What doctors wish patients knew about cutting down on screen time

While the COVID-19 pandemic has been challenging for everyone, digital tools have allowed people to work remotely, participate in school from home and maintain personal connections virtually. It is understandable that people are on their devices more now than ever before to remain connected.

But spending too much time on screens can have negative health effects. That is why it is important to take proactive steps to cut down on screen time.

American children between 8 and 12 years old spend about four to six hours a day watching or using screens. For teens, the amount of screen time jumps to up to nine hours, according to the American Academy of Pediatrics. And while screens can entertain, teach and keep people occupied, too much time with TV or social media is a growing concern.

AMA policy encourages primary and secondary schools to incorporate into their health class curricula the topic of balancing screen time with physical activity and sleep. The AMA also encourages primary care physicians to assess pediatric patients and educate parents about amount of screen time, physical activity and sleep habits.

Two AMA members took time to discuss what they wished all patients knew about reducing screen time. They are:

• Patrice A. Harris, MD, MA, a child-and-adolescent psychiatrist from Atlanta and former president of the AMA.
• Maurice G. Sholas, MD, PhD, a pediatric physical rehabilitation physician in New Orleans. Dr. Sholas is also a member of the AMA Ambassador Program, which equips individuals with the skills and knowledge to confidently speak to the AMA's initiatives and the value of AMA membership.

“We’ve certainly seen parents and guardians relax rules during the pandemic and by some reports, the screen time has increased 50% to 70%, with about 50% of that time spent on social media,” Dr. Harris explained. “It’s important to define screen time as not just one category ,” as the term encompasses “time spent on schoolwork, TV, video games and social media.”

“There are several of subcategories of how we all use screen time and that of course goes to the fact that not all screen time is created equally,” Dr. Harris said.

Dr. Sholas noted that “the American Academy of Pediatrics recommends no screen time at all for kids until they're 18 to 24 months old, except for video chatting. It's a way for those younger children to sort of connect with grandparents who they've been separated from during the COVID-19 pandemic. ... And kids 2 to 5 should get an hour or less of screen time per day because these screen-time things are sort of isolating experiences.”

Dr. Sholas said “screen time is like sugar. You shouldn't cut it all the way out because there is a need and a purpose for it. What if you give them too much? You'll be sorry.”

He sees “screen time as an augmentation of what we can’t have in person. ... If we can’t see our extended family and friends, we have to do something to stay connected and screen time is a way to do that.”

“There's no one right answer when it comes to either defining screen time as good or bad or managing screen time,” said Dr. Harris, noting that she likes “to look at it in terms of context and even a checklist, particularly when you are talking about children, but it is applicable to adults too.

“The questions should be: Is screen time interfering with some of the pro-health, pro-wellness activities that we should all be engaging in?” she added. “For example, sleeping and eating. Is screen time overtaking our ability to get the adequate amount of sleep or interfering with adequate nutritional intake? What about physical activity, quality time with family?”

“If you see that all screen time is, video games and not connecting with friends and family, that's a worry,” Dr. Harris explained.

Doomscrolling is “the act of spending an excessive amount of screen time devoted to absorption of negative news,” Dr. Harris explained. “We have these constantly updating newsfeeds right on our mobile devices and so once we click on that newsfeed, we might continue to click through all of the negative news of the day.”

“Our original intention might be just to get news on COVID-19 because it is important and critical … because getting accurate information about COVID keeps us safe,” she said. “We are in a time of anxiety and sometimes it's just wanting to stay connected. But once we check that first news story, we tend to just continue that doomscrolling and that absorption of the negative news.”

Turning off or limiting mobile or email news alerts is just a start, Dr. Harris advised. Read about what doctors wish patients knew about post-COVID anxiety.

“One of the things people talk about is that—especially when you do things via Instagram—you’re finding that people are really having a hard time with comparing and understanding what’s normal,” said Dr. Sholas. That’s “because everything on these social media platforms is so curated. It makes everyone’s life look fabulous and fantastic and omits all their struggles and shortcomings.”

“When kids look at that out of context, they feel like they must be the only person in the world who had a spat with their parents yesterday,” he added, noting that “what happens is even though we’re hyperconnected in some ways in these social media platforms, we’re more isolated and self-doubting because we’re only seeing the curated selves of all these people rather than who they really are as full persons.”

The pandemic continues to make it a challenge to see many loved ones in person, so “we may only be able to connect with others using the screen, and that's fine,” said Dr. Harris. “But there should be a focus and a commitment to spending quality time with your family—however you define family.”

It’s about making “sure we are having that connection at least on this screen,” she said.
Additionally, “find your village—and find ways to connect your village with your kids in some manner that represents something,” urged Dr. Sholas. “If you have a child that's into Minecraft and building things, there are some architectural hands-on interactive things that they can build in real life to match those things they build in a virtual universe.”

“Be mindful about how much time you are spending and on what particular activities,” said Dr. Harris. “If it's three hours of school time, that may be appropriate but we should be building in breaks even with screen time for schoolwork.

That means paying attention to “how many hours a day you or your children are spending, and then substitute that time with another activity,” she said.

It’s also important for adults to “find what they’re loving about being on screen and some analogous thing that they can pivot to in real life,” said Dr. Sholas. “It can be small things. ... Those things have meaning and help people work it out.”

Screen time can be “toxic when you are not doing some of the social, pro-wellness things that we all need to do,” Dr. Harris said.

“It may not be that you have to turn off the alerts forever, but if you find yourself in the place where you are ruminating, anxious, not sleeping, not eating and more depressed, then you want to substitute these behaviors and turn off those alerts and all of the things that you can do to make sure there's a balance,” she said, adding that it is also about making sure “it's not impacting your ability to function and participate in social, wellness and helping behaviors.”

“Across this country, people are rethinking work, workplaces and commute time,” said Dr. Harris. “For the people who would be working from home, there are stresses there.”

“We find ourselves in Zoom meetings from 9 to 5 and that means we are potentially sitting for eight hours, and we don’t want to do that,” she said. “Just in the same way you want to think about social media and other issues, even if you are using screen time for school and work, you should build breaks into that.”

“Before COVID-19 many of us—and I have to say myself included—didn't always take a break for lunch,” Dr. Harris said. “That was not a good idea before COVID and it's not a good idea now … so try to build in some healthy habits as we all continue to work from home—both through COVID and beyond COVID.”

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