Screen-Time: Supporting Young Children and Their Families in the Digital Age

Introduction

This is certainly a big topic of conversation lately amongst clinicians and families. Most of my career has been with little ones in home-based early intervention, but now we are telepractice-based. There is an element of screen time that is happening in a way very different than ever before. I will touch on that a little bit today. I ask the audience to keep in mind that a lot of this content is not specific to the situation that we are dealing with today regarding the global pandemic. It is research, things that would be applicable to before and after, depending on what that situation will look like. Thank you for understanding that there may be certain exceptions to the rules based on the time that we are in right now. 

Today, we are going to talk about four areas that we will be considering when we make recommendations to families concerning screen time. We are also going to discuss key features of joint media engagement and why professionals might make this particular recommendation to families. We are going to explore and explain how visual perception and attention to 2-dimensional media, meaning screens, develops from birth to age five. I will not elaborate on that much more other than to say I have been doing this type of work that we call media mentorship since 2014. It has evolved and changed and looks very different depending on each individual family. I am not a researcher or professor, but rather I am a clinician. For that reason, this presentation today would not be possible without the support of many researchers and professors, who I am very grateful for. This is a list of those.

• Dr. Daniel Anderson (U. Mass Amherst)
• Dr. Rachel Barr (Georgetown U.)
• Dr. Tim J. Smith (Birbeck U.)
• Dr. Heather Kirkorian (U.Madison WI)
• Dr. Sara Lytle (I-Labs)
• Dr. Jacqueline Snow (U. Nevada Reno)
• Dr. Juliann Woods (Florida State U.)
• Lisa Guernsey (New American Foundation)
• Dr. Marina Kcrmar (Wake Forest U.)
• Dr. Chip Donahur (Tec Center, Erickson)
• Dr. Alexis Lauricella & Dr. Ellen Wartella (Northwestern U.)
• Dr. Deena Weisberg (UPenn)
• Dr. Calum Hartley (Lancaster U.)
• Dr. Rebekah Richert (U. CA-Riverside)

I want to also give you a little bit about my personal background. In 2011 and 2012, this happened (see Figure 1).

Figure 1. Presenter's family. 

And then very quickly, my hands were very full. I was beginning to question my own experiences as a mom of two little ones, and as a parent who had an outside perspective. I had a lot of things in my favor. I had two children who were typically developing. I had a support system, and I was not in a place of a financial crisis. Yet, I was dealing with severe post-partum depression, and I was at a complete loss of how to navigate parenthood in a way that also avoided screens. I had a gut intuition that all the screen time happening could not possibly be good for development. I also had an immense sense of guilt. I had been educating parents for many years and saying, "The American Academy of Pediatrics recommends no screen time." Yet, now in light of my new situation, I could not even imagine making these recommendations to parents in a way that would be meaningful when they have multiple children with special needs.

It was a complete perspective shift for me once I became a parent. I had really deep, pressing questions about screen time. I knew what the recommendations were, and I wanted to know why. For example, what happens at age 2 in a child's brain that suddenly makes them okay to have screen time? Is that recommendation across the board? My training was that every child is different. We need to individualize our recommendations. Children develop differently. What happens in the brain when children watch screens? I began a very detailed, in-depth literature review about six years ago. I have spent this time asking researchers questions, collaborating, meeting with people, diving into the literature, and trying to understand this question about screens and child and brain development. I wanted to know this information not just for myself but for the families that I work with. These questions are still evolving because of screen time changes. All of these devices change and undergo updates, and we do not have all the research yet. I am just bringing you a portion of a much larger conversation. We will hopefully dive into specifics that can be helpful for you in your practices moving forward.

