Healthy Screen Time: What is it and how does it look in the real world?

I’m going to tell a quick personal story from one of my recent sessions. One of my clients, who is two and a half years old, reached for a play-cutting board during our play with toy food, and started to pretend that it was a phone. You might think - “Oh that’s normal for a child to do at that age, great!”

But if you are around my age or older, you’ll know that “phone” means something very different now than what it used to mean. What he did with the play cutting board was not what you might think. Because what “phone” means now is not “device used for talking.” What “phone” means now is “screen.” He pretended the cutting board was a screen.

What does this look like? Saying “hello?” Asking “who is this?” Putting the play cutting board up to his face to make sounds into? Nope. What it looks like is a two and a half year old staring at a small flat piece of plastic, and tapping their index finger against the plastic repeatedly, then staring blankly at the plastic with their eyes, then typing, then staring some more. That was this child’s way of “playing phone.” And after this session, I realized that this is not just THIS child’s way of playing phone, but likely MOST children’s way of “playing phone” now.

Realistically, it makes sense, right? This is what he is observing his adult caregivers do while using their phone throughout the day. I use my phone to text more than I use it to speak, like I’m sure many others do between the ages of 20-40. It is more convenient and time-efficient. While this is true, we can also agree that a child pretending a phone is a screen versus a talking device essentially removes all aspects of language.

Screen time is an important topic for childhood development, and one that we should not shy away from, given that we are living in a world where screens are part of most of our daily routines. They make our lives easier, more efficient, and, for those of us who work in the tech industry, give us a job and means for livelihood. Aside from that, many interactions outside of work are done on screens as well - ordering food, facetiming or texting friends, planning trips, exercise routines, meditation routines - the list goes on.

It would be a lie to say that technology is going away, or that when you have children, living without technology should be your ultimate goal. However the reality is also that we do not fully understand technology and screen time’s impact on child development. There have been numerous studies on this very topic and a few are included in the resource list below. I’m going to summarize the recommendations that experts glean from these research studies now.

Here is the gist (Warning: If you’re a parent, you may start to panic here, but please stay with me)

Experts recommend NO screen time for children under the age of 2. That means if your child is under 24 months, it is a healthy choice to avoid the use of screens for downtime (TVs, tablets, ipads, phones, computers, etc.) altogether. That means no screen time, zero minutes in front of a screen throughout the day, no matter what. Keep in mind, this is based on extensive research, and the “why” is to come.
Professionals recommend no more than 1 hour a day for children ages 2 to 5 years, and they recommend that this includes something called “CO-VIEWING.” We’ll come back to this.
Research shows that after the 5th year, experts recommend placing limits on screen time that allow the child to be functional in their daily routines. You may ask then, why is there no specified amount of time limitation after the age of 5? This is likely because prior to the age of 5, your child’s speech and language skills are developing at such an astoundingly rapid pace that anything impacting these skills has a far greater impact. This does not, however, make limiting their screen time after the age of 5 any less crucial, as children are continuing to develop their language skills until the age of 18, and their cognitive abilities until the age of 25!

Research shows that when children are on screens for more than the above recommended time, there is a higher risk for a delay in language and cognitive development.

So what do we do with this information? We all need language to survive. It is a basic human need, just like nutrients or safety. So, why aren’t more people talking about this?

Like any huge problem, there is likely not just one cause. While I have many speculations as to why this issue is not being talked about, if I were to list these out, at the end of the day, they would be just that: speculation. What is important is that much like nutrition, I believe that when it comes to technology, what works for some people may not work for others.

In today’s world, it is not always feasible to expect every parent to make the huge leap to suddenly place huge restrictions on their child’s screen time. On top of that, what about parents who are on THEIR phone all day and night? Do they get the pass since they are over the age of 18? As pediatric health professionals, do we have the right to tell parents to limit their own screen time as well as their child’s?

I strongly empathize with parents and caregivers who may feel confused and defeated when it comes to using healthy screen time. Much of the information on the internet is riddled with fear-inducing statements and lacking in acceptance and acknowledgement of how enmeshed we all are in technology as a whole. Furthermore, the term “healthy screen time” has for some odd reason, included the limitation of screens altogether - but to me, this is a misnomer. If healthy screen time means the absence of screens, then why not call it something else? Shouldn’t it be called “healthy non-screen time” then? Why not emphasize the alternative activities that parents CAN use to keep their children busy in times of need, or the ways that parents can use screens to ENHANCE their screen time experience?

As health professionals I think it is our duty to not only give healthy recommendations on how to limit unhealthy habits, but also to meet parents and families where they are at. There is so much that we, as parents and caregivers can do DURING screen time that can help our child benefit from technology and open new pathways to learning. Screen time limitations means taking devices away altogether during specific times of the day, but can we do when our child IS inevitably using a device or watching their parents use one? This is where Co-Viewing comes in. I’m including a few healthy screen time strategies explaining co-viewing below.

Healthy screen time strategies:

I can’t emphasize this part enough: If you are choosing to allow your child to use a device (TV, iPad, tablet, phone, etc.) - that means your child is using their eyes to stare at the screen, whether it’s a television screen or other device’s screen, experts recommend using CO-ENGAGEMENT.

Co-engagement, Co-viewing, shared screen time - these are all terms that mean the same thing: SHARE your child’s screen time experience with them. Share your screen time experience with your child. Press “pause” while they are watching a video or playing a game, ask them questions, make your own comments, wait for them to respond.

This is a way to counter the unrealistic and trance-like aspects of a screen-time experience. Basically you want to interrupt your child’s viewing experience (or your own) as much as possible. To those of you who hate being interrupted while watching a TV show like myself, this sounds like a form of torture, I know! But stay with me...

Think of this strategy as a way of enhancing your interactions with your child. Think of screens as a tool for YOU, rather than a tool for your child to use independently. Just like if you were to hand them a hammer and nail, your child needs your constant guidance and help along the way, for them to find any benefit from these tools. Like any teaching opportunity, it is important to be looking at the person guiding you, so having your child shift their eye gaze from their device, to your face repeatedly during your interactions, is a crucial part of co-engagement.

For enhancing your interactions specifically while using a tablet or phone, for toddlers between the ages of 2-4, hold your iPad or tablet in your hands at all times, as your child presses buttons on the screen or responds to you during co-engagement. Avoid letting your child hold the tablet or phone independently, or grab the tablet from you.

Think of this as a rule for YOU rather than for your child. If you set this rule for yourself, you will not be able to allow your child to be on the phone or tablet as often as you might otherwise, because you simply will not be able to hold the device at all times of the day. That means your child will have to find other means to entertain themselves, and that’s okay! For ideas about how to use at-home items to enhance their speech and language skills, check out my blog on Six Ways to Elicit Language Opportunities at Home.

Lastly, although these recommendations may seem daunting at first sight, all I ask is that you try out co-engagement just once this week! See where it takes you. Then once you get into the routine of using co-engagement, and becoming more aware and intentional with your screen time, you may find that it comes pretty easy.