Canadian Paediatric Society Screen Time Recommendations

Photo by Nabil Saleh on Unsplash

A recent study conducted by Michelle Ponti, MD, and the Canadian Paediatric Society Digital Health Task Force has found that children’s screen time for non-school-related purposes is continuing to increase, exacerbated by the periods of social isolation through the pandemic.

Noting that “the immersion of digital media in Canadian family life increased dramatically throughout the COVID-19 pandemic, renewing concerns about how screen time impacts children and family relationships”, the study re-examined the potential benefits and health risks of screen exposure and use on children younger than 5 years old.

The primary concern addressed by the study is that “a child’s earliest screen encounters are formative because patterns of exposure and use are habit-forming and known to track into later life”.

Among the trends in early childhood viewing patterns:

·    Increasing use of screens in young children is linked to changing levels of physical activity, sedentary behaviour, and sleep.

·    Nearly all children in Canada are exposed to screens by the age of 2 [15] and only 15% of Canadian children aged 3 to 4 years meet screen time guidelines of <1 h/day [16]. Even before COVID, the average parent-reported screen time for this age group was 1.9 hrs/day.

·    TVs, tablets, and video portals like YouTube dominate total screen time for this age group. A 2018 Alberta study showed children at 2, 3, and 5 years old watching about 17, 25, and 11 h of TV per week respectively (or about 2.4, 3.6, and 1.6 h per day). Many preschoolers use screens at home and in child care.

·    In the United States, most 2-year-olds use a digital device daily, and 9 of every 10 children are introduced to a device before their first birthday. One recent study reported a 60% rate of touchscreen device use in children younger than 3.

·    A 2020 U.S. survey found that nearly 4 in 10 parents (39%) say the television is either “always” on (10%), or on “most of the time” (29%). In those households, young children also consistently watch far more TV than other children their age, with developmental risks ….. 

Amongst reasons for updating the Canadian Paediatric Society (CPS) recommendations from those previously posted in 2017 is that “research on how (and how much) children younger than 5 years of age actually learn from screens has advanced in recent years. Although babies cannot absorb screen content, digital media can catch and hold their attention. Children under 2 years old can remember brief sequences and imitate screen behaviours and emotions. While toddlers are beginning to understand TV content by the end of their second year, they still have difficulty transferring what they see from screens to real life, and do not learn efficiently from screen media. By contrast, they learn intensely through face-to-face interaction with parents and caregivers.”

In an interview with Dave McGinn for the Globe and Mail in May, 2023, Dr. Ponti, head of the CPS Digital Health Task Force, commented on the increased reliance on screens during the pandemic. “For better or worse, we all needed to be on screens for educating our kids and for work and socializing, making those connections. So the time that we spent on all of our screens just went up exponentially. And it just drives home that it’s more how we use screens, rather than the how much, that makes the biggest difference.”

The study results indicate that screen time for young children has negative impacts on normal development of language skills, executive function skills, and emotional regulation. Also, “risks for being sedentary or overweight, including early, prolonged screen exposure and use, persist into later life…. Another emerging health concern is the risk of developing myopia related to spending more time on screens and less time outdoors.

The CPS recommendations for families include the following:

Minimize screen time:

·    Screen time for children younger than 2 years is not recommended apart from video-chatting with caring adults. There is no evidence to support introducing technology at an early age.

·    For children 2 to 5 years, limit routine or sedentary screen time to about 1 hour or less per day.

·    Ensure that sedentary screen time is not a routine part of child care for children younger than 5 years.

·    Maintain daily screen-free times, especially for family meals and book-sharing.

·    Avoid screens for at least 1 hour before bedtime, given the potential for stimulating and melatonin-suppressing effects.

Mitigate (reduce) the risks associated with screen time:

·    Be present and engaged when screens are used and, whenever possible, co-view with children to model and encourage digital media literacy. Help children recognize and question advertising messages, stereotyping, and other problematic content.

·    Be aware of content and prioritize educational, age-appropriate, and interactive programming. Encourage the use of screen devices for creative activities, such as drawing, over passive viewing.

·    Use parenting strategies that support self-regulation skills in children, without relying on screen-based media.

·    Curate and monitor young children’s media use by creating playlists or selecting appropriate channels, especially on open platforms such as YouTube. Limit children’s exposure to advertising and commercialized content.

As a family, be mindful about the use of screen time:

·    Conduct a self-assessment of current screen habits and develop a family media plan for when, how, and where screens may (and may not) be used.

·    Prioritize shared family media use (watching TV or movies together, playing video games together with family and friends) over solitary use by children.

·    Encourage older siblings to help ‘mentor’ younger children’s digital encounters, and maintain digital media use as a sociable family activity.

·    Remember: Too much screen time means lost opportunities for teaching and learning.

Adults should model healthy screen use:

·    Encourage and participate in activities unrelated to screens, such as shared reading, outdoor play, easy board games, and crafts.

·    Turn off devices during family time at and away from home.

·    Turn off screens when not in use and avoid background TV.

·    Advocate in child care settings and schools, and to local governments, for healthier screen use policies.

Commercial TV and media advertising expose young children to “advertisements for unhealthy food and encourage snacking, both known to increase overall intake and prompt less healthy food choices. When parents are distracted by their phones during meals, they are less likely to encourage trying new foods and more likely to overfeed young children.”

Less sleep overall, shorter nighttime sleeps (and more daytime napping), later bedtimes, delayed sleep onset, and greater sleep resistance can impact child development and family function. Evidence is growing that the volume and nature of screen time—rather than content—alter sleep patterns and that screen time may be displacing sleep. Having screen media in children’s bedrooms has been strongly associated with fewer minutes of sleep per night due to aroused response to screen viewing, melatonin suppression, and sleep displacement combined.

Under the new guidelines, children zero to two should spend no time on screens, with exceptions for events such as an occasional video chat with relatives. The previous limit of one hour of screen time a day for kids 2-5 years old has been expanded to allow for interactive screen time such as educational games or family movie nights.