I love this quote, "Sure, I could parent without screen time. I could also churn my own butter but let's not get crazy here (@PaigeKellerman)". This topic can be pretty polarizing. Some people have very strong opinions, such as no screens whatsoever for early childhood. Other people feel more moderate. To some people, this topic is not a big priority, and we should not be so worried about it. When you take CEU courses, oftentimes you are preaching to the choir. I find that people who take my course often feel similarly to how I might feel about screen time in child development. My opinion about it is not really what matters. It is about how to support families and understand that every situation is different and hard. You will hear me say over and over today that "one size does not fit all." Keep that mind because when we make recommendations, we are individualizing them. I am so grateful for our jobs as clinicians. There is a reason why our fields cannot be automated because of this element of critical thinking. We do not say, "No screens" as a blanket rule. We know that we have to think critically, weigh the pros and cons, and balance our decisions for each family.

Current Screen-time Position from the AAP

• AAP Position: The most widely cited position statement and most familiar to professionals
  • 1999-2015 the AAP had discouraged screen time for children under 2 years old (Strasburger et al., 2013)
• In October 2015, the AAP News Magazine published Beyond Turn It Off and acknowledged “scientific research and policy statements lag behind the pace of digital innovation” (Brown, Shifrin, & Hill, 2015)

This is the current screen-time position from the American Academy of Pediatrics. It is the most widely cited position statement. The position statement changed after 2015. For 16 years, the American Academy of Pediatrics said no screens for kids under age two. Then, they decided that their policy was lagging behind the research and created new recommendations based on research from 2015. These are the highlights.

• New AAP recommendations were based on the results of a two-day symposium in May 2015 with leading scientists, researchers, educators, and pediatricians.
  • Available here: https://www.aap.org/en-us/Documents/digital_media_symposium_proceedings.pdf 
• Highlights:
  • Co-viewing
  • Screen-free bedrooms
  • Setting screen time limits
  • Discouraging screen time for children under 18 months (except for video chat)
  • <1 hour/day of educational screen-time for children older than 2 years
  • Educating families

Their position statement changed to say, "We are recommending when young children look at screens, they are not looking at them alone. They are watching with someone else who can monitor the content or interact with their child in a more meaningful way." This is instead of the child being glued to a screen by themselves. They still recommend no screens in bedrooms and other limits. Those limits could be surrounding what content is on the screen or how much time is spent on this activity. We are still discouraging screen time for children under the age of 18 months of age, except for video chat, which the research says that is a loophole. It is different than just watching something. There is a level of real-time engagement with another person. The other recommendation is that a child older than age two spend less than an hour a day of educational screen time. The big one that always stands out to me is that we are educating families. Right now, my two children are doing remote learning with their public school. We are being given assignments, and I know this is different in every district. There is no actual education happening unless we take it upon ourselves to do the teaching. Now, we are hoping that will change, and there will be in-real-time teaching. As clinicians, we can give parents assignments or recommendations, but there is this piece of education that should also be happening. I am hoping today that we talk about this education piece in a way that makes us feel empowered as clinicians. We can educate families and not just rattle off the stats, the numbers, or the recommendations. We need to help them to understand a little bit more about the interactions with people and objects versus interactions by looking at a screen.

How Likely Are Pediatricians to Talk About Screen Time With Parents?

• 16% of pediatricians talk to families about their media use (Rideout, 2013)
• Pediatricians’ own media habits impacted their opinion of the AAP’s recommendations (Gentile, Oberg, Sherwood, Story, Walsh, & Hogan, 2004)

Despite this recommendation for educating parents about screen time, how likely are pediatricians to educate parents and talk to them about this topic? The research has shown that about 16% of pediatricians will talk to families about media use, screen time, making choices, and what that means for child development. Pediatricians who did talk to parents were more likely to restrict their own screen-time behaviors as compared to pediatricians who were not talking to parents about this subject. Again, their own habits impacted whether or not they valued the recommendations of the American Academy of Pediatrics and whether or not they would discuss that with parents.

