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How much is harmful?: New guidelines released on screen time for young children

The Canadian Paediatric Society’s new position on toddlers and tech is that children under the age of two should not have screen time of any kind.

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When my 22-month-old son, Ethan, wakes up in the morning, one of the first things out of his mouth is: "I want Old MacDonald Farm!"

This is not a request for any of his three-dimensional barnyard toys or for me to sing him the classic nursery rhyme. It's a request – nay, a demand – that I whip out the electronic babysitter and navigate to a YouTube remix of Old MacDonald-themed cartoons, something I do every weekday morning so I can shower in peace.

Part of me knows this is bad. The anti-screen-time stories I've read on my phone have told me so. But a much bigger part of me just wants to get through the morning. I have three boys (the others are 4 and 6) and a husband who leaves for work before the rest of us wake.

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Related: Six realistic ways to manage your kids' screen time

Is a little shower-enabling screen time really going to harm my toddler?

That's the kind of question Canadian pediatricians are hearing more and more from parents who want to know if the old rules around kids and TV viewing still apply in the new age of omnipresent screens, interactive "educational" apps and FaceTime with grandma.

On Thursday, the Canadian Paediatric Society (CPS) tried to answer some of those questions with its first new position statement in 14 years on screen time for children five and younger.

To sum up: Screen time of any kind is still not recommended for children under the age of two, a reaffirmation of a long standing rule of thumb for babies and toddlers. For children between the ages of two and five, the society recommends routine screen time be limited to less than one hour a day and that parents and caregivers watch TV programs or play online games with their preschoolers and kindergartners, rather than leave them to swipe and zone out on their own. The society also urges parents to power down their devices during family time and turn off the background TV.

The Canadian pediatricians' group opted not to follow the lead of its U.S. counterpart, the American Academy of Pediatrics, which just last fall, softened its old hard-and-fast prohibition on screen time for children under the age of two.

The U.S. guidelines make specific exceptions for Skype and FaceTime (which many doctors and parents don't categorize as screen time anyway) and for 18- to 24-month-olds, so long as adults watch or play the digital content with them.

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Otherwise, the pediatricians' groups on both sides of the border agree: There is no good evidence that infants and toddlers benefit from solo screen time. Some studies have found that preschoolers can learn from screens, but only if the digital content is high-quality, educational and dolloped out judiciously by moms and dads with the self-control of hunger strikers at a buffet.

"The youngest children cannot learn from screens. They're not developmentally ready to transfer what they see on a screen to real life," said Michelle Ponti, the London, Ont. pediatrician who chaired the digital health task force that researched and wrote the new Canadian guidelines.

"We do know what does benefit early learning and that is face-to-face, live interactions with an engaged parent or other caregiver," Dr. Ponti said.

Point taken. You would be hard-pressed to find a parent who doesn't understand, instinctively, that reading paper books to young children or helping them stack wooden blocks beats plopping them in front of the television or iPad, even if the app store is now overflowing with games that claim to be educational.

But most of us can't spend all day on the carpet, dutifully enriching the minds of our progeny. We have jobs, other children, laundry. So what does the scientific evidence say about the potential harms of any screen time at all for children under 2, or too much screen time for those in the two-to-five age bracket?

The evidence is mixed, and the bulk of it comes from the research related to TV. But the chief concern is the way that screens crowd other experiences out of children's lives – constructive experiences like exercising, talking to parents and playmates and exploring freely with all five senses in gear.

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Screens are, in a sense, like cookies. They're not great for you to begin with, but they're really bad for you if they also push all the vegetables off your plate.

"The main thing in the younger children's cases is that [screen time] displaces the most important kind of eye-to-eye contact, one-on-one learning and parent-child communication," said Robert Mendelson, a Portland, Ore. pediatrician who helped to craft the U.S. guidelines. "To me, that has always been the most important thing – not that it is so detrimental, but that it displaces things the child should be doing otherwise."

Beyond the displacement factor, some studies have raised more direct concerns about the risks of screen time.

Among the exhaustive list of citations attached to the Canadian Paediatric Society's position statement is a recent systematic review of 76 studies that looked at how television exposure affects children's cognition and behaviour. Published in the journal Developmental Review, the paper found that, overall, high-quality educational shows (Sesame Street is a popular example) can help improve preschoolers' basic academic skills.

