Screen Time and Children’s Health

Many children and teens are spending much of their week doing remote learning, meaning kids are spending much more time in front of a screen. So, what are the old screen time rules and what are reasonable new rules for a pandemic? We’ll discuss guidelines, limits, and alternatives to reduce screen time’s impact on your child’s physical, social and mental health. Joining us for this episode are child & adolescent psychiatrist Dr. Tony Pesavento with Children’s Behavioral Health & pediatrician Dr. Jeremy Toffle from Children’s Physicians, West Village Pointe.

Topic Breakdown

1:43 – How COVID-19 and changes to screen time have changed pediatric practice
13:52 – Quality over quantity: Differentiating between “good” and “bad” screen time
7:06 – Modeling screen time behavior
10:10 – The “right” amount of screen time and creating structure
14:43 – The pros and cons of social media in the age of COVID-19
17:25 – Adapting to the new normal — and remembering that there is not one “correct” answer
20:12 – Keep checking up on your kids
22:05 – Remembering the positives
23:25 – Parents are doing a great job
25:00 – Developing healthy habits


Here at Children’s Nebraska in Omaha, Nebraska, it’s all kids — all day, every day. Our pediatric experts are here to answer your questions and weigh in on hot topics, helping you keep your child healthy, safe, and strong. We’re here for you. Listen in.

Dr. Tony Pesavento: I’m Tony Pesavento. I’m one of the psychiatrists at Children’s Hospital & Medical Center Behavioral Health. I work in our outpatient clinic, in addition to work on our hospital inpatient consult service.

Dr. Jeremy Toffle: And my name is Dr. Jeremy Toffle. I work with Children’s Physicians at the West Village Pointe Office. I’m a general pediatrician and I work in the outpatient setting, seeing patients there.

We’re here today to kind of discuss about screen time in the times of COVID. I guess we should reference that as things are all different with us. And I know, I think both of us, me and you, Tony, understand a difference in our daily lives.

Dr. Pesavento: Absolutely.

How COVID-19 and changes to screen time have changed pediatric practice

Dr. Pesavento: So Jeremy, tell me from your standpoint in the outpatient pediatric world — how has COVID impacted your practice, specific to screen time and talking to parents and kids?

Dr. Toffle: That’s a really good question, because COVID has definitely affected a lot of us. But kids, I would argue, probably the highest and they’ve been the most affected. Because with most kids — and I’m sure you’ve seen this in your practice — they’re still learning to cope with things. So you look at social circles, you look at physical activity. The normal routines of life have been all up-ended on them. One of those is definitely screen time, too. You look at that and that definitely has affected them a lot.

I think one thing we see a lot with kids recently — we’ve seen a big increase in obesity and weight going up. And the other thing we’ve been seeing is big jumps in things like anxiety and depression. I’m sure you can comment from your side and from what you guys are seeing in the office, how that’s really affecting you guys, too. I’m sure you can maybe comment more on that.

Dr. Pesavento: Oh absolutely. It’s not only just the COVID part with kids being more isolated, being kept away from their friends. It’s amazing how many kids who used to hate going to school are now wanting to go to school every day. They miss the day-to-day interaction and they miss the structure that comes along with it.

From a screen time standpoint, it’s definitely been impactful. Kids feel isolated. Depression and anxiety comes along with that. And they are not — you don’t realize how much interaction comes, how much learning comes from interaction with friends and teachers. It’s so much more than just math and English. It’s much more about learning conflict resolution. It’s about learning how to get along with somebody that you might not necessarily like. Those little learning things that are missing. We’re definitely seeing a lot of mental health ramifications come from that. And their parents are struggling, too.

