Joey Wahler (Host): It's a common bone of contention between parents and their kids, so we're discussing children's screen time. Our guest is Dr. Giulia Izzo Castellano, pediatric resident with BayCare. This is BayCare HealthChat. Thanks for joining us. I'm Joey Wahler. Doctor, welcome.

Dr. Giulia Izzo Castellano: Hi there. Thank you so much for having me.

Host: Oh, great to have you aboard. So first, what do we mean exactly by screen time? Does that include phones, TVs, all the devices that are in between nowadays?

Dr. Giulia Izzo Castellano: Yeah, for sure. Nowadays, there are so many more devices than many years ago. Screen time includes cell phones, TVs, iPads being one of the big ones. So, all of those things that can impact our children.

Host: It seems the impact of screen time on kids can be broken down into a few categories, one being the developmental and learning effects on kids, right?

Dr. Giulia Izzo Castellano: Yeah, for sure. Development is a huge part of our children. And the first five years of their life is really a critical period, where a lot of brain development happens and the foundation for their future learning. A lot of developmental skills like emotional, social, and cognitive skills occur in this time period too. So, screen time definitely could play an effect there.

Host: So, how so? What are the good and the bad from a developmental standpoint?

Dr. Giulia Izzo Castellano: There are different types of screen time when it comes to just the overall topic. So, there's passive screen time, interactive, communication, and then creation. So, more of the interactive, the communication side of things, those are more of the beneficial sides that can enhance their development. A screen really only provides a two-way experience for them, more of a two-dimensional. So, screen time has to be more interactive for them to have a positive experience with their development.

Host: And by that, you mean there are a lot of apps now on these devices where it's asking the child to make a choice or to use a skill. And so, both physically and mentally, it's really teaching them a lot, right?

Dr. Giulia Izzo Castellano: Yeah. Interactions can be not only with the person on the other side of the screen, but it also comes to our children's parents, interacting with their child, trying to connect with them and asking them questions that can lead them to critically think, be creative. So, asking your kiddo, "Hey, what is the little boy doing in the show?" Questioning what's happening on the screen to trigger their little minds to focus on more learning.

Host: How important is that, doctor, to have that connection, to show an interest? Because we know the kids when they're very young, couple of years old, thereabouts, and a little bit older, they're very focused on their parents, watching what they're doing, praising them, that feedback is important, right?

Dr. Giulia Izzo Castellano: Yeah, feedback is everything at that age. Our children learn from how we react to things, how we respond to different situations. So, definitely making it a positive experience, engaging with your child, and making sure that the screen time that they are experiencing has positive behavior, so that they can learn to mimic from a positive behavior.

Our kiddos that are very little may look at screen time and different things that they're watching and find that kind of confusing or mimic negative behavior if they see it. So, making sure that we're selective with their screen time, because our children's brains are just absorbing everything that we do and show them.

Host: How about the mental health impact? I would say, as a parent, one thing I noticed with our daughter using the kid's tablet is that it can really be confidence-building because they're having fun at times, but they're also learning and regardless of which one they're doing, maybe both simultaneously, the fact that they're doing it successfully and they've mastered it, it really builds confidence, right?

Dr. Giulia Izzo Castellano: Yeah. Screen time can have a lot of positive effects if it's done mindfully. It can definitely overcome a lot of barriers of distance and time. If we don't have family members nearby or friends, it shows our kiddos how to connect and expand their networks, and this is for our older kiddos too. It can help them find communities where they belong and that can definitely increase their confidence for sure.

Host: So, switching gears a little bit, how about the physical health effects of screen time on kids? We hear about that question when it comes to adults as well. What are some of the potential pitfalls of spending too much time on these devices?

Dr. Giulia Izzo Castellano: When it comes to the physical effects, a lot of it has to do with how much time we're using screen time. And like you said, that really affects adults as well. A lot of screen time can cause some eye strain, neck pain, shoulder pain, poor posture. But besides that, there's a higher risk for obesity. So, research does show that watching TV for more than an hour and a half per day is a risk factor for obesity for our children between the ages of four and nine. And then, for our teenagers, if they watch five or more hours of media per day, they're five times more likely to be overweight than children who watch zero to two hours of media.

Host: What kinds of changes are recommended regarding screen time for kids as they go from toddler age to preteen to eventually teenage years?