Media Mentorship​

• A relationship in which a person with more experience or more knowledge about screen time, helps to guide a less experienced or less knowledgeable person.
• Lisa Guernsey – Ted Talk 2014
• According to Donahue (2016):
  • Every child needs a media mentor
  • Every parent and family needs a media mentor
  • Every librarian and educator needs to be a media mentor

Media mentorship is just a fancy way of saying that one person is in a relationship with another person to help guide them or become more knowledgeable about screen time. When you have a conversation with a parent and you say, "Let's talk about watching TV right before they fall asleep for their nap each day," and you give them information about that, you are providing a level of media mentorship. According to Dr. Chip Donahue, of Erikson in Chicago, "Every child needs a media mentor, every parent and family needs a media mentor, and every librarian and educator needs to be in media mentorship. There is no certification that we know of at this time to become a media mentor." What he is saying is we all need this level of support. We need to be able to provide this information because parents have questions about it.

There is a great TED talk with Lisa Guernsey from 2014. This was one of the first references to this idea of media mentorship. 

• Goals
  • Identify and understand parents’ perspectives about screen time and family practices/habits (assess a baseline)
  • Change or broaden caregivers’ perspectives and behaviors with media as needed
  • To be media mentors to parents, so they can be media mentors to their children
• When surveyed, most parents indicated that they DO want guidance from experts on media consumption for their children (Rideout, 2014)
  • This desire for media mentorship was expressed at a greater percentage among low-income and minority parents (Rideout, 2014)

The goals of media mentorship are to identify and understand parents' perspectives about screen time and their own family practices and habits. This is to assess a baseline. How do parents feel about this topic? What are they doing in the home? What is tricky about these types of goals right now is that everybody's screen time looks very different. For many people, their screen time looks very different now than it did before the pandemic.  We need to be mindful of that when we are assessing this baseline or making any recommendations in hopes that some of this is temporary or may look different in the future. That is the first goal.

Then, if possible, we try to change, educate, or broaden caregivers' perspectives and their behaviors with screen time as needed. Some families that I work with do not need support in this area. Other families want support and are seeking it.

Our other goal is that we become media mentors to parents to provide this education that they can, in turn, be media mentors to their children. This goes into a broader scope of this idea of early intervention and working with parents. This is more of a coaching type of model. It is not so much about us teaching children about screen time, but rather it is about us supporting parents so that they can support their children.

The cool thing is that when parents were surveyed, they indicated they wanted this type of guidance from experts on media consumption for their children. That desire was even expressed at a greater percentage in low-income and minority parents, who were seeking more support in this area. 

Does Media Mentorship Work?

• 58 clients in 2016 (18 – 33 months old)
  • White n=8
  • Black n=1
  • Asian n=four
  • Mixed Race n=5
  • Hispanic n=40
• 6 families intentionally limited screen-time to <2 hours per week. All six of these children were white and middle to upper class.
• 18 children averaged 3+ hours of screen-time daily (up to 10 hours daily)
  • 11/18 at the low income to the poverty level
  • 17/18 were Hispanic

I am glad that people might want this media mentorship that is being recommended. From my own perspective, I thought, "If we provide it, does it work?" Does that mean that we will see positive outcomes and effects? I started to track this with my own clients. In 2016, I had 58 clients that I saw at home between the ages of 18 to 33 months. The majority of my caseload here in Los Angeles, at that time, were families from Mexico. Of those 58 clients, only six were limiting the screen-time amount to two hours or less per week. All of those six children were from white and middle to upper-class families. Eighteen of those 58 children averaged three or more hours of screen time daily, and up to 10 hours daily. When I say 10 hours daily, these are families who live in small homes and their TV or some type of screen was on all day long in the background. Of those 18 with a higher number of screen-time hours, 11 of the 18 were at the low-income to poverty level and 17 of the 18 were Hispanic.