Dr. Toffle:: Definitely

Quality over quantity: Differentiating between “good” and “bad” screen time

Dr. Pesavento: I Can’t tell you the number of times that I’ve been asked in just my day-to-day work and practice — “What do we tell our kids? What do we do with it? How do we do moderation?” I’m curious — I’m sure you’re hearing a lot of this, too — I’m curious what you tell parents when they’re asking. When they ask you, you know, “Dr. Toffle, I tell my kids 4 hours of screen time. But that means they miss half their day in school. How do we — what do we do with this? How do we manage this?”

Dr. Toffle: Yeah, it’s so — it’s such an interesting time. Because before, it was “Follow the script. 2 hours of screen time a day. That’s your guideline. And, you know, check the box and move onto the next thing.” And it’s not that easy now for anybody. We have family friends and friends of friends that are constantly asking, “How do we do this? Because I feel bad because it feels like we’re letting our kids have more screen time than we should?” And yeah, I mean, these kids who are in the situation of having to be at home for school, they’re getting a lot of screen time.

I think when you look at how the American Academy of Pediatrics has kind of discussed this — they haven’t said a set time, but they’ve talked more about the quality of screen time. Obviously, I think we would both agree that school time is quality screen time. At least you hope so. In some settings, it might be 3 hours for some schools. In other schools, they might be there for that 7-8 hour day, sitting there doing it.

I think when you start talking to parents about it and looking at screen time, you differentiate what’s good screen time, what’s not as good screen time. And I think too, for kids, it’s important for them to understand — screen time is not just staring at the computer. Not just staring at the TV. You’ve got your phone out, you’re playing video games, and all of that comes together as one thing.

And so, what I tell parents is usually, I still try to stick to that 2-hour recommendation. But what I also tell them is, “Hey, if you’re sitting down a lot during the day, you’ve got to move. Your body’s meant to move, not meant to sit.” And so I tell kids, “Set a timer for 30 minutes. Every 30 minutes, you pause what you’re doing — show, game, whatever it is — and do something. Do some push-ups, do some sit-ups, go out, run up and down the stairs. I don’t care what it is, but just do it.” Hopefully, that will help.

Because yeah, when you talk — when you look at the screen time stuff like I mentioned before — the obesity rates have gone up like crazy. Because you’ve got kids sitting around, sitting at home for school. Instead of being in a structured setting where they Can’t get up and get a snack, they Can’t get up and do this and that, go drink a pop, things like that — they’re doing it at home.

Even with that kind of screen time, there needs to be a little more structure to the day. Not just with the amount of time they’re looking at the computer, but what they’re doing during that time, too, which is important.

Dr. Pesavento: Right, and I think that that brings up a really interesting point — is that you almost have got to reframe how you do the screen time, in terms of what is educational vs. what is not. Kind of like what you were talking about, the good vs. bad screen time. It’s also become — kids need to shift the idea of what they do during their free time. If their “business” time, if you will, is school, doing it on a screen, then their not-business time Can’t also be on a screen, right? We need to get them outside and we need to get them doing other things, as opposed to just relying on the screen for entertainment. And I recognize that that’s a major challenge. It’s a big thing, but it’s something that if you work at, can really be beneficial.

Modeling screen time behavior

Dr. Toffle: Yeah, I think that’s a really good point. And I know for you guys, I’m sure with a lot of stuff with you guys, you talk about modeling behaviors and things like that. What do you — I mean, how are you guys approaching that with parents in modeling behaviors in terms of screen time as well?

Dr. Pesavento: I think that this has probably been, in my view, the biggest challenge that I’ve seen with screen time — is when I will bring even the idea of limiting screen time up, most adolescents will come back to me and say, “Well, Mom and Dad are on their computers 12 hours a day.” And they’re right. I look at my day, and when I’m not doing hospital stuff, I’m on the screen talking to patients. We’re still not doing 100% face-to-face business, so I’m doing a lot of Zoom appointments, which have been great. They’ve been beneficial. But still, I’m in front of the screen.