Dr. Giulia Izzo Castellano: American Academy of Pediatrics has different recommendations on how much screen time and the quality of screen time in different age groups. So for our little ones under 18 months, we really recommend avoiding screen time outside of video chatting and connecting with family and friends. For our a little bit older kiddos or toddlers from 18 months to 24 months, we really recommend programs that are very high in quality, that have a lot of interaction, and that you can play together with parents, your family. For a little bit older, between two and five, we want kiddos to limit their screen time to about an hour per day, but always high-quality programming.

And then, when it gets to older kiddos from six or any time older, we really just want balance. So, making sure that we're still able to have all of our educational requirements with school met and increasing reading time, time with family, time with friends, and making sure that the screen time is not interfering with that or interfering with other things like sleep, exercise, and other healthy behaviors as well.

Host: Well, now you've hit on something that's often an issue when it comes to this, and that is that balance, right? I know that there are certain other things that our daughter was enjoying doing, but once she got ahold of that tablet on a regular basis, sometimes we'd ask her while she was using it, "Hey, would you like to try blah, blah, blah?" And she'd be like, "No." Whereas normally, she'd jump at it because she's leaning on the tablet a little bit too much at times. So, how do you address that as a parent?

Dr. Giulia Izzo Castellano: Open and honest conversations are always really great to have with our kiddos, no matter how young or how old they are. The best thing to do is really create a plan together and make your children a part of that. It's easier to have them make some decisions and have more confidence in that. So, having boundaries, showing priorities, are ways to help that. Also finding, "Hey, let's do this activity together and then we can have some screen time." So, having some type of guidance there. Also, having media-free time together as family helps a ton with just family bonding and well-being. So, including things like sports, reading, or talking together helps a lot.

And the last thing that I would recommend as well is having media-free spaces and times. So, making sure that we say, "Hey, if we're going to do screen time, it's going to be in the playroom. But once we go to bed in the bedroom, that's a media-free zone." Or with, "Hey, dinnertime, that's the media-free time. We're going to spend time as a family, we're going to interact together."

Host: How about trying to turn what otherwise would be just entertainment or fun, et cetera, into something educational like watching a TV program with your kid, watching a movie, whatever the case may be, and asking them questions and making comments like, "What do you think he's thinking about there?" or "What would you do in that situation?" How important is it to have that interaction and try to turn it into something educational?

Dr. Giulia Izzo Castellano: Yeah, that is wonderful, wonderful things that parents should be doing with their kiddos. Making sure that they are critically thinking and not just making it a passive experience. So, making sure that it's active thinking and making them question and learn, as they're participating in screen time is really essential to the whole experience with their kiddos.

Host: And so, in summary here, doctor, what advice do you have for parents when walking that fine line that we've discussed between allowing enough screen time, but not too much? Where do you draw that line?

Dr. Giulia Izzo Castellano: The important thing to think about screen time is the quality over the quantity and just looking at the overall picture as a whole on your child's health. So, making sure that they are using the internet safely. And that is not interrupting with things like their sleep or school, or their development as well. So, just being open, honest, having a plan with it, and modeling that as well. So, adults also have a lot of screen time nowadays, so making sure that we're modeling appropriate screen use for our children is really important as well.

Host: I guess in closing, I would just add that if anyone joining us right now in the audience hasn't seen lately some of these apps for little kids, they're really pretty amazing. I mean, some of the graphics and some of the stuff that they have, a lot of it's based on different TV characters that the kids are already familiar with. And Lord knows we didn't have that when we were kids, but I guess the lesson here is all great, but in moderation, right?

Dr. Giulia Izzo Castellano: For sure. That's a life lesson for all of us. Moderation is really the key and making sure high-quality is the priority.

Host: Well, folks, we trust you're now more familiar with children's screen time. Dr. Giulia Izzo Castellano, great advice indeed. Thanks so much again.

Dr. Giulia Izzo Castellano: Thank you so much for having me. I appreciate it.

Host: Absolutely. Same here. And for more information and to connect with a provider, please visit BayCare.org. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts as well.

For more health tips and updates, please follow us on your social channels. If you found this podcast informative, please do share it on your social media and be sure to check out all the other interesting podcasts in BayCare's library. I'm Joey Wahler, and thanks again for being part of BayCare HealthChat.