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Plan and manage children’s screen time, urge US experts

Directional link between excessive screen time and lower scores in developmental tests

Louise Prime

Wednesday, 30 January 2019

Excessive screen time can impinge on children’s ability to develop optimally so paediatricians and health care practitioners should guide parents on appropriate amounts of screen exposure and discuss potential consequences of excessive screen use, according to the researchers behind a new study* published in JAMA Pediatrics. The study design meant it could rule out the reverse association, of children with poorer development simply being allowed longer screen times.

The American Academy of Pediatrics (AAP) said in autumn 2016: “When media is [sic] used thoughtfully and appropriately, media can enhance daily life. But when used inappropriately or without thought, media can displace many important activities such as face-to-face interaction, family-time, outdoor-play, exercise, unplugged downtime and sleep.” The AAP recommended** that parents and caregivers develop a family media plan that takes into account the health, education and entertainment needs of each child as well as the whole family.

The team behind the current study said that although excessive screen time is associated with delays in development, it is unclear whether greater screen time predicts lower performance scores on developmental screening tests – or if children with poor developmental performance receive added screen time as a way to modulate challenging behaviour. They designed a longitudinal cohort study to assess the directional association between increased screen time and performance on children’s developmental screening tests.

The study included 2,441 mothers and children (just under half of them boys) in Calgary, Alberta, Canada. When the children were aged 24, 36, and 60 months, children’s screen-time behaviour (total hours per week) and developmental outcomes (Ages and Stages Questionnaire, Third Edition) were assessed via maternal report.

The researchers’ analysis revealed that higher levels of children’s screen time at 24 and 36 months were significantly associated with poorer performance on developmental screening tests at 36 months and 60 months. They commented: “The obverse association (i.e. poor developmental performance to increased screen time) was not observed.”

The study authors noted that its longitudinal design, although necessary when looking at directionality of associations, is also a disadvantage when technology development is rapidly evolving and outpacing research; and, they said, another limitation was its consideration of total ‘screen time’, rather than time spent on different types of media content.

They pointed out that, in the US, although educational curriculums and programmes have continued to progress there have been no improvements in student academic performance over the past decade, which parallels the period in which technology use and screen time have rapidly increased. They concluded: “To our knowledge, the present study is the first to provide evidence of a directional association between screen time and poor performance on development screening tests among very young children. As technology use is entrenched in the modern-day lives of individuals, understanding the directional association between screen time and its correlates, and taking family-based steps to engage with technology in positive ways, may be fundamental to ensuring developmental success of children growing up in a digital age.”

They recommended encouraging family media plans, as well as managing screen time, to offset the potential consequences of excess use.


*Madigan S, Browne D, Racine N, et al. Association between screen time and children’s performance on a developmental screening test. JAMA Pediatr. Published online January 28, 2019. doi:10.1001/jamapediatrics.2018.5056.

**The AAP recommendations include that:
  • For children younger than 18 months, avoid use of screen media other than video-chatting. Parents of children 18-24 months of age who want to introduce digital media should choose high-quality programming, and watch it with their children to help them understand what they’re seeing.
  • For children aged 2-5 years, limit screen use to one hour per day of high-quality programmes. Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
  • For children aged six and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity and other behaviours essential to health. 
  • Designate media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms. 
  • Have ongoing communication about online citizenship and safety, including treating others with respect online and offline.

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