Parents, please note: mobile phones are closely related to children’s obesity, sleep, mood, language development, etc.!

Children's Hospital Affiliated to Capital Institute of Pediatrics

Children's Health Center Wang Lin

With the advancement of digital technology and the popularization of electronic products, screen-based electronic products such as televisions, mobile phones, and tablet computers have become the background environment for the growth of contemporary children and even infants.

Screen exposure refers to a series of screen-based activities, including watching TV, using smartphones, tablets, etc. For children in the critical period of growth and development, screen exposure has both advantages and disadvantages. Moderate and reasonable screen exposure has a positive effect on children's growth, such as early learning, exposure to new knowledge, and richer interpersonal communication. However, excessive and inappropriate screen exposure can have negative effects. Studies have shown that the problem of children's screen exposure is increasing worldwide, and infants, toddlers and preschoolers have different degrees of excessive screen exposure time.

Increased screen exposure time is associated with childhood obesity, diabetes, impaired vision, sleep problems, etc. Excessive screen exposure time can also lead to psychological and behavioral abnormalities, such as attention deficit hyperactivity disorder, tic disorder, conduct problems, emotional problems, etc. In addition, children's screen exposure is closely related to the development of cognitive functions such as language and executive functions in early life. As a tool for human communication and information transmission, the development of language is an important part of reflecting the level of children's cognitive development. Too much screen time reduces the opportunity for face-to-face communication, especially for children in the language development period. The screen exposure habits in infancy can extend to school age and even adulthood, and have a profound impact on their developmental behavior and lifestyle. Screen exposure has become a social problem that affects human development.

The American Academy of Pediatrics recommends that children under the age of 2 should avoid all types of media, except for video calls; children from 2 years old to preschool can have no more than 1 hour of high-quality screen time per day. However, the current situation of screen exposure for children around the world is not optimistic, and excessive screen exposure is common.

Domestic studies have shown that children aged 0 to 18 months (excluding 18 months) and 18 to 36 months are exposed to screens for 0.3 and 1.2 hours per day, respectively. A survey of 11,731 children from 48 kindergartens in Beijing in February 2020 showed that 56.7% of children had an average screen time of more than 1 hour per day. Madigan et al.'s longitudinal study data on Canadian children showed that the average weekly screen time for children aged 24 months was (17.09±11.99) hours, and for children aged 36 months was (24.99±12.97) hours. Preschool children around the world generally have more than 1 hour of screen time per day as recommended by the guidelines. The impact of excessive screen exposure on children's poor communication is that the frequency of conversation with caregivers is reduced, which hinders the interaction between caregivers and children. Children in the pre-language stage communicate through eye contact, joint attention, emotional sharing, and gestures, and this ability has a predictive effect on later language development. Infants and young children cannot learn language through passive input from screen time alone. When electronic products replace these interactions, infants and young children lack communication opportunities, language stimulation and language input, and their language and communication development will be affected. Studies have shown that for every 30 minutes of daily screen time for infants and young children aged 6 to 24 months, the probability of language delay will increase by 49%. Excessive screen exposure in early life affects the development of language and cognitive abilities.

Screen exposure time is not the only variable to assess the impact of screen behavior on children. The quality of screen exposure is equally important. The quality of screen exposure mostly refers to whether the child is accompanied by parents to watch and watch content when they are exposed to electronic products. Because children under the age of 5 can learn limited content from the screen, it is difficult for infants and young children to transform the 2D content learned and imitated on the screen into 3D objects in real life. In contrast, face-to-face interaction and learning with parents and guardians are richer for children. Watching with children, parents can combine the content they are watching with real life, and turn passive acceptance into active acquisition in the form of questions, so as to cultivate children's language and cognitive abilities. In the process of language acquisition, watching high-quality educational programs is conducive to the development of children's language ability. Studies have shown that educational programs such as "Sesame Street" and "Dora the Explorer" have a promoting effect on the development of children's language ability. The auditory and visual simulations of educational programs are often carried out appropriately according to the development needs of children, mobilizing children's multi-sensory participation and improving language communication skills. Warm parenting and educational content interact with appropriate screen exposure to promote children's neuropsychological development. Parents can choose stories that are suitable for their children's age to help children connect what they see on the screen with scenes in life and promote children's language development.

Technological progress and environmental changes have greatly changed the lifestyles of today's children. In the context of digitalization and the post-epidemic era, the problem of excessive screen exposure for children cannot be ignored. At present, my country has issued relevant policy guidelines and intervention measures for children's screen exposure, suggesting that parents should become guides for children's screen use and should strictly control it. McDaniel's research shows that there is a significant positive correlation between parents' screen time and children's screen time. If parents' screen time increases by 1 standard deviation, children's screen time will increase by 0.864 standard deviations. Infants and young children are in a critical period of imitation and learning. They will imitate their parents' behavior to establish their own behavioral habits. Parents' long-term use of electronic products in front of children will affect children's normal imitation learning and may lead to an increase in children's screen time. Therefore, parents should set an example and control children's screen time while minimizing the use of electronic products in front of children. Children's screen content should choose high-quality programs, with plots that make children feel interesting, warm or imaginative, closely related to daily life, and require parents to watch together, actively provide responsive care, stimulate children's potential, and better benefit from television or media. However, there is a lack of multi-center, large-sample longitudinal follow-up studies in China. Most of the current research evidence on children's screen exposure comes from Western developed countries, which have cultural and parenting differences. Children live in multidimensional environments such as family, school, and community, and various environmental factors are not independent of each other. At present, there is a lack of research on the impact of the vertical and horizontal interactions of multidimensional environmental factors on screen exposure. Further in-depth research is needed to provide a scientific basis for formulating more comprehensive screen use recommendations.