March 29, 2016

Practical Screen Time Advice for Parents

Paul Smolen MD FAAP

Carolinas Medical Center, Charlotte NC
Creator of the blog, Portable Practical Pediatrics

Author of Can Doesn't Mean Should-Essential Knowledge for 21st Century Parents

This COCM post is an adaption of a post from Dr. Smolen’s blog, Portable Practical Pediatrics.
You can find some fascinating stuff in a pediatric journal. The other day I was reading my copy of Pediatrics, and I found an article that I thought parents and pediatricians might find interesting and meaningful. The article talks about the activation that occurs in a child's brain when he or she is stimulated by storytelling or being read to. This subject is getting a lot of attention because of its relevance in today's electronic-rich environment where screens have begun to substitute for the storytelling/reading experiences of the past. The article speaks to the core of childhood:  a child’s imagination, language skills, and cognitive development.
    I watch the daily struggle that parents have with regard to limiting screen time for their children. As they wait in my office, parents often try to distract and placate their children with a smartphone showing an animated video game or movie.  Cartoons on a little screen seem magically to tame even the most upset, misbehaving, out of control child. Children love these devices, and parents often use them to reward certain childhood behaviors or simply to distract a bored, annoying child.  The peace and quiet is instantaneous!  Everyone appreciates the quiet, but is the method of achieving it—with screen time—good for the children? I'm not so sure.

    Followers of my blog,, will remember the post (1)  about a study (2) showing that an iPad, given to children just prior to surgery is as effective at relieving anxiety as the potent sedative Versed.

    No one would advocate giving Versed to children on a regular basis to relieve anxiety or boredom. This is clearly not in their best interest.  If giving Versed regularly to children to relieve anxiety isn't beneficial, is frequent use of screen time with the same goal any better? Could today’s use of screens be the “Soma,” the negation of negative feelings, that George Orwell warned us about in his novel 1984?

    In the Pediatrics study, researchers used active MRI scans to measure brain cortex activity while young children (three to five years of age) were read to. (3) They found that children with “greater home reading exposure” showed greater cortical brain activity while listening to stories in the lab. They conclude that active imaginary verbal activities such as reading to children, developed the children’s ability to create “mental imagery and narrative comprehension.” Is anybody surprised? I certainly am not.

    We know that reading to children is good for their brains, but the word is still out on screen time. Common sense tells me that children who are not instantly pacified with screens learn more self-control; they learn to be more patient without the screen to fill the void of time. Learning to be patient without demanding to be distracted is actually a skill that children need to learn. Psychologist Dr. John Rosemond believes that children around the world generally stop interrupting their parents’ conversations—a skill that requires patience—by their fourth birthday. (4) Do we observe this tendency in contemporary American children?  No. Perhaps learning to cope without screens while the pediatrician is tending to a sibling is something that children need to master and that we as pediatricians should foster.

    But we live in the times that we live in. Telling parents just to say no to screens is not practical and not likely to happen.  How can we encourage parents to achieve a healthy balance for their children? How can we encourage parents to limit time with virtual, passive devices like screens and, at the same time, help children to develop active imaginations with less need for high stimulus, passive entertainment?

    I think parents should adopt what I call the Zero Sum Solution:  for children over two years of age who are too young to read on their own, parents should read to them for at least as much time as they permit the children to have screen time. Older children who are good readers should earn screen time by reading for an amount of time equal to their screen exposure. It is important to note that the reading/storytelling time should precede their screen time.  No reading, no screens. Using this strategy, children may relax with a screen only after they have spent an equal amount of time stimulating the parts of the brain that use mental imagery and more active verbal engagement. I think the Zero Sum Solution is a practical means of balancing screens with traditional imagination and verbal formation. It also shifts screen time to an activity that is earned, not expected. Oh, and by the way, I do occasionally see children who learn to love reading as much as most children love screens. These book lovers always seem to succeed in school.  Just saying...

(1) See more at:

(2) Pediatric Anesthesia Volume 24, Issue 12, pages 1217–1223, December 2014 –

(3) Pediatrics Volume 136 Number 3, October 2015  pp 466-478

(4) Psychologist John Rosemond's developmental milestones for children