• Of the 18 children who averaged 3+ hours of screen-time daily:
  • Direct “media mentorship” was provided to caregivers of all 18 children.
  • 9 of the 18 families made significant screen-time changes (primarily restricting use and monitoring content)
  • 3 of the 18 families spontaneously reported that they felt their child’s language and/or behavior improved due to significant changes in screen-time

Back to my original question, "Does the media mentorship work?" Of those 18 who were having the most screen time per day, I provided direct media mentorship in the form of parent education. I provided that to all the caregivers and that looked different for each child. I discussed things like content, screen time, and joint media engagement, and this was customized for each situation. I made those decisions by using critical thinking, assessing parent priorities, and building trust and relationships with families. Again, not every child or family got the same education or recommendations.

As a result, nine of those 18 families intentionally made screen-time changes. Most of them made changes in the amount of use, and others increased the monitoring of the content that their children were exposed to. Three of the 18 families spontaneously indicated that heir children's language and/or behavior had improved due to the changes in screen time. One mom, who had older children and who had never had iPads before said, "I wish I had known that taking away the iPad would help her to start communicating with us more." Her daughter would just take the iPad and be gone for hours in the other room. Many felt like some of the changes were because of habit changes in the house with screens.

Despite some of these testimonials, when I reflected on the numbers, I still felt that this was a poor reflection of the effects of media mentorship. I was mentoring 18 families with nine of them trying to make changes. However, only three of them reported that they felt like it made an impact on their child's development. As a Speech-Language Pathologist (SLP), I do not understand the reason. It might have been that my own efforts needed to be fine-tuned and perfected. Or, as clinicians, we often get to these kids a little bit later after habits have already formed. I was seeing children at 18-24 months, and these kids had already had a lot of bad screen habits. Now, I was trying to change habits instead of preventing these habits from forming in the first place. I look to my colleagues, like occupational therapists and physical therapists, who sometimes have earlier access. Here in California, it is very rare to get a referral for early intervention from a speech pathologist before 18 months. Many of my colleagues are working with these children as young as four months, even younger sometimes. It is nice to be able to have those conversations a little bit earlier.

Understand & Assess the 4 C’s

1. Content
2. Context
3. Child
   • (3C's: Guernsey, 2012)
4. Caregivers

Historically Scenes ARE Getting Shorter

• http://www.cinemetrics.lv/database.php
  • ASL = Average Shot Length
• 1971 -  Willy Wonka and the Chocolate Factory
  • ASL 7 seconds
  • 98 minutes long
  • 844 shots
• 2005-  Charlie and the Chocolate Factory
  • ASL 3 seconds
  • 103 minutes long
  • 2091 shots
• New and old research supports intentionally limiting the number of scenes in children’s media (Kirkorian & Anderson 201six; Anderson & Smith, 1984)

What is interesting, along with formal features, is the scene length. When you are watching a scene of something 10-15 years ago, that scene would often be pretty long. The average scene would be about 7-10 seconds, and then the camera would cut to the next scene. Scenes are getting shorter and shorter, and the pacing is getting more rapid.

I share this as an example. This is a cool website where you can plug in most movies, and they will tell you what the average scene length or the average shot length of each scene. I looked at "Willy Wonka and the Chocolate Factory" from 1971 and compared it to the "Charlie and the Chocolate Factory" version with Johnny Depp from 2005 to see the difference. In the 1971 version, the average scene was seven seconds long. That is before the camera cuts and goes to the next scene. In 2005, the average scene length was three seconds long. Again, there is more rapid pacing. The movies differed by 5 minutes in length, meaning the Willy Wonka version was 5 minutes shorter. In the 1st version, the 1971 film, there were 844 different shots and scenes. In the newer version, with this rapid pacing and the average scene length being only 3 seconds, there were 2,091 different shots or different scenes. This is just an example to show us that scenes and shot lengths are getting shorter.

What is interesting is that both new and old research supports limiting the number of scenes in children's media. This rapid pacing is very hard to follow and very hard to understand for young children. It is just something to think about. If we know that families are open to learning, I talk to them about watching a slower-paced show. I explain why a slower-paced show might be beneficial.

