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Supporting Youth in Achieving Digital Wellness: Physical Health, pt. 2

Amy Forrer, MD, a Physician at Emerson Family Medicine of Maynard, explains how children's physical health can be affected by the use of technology.
Supporting Youth in Achieving Digital Wellness: Physical Health, pt. 2
Featured Speaker:
Amy Forrer, MD
Dr. Amy Forrer, cares for both adults and children. She is board certified in internal medicine and pediatrics and is pleased to share these tips with the community to help families beat the winter blues. 

Learn more about Amy Forrer, MD
Supporting Youth in Achieving Digital Wellness: Physical Health, pt. 2

Scott Webb (Host):  Emerson Hospital has teamed up with Turning Life On, a local grassroots movement to create a digital wellness program. Digital wellness is using technology with intention to achieve optimal physical, mental and spiritual health, enhance relationships, safety and privacy and increase our ability to learn and be productive. The goals of this partnership are to increase awareness of the many impacts that devices have on youth today and to provide research backed tips that empower families to make healthy choices about digital media use. Through this podcast, our guests will discuss the six pillars of digital wellness and how we can support our youth in balancing their device use to optimize their overall health and development.

This is The Healthworks Here Podcast. I’m Scott Webb. And in part two of our series on digital wellness, I’m joined by Dr. Amy Forrer. She’s a Double Boarded Physician in Internal Medicine and Pediatrics and she’s here to discuss the physical affects of digital device use and screen time by our kids. Dr. Forrer, thanks so much for joining me. In your clinical experience, how is the physical health of our kids affected by the use of all these devices?

Amy Forrer, MD (Guest):  Many aspects of our physical health are affected by devices. We’re really just affected almost head to toe and unfortunately, not in a good way. Our brain’s health is affected, eye health, our posture, our cardiovascular health, the strength of our bones and muscles are all affected by devices. And as a pediatrician, I often see kids struggling with attention, headaches, premature curvature of their upper spine, as well as some more commonly understood concerns such as being overweight or obese. And so generally speaking, the consensus is that our kids are not getting enough physical activity. They are not getting enough free creative play that really offsets that allure of the ever present digital technology.

So, Scott, that’s why talking about digital wellness and educating our community about it is so important. Because we want our kids’ bones to be strong, we want their posture to be appropriate. We want them not to suffer from being overweight and having hypertension. We also want to help decrease their stress and anxiety. And also have a great self-esteem as they move into adulthood.

Host:  I have two kids myself. My 17 year old plays baseball and he had some issues with his back brought on by I don’t know, improper swinging or whatever it was. Anyway, he went to a physical therapist and the physical therapist said to him, you’re only 17, and your spine is curving because you are leaning over, looking at your phone, buried in your phone all the time. And it was pretty alarming because I’m thinking, geez, he’s only 17, but for him, it’s been five years of phone use so far. And so what I want to talk about here is what does the research show as we talk about all the affects, the devices, the affects on kids; what’s the research on this?

Dr. Forrer:  Yeah, that’s a really good point Scott and that’s what we’re seeing. We see both the physical and the emotional aspects of screen time. But today, we’re really going to focus on what those physical aspects are. So, there’s two ways to really look at the research. And the first way, or the first thing I like to talk about is how do we use screens and then how much time should we be using our screens. So, there’s some really good guidelines from the CDC that balance both screen time as well as physical activity. And it’s broken down by age. So, I like to explain to the parents based on their children’s age, what are the guidelines? What should they expect and what should they hold true to?

So, for our babies and toddlers, those are kids under 24 months; really no screen time at all is recommended. Except for when they are video chatting with family members. That’s the one exception. For our preschoolers, these are our three to five year olds, they’re supposed to running around and active all the time. And really only one hour of educational material through a screen is recommended a day and when that child is in front of that screen; they’re supposed to really have a parent or a caregiver who is guiding them through and explaining what the material is that they are looking at.

And then there’s our older children. So, these are children and adolescents ages six to 17. And there’s really no exact screen time guidance on this age group. But what we do tell parents, is that these kids need to get at least 60 minutes a day of moderate to vigorous physical activity along with adequate sleep. And the parents should really guide the amount of screen time that they get so that they reach that balance. And for our older adults, well we’re all supposed to be getting about 150 minutes a week of moderate physical activity.

So, now, what does the research show about our physical aspects of our life and how it’s affected by screens? So, what we know is that about a third of children and adolescents are overweight or obese. And unfortunately, two thirds of these children will continue to experience this into adulthood. That’s a big impact on health. And obesity in children is strongly influenced by environmental factors such as sedentary lifestyle, as well as caloric intake that’s greater than their needs. So, one area of research that is the strongest is that the time in front of a television really influences obesity and weight gain.

