Setting Up Toddlers for Success Entails Less Screen Time

Lara Salahi

October 17, 2022

More physical activity and less screen time may help toddlers better regulate their emotions and behaviors, according to a study that adds to mounting evidence of the possible harms of excessive screen time for children.   

The study, published recently in The Journal of Pediatrics, explored whether toddlers' adherence to guidelines from the American Academy of Pediatrics (AAP) related to diet, physical activity, and screen time could be linked to executive function skills like the ability to remember, plan, pay attention, and regulate thoughts and behavior.

Carol Weitzman, MD, a development behavioral pediatrician in the division of developmental medicine at Boston Children's Hospital, said introducing screens to babies and toddlers can hurt their ability to build meaningful relationships with caregivers. 

"How does one learn language, social skills — all of those kinds of things are gained through interaction," Weitzman, who was not involved in the study, said.

The AAP recommends that children between ages 2 and 5 years limit their screen time to no more than 60 minutes per day. The group also advises that children within the same age group prioritize play time to promote physical activity.

"These were guidelines that are specifically related to weight management in childhood, so we wanted to see if the link between weight management and cognitive health extended to younger ages," said lead study author Arden McMath, a PhD candidate at the University of Illinois Urbana-Champaign.

McMath and her colleagues analyzed data from approximately 356 toddlers in the STRONG KIDS 2 cohort study, which followed children from birth to age 5. In addition to the data, the researchers looked at survey responses from parents.

One survey included questions related to a child's daily habits, including the use of screen time; physical activity; and consumption of fruits, vegetables, and sugary drinks. Another survey measured executive function through questions related to emotional response, impulse, memory, and focus.

Three fourths of parents reported that their toddlers were physically active every day; a little over half reported limiting their child's screen time to 60 minutes; and over two thirds reported limiting their toddler's consumption of sugar-sweetened beverages. Fewer than 5% reported that their toddler ate at least five servings of fruits and vegetables per day, McMath's group found.

The children who spent less than 60 minutes looking at screens each day had better control over their emotions and inhibitions, and better memory and focus than those who didn't meet the recommended guidelines, the researchers found. Children who engaged in daily physical activities were also found to have better cognition, according to the study.

The researchers accounted for the children's sex, ethnicity, socioeconomic status, birth weight, and mothers' weight during pregnancy. The study participants were mostly White, of normal weight-for-length, and were presumed to not have developmental disorders.

McMath's group found no correlation between the toddlers' weight and their executive function, which was a surprise as prior research on older children and adolescents has suggested a link between sedentary habits that can lead to weight gain and decreased self-regulation, she said.   

For younger children, perhaps habits provide a clearer marker of executive functioning skills than weight, McMath said.

"These health behaviors that we know matter in adulthood, they do also apply and are important to the health of young children as well," she said.   

Helping Parents With the Next Generation

Weitzman said physicians should educate parents on setting time limits and other boundaries for screen use from the start. As screens may seem to have a calming effect for some children, parents may face difficulties when they later try to impose rules.

"We have to help people understand how seductive it is," Weitzman said. "Once that genie has come out of the bottle, there's no going back in."

The study also builds on previous research linking physical activity and screen time to problems regulating emotions and behavior in school-aged children and adolescents. Parents must be aware that the choices they make for children now will have an effect later on.

"Some of those pathways are being laid down earlier in life," Weitzman said. 

Children's capacity for self-regulation — such as the ability to pause and think before acting or waiting for a turn — is an indicator of how well they will learn in school, she noted.

"When we look at predictors of how kids are going to do when they get to school, a lot of parents will think that kids need the cognitive skills, like counting," Weitzman said. "But executive functioning skills are a large predictor of how well you'll do in school."

The STRONG KIDS 2 cohort study was funded in part by the National Dairy Council, the National Institutes of Health, the Gerber Foundation, the US Department of Agriculture, and the Christopher Family Foundation.

J Pediatr. Published online August 23, 2022. Abstract

Lara Salahi is a journalist living in Boston.

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