I think that kids definitely mirror their parents’ behavior. There’s no way around it. I think that the few things that you can do as a parent is, #1 — model that good vs. bad screen time. Really talk to your kids about, “I’m on a meeting right now and that’s what I’m doing for screen time. But I might not be reading the Wall Street Journal on the screen later. I’m going to go do something else.” Because you’re trying to find that balance between what is good and what is bad screen time.

I think that another interesting thing that is an opportunity for parents, is to do co-screen time. Because if you’re going to be — if kids are going to be doing screen time, there’s a lot of research about how much more beneficial it is if the parent is doing it with them. Not only for monitoring the contents and making sure that it’s appropriate for kids and trying to lean heavily on the educational side. But just the idea that you’re getting — they’re getting that interaction with their parents with watching a screen, whether it be a movie or an educational program or even watching a documentary or something that can kind of engage them in some type of learning. If their parents are there and they’re commenting on what they’re seeing and what they’re hearing, that’s going to make a major difference for the way that their screen time goes. And it’s not going to that mind-numbing time. It’s going to be more of an enriching time. That’s a big thing. I think that’s a big thing.

Dr. Toffle: Yeah, I think that’s a good point. I think a lot of — a lot of times, we think, “Oh, I’m going to put them in front of the screen. they’re watching Sesame Street, they’re learning something. Now I can do the dishes or now I can do this…”

Yeah, you look at studies. And kids under the age of 2, we still kind of recommend really limiting any screen time. Because their brains really just aren’t made to learn directly from screens. they’re made to interact with the world around them. But that 2 to 5 age, and even older, you can get some benefit from screen — educational screen time. But, it really does require that parental involvement. Relating, “What did you see on TV?” to “Okay, what’s going on around us here at home? Let’s do that.” So I think that’s a really good point, the involvement part. That’s a really good topic to discuss there.

The “right” amount of screen time and creating structure

Dr. Pesavento: Jeremy, you brought up the American Academy of Pediatrics. I think that a lot of families, and rightfully so, view the organization as well-meaning, it’s evidence-based. A lot of parents look to them for what to do, for recommendations on what is the best way to handle these things.

You commented already, about how their guidelines don’t include time anymore. It’s more about quality than quantity. And I’m curious — when parents ask you about that, “Do we have a time? Is there a time? What’s the limit?” — is there any general guideline you give them? Or do you just kind of say, “We’re doing the best we can right now”?

Dr. Toffle: Yeah, you know, I still try to say — I kind of go back to the old guideline and say, “We used to recommend 2 hours and this is the reason why.” But the caveat that, okay, we recognize that things are different. Our world is changing. Things are always changing. Making that distinction is really important.

I think for me, what we usually do, is we’ll say, “Okay, if you’re going to have any of that leisure screen time, you guys need to set a guideline.” Because, you know, if you just say, “Hey, we’re going to do this for a little bit and then we’re going to do something else,” that “little bit” means different times to different kids. So if you don’t have that structured time, or kind of that thought process planned out, I think that’s for a lot of, at least, “Oh, it’s just one more show.” Or, “Oh, just one more match,” or, “Oh, just one more song,” or, “One more TikTok Video.” Whatever it is. It’s — they want that little bit more, little bit more, little bit more.

I think if you get that structure and you stick with it, then it helps over time. Because I’m sure that as you guys talk about, I’m sure that all of the time on a daily basis, routines are important for kids and their structured day and how their brains work, and those kinds of things. And so if you stick with that routine on a daily basis, unless it becomes routine, it just makes things easier. So I think that’s important.

Dr. Pesavento: Yeah, and this is stepping a little bit away from screen time, but I still think that it’s super important when we’re talking about adapting in the pandemic world that we live in right now is, the best thing that we can probably do for kids — from a behavioral health standpoint — is to establish as much routine as possible.

Kind of going back to one of the reasons that school is so beneficial — it’s much more than the academic side of things. It’s the idea that it gives kids a routine every day. And that does so much for them. If I talk to kids about things that they don’t like the least, it’s the unexpected, right? They want to know what’s coming next. And if there’s been anything that’s been in this COVID-19 world, it’s unpredictability. It’s so challenging for them.