There is a lot of speculation about rapid pacing, brain development, and potential for ADHD. We do not have research yet that can make that direct correlation to say that is a concern. However, it is something to be mindful of since we do not have all the research yet.

Recommendations of Better Shows for Young Children

• Mr. Roger’s Neighborhood
• Bear in the Big Blue House
• Play School (YouTube, Australia)
• JBRARY https://www.youtube.com/user/Jbrary

These are just a few recommendations of shows with slower pacing. All of these can be found on YouTube. "Play School," which is an Australia show, is darling. These are slower-paced and use real people or puppets instead of cartoons, which is more real life. Jbrary is run by two librarians who sing songs. They have a library of over 3,000 videos. It is very slow-paced. I like to recommend these for parents if they are looking to change the content.

4 C's – Context

• Context: Who? When? Where? How much?
  • Who the child is/is not with the child during screen time
  • When is the screen time happening? At bedtime? During therapy? During meals?
  • Where is the screen time taking place?

• Or realistically - Where/When is screen time NOT taking place?

The next of the four C's is the context. This is who, when, where, and how much screen time is happening. Think about what types of recommendations we might be making. Is the child alone? Could we recommend that a parent sit with them during screen time? Can we move the screen time to a different part of the day so it is not right before bedtime? We know there is research about sleep and screens right before sleep. Where is the screen time taking place? Or maybe more realistically, when and where is it not taking place? For a lot of families, it is taking place at the dinner table, in the car, and all these other places. These are other areas that we can have conversations with families and make recommendations.

• Context: Who? When? Where? How much?
• 6-36-months-old average 1-2 hours of screen-time daily
• How much screen time is occurring?
  • 1. Can your child walk upstairs independently?
  • 2. Does your child wipe his own nose or cover his mouth when he coughs?
  • 3. How much time does your child spend wiping his nose each day?
  • 4. How much time does your child spend walking upstairs each day?

We know that children between six months and 36 months of age average one to two hours of screen time daily. I would say that number is probably much higher right now during this quarantine. We often ask parents, "How much screen time does your child have?" I have removed that question from my conversations with parents altogether. It immediately imposes that I am going to be judging whatever they say. Then, I do not know if the parents are going to be honest with me. We often ask questions such as, "Can your child walk upstairs independently?", "Do they know to cover their mouth when they cough?", and "Do they wipe their own face off?" We do not usually ask parents things like, "How much time does your child spend wiping his nose every day?" Or, "How much time does your child spend walking upstairs each day?" I think the question about how much screen time can be a hard place to start with parents.

Population Changes

• 2010 - 20% population <15 years old
  • 13% population >65 yo (Pew Research Center, 2014)
• 2050 –Drastic population changes anticipated
  • The US and most countries can anticipate a higher senior citizen population and a lower population of children.
• 2016: More kids are being raised by grandparents
  • 10% of U.S. children live with a grandparent
• 2.7 million grandparents are raising grandchildren (Ellis & Simmons, 2014).
  • Adults aged 50-64 watch 43+ hours of  TV per week.
  • 65+ —> 51+ hours (Nielsen, 2017)

These are some interesting things to think about with population changes. In 2010, we had a greater population of young people and a lower population of elderly. By 2050, we are expecting rapid population changes as people live longer. We are anticipating a lower population of children and a higher population of senior citizens. Today, more and more kids are raised by grandparents. Ten percent of children live with a grandparent. That number is probably even higher now. What we know about grandparents is that this age group of adults have the most screen time per week. Even if we have recommendations to make, most of what is happening in these homes we have no control over. If they cannot afford different types of childcare settings or grandparents are raising children, there is going to be more screen time. We need to be mindful that there are certain things that we can make recommendations about and other things that we cannot change. We need to assess a family's situation when making recommendations.

