RCPCH Issues Child Screen Time Checklist

Nicky Broyd

January 04, 2019

The Royal College of Paediatrics and Child Health (RCPCH) has issued the UK's first guidance on child screen use but says direct evidence is lacking that time in front of TVs, phones, tablets and computers is 'toxic'.

However, some negative impacts were found when the RCPCH consulted 109 11-24 year olds while preparing its guidance:

  • Sleep was negatively affected for 88%

  • Play or fun was affected for 41%

  • Mood and mental health were negatively affected for 35%

  • Family time and schoolwork was impacted for 18%

On a typical day 3 hours was spent on phones, 2.5 hours on a computer, laptop, or tablet, plus 2 hours of TV viewing.

Screen Time Checklist

In its 'Screen Time Guide’ the College recommends children avoid screens for an hour before bedtime.

Overall it recommends parents build and 'negotiate' screen time around family activities, not the other way round.

It said it was not possible to issue specific time limits but instead asks parents to consider a checklist:

  • Is screen time in your household under control?

  • Does screen use interfere with what your family wants to do?

  • Does screen use interfere with sleep?

  • Are you able to control snacking during screen time?

If parents were happy with the answers to those questions they were probably doings as well as they could with what is a tricky issue the College said.

Let Parents Be Parents

Dr Max Davie, RCPCH officer for health promotion, said in a statement:

"Technology is an integral part of children and young people’s everyday life. They use it for communication, entertainment, and increasingly in education.

"Studies in this area are limited but during our research analysis, we couldn’t find any consistent evidence for any specific health or wellbeing benefits of screen time, and although there are negative associations between screen time and poor mental health, sleep and fitness, we cannot be sure that these links are causal, or if other factors are causing both negative health outcomes and higher screen time. To help us develop a better understanding of this issue, I urge both more and better research, particularly on newer uses of digital media, such as social media."

Dr Davie said we need to "let parents be parents" and set limits appropriate for their family. He continued: "When it comes to screen time I think it is important to encourage parents to do what is right by their family. However, we know this is a grey area and parents want support and that’s why we have produced this guide.  We suggest that age appropriate boundaries are established, negotiated by parent and child, that everyone in the family understands. When these boundaries are not respected, actions need to be put in place with parents making consequences clear. It is also important that adults in the family reflect on their own level of screen time in order to have a positive influence on younger members."

One key area highlighted is links between screen time and poor diet: "We know that watching screens can distract children from feeling full and they are also often exposed to advertising which leads to higher intake of unhealthy foods."

Reaction and Limitations

Several experts have issued comments reacting to the guidance.

Professor Stephen Scott, director of the National Academy for Parenting Research at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, and Head of the National Conduct Problems & National Adoption and Fostering Services at the South London and Maudsley NHS Foundation Trust, welcomed the guidance and the links with physical and mental health. However, he said: "The association between playing violent video games and being violent in real life is not discussed, and the main type of screen time reviewed is television, so restricting screen time to this is now relatively out of date in comparison to the use of video games and social media which have become far more prevalent in recent years.  A major concern is it is not clear the extent to which studies control to the confounder of social class, which is strongly associated both with increased use of screens and increased obesity."

He also criticised the lack of guidance around different types of screen time: "The notion that it should stop 1 hour before bedtime is welcome, but more detail on exactly how to turn off Wi-Fi access and keep smart phones out of the bedroom would help parents.  Likewise, it would have been good to have some specific number of hours recommended, eg. 1 hour a day on weekdays, perhaps 2 to 3 hours at weekends, or whatever a family feels comfortable with.  Given that surveys show that many children use screens for 4-6 hours a day this would be quite a reduction in vulnerable groups."

Prof Kevin McConway, emeritus professor of applied statistics, The Open University, welcomed guidance being evidence based, and agreed that there are shortcomings in current evidence: "Research in this area is not easy, for several reasons.  It’s not clear whether just measuring amounts of screen time is an appropriate way to do things anyway.  An hour using a good educational app or doing some research for homework isn’t likely to have the same effect on a child as an hour watching TV with advertisements, let alone an hour on social media possibly being bullied." 

He highlights an important issue raised in the guidance on cause and effect: "If young people who report more screen use are also more likely to be depressed, that could be because screen use tends to cause depression, or it could be because young people who are depressed anyway tend to spend more time using screens. 

"It’s difficult or impossible to tell which it is from observational research, but doing non-observational research, where children and young people are allocated to different amounts of screen time by the experimenters, is really challenging to design and carry out.  Most of the research that was reviewed is on TV screen time specifically, but the RCPCH guide points out that most screen time these days is on phones, tablets and computers rather than TV. 

"The concentration of research on TV use is because much of it was carried out some years ago when television watching was generally a bigger part of young people’s lives. It’s difficult for the research to keep up with usage patterns when research studies take a long time to carry out but the way people use screens changes quite rapidly.  And it’s hard for researchers to generalise about the effects of cutting down screen time, because they will vary between individuals depending on what alternative ways of using their time are available."

He also approved of the focus on general parenting ideas and principles: "That’s backed up by far more experience and, indeed, research than is the case for screen time specifically.  I can’t comment on its statistical aspects, but I’ve been a parent, and the advice to parents does seem admirably sensible and practical."

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