I think that’s another reason why we’re seeing such an uptick in things like depression and anxiety, is just a general sense of unpredictability. Not only in terms of what kids are going to be doing during the day. There’s a lot of real-world stuff out there, with people struggling with losing jobs, with people struggling financially, people struggling with not seeing their relatives, missing seeing their grandparents. I talk to kids that say, “We haven’t seen Grandma in 6 months.” That unpredictability really is what weighs on kids and can be really impactful for them. And so just not only with screen time. Just some general life, as a parent. The more routine things you can introduce for kids, the better off things are going to be.

Dr. Toffle: Yeah. And I think a good point there is when you talk about, you know, not going to see friends, not getting to see family. When we talk about having healthy screen time, structured screen time — one of those, absolutely, FaceTiming friends, or using Zoom, or whatever that might be to call Grandma or call up your friend from school that you don’t get to see more on a regular basis.

Finding those times and maybe structuring them in your day or in your week. Saying, “Alright, Saturday is ‘catch up with Grandma’ Day,” or something like that. Having those things to look forward to is good. But on the flip side, also having that structured no screen time, so everybody stops. So no phones at the table or, “Okay, hey, 6:00-7:00, we just had dinner, we’re doing something as a family.” Maybe it’s a game night, maybe it’s this, maybe it’s that. And I think that goes back to, you know, it’s hard — you Can’t tell your kids, “Hey, get off the screen” and then you’re sitting there on your phone running through emails.

Dr. Pesavento: Exactly, exactly.

Dr. Toffle: It’s hard for them to recognize it. So if everybody follows the rules, everyone sticks with it, the more everybody gets used to that, the more it’s going to benefit children in the long run.

The pros and cons of social media in the age of COVID-19

Dr. Pesavento: Another thing that you brought up that I think is super important is that friend contact. And that has — not only has this changed the way that we view screen time from an educational vs. non-educational standpoint, it has changed my view on social media.

My patients will tell you, I’m not the biggest social media fan in the world, and that’s mostly because I see some of the bad stuff that comes with it. But I think during the pandemic, I’ve seen a lot more of the positives that come with it, in terms of the ability to connect with people.

The ability to visit with friends and the ability to feel like you’re still included. Kind of that fear of missing out. Social media can help with that. They can interact with their friends. They can see things that their friends are doing. They almost can have a reassurance that their friends are still there.

But it also has brought out some of the not-so-fun parts of social media, too, in that I think it does highlight a lot of the different political views on the pandemic. Whereas a lot of kids will say, “I don’t understand why I Can’t go to the store when my friends are at the amusement park.” It just highlights the differences in the ways that people view this, and that can be a real struggle. And kids kind of seeing the difference between the way their parents are responding to the pandemic, as opposed to their friends’ parents. I’m not necessarily saying one is wrong or one is right, I’m more saying that kids are all about “fair,” right? Kids want everything to be just fair. And so it kind of highlights the discrepancies sometimes between the way that families are approaching this day in time.

Dr. Toffle: Yeah, and I think that’s a really important point. Because you’ll see that in some cases with families, like you said, some are approaching it a lot more aggressively than others. And some are a lot more laid back. I think that’s going to be really interesting here in the future, to see how our kids respond in the next year, the next 2 years, the next 5 years, in terms of how they act toward situations like this.

And I think — the guidelines, I’ve always been telling my families, you know, “Take it from a calm approach. Just don’t be super aggressive in the way you talk about things. Don’t talk down about other people, about their beliefs, and things like that.” Just say, “You know what, hey, this is what we’re doing and this is why.” Make sure kids understand the importance of it, but don’t turn it into stress. Don’t turn it into anxiousness. Don’t turn it into those kinds of things.