4 C's – Child

• The average child (US) starts screen-time at four months of age
• We must consider each child’s unique
  • Environment
  • Developmental Levels
  • Personal Experiences / Exposure
  • Circumstances/health (e.g. do they live in a hospital, homeless, foster care)
• Culture
  • Latino children spent more time viewing TV compared to non-Latino, white children (Thompson, Matson, & Ellen, 2013)
• Socioeconomics
  • Changes by FCC in March 201six: Low-income families now qualify for high-speed Internet subsidies
  • Which average $9.25 per month (Puzzanghera, 2016)
• Access: 91% of families at the poverty level have Internet access (Rideout & Katz, 2016)
  • 83% own tablets
  • 77% have smartphones

The average child in the US today starts screen time by four months of age. Our recommendations are going to be unique for each child and each family, depending on what that family's priorities are, the environment itself, this child's developmental levels, and their own experiences. If we are working with a bedridden child, for example, they may have a lot more screen time than a child who can move and who is not in a hospital setting. As clinicians, we already factor this in. This is my biggest problem with the American Academy of Pediatrics recommendations. They are "one size fits all." We have to use our clinical judgment and use the guidelines as a "guide." They are not a hard, fast rule for every family.

• Culture: Latino children spent more time viewing TV compared to non-Latino, white children (Thompson, Matson, & Ellen, 2013).
• Socioeconomics: Changes by FCC in March 2016: Low-income families now qualify for high-speed Internet subsidies, which average $9.25 per month (Puzzanghera, 2016).
• Access: 91% of families at the poverty level have Internet access (Rideout & Katz, 2016).
  • 83% own tablets
  • 77% have smartphones

Here are a few stats. Latino children have more TV time than white children. Socioeconomically, having access to high-speed internet is not an issue anymore for most families. Since 2016, we have had more younger children online and the ability to stream YouTube during the day because of easy access to wireless internet. 

4 C's – Caregivers

Education/Language

• Education – Mothers with higher education levels were more likely to restrict screen time (Borzekowski & Robinson, 2007).
• Language – Moms who prefer to use Spanish may be less likely to watch with their children or instruct their children during screen time (Thompson et al., 2016).

Mothers with higher education levels were more likely to restrict screen time (Borzekowski & Robinson, 2007). And, moms who prefer to use Spanish may be less likely to watch with their children or instruct their children during screen time (Thompson et al., 2016). Speaking about caregivers, this is the direction of the research now. Moms who have higher education levels were more likely to restrict screen time, and mothers who prefer to use Spanish were less likely to watch or to co-view with their children or instruct their children during screen time. When asked about that, the parents would say, "Oh, it is because when they are watching TV so they will learn English." They see the TV as a teaching tool for their child to learn English. 

Other Factors to Consider

• Our work as Media Mentors will likely be affected by Caregivers'
  • Beliefs
  • Priorities
  • Behavior
• 52% of moms multitask during infant bottle feedings – TV was the most common activity (Golen, R.P., & Ventura, A.K., 2015)
• Parents’ own media behavior was strongly associated with children’s screen time (Lauricella, Wartella, & Rideout, 2015)

Our work as media mentors is going to be affected by the parents' beliefs, priorities, and behaviors with screens. Many mothers will multitask during bottle feedings. In fact, parents' own media behavior was associated with their child's screen time. Parents who are on their phones a lot may have children who have more screen time than parents who self-monitor their own media consumption. I always think about this because it is definitely an issue for me. I have a lot of screen time, especially right now, while I am doing telepractice. I often think about how this affects my children and their perception of what I do for a living. I think having those mindful conversations with children is important. I want them to know why I am plugged into a screen all day. "I am meeting with a family right now." "I am providing a service." "I am reading." I cannot imagine going through this time right now without screens. They are a gift in some ways. I think this piece of having conversations to help them to understand what we are doing is also important.

