AAP report ignores health impacts of screen time

I just came across a new release from the American Academy of Pediatrics titled "Beyond 'turn it off': How to advise families on media use".  The report is the result of their recent invitation-only Growing Up Digital Media Research Symposium.

From the release:

The most well-known of these guidelines discourage "screen time" for children under age 2 and limit "screen time" to two hours a day for children over age 2 (Pediatrics 2013;132:958-961ABSTRACT/FREE FULL TEXT; Pediatrics2011;128:1040-1045ABSTRACT/FREE FULL TEXT). As we know, however, scientific research and policy statements lag behind the pace of digital innovation.

The thrust seems to be that kids are way over the above guidelines, causing the AAP to consider new ones:

Today, more than 30% of U.S. children first play with a mobile device when they still are in diapers, according to Common Sense Media. Furthermore, almost 75% of 13- to 17-year-olds have smartphones, and 24% admit using their phones almost constantly, according to the Pew Research Center.

Although they have not actually changed their screen time guidelines as of yet,  they have stated that more formal guidance is on the way.  As someone actively researching the health impact of screen time in children and youth (and as the father of a young child), I have a number of concerns with this latest release, and the likely direction of their future guidelines.

First and foremost, this new release, and the symposium based on this release, only focused on the benefits of screen time.  Here is the description of the symposium from the latest release:

Given the breadth of the topic, the symposium limited its focus to early learning, game-based learning, social/emotional and developmental concerns, and strategies to foster digital citizenship.

In the section of the recent AAP symposium focused on the "Health and Developmental Impact" of screens, the focus was:

the physical, social, emotional, and educational health advantages and challenges of digital media, including gaming and game theory

In other words, the focus of the health research portion of the symposium seems to have been explicitly focused on the benefits of media use, rather than the potential harms. Much of the discussion appears to have been overtly pro-media use.  For example, here's a description of the Education and Early Learning discussion:

Panelists emphasized that developmentally optimized media can be beneficial for young children, and is a proven learning tool for children over age two. It may play a key role in bridging the learning "achievement gap" noted among low-income, disadvantaged, and underserved populations. Digital media can be used to facilitate executive function, build self-control and problem-solving skills, and improve children's ability to follow directions. Industry leaders recommended creating media for a dual audience (i.e., both parent and child) to facilitate family participation in media use and model more effective social and learning interactions.

Reading the above, I can't help but think "yeah, but."

It also seems that the AAPs current approach is that the guidelines need to be changed simply because kids are not meeting them, so the call for "science-driven" advice seems a bit odd to me.  From their report:

In a world where "screen time" is becoming simply "time," our policies must evolve or become obsolete. The public needs to know that the Academy's advice is science-driven, not based merely on the precautionary principle.

As I've pointed out here ad nauseum, there is a massive amount of evidence that screen time is associated with bad health outcomes in kids, ranging from obesity to increased risk factors for cardiovascular disease and diabetes.  And the research just keeps accumulating – our systematic review on the health impact of sedentary behaviour published in 2011 identified 232 studies with nearly 1 million participants, and that number has increased dramatically in the 4 years since.  Although this latest report rightly identifies the negative impact of screen time on sleep, no other health impacts of screen time appear to have been discussed, which strikes me as odd given the wealth of evidence on the topic, and AAPs focus on child health.  I'm concerned that a health focused organization that has been a leader in this area, would release a report and consider changing their guidelines while simply setting aside a massive chunk of research evidence.  

Are the current guidelines realistic?

Some people will suggest that the current guidelines are unrealistic, and therefore of little value.  To me, that seems like a discussion around messaging, rather than health guidelines, which are supposedly evidence-based.  For example, you can acknowledge that the "ideal" amount of screen time for a toddler is probably "none", but still provide ways to minimize the harms and maximize the benefits of screen use in this age group.  "E.g. Avoid screen use when possible; when that's not possible, here are some suggestions…".  A lot of the key messages in the AAP report are good ones, but I think it's important to state the potential harms up front, before moving on to ways to maximize the benefits.

Oddly, the opposite debate took place a few years back with Canada's physical activity guidelines, when they were reduced from 90 to 60 minutes/day (For example, see this article titled "Canadians so lazy, experts lower targets").  People argued that activity guidelines should set a high standard, regardless of the health evidence, which suggested that 60 minutes/day was a reasonable guideline.  Now the opposite is happening with screen time – since kids are getting way more TV than they should, why not just increase the guidelines?  We don't treat other health guidelines (e.g. blood pressure, sodium, etc) this way, and I would argue that it's a bad approach for screen time as well.

For the record, I believe that there should be nuance in these things, especially in the messaging used to promote and explain the guidelines to the public.  Kids are going to get screen time, so recommendations on ways to maximize the benefits and minimize the downsides absolutely makes sense.  I just find it strange for the discussion to focuse so heavily on the benefits, when there is such a large volume of evidence on the downsides.

This story is republished courtesy of PLOS Blogs: blogs.plos.org.