Study shows screen time is associated with developmental delays in infancy

A new study found that giving your baby a phone or tablet to play with when you're busy may seem like a harmless solution, but it could quickly impact his development.

According to a study of 7,097 children, daily screen time of one to four hours at age 1 is associated with a higher risk of developmental delays in communication, fine motor skills, problem solving, and personal and social skills by age 2 published Monday in JAMA Pediatrics magazine.

“This is a really important study because it is a very large sample of children followed over a number of years,” said Dr. Jason Nagata, an associate professor of pediatrics at the University of California, San Francisco, who was not involved in the study.

“The study fills an important gap because it identifies specific developmental delays (in skills) such as communication and problem-solving that are associated with screen time,” Nagata said, noting that there haven't been many previous studies that have reported this issue had examined follow-up data for several years.

The children and their mothers were part of the Tohoku Medical Megabank Project's Japan-based Birth and Three-Generation Cohort Study and were recruited from 50 maternity clinics and hospitals in Miyagi and Iwate Prefectures between July 2013 and March 2017.

The study measured how many hours per day children used screens at age 1 and how they performed at ages 2 and 4 on various developmental domains—communication skills, fine motor skills, personal and social skills, and problem-solving skills—as reported by the mothers .

At age two, those who spent up to four hours a day in front of a screen were up to three times more likely to have developmental delays in communication and problem-solving skills.

Those who spent four hours or more in front of screens were 4.78 times more likely to have underdeveloped communication skills and 1.74 times more likely to have under-average fine motor skills at age 2 higher and twice as likely to have underdeveloped personal and social skills by age 2. Risk persisted only in the communication and problem-solving categories.

“One of the areas that is relatively underexplored in the entire screen time literature is studying the effects of screen exposure on very young children, particularly when screens are introduced to babies,” said Dr. John Hutton, associate professor of general and community pediatrics at Cincinnati Children's Hospital Medical Center, who was not involved with the study. “It's definitely a global problem and I think the results[here]should really apply to other countries as well.”


The potential damage that screen time has on communication skills could be related to depriving children of the drivers for language development, Hutton said.

“Children learn to speak when they are encouraged to speak, and by just looking at a screen they often don't have an opportunity to practice speaking,” he said. “They might hear a lot of words, but they don't practice saying a lot of words or having a lot of that back-and-forth interaction.”

The use of technology can mean that interpersonal relationships that foster social skills lose time because real people are more dimensional than characters on a screen, Hutton added. When looking at people's faces, our brains tune in to figure out how to interact with them.

“Also, when passively watching screens without an interactive or physical component, children tend to be more sedentary and unable to train their motor skills,” Nagata said.

If children don't have enough time to play or are given a tablet to soothe negative emotions, it could prevent them from reaching that important developmental milestone, the ability to manage discomfort.

“In the longer term, one of the real goals is for kids to just be able to sit quietly in their own thoughts,” Hutton said. “If they're allowed to be a little bored for a second, they feel a little uncomfortable, but then they're like, ‘Okay, I want to make myself more comfortable.' And that’s how creativity comes about.”

There are other factors that can affect a child's development, such as genetics, negative experiences like neglect or abuse, and socioeconomic factors, Nagata said.

In the latest study, mothers of children with a lot of screen time tended to be younger, had never given birth, had lower household incomes, were less educated, and suffered from postpartum depression.

The study has limitations. Because of the tendency toward social desirability — the desire to say the “right thing” or socially acceptable thing — parents may understate their child's screen time and overstate their child's development, experts say.

Additionally, the authors didn't have details on how much screen time kids spend on it, and not all forms are equal in their ability to cause harm or benefit, experts said.

“The other question that's always really important is, are the parents watching with the kid?” Hutton said. “If a parent is watching with a child, it tends to mitigate a lot of the negative aspects.”

Healthier ways to keep your child busy

If you need to keep your toddler busy so she can get things done or have some alone time, try giving her a book, coloring material, or toy, experts say. Sometimes they can even enjoy these activities in the high chair.

If you're sometimes dependent on screens, opt for educational content or video chatting with a loved one so they can still have social interaction, Nagata said.

A problem with some online content for children is that parents find it educational because it's marketed as such and contains a lot of information about the alphabet, colors, numbers or animals for their children to see and hear, Hutton said. But what fuels learning is content that helps kids apply their knowledge beyond just memorizing — so they can “thrive in the real world, where things are more unpredictable and require more creativity and resilience,” he said.

Hutton and Nagata recommended choosing longer videos because watching many short videos could affect children's attention span and ability to understand what they are watching.

Be selective about relying on Screen Time and turn off devices when not in use, Nagata said. “Aimless viewing can also distract children from focusing on an upcoming activity or face-to-face communication.”

Also, set a good example by not spending excessive amounts of screen time yourself, as experts say kids tend to mimic what they see. The American Academy of Pediatrics recommends considering the quality of screen time rather than just the quantity, but the organization has resources for setting guidelines and boundaries for your family — such as the Family Media Plan, which you customize to fit your needs your own family, and advice on how to help your children develop healthy habits.

“We just have to slow down and … be as careful and observant as possible to ground kids in the real world, because that's really how we evolved as humans,” Hutton said. “Once we get a better sense of who the kids are and what they need, there will be plenty of screen time later.”

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