Times have changed. Instead of hanging out with friends or playing outside, kids may prefer to stay at home, glued to the computer screen. While parents might think these activities are risk-free because their child is safe in the comforts of their own home, there are some cautions they need to keep in mind.
T. Eric Spiegel, MD, discusses screen time for kids, the updated recommendations from the AAP and how pediatricians and parents can work together to combat excessive screen time.
Selected Podcast
Excessive Screen Time for Kids
Featured Speaker:
Learn more about T. Eric Spiegel, MD
T. Eric Spiegel, MD
Dr. Spiegel specializes in child and adolescent psychiatry. He has a particular interest in pediatric patients with medical illness (consult/liaison) as well as psychotherapy.Learn more about T. Eric Spiegel, MD
Transcription:
Melanie Cole (Host): You know today’s children, they grow up immersed in digital media, which can have both positive and negative affects on their healthy development. My guest today, is Dr. T. Eric Spiegel. He’s a Washington University Pediatric Child and Adolescence Psychiatrist at St. Louis Children’s Hospital. Dr. Spiegel, let’s just start with the little guys, because what age would you say they should be introduced to electronic devices, because you see some kids sitting there on their parents’ phone or they used to have the handheld little game toys. What do you think about what age they should be introduced to some of these electronics?
Dr. T. Eric Spiegel, MD (Guest): I think the main thing Melanie that I would think of is that you want to wait as long as you can. It’s harder and harder to wait because it’s so easy to hand the phone or a device to a child to keep them occupied or give yourself a little bit of a break. The AAP used to say no television until after the age of 2 and I think that these days, we can’t think of just television, we have to think of all these screens as kind of one basket and preschool is a good time to start using them I think, sitting there with your parent, with your child and using it intentionally to do some sort of learning or something together. I think that’s the goal. We all know that there are times that they are going to get their hands on them from time to time; but it shouldn’t become a part of their regular world until preschool time.
Melanie: What a good point. I know the AAP has changed the recommendations because screen time as you say, has changed. It’s not just television. But kids do have homework and schoolwork and we will get into the teens and tweens in a minute, but with the little guys, how can pediatricians help parents to identify when their kids might be overstimulated because some kids if you take it away, they get really, really upset or you can tell that it is bothering them or that the game is messing around with their minds. So, what are some of those red flags?
Dr. Spiegel: Well, some of the things that you said are red flags. I think that you have to – some kids are just going to enjoy that a lot more than others and have the temperament that they are going to be more upset when you take away a preferred activity like that. But the real hallmark is balance. One of the things that the AAP offers on healthychildren.org is what’s called a media time calculator. And it says here are some other things that are going on in this kid’s world, you have got a lot of time for sleep, a lot of time for school, a lot of time to be with your family, to take care of yourself, to get some physical activity, do your homework and then – so the screen time gets smaller and smaller as you add in all these things that you are doing in your day. So, we have to be able to shift from screen time to all these other activities that we know are very important for children’s development. And so, if a child is having a hard time shifting from screen time to something else; we need to work on that, especially. I think that’s an important red flag for sure.
Melanie: Well it certainly is and as they get to be tweens and they want their first phone, then all of the sudden all of these other aspects come into it Dr. Spiegel, with social media and they want to be on Snap Chat and Instagram and all of these other things and this is where the parents kind of throw up their hands and say what do I do now? Speak about communication and how the pediatrician can even help facilitate that communication between the parent and the teen or tween so that we know what’s going on with our kids’ iPhones.
Dr. Spiegel: Yeah, I think that the basic rules are we need to know what’s going on when you are using it, what apps are on there. If you look at the apps every once in a while and you don’t know what they are, sit down curiously with your tween or your teen and say what is this, what do you use it for, can you show me some of your posts; not in a spying way but it is as I’m interested in your life kind of a way. I think that that’s the best thing to set up from the very beginning and the other thing is there’s a physical nature to this. The phones really should be used in certain areas of the house and not used in others. A lot of pediatricians would do a lot of help to families by recommending at a certain time of the day, all the devices are charging, including the parents’ and there are certain places in the home they just don’t go. They don’t go into bedrooms at all. That helps with knowing what’s going on with the devices and it also helps with not allowing these devices to impact our child’s sleep which is very important and quite easy to impact with a screen in front of your face past bedtime.
Melanie: Certainly, is and you’re a psychiatrist. Do you feel that these kinds of devices and since schools are using them so much more; do you think it’s making our kids smarter, more worldly? Do you feel it has a positive impact or kind of a little bit of both?
