Toddler Screen Time – How much is too much?

Dr Gill Harris, Consultant Paediatric Clinical Psychologist

 

In today’s digital age, it is no surprise that the amount of screen time suitable for children is a highly debated topic, with the subject regularly dominating media headlines. Children are spending more time than ever before immersed in screens from a very young age; this includes time spent watching television, playing a video game, or using an electronic device with a screen (such as a smartphone or tablet). While evidence is still limited as to the effects, it is thought that screen time affects sleep, interactive play and obesity – but it is not yet clear which type of screen time and when screen time might have the most impact.

In our latest blog post, we examine the evidence and aim to provide clarity on how much is too much when it comes to screen time.

How screen time affects sleep, play and obesity: The evidence

Sleep

There are several studies which show that longer screen use during the day is associated with sleep problems in children. 1 One study found that for each hour of touchscreen use, there was roughly a 15 minute decrease in the amount of sleep, and it also took children longer to go to sleep. 2 While evidence is still limited, the overall picture seems to be that there are indeed links between screen use and sleep, even in toddlers, but the reasons for this are not yet fully understood.

Play

Currently, there is very little evidence showing that screen time displaces activity time in children. A recent study looking at children followed from 3 weeks to 2 years, separated parents into two groups – a responsive parenting group, where screen time and television exposure were reduced – and a control group. The study revealed that the reduction in screen time and television exposure, did not prove an increase in the frequency or amount of play amongst the children. 3

Obesity

In older children, foods eaten during passive screen watching are more likely to be calorie dense ‘snack foods’. Research also shows that food responsive children, who are at risk of obesity, will eat more whilst passively watching programmes, especially those that include food advertisements. 45 Although there is little evidence to support this observation in toddlers and pre-school children 6, the Avon Longitudinal Study of Parents and Children (ALSPAC) study showed that three year olds who watched more than an average of an hour of TV or DVDs each day were more likely to become obese in later childhood. 7 This finding is not related specifically to passive eating but could be a function of lower activity levels in these children.

What the guidelines say

The World Health Organization’s (WHO) recent guidelines on screen time recommend that infants up to 2 years of age should have no screen time; and that the maximum for a 2-year-old should be one hour. 8

The Royal College of Paediatrics and Child Health (RCPCH) guidelines 9 however, recommend that screen use should be restricted before bedtime and that parents should be aware of the risks of snacking whilst passively watching. 10

Balancing the pros and cons and the need for more evidence

The recommendations to avoid screen use at bedtimes and mealtimes have cross-agency consensus and a small but growing body of evidence to support them. Broader recommendations to avoid screens below the age of 2 years and limit the daily screen time above that age are common, but evidence which shows the benefits of sticking to these limits is unclear. More evidence is also needed to establish whether the type of screen (traditional passive screen media like TV viewing, versus interactive touchscreen use), choice of programme (adult versus child-directed) and context of use (alone versus with a parent or sibling) have different outcomes in terms of health, fitness and cognition.

Top tips on managing toddler screen time

It can be difficult to know how to manage and improve your toddler’s screen time; here are our top tips for getting the most out of screen time use:

  • Make screen time family time – Watch, interpret and play with your toddler as you share the screen together
  • Choose the right kind of screen time – The nature of the screen time is equally as important as the length of screen time. Make sure that what your child is watching, playing and reading is high quality and safe
  • Create “screen-free” zones at home -Including the bedroom and the time leading up to bed time
  • Encourage other activities such as physical activity – Children can easily grow dependent on technology for entertainment and should be encouraged to become involved in activities that don’t involve screens. Most toddlers enjoy active play, particularly with their parents and friends. The Department of Health recommend that children under the age of 5 are physically active for at least 3 hours every day. 11 Activities such as active play inside and outside – including playing in the park, walking upstairs, bouncing on a trampoline, dancing, running, walking to nursery and other similar activities – all count and should be encouraged.

1 Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS. Association between portable screen-based media device access or use and sleep outcomes: a systematic review and meta-analysis. JAMA pediatrics. 2016 Dec 1;170(12):1202-8.

2 Cheung CH, Bedford R, De Urabain IR, Karmiloff-Smith A, Smith TJ. Daily touchscreen use in infants and toddlers is associated with reduced sleep and delayed sleep onset. Scientific reports. 2017 Apr 13;7:46104.

3 Adams EL, Marini ME, Stokes J, Birch LL, Paul IM, Savage JS. INSIGHT responsive parenting intervention reduces infant’s screen time and television exposure. international journal of behavioral nutrition and physical activity. 2018 Dec 1;15(1):24.

4 Gilbert-Diamond D, Emond JA, Lansigan RK, Rapuano KM, Kelley WM, Heatherton TF, Sargent JD. Television food advertisement exposure and FTO rs9939609 genotype in relation to excess consumption in children. International journal of obesity. 2017 Jan;41(1):23-9.

5 Harris JL, Bargh JA, Brownell KD. Priming effects of television food advertising on eating behavior. Health psychology. 2009 Jul;28(4):404.

6 LeBlanc AG, Spence JC, Carson V, Connor Gorber S, Dillman C, Janssen I, Kho ME, Stearns JA, Timmons BW, Tremblay MS. Systematic review of sedentary behaviour and health indicators in the early years (aged 0–4 years). Applied Physiology, Nutrition, and Metabolism. 2012 Aug;37(4):753-72.

7 Reilly JJ, Armstrong J, Dorosty AR, Emmett PM, Ness A, Rogers I, Steer C, Sherriff A. Early life risk factors for obesity in childhood: cohort study. Bmj. 2005 Jun 9;330(7504):1357.

8 https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more

9 https://www.rcpch.ac.uk/resources/health-impacts-screen-time-guide-clinicians-parents

10 Stiglic N, Viner RM. Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ open. 2019 Jan 1;9(1):e023191.

11 http://www.nhs.uk/Livewell/fitness/Pages/physical-activityguidelines-for-children.aspx (Accessed August 2016)

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Further Reading

  • Lucy Upton, Specialist Paediatric Dietitian and Nutritionist   As social distancing policies are put in place, and schools and nurseries shut their doors indefinitely, keeping your toddlers entertained and active for hours on end during COVID-19 may seem daunting and at times virtually impossible! Parents and carers have been thrown into a cozy and chaotic ‘new normal’ and may wonder how they can meet the recommended three hours a day of physical activity for under-fives who are walking. But do not panic, the Infant & Toddler Forum are here to help make sure you have plenty of ideas to keep your toddler happy and entertained whilst encouraging physical activity.
  • Lucy Upton, Specialist Paediatric Dietitian and Nutritionist   The start of a new year is a good time to consider establishing healthy feeding habits for the year ahead. Toddlers' nutritional requirements differ greatly from those of older children and adults. Rapidly growing and with small stomachs, toddlers require more nutrients in each mouthful of food.
  • Dr Gill Harris, Consultant Paediatric Clinical Psychologist   Yesterday marked an exciting point in the history of the Infant and Toddler Forum! After fifteen years of supporting parents and professionals in early years’ nutrition and development, we are transitioning to become a Community Interest Company (CIC).