Building Better Brains and Bodies Through Screen Time Reduction Jean Rystrom, Practice Director – Pediatrics, Kaiser Permanente Northwest EMO November, 2010

Take Home Messages Screen time is associated with many health and development risks Screen time is associated with many health and development risks The total number of hours spent watching determines many of the outcomes, and reduction helps The total number of hours spent watching determines many of the outcomes, and reduction helps How we can do our best for the kids How we can do our best for the kids

Possible health effects of screen time: starting with early childhood Weight Weight Reading and scholastic achievement and development of the brain Reading and scholastic achievement and development of the brain Violence and aggression Violence and aggression Sleep problems Sleep problems Attention problems Attention problems Risk behaviors (older kids): Early sexualization, tobacco and alcohol abuse Risk behaviors (older kids): Early sexualization, tobacco and alcohol abuse

What is screen time? Its all screen activities for entertainment: TV, movie, video game, computer game, cell phone game, etc. Its all screen activities for entertainment: TV, movie, video game, computer game, cell phone game, etc. The number of hours with the screen means greater exposure to risks and fewer hours for other activities. The number of hours with the screen means greater exposure to risks and fewer hours for other activities.

No guilt! (If you are thinking about your own experiences, remember: you didnt know what you didnt know)

Part 1: Screen Time Usage

6 Usage: Under age 12 months The AAP recommendation is no screen time before age 2, but… By 3 months of age, about 40% of children regularly watched television, DVDs, or videos The median age for introduction was 9 months Average 1 hour per day by age 12 months Zimmerman et al, Arch Pediatr Adolesc Med, May 2007

7 School Age AAP recommendation: no more than 1-2 hours per day, but…. AAP recommendation: no more than 1-2 hours per day, but…. KFF report Generation M2 KFF report Generation M2 Increase of over 1 h/day from 5 years previous on total media use Increase of over 1 h/day from 5 years previous on total media use Over 4.5 hours per day screen media Over 4.5 hours per day screen media Smart phones….(39% to 66% have them – but this doesnt count talking or texting) Smart phones….(39% to 66% have them – but this doesnt count talking or texting)

FocusCope For every hour watched Read Run Talk TV Talk Create Imagine Play Buy More Eat This Violence Is Fun/Normal Sit More ExploreInteractSleep

Part 2: Weight

Screen time and Weight: Possible mechanisms More Calories In Fewer Calories out Food advertisements, Product placements, Normative behaviors, and Snacking Very sedentary behavior = =

calories Additional calories consumed per hour of watching television in teens Additional calories consumed per hour of watching television in teens Wiecha, et al, Arch Pediatr Adolesc Med, April 2006

12 Activity level is very low 84 Calories per hour to sit quietly 84 Calories per hour to sit quietly 114 Calories per hour to play cards 114 Calories per hour to play cards 198 Calories per hour to walk (2 MPH) 198 Calories per hour to walk (2 MPH) The Presidents Council on Physical Fitness and Sport, Exercise and Weight Control (based on 150 pound person)

Part 3: Reading, Scholastic Achievement and Brain Development

14 Educational Claims No proof of benefit for baby products No proof of benefit for baby products Slows development in language, reading and math Slows development in language, reading and math No studies compare to beneficial activities No studies compare to beneficial activities Christakis and Zimmerman, The Elephant in the Living Room

Educational Impact Bedroom TV: lower 3 rd grade standardized tests (math, reading, and language arts) Bedroom TV: lower 3 rd grade standardized tests (math, reading, and language arts) Regression models predicted up to 24% of the variation in scores Regression models predicted up to 24% of the variation in scores 71% had a bedroom TV 71% had a bedroom TV TV in bedroom predicts greater viewing time TV in bedroom predicts greater viewing time Borzekowski and Robinson, Arch Pediatr Adolesc Med, 2005

Long Term Impact 30% lower college degree associated with each additional hour of media watched age 5-15 in longitudinal study Hancox, et al, Arch Pediatr Adolesc Med, July 2005

Brain development Brains are plastic – especially young kids (even older adults) Brains are plastic – especially young kids (even older adults) Stimulus influences structure: babies need interaction with all senses during critical periods Stimulus influences structure: babies need interaction with all senses during critical periods Baby videos: little dialogue, short scenes, disconnected images, no interactive practice Baby videos: little dialogue, short scenes, disconnected images, no interactive practice No human interaction: babies experience world in relationships No human interaction: babies experience world in relationships