Dr. Spiegel: As with any new technology, it’s going to be a little bit of both. We would be not preparing our children for the world they are going to live in, if they had no technology involved in their learning or creation of understanding of the world around them. At the same time, I think you do give something up when you are not looking a physical book. I think there’s something to that. It’s a really different activity than looking at the screen or writing with a pencil. And so I think that creating those kinds of opportunities as well as using technology to learn, is probably going to kind of iron itself out over the years where schools will offer both things and if your school seems to be offering a little too much technology for the learning, I think honestly kids kind of get tired of their iPads after a while and they would like to draw or write or read a book and as parents, we want to offer those opportunities for our children to kind of diversify all the different ways that they think through something. This impact is even greater for those younger kids. One of the reasons that zero to 24-month stage we want to stay away from the screens is because they really do develop better, children develop better when they interact with the world around them in 3D and kind of figure out how things work and that just isn’t accomplished on a screen as well.
Melanie: Well, it’s interesting that you brought that up because now the AAP has determined that Facetime is not considered screen time anymore because it’s more like talking on the phone. So, kids kind of use this new recommendation to say oh well I can Facetime my friends for as long as I want, because that’s not considered screen time anymore. What do you think of that?
Dr. Spiegel: Well, I think that in the end, we are going to get down to it where we have to start thinking of different screen times as – I’m contradicting myself because I said we are putting it all in one basket if we are passively watching. Actually, my son was saying, heh there are all these different categories of screen time, some of which use your brain more actively than others dad and so he’s definitely keeping tabs on these things and he’s just a tween himself. So, yes, but at the same time, whenever teenagers twenty to thirty years ago would get on the phone with their friends, we wouldn’t allow them to do that for six hours every night. It has to do again, with balance. What other things do you need to do from the time you get home from school to the time that you go to bed? What time are you going to bed? Are you getting physical activity, which is an important piece of all of this, which can’t really be accomplished with a screen, not yet at least. Not well. And so, finding the time for all these other things, interacting with family sometimes has to be accomplished over a screen and that can be a real benefit as well. So, we can’t just be the – as parents and pediatricians, we don’t want to just be naysayers and trying to limit, limit, limit. I think the conversations of right, this is a little different than playing a video game or something like that and yes you are doing your homework, so I don’t want to punish you for that. So, having an open conversation as these things evolve because five years from now, all these recommendations might be revised again.
Melanie: Well, it certainly is all about communication. Communication between the pediatrician and the parent, the pediatrician and the teen and the parent and the teen. So, when we are looking at things like because kids hear now about sexting and cyberbullying and parents get concerned about that. Do we start from that place of trust, because you mentioned getting on and saying so what are these apps and what do you, looking at some of their posts, but sometimes especially with our teenagers today, you want to kind of look and see that they are not doing anything inappropriate or that nobody is saying anything to them through Snap Chat or Instagram that shouldn’t be said like that. So, what do we do as parents?
Dr. Spiegel: Well, I think it all comes down to the age that the child is. When children are very young, you get a lot of supervision 24 hours a day, unless you are asleep and as you get older, and older, and older, we expect our children to use the lessons that we have taught them and use us as a resource more than somebody that is supervising all the time. And this is a constant challenge of parenting adolescents because they are not fully functioning adults yet, but we can’t supervise them all the time if we want them to become one.
So, discussing cyberbullying as a concept as well as sexting as a concept and I think sexting fits in with a discussion about human sexuality that you should be having when kids are much younger than ready to do it, so that you can talk about it in theory first, and then as things maybe start to happen, you have already discussed these kinds of things and you have a relationship where that’s something you would talk about. And hopefully, then they will come to you as a resource but also make responsible decisions for themselves with the lessons that you have taught them. I know that sounds kind of scary for some parents, but there really is no way to know 100% of what’s going on with your child online, which is why we do try to push the internet ownership in the form of a handled smartphone to older and older if possible. At the same time, the normalcy is that it’s happening younger and younger and so in the end, sometimes you may be unpopular with enforcing those rules for sure.
Melanie: I think so too. And it’s really such an important and timely topic right now Dr. Spiegel. Please wrap it up for with your best advice or anything else you think a referring physician would want to know about these new recommendations from the AAP about opening lines of communication and even for the pediatrician, in being that go between, helping parents to communicate with their children. I mean that’s kind of the job of all of us together. So, wrap it up for us if you would.
Dr. Spiegel: Well, I think that the main thing is that the world is changing very fast now. Smartphones have only been around for about ten years and they have really changed the way that we interact with one another, the way that we interact with friends growing up and the way we are learning and so, there’s always going to be something new that parents aren’t going to know and it’s going to be a surprise to them. So, if they have built this foundation of communication with their kids, hopefully, they can learn some things from their kids as well as teaching them. And the pediatrician, he or she may be aware of some of the things that have become a problem for other families and can sort of give that guidance, that in the next few years, these are some things to think about that you may not even know about because they weren’t around when you were a kid and to direct them to resources for creating these dialogs and then creating these family media use plans that are so helpful on the AAP website.