I think you’re going to see that a little bit with screen time, too. I think we’re seeing a big shift in that with what’s going on now, and I think discussing with your family the importance of positive screen time, and then not having screen time, and getting out — getting in the world.

Adapting to the new normal — and remembering that there is not one “correct” answer

Dr. Toffle: I think one of the things that I’ve been seeing in the office, too, is these sleep routines are totally off in kids. You think about, you’re inside all day. You’re not getting any sun exposure. Your brain has no clue what time of day it is. The normal melatonin structures of your brain are totally off. You get no sunlight, then all of a sudden, it’s 8:00 or 9:00 at night and you’ve been in front of a screen all day and you’re supposed to go to sleep. And your brain doesn’t know what to do.

And so I think it’s — our whole bodies are developing new routines and new pathways. It’s going to be interesting to see how these next few years go, but I think parents are going to do a good job.

Dr. Pesavento: I agree.

Dr. Toffle: I think we’re all concerned about how we’re going to do, but I think in the end here, I think we’re going to get it figured out. I think if we just take it a day at a time, take it calmly, and just discuss in a normal way how things are going, I think it’s important.

Dr. Pesavento: I fully agree. I totally agree. I’m a parent of a 2 ½ year-old, and so I’m kind of new to this parenting world, Jeremy, and I know you’ve got kind of a jump start on me. But if I’ve learned anything about parenting, it’s that it’s all about adapting.

Dr. Toffle: Yup, all about adapting.

Dr. Pesavento: Oh yeah, there’s —

Dr. Toffle: There’s no textbook that’s going to tell you how to do it exactly right.

Dr. Pesavento: Exactly. And even more the test these days with everything going on in the world. I think in some ways, screen time is all about adapting. It used to be, a lot of years ago, we never even dealt with this. I read somewhere where the iPad turned 10 years old this year. I was like — I Can’t really remember life without it.

Dr. Toffle: I know, right?

Dr. Pesavento: And so, it’s just a lot of adapting. And I agree with you. I think that for the most part, the parents that I’ve interacted with, I’ve been just amazed with the things they’ve done and the hats that they’re wearing. Because not only are they wearing the hats of parents and of screen time police, they’re also right now doing a large majority of the teaching. they’re doing — we’re now asking them to almost be medical experts because they’ve got to make decisions that are really tough about what their kids can and Can’t do in terms of exposure to the virus. It’s a lot.

A lot of parents who are listening to this — I think that Jeremy and I would both echo that you’ve just gotta keep going. And I think the majority I’ve talked to have done an amazing job.

Dr. Toffle: Yeah. I don’t know for you, I mean, I guess as kind of a closing — do you have in your expertise and in your experience so far with what’s going on, any kind of final tips for families? Or thoughts on that, in terms of just some final bullet points, I guess, for them to kind of read up on or follow anything there?

Keep checking up on your kids

Dr. Toffle: I think the main — I think there’s a couple things. I think #1 is to, when we talk about screen time, when we talk about the coronavirus pandemic, is kind of like when I was describing all the hats that parents are being asked to wear and assume.

Just keep checking in with your kids. Just keep checking in. Make sure that — I’ve talked to a ton of kids who are doing online and in-person school, and each has its positives, each has its negatives. Some kids love it, some kids hate it. And some kids are comfortable staying home all the time and understand, some kids don’t. Some kids have felt like their mental health hasn’t been really impacted, some kids have drastically had their mental health impacted. That is regardless if you have a psychiatric illness. I’m talking about mental health in general.

Just keep checking in with them. Know where they’re at. And like we talked about, adapt. Find a way — if you can work with your schedule, if you can work with a routine. If it’s — kind of like screen time. It’s what — can you adapt to the type of screen time that they’re doing, can you change, limits, what kind of screen time you’re doing? Just really have your finger on the pulse of your kids and know where they’re at. Because they’re, as like — I Can’t imagine a parent who has not been stressed during this — I think everybody has been affected by this in some way.