But the review found that, for infants, watching TV was associated with "inattentive/hyperactive behaviours, lower executive functions, and language delay, at least in the short-term."

Still, associations can be tricky. They are not causes. Are TV watching and hyperactivity sometimes linked because TV makes kids hyper, or because parents of hyperactive children are more inclined to switch on the TV to give themselves a break? Several of the studies found that content mattered a great deal. Slowly paced educational programming seemed not to have the same negative effects as fast-paced cartoons.

Many of the studies in the review involved children who watched two or more hours of TV a day. Is screen time safe in shorter bursts? And what about the new generation of interactive, educational apps that have yet to be the subject of much rigorous research? Are they more like TVs or more like interactive toys?

Dimitri Christakis, the director of the Center for Child Health, Behavior and Development at Seattle Children's Hospital, said the rise of touch-screen technology was "fundamentally a game changer," for researchers who study child development.

Children sit passively while they watch TV, but they can engage with an interactive app – the kind that rewards their counting or letter knowledge with a star or whistle, for example – in a totally different way.

Dr. Christakis, who co-authored the recent AAP policy statement, said the research on these products is in its infancy and the vast majority of the hundreds of thousands of apps that market themselves as educational are not backed by any real science.

"We don't recommend that children use these apps before the age of two," he said. "I just think we have to be thoughtful … we say that limited use starting at [18] months of age, ideally with a parent and with interactive apps that are slow-paced, is okay. That's a far cry from endorsing their usage."

Listening back to my interview with Dr. Ponti of the Canadian Pediatric Society, I winced as I heard the self-justification in my voice while I questioned her about the society's recommendation that parents interact with their children while they use screens.

It struck me as ridiculous. When I have one-on-one time with Ethan, I read him a real book. The only reason I bust out the iPad is so I can shower or prepare dinner or prevent Ethan from repeatedly running on to the ball hockey rink while his dad coaches his brothers, I protested.

Dr. Ponti shut me down gently but firmly. "What did parents do 10 years ago?" she said. "It's not that long ago. They would sit their children in a bouncy chair and give them a board book."

Truth is, I was looking for her to cut me some slack. I find it's much harder to stick to the no-screens rule for my toddler than it is to adhere to the less than one-hour a day rule for my older boys, William and Campbell, even though they ask to play Mario on the iPad approximately 500 times a day.

They're old enough to entertain themselves. And they have each other. In Ethan's case, it's harder. That Old MacDonald remix allows me to shower without a sobbing toddler trying to yank open the glass door. I don't want to give that up.

Dr. Ponti said she gets it. A mother of three herself, she knows how hard it is to keep screen time from taking over family life. The Canadian Paediatric Society's position statement is a "gold standard," she explained, a guideline for pediatricians who want to know how to offer the best possible advice to their patients.

That is part of the reason the CPS opted – after much discussion – not to insert into their recommendations a specific exemption for FaceTime or Skype with family, she said.

Dr. Christakis was more willing to cut me that slack. "I often to say to parents, if you're using the device to give yourself a break … I think that's fine. I really do," he said. "But know that that's why you're doing it. I think if you're using it because you think it's educational or beneficial for your child, that's where you need to think again."

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How to manage screentime

The Canadian Paediatric Society's new position statement recommends families follow the four "M"s when it comes to screen time and young children.

Minimize screen time

Screen time for children under 2 is not recommended. For two- to five-year-old children, limit routine screen time to less than one hour a day. Maintain daily screen-free time, especially at meals and at least an hour before bedtime.

Mitigate the risks associated with screen time

Be present and engaged when screens are used and, whenever possible, co-view with children. Be aware of digital content, prioritizing educational, age-appropriate, interactive content.

Be mindful about the use of screen time

Conduct a self-assessment of screen habits and develop a family media plan for when, where and how screens may (and may not) be used and be reassured there is no evidence to support introducing technology at a young age.

Model healthy screen time

Adults should turn off their devices at home during family time, turn off screens when not in use and avoid background TV.

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About the Author
Health reporter

Kelly Grant is a health reporter with The Globe and Mail. More

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