And there’s two aspects of the TV that really influences it. It is the time they spend with TV and also research shows us that increased risk if you’re TV is in a child’s bedroom. So, why is this? Well, simply stating time in front of a TV really displaces your physical activity, it slows down our metabolic rate. TV also has this adverse effect on our diet where we consume calories that are not appetite driven but more influenced by commercials and boredom. Another adverse effect of TV is on our sleep. So, when we watch too much TV or too close to bedtime; it really disrupts our sleep, so we have a shortened sleep duration as well as irregular sleep patterns.

One area of research also is the exergames. So, exergames have been developed to kind of replace video games in the sense that they are designed to require physical interaction. So, this physical interaction has been studied and yes, true kids do spend – studies have shown that the kids do use more energy than in sedentary games, but these games are not superior to playing the real sport or that they are trying to recreate.

Another thing to review is the research is the impact of just staring at your computer screen. So, screen light also referred to as blue light, computer screen glare, improper viewing distances, poor posture, can cause a syndrome called computer vision syndrome. And this is constellation of symptoms that are related to prolonged screen time such as eye strain, headaches, blurred vision and dry eyes.

Host:  There’s a lot to unpack there and let’s go through this and I think one of the challenging things during the pandemic and as we enter into the school year, at least for my kids is that they’re attending online school. So, they are up in their rooms right now, staring at their screens. So, when moms and dads say stop looking at your phone, go outside and exercise, do something else; that the screen time isn’t great, well they look at us and say well we were in school all day. So, how do we rectify that? How do we explain that to them that there’s some “good screen time” because it’s school but some of the recreational screen time with their phones when they have breaks between classes or after school that that’s the harmful stuff. So, how can we support parents and kids in achieving our physical health goals for them. As it relates to digital wellness and the use of all these devices, they are on their computers all day, they are on their phones all night, they’re watching television. How do we help parents?

Dr. Forrer:  We can go through some tips to help us to improve our digital health. So, these tips all come back to kind of three things. The use of screens should really be meaningful, educational. So, always focusing on why we’re using the screen is important. It’s also important to focus on the specific time of day. So, really, holding off on the one to hours before bedtime as well as setting limits on use as we talked about it to make sure that kids are incorporating proper physical activity and sleep hygiene and also the location. So, really pulling those devices out of bedrooms, or secluded areas, getting it out in the open so that we can both monitor how much our kids are using the screens and also what they’re viewing.

So, let’s go through some tips that I put together. The first tip is take frequent breaks. So, our kids need to take frequent breaks during the school day when they are virtually learning to get up and get their bodies moving, as well as to protect their eyes. Besides taking breaks, to protect their eyes, we should also make sure that the ergonomics are healthy in the home. So, keeping the screen about an arms’ length, using blue light protective glasses as well as avoiding glares at the screen are all important to keep in mind.

One of the best things that I like to share with families is to help reduce a child’s risk of digital eyestrain is to get them to follow a 20/20/20 rule. So, and I like to tell this to kids themselves. Every 20 minutes, take your eyes off your screen and look at something that’s at least 20 feet away and do that for 20 seconds. And this is the 20/20/20 rule that really gives them a digital eye strain break. Also, during these breaks, we want to emphasize stretching, moving around the home. This is going to help decrease the strain on the back and neck and really help their posture.

A second tip is location. So just like you mentioned, right now for our youngest children who are homeschooling and doing virtual learning; it may make sense to put their computers on desks in their bedroom. But in a few years, when your kids are older, and they’re exploring the internet more and they are finding their own way to be on social media; you’re going to want to pull those devices into a more central location. So setting that expectation that there’s no screens in bedrooms or behind closed doors, setting that expectation early is something really to keep in mind.

The third tip, so we really do need to work hard as parents to keep our kids motivated to be active. It’s important just to keep motivating them to find their interests and things that they love to do that involve physical activity. All of our kids are not athletes but all of them need to stay active to be both physically and emotionally healthy. As a parent, we just want to keep providing plenty of activities for them to do and for our older kids, it’s nice to actually give them the task of scheduling in the required 60 minutes a day of physical activity so that they can also figure out the importance of that and how they’re spending their time.

Another tip is really to help parents to break the cycle of sedentary lifestyle, calorie consumption and weight gain. So, remember screens contribute to a sedentary lifestyle and also influential commercials. So, when our kids are in front of the screens, they are more likely to consume calories that they don’t need and that are not appetite driven. And then this cycle leads to weight gain. So, a lot of times, when I have my families here for well checks, I talk to them about another rule and this is 5/2/1/0+10. 5/2/1/0+10. And this stands for emphasizing the importance of five servings of fruits or vegetables a day, two hours or less of recreational screen time per day, one hour of physical activity per day, zero sweetened or sugary drinks and 10 hours of sleep every night for children. Using this rule helps both the parents and the kids put some of our healthy recommendations into context. It helps them to understand this cycle of being sedentary, consuming calories and weight gain.