Newer Direction of Research: Parents’ Screen Use and Child Development

• Two-year-olds did not learn new words from parents when dyadic interaction was interrupted by a cell phone (Reed, Hirsh-Pasek, & Golinkoff, 2017)
  • http://www.apa.org/pubs/highlights/spotlight/issue-104.aspx
• Parents’ attention sustains 1-year-olds’ attention (Yu, C., & Smith, L. B., 2016)
• Parents’ device use was associated with tantrums in 3-year-olds (McDaniel & Radesky, 2017)
  • https://www.inc.com/minda-zetlin/want-emotionally-healthy-kids-science-says-stop-doing-this-most-parents-wont.html?cid=nl029week25day19

The direction of research now is looking at parents' screen use, and how that affects child development. There have been a few interesting studies. One is related to vocabulary use. They had parents teach their children a new word. The two-year-olds learned it pretty easily from the parent unless the parent was interrupted by a cellphone. In the middle of their teaching or interaction, if a cellphone went off, then the child, when they were tested later, had not learned the new word.  Parents' attention seems to sustain their young children's attention. When a parent is distracted by a screen, we notice that the child also tends to divert their attention. The child also shifts instead of continuing to play with the same type of activity. There was also a study in 2017 that showed parents' device use was associated with more tantrums in their three-year-olds. I think we are going to see more research looking at parents' behaviors and how this might influence child development.

Mental Health

• Children of depressed mothers watched twice as much TV (Bank et al., 2012)
• Mothers of children with ASD had the highest rates of depression
• Poorer relational well being was associated with increased tablet use by 12-48-month-olds (Pempek & McDaniel, 2016)

We need to be mindful, especially right now about this mental piece. Children who have depressed mothers tend to watch as much as double the amount of TV as children whose mothers are in a positive mental health state. Mothers of children with autism have the highest rates of depression. When there are relationship issues in the house, this also associated with increased tablet use for children between one and four years of age. These are some older stats. I would say that given the current climate and mental health concerns, the rates of depression are probably higher. We are anticipating a lot more screen time for all families and all family members, regardless of age. 

I love this quote from Fred Rogers, "Strengthen a parent, and you strengthen a child." Our screen time work and our work as media mentors are to strengthen parents. It is to support them and help them feel like they have a safe place to ask questions, to be honest, and to make small changes that are meaningful and relevant without feeling overwhelmed.

Free & Affordable Mental Health Support/Counseling

• Universities
• Churches/Temples
• Meet-Ups; Support Groups
• Parent to Parent – USA - http://www.p2pusa.org/p2pusa/SitePages/p2p-home.aspx
• National Alliance on Mental Illness: http://www.nami.org/  -  search “COVID-19

I share these resources with parents who sometimes the screen time is secondary. Maybe you help a family get access to mental health support. Some of those screen behaviors change automatically in the home. The National Alliance on Mental Illness has special resources right now for the COVID-19 crisis.

4 C's – Summarized

• Content (What’s on?)
• Context (Who, When, Where, How much?)
• Child (environment, circumstances/health, SES, developmental level, culture/personal experiences)
• Caregivers (beliefs, behaviors, priorities, mental health, education level, language)

To summarize, the 4 C's are what is on the screen. Who, when, where, and how much screen time is happening, factoring in the individual child and the caregivers. Your recommendations and conversations with one set of parents might be about what is on the screen, and how we might make changes in that sense. In another family, it might be about the time of day that screen time is happening. Are they are viewing alone versus viewing with a sibling or a caregiver. We also need to support that parent with their mental health

Nudges

• Media Diet Ideas
• Developmental Menu Ideas
  • Use enhancements to build on what the caregiver is already doing (e.g. increase frequency, quality, quantity) (Woods, Kashinath, Coston, Richmond, & Goldstein, 2007)