Melanie: Good points all. Thank you so much for being with us today. A physician can refer a patient by calling Children’s Direct Physician Access Line at 1-800-678-HELP, that’s 1-800-678-4357. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis Children’s Hospital you can go to www.stlouischildrens.org that’s www.stlouischildrens.org . This is Melanie Cole. Thanks so much for tuning in.
Melanie Cole (Host): You know today’s children, they grow up immersed in digital media, which can have both positive and negative affects on their healthy development. My guest today, is Dr. T. Eric Spiegel. He’s a Washington University Pediatric Child and Adolescence Psychiatrist at St. Louis Children’s Hospital. Dr. Spiegel, let’s just start with the little guys, because what age would you say they should be introduced to electronic devices, because you see some kids sitting there on their parents’ phone or they used to have the handheld little game toys. What do you think about what age they should be introduced to some of these electronics?
Dr. T. Eric Spiegel, MD (Guest): I think the main thing Melanie that I would think of is that you want to wait as long as you can. It’s harder and harder to wait because it’s so easy to hand the phone or a device to a child to keep them occupied or give yourself a little bit of a break. The AAP used to say no television until after the age of 2 and I think that these days, we can’t think of just television, we have to think of all these screens as kind of one basket and preschool is a good time to start using them I think, sitting there with your parent, with your child and using it intentionally to do some sort of learning or something together. I think that’s the goal. We all know that there are times that they are going to get their hands on them from time to time; but it shouldn’t become a part of their regular world until preschool time.
Melanie: What a good point. I know the AAP has changed the recommendations because screen time as you say, has changed. It’s not just television. But kids do have homework and schoolwork and we will get into the teens and tweens in a minute, but with the little guys, how can pediatricians help parents to identify when their kids might be overstimulated because some kids if you take it away, they get really, really upset or you can tell that it is bothering them or that the game is messing around with their minds. So, what are some of those red flags?
Dr. Spiegel: Well, some of the things that you said are red flags. I think that you have to – some kids are just going to enjoy that a lot more than others and have the temperament that they are going to be more upset when you take away a preferred activity like that. But the real hallmark is balance. One of the things that the AAP offers on healthychildren.org is what’s called a media time calculator. And it says here are some other things that are going on in this kid’s world, you have got a lot of time for sleep, a lot of time for school, a lot of time to be with your family, to take care of yourself, to get some physical activity, do your homework and then – so the screen time gets smaller and smaller as you add in all these things that you are doing in your day. So, we have to be able to shift from screen time to all these other activities that we know are very important for children’s development. And so, if a child is having a hard time shifting from screen time to something else; we need to work on that, especially. I think that’s an important red flag for sure.
Melanie: Well it certainly is and as they get to be tweens and they want their first phone, then all of the sudden all of these other aspects come into it Dr. Spiegel, with social media and they want to be on Snap Chat and Instagram and all of these other things and this is where the parents kind of throw up their hands and say what do I do now? Speak about communication and how the pediatrician can even help facilitate that communication between the parent and the teen or tween so that we know what’s going on with our kids’ iPhones.
Dr. Spiegel: Yeah, I think that the basic rules are we need to know what’s going on when you are using it, what apps are on there. If you look at the apps every once in a while and you don’t know what they are, sit down curiously with your tween or your teen and say what is this, what do you use it for, can you show me some of your posts; not in a spying way but it is as I’m interested in your life kind of a way. I think that that’s the best thing to set up from the very beginning and the other thing is there’s a physical nature to this. The phones really should be used in certain areas of the house and not used in others. A lot of pediatricians would do a lot of help to families by recommending at a certain time of the day, all the devices are charging, including the parents’ and there are certain places in the home they just don’t go. They don’t go into bedrooms at all. That helps with knowing what’s going on with the devices and it also helps with not allowing these devices to impact our child’s sleep which is very important and quite easy to impact with a screen in front of your face past bedtime.
Melanie: Certainly, is and you’re a psychiatrist. Do you feel that these kinds of devices and since schools are using them so much more; do you think it’s making our kids smarter, more worldly? Do you feel it has a positive impact or kind of a little bit of both?
Dr. Spiegel: As with any new technology, it’s going to be a little bit of both. We would be not preparing our children for the world they are going to live in, if they had no technology involved in their learning or creation of understanding of the world around them. At the same time, I think you do give something up when you are not looking a physical book. I think there’s something to that. It’s a really different activity than looking at the screen or writing with a pencil. And so I think that creating those kinds of opportunities as well as using technology to learn, is probably going to kind of iron itself out over the years where schools will offer both things and if your school seems to be offering a little too much technology for the learning, I think honestly kids kind of get tired of their iPads after a while and they would like to draw or write or read a book and as parents, we want to offer those opportunities for our children to kind of diversify all the different ways that they think through something. This impact is even greater for those younger kids. One of the reasons that zero to 24-month stage we want to stay away from the screens is because they really do develop better, children develop better when they interact with the world around them in 3D and kind of figure out how things work and that just isn’t accomplished on a screen as well.