Part 4: Violence and Aggression

Preschool Aggression Sustained exposure > 2 hours/day of TV/video from age months associated with much higher levels of aggression (also problems with sleep, self control, attention and cooperation). Sustained exposure > 2 hours/day of TV/video from age months associated with much higher levels of aggression (also problems with sleep, self control, attention and cooperation). Content not specified (what is watched) Content not specified (what is watched) Mistry et al, Pediatrics, October 2007 Sustained exposure > 2 hours/day of TV/video from age months associated with much higher levels of aggression (also problems with sleep, self control, attention and cooperation). Sustained exposure > 2 hours/day of TV/video from age months associated with much higher levels of aggression (also problems with sleep, self control, attention and cooperation). Content not specified (what is watched) Content not specified (what is watched) Mistry et al, Pediatrics, October 2007

Elementary Bullying Behavior For every hour of daily TV at age 4, increased chance of bullying age 6-11 For every hour of daily TV at age 4, increased chance of bullying age 6-11 Content not specified (what is watched) Content not specified (what is watched) Zimmerman, et al, Arch Pediatr Adolesc Med, April 2005

21 Updates 2009/10 AAP has revised policy statement AAP has revised policy statement a significant risk to the health of children and adolescents a significant risk to the health of children and adolescents media violence is 1 of the causal factors of real life violence and aggression media violence is 1 of the causal factors of real life violence and aggression The debate should be over. The debate should be over. 3 year olds exposed to more TV have greater risk of aggressive behavior 3 year olds exposed to more TV have greater risk of aggressive behavior (Manganello and Taylor, Arch Pediatr Adolesc Med, Nov 2009)

Part 5: Sleep Problems

TV and Sleep More television viewing among infants and children = more irregular sleep schedules More television viewing among infants and children = more irregular sleep schedules Thompson and Christakis, Pediatrics, October 2005 Owens, et al, Pediatrics, 1999

Possible mechanisms Bedtime resistance Bedtime resistance Delay of sleep onset, duration Delay of sleep onset, duration Melatonin and light Melatonin and light Less relaxed after watching Less relaxed after watching Anxiety, nightmares Anxiety, nightmares

Part 6: Attention problems

Early childhood 10% increase in symptoms of ADHD at age 7 per hour watched at ages 1 or 3 Christakis, et al, Pediatrics, April 2004

Possible factors Causality may be bidirectional Causality may be bidirectional Brain development: Interaction between genetics and environment may condition risk, severity and progression of attention problems Brain development: Interaction between genetics and environment may condition risk, severity and progression of attention problems Conditioning: Frequent edits, pans, zooms, etc. = rapid distraction Conditioning: Frequent edits, pans, zooms, etc. = rapid distraction Displacement: In place of other activities which promote attention Displacement: In place of other activities which promote attention Content may have a role Content may have a role

28 2 nd hand TV Background adult television is a disruptive influence on very young childrens behavior Background adult television is a disruptive influence on very young childrens behavior Reduced toy play episode length Reduced toy play episode length Reduced focused attention during play Reduced focused attention during play Effects in all ages (12, 24 and 36 months) Effects in all ages (12, 24 and 36 months) They werent watching much They werent watching much Schmidt et all, Child Development, July/August 2008

Part 7: What do we do about it?

What children and youth need As much time as possible for: As much time as possible for: Interaction with other humans Interaction with other humans Verbal experimentation, with feedback from other humans Verbal experimentation, with feedback from other humans Creativity and exploration Creativity and exploration Reading and prereading activities Reading and prereading activities Being physically active Being physically active

Quantity matters For children under the age of 2, the recommendation from the expert group (American Academy of Pediatrics) is NO screen time at all. For children under the age of 2, the recommendation from the expert group (American Academy of Pediatrics) is NO screen time at all. For older children, the Academy recommends no more than 1-2 hours per day of total leisure screen time. For older children, the Academy recommends no more than 1-2 hours per day of total leisure screen time.

What can faith communities do? Educate! Newsletter and/or materials Newsletter and/or materials Post information on site Post information on site Create activities such as Create activities such as Log sheetLog sheet Draw What do YOU like to DO?Draw What do YOU like to DO? Do More/Watch Less programDo More/Watch Less program Get My Life Back contestGet My Life Back contest Screen Free WeekScreen Free Week

What can parents do? Set environment Set environment Keep the TV out of kids bedrooms Keep the TV out of kids bedrooms Place the TV in a less desirable area Place the TV in a less desirable area Reduce total number of sets Reduce total number of sets Have TV-free meals Have TV-free meals Make new family traditions (walk after dinner) Make new family traditions (walk after dinner) Set limits – aim for 1 hour a day for older kids Set limits – aim for 1 hour a day for older kids No TV under age 2 No TV under age 2 TV only on certain days of the week TV only on certain days of the week

Part 8: Summary

35 FocusCope For every hour watched Read Run Talk TV Talk Create Imagine Play Buy More Eat This Violence Is Fun/Normal Sit More ExploreInteractSleep

What youve learned! Health risks of screen time Health risks of screen time Reducing hours reduces risk Reducing hours reduces risk