Let us just talk about a couple of recommendations. We call these "nudges." There are media diet ideas and developmental menu ideas. That is how I refer to them. We always want to build up caregiver strengths. Identify what somebody is doing well and build from there. For example, if a parent says, "We are going on two walks a day." This is not even talking about screen time, just talking about what they are doing something well. How can we build on that? "If you are going on two walks a day, can you make those walks longer?" Can we talk about what they are going to do on the walk that is going to work on some of the goals that we are seeing that child for? For me, as a speech pathologist, I often say, "Think of three things that you can help your child identify on that walk that maybe you would not have pointed out before." This is focusing on language. As an occupational therapist, perhaps they can touch different textures.  When we build off these strengths, and we are not even talking about screen time, we are hopefully increasing the amount of time spent on other things. Sometimes by default, the screen time is reduced or changed as it is not as interesting to a child as some of these other things.

Possible Nudges (Media Diet Ideas)

• Low Tech (or No Tech) Tuesday
• Digital Free Dinners
• Screen-Free Sundays
• Media free mornings
• No screens after 7 pm
• Tech-free home zones
• TV-free kids’ rooms
• Decreasing or eliminating background TV
• Media Free Meals / Screen-free snacks
• Replacing sedentary screen time with physical movement screen time (e.g. yoga videos, gonoodle.com)

These are the media diet ideas. These are the ways that we talk about limiting screens or making screen choices. We have these different ideas for families that we can just talk about, or maybe we suggest no screens at the table. Oftentimes, I will show this list to parents, especially during a telepractice. I will share my screen, and we will look at a list together. I will say, "What are you already doing? Is there anything on this list you think that you would want to try to do?" It is not, "This is what you should do or try to do all 10 of these". Number ten is often a favorite. That is why it is in bold. It is making a content change.  

Possible Nudges (Developmental Menu Ideas)

• Outside Play twice a day
• Book sharing before bed and nap
• Interacting with our voices AND eyes
• Pretend play twice each day
• Daily Development Activities (e.g. Vroom)

There are developmental menu ideas, which I kind of touched on with going on walks, thinking about what we are doing outside of screens, and how we might be able to increase that. Again, I will share these ideas with parents. I will let them be the one who chooses so that they are taking ownership.  They feel like they have a voice to say, "Oh, I did not think of doing that." I will say, "Is there anything else you'd like to do or try?" 

Nearly Every Activity Other Than Screen Time and Sleep Requires Some Movement

By focusing on increasing other activities and expanding on daily routines, screen time may decrease without us having to say “reduce screen time.” 

Almost every other activity aside from screen time requires some movement. To summarize, when we focus on increasing other activities or expanding on everyday routines, screen time might even decrease without us having to say it. 

Free Tools From the AAP (2016)

These are some free tools regarding media time calculators and family media plans:

• Family Media Plans:
  • https://www.healthychildren.org/English/media/Pages/default.aspx#wizard
• Media Time Calculator:
  • https://www.healthychildren.org/English/media/Pages/default.aspx#wizard

If you are doing telepractice right now, it is easy to pull these up with parents and go through them together. Have parents make their own choices and take ownership regarding this topic, if they are open to it.

Joint Media Engagement

• Previously termed “co-viewing”
  • Infants and toddlers are more likely to learn from screens when interacting with peers or adults (Barr, Zack, Garcia, & Muentener, 2008).
• The more caregivers verbalized while co-viewing, the more their infants and toddlers responded and looked at the screen (Barr, Zack, Garcia, & Muentener, 2008). 

Joint media engagement was previously called co-viewing. We call it joint media engagement now because we want parents not just to sit there with their child but to engage with them. Infants and toddlers are more likely to learn from screens when they are interacting with peers or adults. Sharing a screen is better than 2 kids sitting with separate tablets. The more that caregivers verbalize while co-viewing, the more their infants and toddlers responded and looked at screens.

When we look at the research, joint media engagement is happening only about 1/3 of the time for 2 to four-year-olds, especially with mobile devices (see Figure 2).