Melanie: Well, it’s interesting that you brought that up because now the AAP has determined that Facetime is not considered screen time anymore because it’s more like talking on the phone. So, kids kind of use this new recommendation to say oh well I can Facetime my friends for as long as I want, because that’s not considered screen time anymore. What do you think of that?
Dr. Spiegel: Well, I think that in the end, we are going to get down to it where we have to start thinking of different screen times as – I’m contradicting myself because I said we are putting it all in one basket if we are passively watching. Actually, my son was saying, heh there are all these different categories of screen time, some of which use your brain more actively than others dad and so he’s definitely keeping tabs on these things and he’s just a tween himself. So, yes, but at the same time, whenever teenagers twenty to thirty years ago would get on the phone with their friends, we wouldn’t allow them to do that for six hours every night. It has to do again, with balance. What other things do you need to do from the time you get home from school to the time that you go to bed? What time are you going to bed? Are you getting physical activity, which is an important piece of all of this, which can’t really be accomplished with a screen, not yet at least. Not well. And so, finding the time for all these other things, interacting with family sometimes has to be accomplished over a screen and that can be a real benefit as well. So, we can’t just be the – as parents and pediatricians, we don’t want to just be naysayers and trying to limit, limit, limit. I think the conversations of right, this is a little different than playing a video game or something like that and yes you are doing your homework, so I don’t want to punish you for that. So, having an open conversation as these things evolve because five years from now, all these recommendations might be revised again.
Melanie: Well, it certainly is all about communication. Communication between the pediatrician and the parent, the pediatrician and the teen and the parent and the teen. So, when we are looking at things like because kids hear now about sexting and cyberbullying and parents get concerned about that. Do we start from that place of trust, because you mentioned getting on and saying so what are these apps and what do you, looking at some of their posts, but sometimes especially with our teenagers today, you want to kind of look and see that they are not doing anything inappropriate or that nobody is saying anything to them through Snap Chat or Instagram that shouldn’t be said like that. So, what do we do as parents?
Dr. Spiegel: Well, I think it all comes down to the age that the child is. When children are very young, you get a lot of supervision 24 hours a day, unless you are asleep and as you get older, and older, and older, we expect our children to use the lessons that we have taught them and use us as a resource more than somebody that is supervising all the time. And this is a constant challenge of parenting adolescents because they are not fully functioning adults yet, but we can’t supervise them all the time if we want them to become one.
So, discussing cyberbullying as a concept as well as sexting as a concept and I think sexting fits in with a discussion about human sexuality that you should be having when kids are much younger than ready to do it, so that you can talk about it in theory first, and then as things maybe start to happen, you have already discussed these kinds of things and you have a relationship where that’s something you would talk about. And hopefully, then they will come to you as a resource but also make responsible decisions for themselves with the lessons that you have taught them. I know that sounds kind of scary for some parents, but there really is no way to know 100% of what’s going on with your child online, which is why we do try to push the internet ownership in the form of a handled smartphone to older and older if possible. At the same time, the normalcy is that it’s happening younger and younger and so in the end, sometimes you may be unpopular with enforcing those rules for sure.
Melanie: I think so too. And it’s really such an important and timely topic right now Dr. Spiegel. Please wrap it up for with your best advice or anything else you think a referring physician would want to know about these new recommendations from the AAP about opening lines of communication and even for the pediatrician, in being that go between, helping parents to communicate with their children. I mean that’s kind of the job of all of us together. So, wrap it up for us if you would.
Dr. Spiegel: Well, I think that the main thing is that the world is changing very fast now. Smartphones have only been around for about ten years and they have really changed the way that we interact with one another, the way that we interact with friends growing up and the way we are learning and so, there’s always going to be something new that parents aren’t going to know and it’s going to be a surprise to them. So, if they have built this foundation of communication with their kids, hopefully, they can learn some things from their kids as well as teaching them. And the pediatrician, he or she may be aware of some of the things that have become a problem for other families and can sort of give that guidance, that in the next few years, these are some things to think about that you may not even know about because they weren’t around when you were a kid and to direct them to resources for creating these dialogs and then creating these family media use plans that are so helpful on the AAP website.
Melanie: Good points all. Thank you so much for being with us today. A physician can refer a patient by calling Children’s Direct Physician Access Line at 1-800-678-HELP, that’s 1-800-678-4357. You’re listening to Radio Rounds with St. Louis Children’s Hospital. For more information on resources available at St. Louis Children’s Hospital you can go to www.stlouischildrens.org that’s www.stlouischildrens.org . This is Melanie Cole. Thanks so much for tuning in.