Limiting screen time is really an effective anti-obesity tool and when our kids are not in front of a screen, they are more likely to be active and less likely to consume calories that are not appetite driven. And one final tip is for our older kids. So, as we parent our older children, it’s important to help them – if they are using Smart phones to explore Smart phone apps that can help encourage healthy behaviors. So, there are some amazing apps that do emphasize mindfulness, regular exercise as well as exploring healthy dietary choices.

Host:  Those are all great tips and I’m just saying this over and over in my head right now, 5/2/1/0+10. I’m going to text my kids that as soon as I get done with you today. 5/2/1/0+10. I’ve got it. Great tip. And we are both parents and you have three school aged children so what does device use look like in your family? What tips do you have to share as a mom and a pediatrician for keeping device use healthy?

Dr. Forrer:  Sure. It’s a good question. And no one is perfect and I’m definitely one of those nobody’s perfect model. But I think it’s an important question and a really good time to emphasize our own screen hygiene as adults. So, personally, over the past few years, I’ve tracked my own cell phone use and I get a daily average on how much I’m using my Smart phone as well as which apps I’m mostly using. I gained a lot of insight into my own cell phone use and how I turn to it during times of boredom and stress. I’ve come to understand that dopamine hit that you experience when you’re scrolling through sensational news and my goal is really to be better than this and to always have a purpose now when I reach for my phone and to understand how much power that phone holds, how it makes me feel and most importantly, how it just hijacks my time.

So, as a parent, it really wouldn’t be right to expect our children to adapt different habits if we’re not modeling those, we want them to have. I think the screen rules in our house are pretty strict. But that additional effort it takes to parent children during a time of pervasive devices is really beneficial and something that I really focus on. So, in our household, we follow a lot of the commonly recommended rules. Some of those include no screens during family meals, no TV on school nights, we turn off all devices one to two hours before bedtime. And we plan to hold off until at least eight grade to introduce any Smart phone use, possibly even past. Despite having some of these common rules in our own household; I do think there’s somethings that we do that other people can learn from.

And one of the things I’d like to share is that even though my children are different ages and developmental stages; when they watch TV, they mostly watch it together. And as parents, we look for programming that’s educational and nonviolent. We use as a resource to figure out which programs meet our family’s goals to make screen time meaningful. I think making my kids watch TV together also helps foster similar interests as well as tolerance for different interests. We keep all screens out of the bedrooms and in a central location and during the home schooling of the 2020 pandemic, this certainly has brought on a lot of challenges to the rule. But we’ve held true to it and we set up a dedicated area for learning in our home. Our kids refer to it as the kids’ office. The use of earbuds with Zoom has really been pretty important to make this work.

Another family I learned from has dedicated a kitchen drawer for computers and so once that school day is over, they put them away so that they are out of sight, out of mind and less tempting. And so lastly, as far as getting everybody moving, that’s always one of my goals every day is to get people out and get them moving and really incorporating at least 60 minutes of exercise. I’m always looking for new ideas and things to do that involve no devices at all. So, lately, we’ve been exploring public places that allow for long walks and exploring nature and our goal is to keep this up even when the weather gets cooler by getting some proper winter gear to stay outside and be comfortable.

Host:  Yeah, so Doctor, this has been so great today, so many tips and suggestions and of course, we all want to give ourselves a break a little bit. None of us are perfect. We’re all trying to be the best parents we can be and to help our kids and we’re all guilty of using our phones probably too much and we’re just trying to do everything we can to help them, to educate them so that they don’t have short and especially long term physical effects. So, as we wrap things up here today, how would you like to summarize your view of the physical effects of excessive device use by our kids?

Dr. Forrer:  I think that just to summarize and also to end on a really positive note. I like parents to understand that we can always be reminded that the habits your family have now, can be modified towards a more mindful use of screens. And each day, is an opportunity to make an incremental change to keep things more balanced. So, if you think your family is on an unhealthy trajectory, just take it one day at a time and focus on one of the tips we mentioned earlier. Try to avoid battles with your kids regarding screens. And instead really focus on communicating to them how much you want them to be healthy both physically and emotionally for years to come.

Host:  And that’s a great way to end and I keep saying it over and over in my head, 5/2/1/0+10. So great having you on and always really fascinating and helpful to not only speak to other parents but to speak to experts like yourself and as you say, if you think you are on the wrong path, you can make incremental changes. It’s never to late to sort of right the ship so to speak. So, Doctor, thanks so much for your time today. Great having you on and you stay well.

Turning Life On and Emerson Hospital are working together to convene teams of parents, teens, clinicians and mental health professionals to discuss digital media use, challenges and best practices specific to our digital wellness pillars. This work will offer anecdotal evidence to further support our research based suggestions. And if you’re interested in getting involved with this project or learning more please visit And thanks for listening to Emerson’s Healthworks Here Podcast. I’m Scott Webb. And make sure to catch the next episode by subscribing to the Healthworks Here Podcast on Apple Podcasts, Google Podcasts, Spotify or wherever podcasts can be heard.