And kids, I feel like, are going to be a little bit hesitant to talk with their parents, because they understand that they’re going through a stressful time, just like they are. And so just, for parents — just keep checking in with their kids. Know where they’re at and see if there are ways that you can be of service to them. And if you ever feel like they need more help, we are always, always here to visit with them. So that’d be the first thing, is just keep checking in.

Remembering the positives

Dr. Pesavento: The second thing is kind of the “lemonade out of lemons” thing, right? As much as this has been not so fun, this has also done some things for families that may be very beneficial. I’ve talked to a lot more parents that are like, “I spent more time with my kids in the past 6 months than I have in the past 6 years.” Just because of the circumstances. Embrace that. Enjoy that.

Try and find ways the family can reconnect even just a little bit, because — as hard as things have been, there’s also some benefits in terms of people’s schedules and being at home, that can provide some unique opportunities that they may not have had in the past.

I have no idea when we’re going back to a new normal — or if we’re going back to a new normal — but try and make the best out of this that you can. So that would kind of be my closing thoughts. Jeremy, I’m curious from a physical expert health — or health expert — what your thoughts on how kids can adapt to screen time and COVID? And kind wrapping up today.

I guess I would echo what you said about checking in on your kids. I definitely think that’s a huge thing. Because it’s really easy, with school, just having them sit in their room, just doing their teaching, to not really know what’s going on. So checking in is super important. I won’t push more there because you did a really good job covering that.

Parents are doing a great job

Dr. Toffle: I think — the first thing I would say is, if you’re a parent out there, you’re doing a good job. Don’t beat yourself up on it.

Dr. Pesavento: Absolutely.

Dr. Toffle: You know, you’re going to have good days, you’re going to have some bad days. And all you can is move on. All you can do is — if you need to make an adjustment here and there, you Can’t fix everything in a day, so don’t feel like you have to. Make adjustments, try to figure out what’s going to work best for you and your family.

We covered healthy screen time as a family, we’ve covered screen-free times as a family. I think I’d echo, too, with spending more time together — yeah, I think that’s something new for a lot of people, which is interesting. I think structuring a time where you get to go outside as a family to a park, go hiking, go on a bike ride. It’s crazy how little people do that as families anymore.

Even though we’ve been — there’s going to be situations, and who knows what the next months are going to be in terms of numbers and do we see more restrictions, less restrictions, but there’s definitely ways to be active. There’s definitely ways to get out there. And there’s definitely ways to spend time with your family. So I think it’s — take every day as a new day. Like you said, you don’t know what the new normal is going to be, or is this the new normal, or what that is.

But despite what the new normal is, I would just take every day as you’re starting from square one. Don’t let the day before affect your day and the next day and the next day. I think you
brought up some really good points there.

Developing healthy habits

Dr. Toffle: Just stay active, stay healthy.

I guess the other thing I didn’t really comment on is we’re all just stuck sitting at home. Watch your snacking. You’re getting healthy options in there. It’s really easy to grab a bag of chips compared to some carrots or something. So kind of watch that, watch your water intake, all of those fun things.

If you have questions out there, you can call your pediatrician, talk to them. If you haven’t had a physical yet, make sure you see them. Make sure your kid’s health is up to date. Make sure there’s nothing that you’d maybe forgotten to ask about or thought about that they can bring up with you.

Hopefully, the parents out there, you’ve gotten something out of this. And hopefully we’ve answered your questions on screen time. If you have other questions, like I said, contact your pediatrician. The American Academy of Pediatrics has great information if you look for it online. And with that, I think, we covered a lot of it there.

Dr. Pesavento: Yeah. Both Jeremy and I appreciate everybody — everyone that’s tuned in here. I know everyone here at Children’s really, really cares about our kids. So we — I echo what Jeremy said. I feel that our parents have done an amazing job. But if we at Children’s Hospital in any realm can be of any help, please feel free to reach out to us.


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