosis.

Sleep problems

The light that is emitted by screens mimics daylight and suppresses MELATONIN release. This leads to an upset of the circadian rhythm, which leads to sleep disorders. Beyond that, being woken throughout the night because of phone alerts can lead to poor sleep quality. Inadequate sleep has been linked to physical and mental health problems, as well as problems with executive function and learning.

Obesity

Screen time has a tendency to displace active time with sedentary time. It also encourages mindless snacking, which tends to lead to excess caloric intake.

Bullying

Digital media gives kids a new platform to use for bullying. Cyberbullying is something that all parents should be aware of, and kidshealth.org has a good article for parents about this (https://kidshealth.org/en/parents/cyberbullying.html)

Depression

There is evidence that increased social media use is associated with increased depression rates in adolescents. There are many potential reasons for this association. Teens spend less time connecting to their peers in person, which may lead to feelings of isolation. They also have a tendency to compare themselves to their peers’ online identities, which may lead to feelings of inadequacy.

They are constantly aware of what their peers are doing, which may lead to feeling left out. Teens also have a tendency to associate the number of “likes” with their self-worth. This article from the Child Mind Institute has some good information about depression and media use (https://childmind.org/article/is-social-media-use-causing-depression)

Earlier exposure to adult content

Pornography, sexting, and online solicitation are all concerns here. Exposure to pornography can have long-term adverse effects, as discussed in this article: (https://preventchildabuse.org/resource/understanding-the-effects-of-pornography-on-children/).

Our youth are also becoming desensitized to sexting, as it is becoming more common.  This article (https://jamanetwork.com/journals/jamapediatrics/article-abstract/2673719) from 2018 discusses the prevalence of sending and receiving sexual content.

Are you seeing the problem?

We are treating more children and adolescents for ADHD, anxiety, depression, suicidal thoughts, suicide attempts, anger and aggression issues, sleep problems, and poor social skills. We’re also seeing interesting trends, such as teens beginning to drive at older ages and lower rates of sexual activity.

A recent study from the Pew Research Center showed lower levels of teenage reported sexual activity, drinking, and drug use, but higher levels of depression and loneliness.  Could these trends be due to the

Are there any benefits?

Despite all the risks we tend to name regarding digital media, we still need to remember that there are some benefits.

Social media and video chatting help us keep in touch with friends and family members, especially those who live far away. Digital media exposes us to new knowledge, new ideas, and can help us keep up with current events. The Internet and social media allow us a large platform to access in emergencies or to promote charitable events or programs. There are apps and online communities that help support a healthy lifestyle.

There is evidence to suggest that the use of social media may provide valuable support to some of our kids and teens who may feel isolated, including LGBTQ individuals and their allies (Krueger EA, Young SD. Twitter: a novel tool for studying the health and social needs of transgender communities. JMIR Ment Health. 2015;2(2) ).

Social media likely also provides valuable support to those who are struggling with serious mental illnesses (Naslund JA,Aschbrenner KA, Marsch LA, Bartels SJ. The future of mental health care: peer-to-peer support and social media. Epidemiol Psychiatr Sci. 2016;25(2):113–122pmid:26744309)

So what recommendations do we have?

1) Develop a plan and stick with it.

This website (www.healthychildren.org/MediaUsePlan) can help you develop a plan that works for your family.

2) Limit, reduce, and restrict the amount of time spent in front of screens.

– A recent study showed actual brain changes in kids getting more than 7 hours of screen time per day, while another study showed kids who spend more than 2 hours per day scored lower when tested on language and thinking skills.

– Do not focus only on hours per day.  FOCUS ON TAKING MORE BREAKS.  Try to limit a single screen time session to less than 1-1.5 hours, then have them take a break for an equal amount of time.  In front of a screen for 1 hour?  Off all screens for an hour.  Simple.

3) Keep bedrooms screen free – No TVs in rooms and charge other devices in another place overnight.

Kids are less likely to access dangerous or otherwise unhealthy content if they are using screens in a high traffic area in the home while parents are nearby monitoring their screen use.  Also, I don’t know about you, but I don’t want to go to bed worrying about what my kid is watching and how late they may be staying up on a school night.

4) Never let screen time be a part of routine daily activities.

What we mean here is to avoid making screen time part of meals, car rides, grocery store trips, and other daily activities.  Kids need to lean to be patient, to tolerate boredom, and to interact with people around them.  Allowing them screens all the time will create a sense of entitlement to having the screen.  Screens should either be earned or reserved for special occasions like long car rides, vacation, illness, bad weather, etc.

5) Make kids EARN screen time.

This is ONE OF OUR ALL TIME FAVORITE RECOMMENDATIONS! It will help develop the habit of DOING THE WORK BEFORE HAVING THE FUN.  This is a habit of successful people.  I like to have kids and teenagers do 3 things before they get screen time:

– HOMEWORK – Grab a glass of water and snack.  If they have no homework, have them find an activity that requires mental effort or creativity (studying, reading, drawing, LEGOs, etc).  If their homework is only available on a computer, that’s ok.

– CHORES – ALL kids are capable of helping contribute to the household.  We all participate in the fun activities, so we should all help the house run.  In general, keep chores short, simple, and mix them up.  Give kids more responsibilities as they want more freedoms.

– EXERCISE – Have your child spend 30-60 minutes engaged in an activity that they love, which also gets their heart pumping and their body sweating!  If they have a game or practice that night, that can be their exercise for the day.

6) Make sure your kids have time to socialize with family and friends.

These days, you can do just about anything without leaving your home.  Kids need to learn to talk politely, make eye contact, and interact with people if we want them to be successful adults.

7) Know what types of media your kids are using as well as what apps they are using. You can do this by having a family account through the app store, which allows you to see all of the app purchases and downloads for each individual. Once you know what they’re using, download the same apps so you can know what they are, how they work, and what advertisements your kids are being exposed to.  Make a habit of “following” or “friending” your kids on social media.  Also, don’t be afraid to periodically check their devices to monitor their use.

8) Help your kids protect themselves from misinformation. There are many websites out there that appear to be legitimate that are actually spreading misinformation. Common sense media has put together a list of websites to help with fact checking (https://www.commonsensemedia.org/lists/fact-checking-tools-for-teens-and-tweens)

9) Consider an alternative to a smartphone when you feel your child may need a phone. According to this article (http://influence-central.com/kids-tech-the-evolution-of-todays-digital-natives/), the average age kids are when they get their first phone is 10.3. Fortunately, smartphones aren’t the only option.  There are multiple options available for basic or “dumb” phones.  There are also several watches that allow texting or two way calling.  Wait until 8^th (https://www.waituntil8th.org/) is a pledge that parents can make to wait until at least 8^th grade to give their children smartphones.

10) Lastly, make sure you are modeling healthy digital media use.

Make sure you find time to put your phone away and talk with your kids.  Show them how you can wait in a line or on an elevator without having your eyes on a screen.

Additional resources used for this article:
https://pediatrics.aappublications.org/content/138/5/e20162592