Scott Webb (Host): Most of us love our phones and spend more time than we should looking at screens. And this is especially true for our kids. And joining me today to discuss the relationship between screen time and behavioral and emotional issues in our kids and what we can do to help is Dr. Jorie Moberley. She's a PhD and Certified Nurse Practitioner with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Jorie, thanks so much for your time today. We're essentially going to talk about the relationship between screen time and behavioral and emotional issues in our children, and you know, what we can do about it as parents. And I know in today's news we hear more and more about the damaging impact that advanced screen time has on the emotional and behavioral health of children.

Scott Webb: Maybe you can share some evidence and research about this and explain what our children are facing today that we didn't encounter 5, 10, 20 years ago.

Jorie Moberley, RN, PHD, CPNP: Oh, for sure. There's definitely a lot of information out there. Psychiatrists at John Hopkins studied the rate of depression among teens. And then from 2005 to 2014, adolescents suffering from depression increased by 37%. And if you notice, that span of time correlates with the early days of Facebook and iPhone. Being in front of a screen results in less face-to-face time and meaningful conversation, which are two things that are essential to emotional health.

Anxiety is also on the rise. There's a psychologist by the name of Jean Twinge who studied survey results of 77,000 high school and college students, and she found that anxiety and depression was six times more common today than it was in 1938. Her research also showed that the more time teen girls spend on social media and smartphones, the more likely they are to be depressed and exhibit suicidal ideation.

In another study in the Journal Cyber Psychology Behavior and Social Networking, they looked at middle and high school students. And middle and high school students that spend more than two hours on social media per day are also more likely to report poor mental health and psychological distress.

The past decade has also seen a big jump in both loneliness and the lack of sleep. Kids are trading face-to-face interactions with their peers for screen time, which contributes to social isolation. Children who game or stream videos way past their bedtime, are not only losing sleep, but are also setting themselves up for emotional, mental, and spiritual problems.

16% of American children aged six to 17 experienced a mental health disorder in 2016. In the United States, suicide is the second leading cause of death among people aged 10 to 34, and according to the CDC, deaths by suicide among 10 to 24 year olds increased by 56% from 2007 to 2017. In children aged 10 to 14, the suicide rate almost tripled to about 500 suicide deaths in 2017.

Strong relationships and social support are important protective factors against suicides, but many kids lack this type of emotional support.

Host: Yeah, they definitely do. And I know I've observed with my 15 year old daughter that even sometimes when she is with a group of friends, they're all on their phones, right? So they're, they're physically near each other, and yet they're all still, you know, glued to their phones and playing on their phones and responding to other people who aren't with the group.

So,

Jorie Moberley, RN, PHD, CPNP: Exactly. They're geographically present, but not, you know, present socially.

Host: Right. Socially, emotionally, mentally, and I know we've all experienced this, right? We've been in waiting rooms, restaurants, churches, we see toddlers and infants having phones and iPads and things. Maybe you can remind parents and caregivers about some of the other options.

Jorie Moberley, RN, PHD, CPNP: Yeah. Gosh, I can't tell you how much it bothers me when I walk into an exam room and I see a child with an electronic device in their hands, and I realize it's the parents' attempt to keep their child entertained while they wait for me. But there are so many better options. You know, I love it when I walk in and I see the child using the table paper to draw pictures or practice writing their letters.

 You can spend that time, you know, reciting the alphabet with your child or teaching them how to count to a hundred. You can teach your child to learn their address and phone number. I love it when I see parents bringing books in. I think that reading to children has become a lost art. You know, reading is an excellent way to bond with your child. It also fosters language development and hopefully the child's own love of reading. According to American Academy of Pediatrics, play is essential to the cognitive development of children. But playtime isn't sitting idly in front of a screen. It's you know it's running around outside, riding a bike, playing at the playground, engaging in imaginative play.

If you have an older child, like a teenager and you're in the doctor's office waiting to be seen, you try and engage them in conversation. Ask them if there's anything they would like me to address during the visit. Ask them how school is going or how their friends are. Ask them about things that are of interest to them.

You don't want to bombard them with interrogations or criticisms, but try to engage them in reciprocal conversation. You know, teenagers are much more likely to participate in a conversation if they feel like they're being respected and heard. To play off of that, I think mealtime is also important.

 I know it's got nothing to do with, you know, sitting in a waiting room, but what you do during mealtime is important. You know, does your family eat in front of the TV or do you allow cell phones at the table? Do your kids gobble their meals so that they can get back to their electronic devices? Meal time is a great opportunity to spend time together. You know, you shouldn't allow screen time to interfere with meal time. Meal time should not only be a time to eat, but a time to talk and re-engage with one another. And research shows that eating meals as family, you know, benefits children greatly. Children whose families routinely eat meals together, they spend more time together on homework, they read for pleasure. They're also more likely to eat nutritious foods and are less likely to engage in future substance abuse issues or suicidal tendencies or sexual intercourse. So it should really be the goal of every family to make mealtime a priority and to try and eat as many meals together as possible.

You know, social contact is a core human need and interacting with screens more than people can foster an unhealthy pattern of isolation for sure.

Host: Yeah, I so agree about mealtime and I think sometimes too that parents forget that the kids are watching us. I want to talk about social media; social media, bullying, school aged children. You talked about suicidal ideation and some of the factors that can lead to that and bullying, it's certainly, you know, on that list. So what do parents need to know?

Jorie Moberley, RN, PHD, CPNP: So social media has definitely changed the complexion of bullying in a very negative way. Cyberbullying, by definition, is using digital media to intentionally communicate false, hostile or embarrassing information about another person. Before the advent of social media, bullying was confined to the playground or to the hallways of the school, but social media has changed all of that.

Now bullies have access to their victims 24 hours a day, seven days a week. Bullies are also no longer limited by geography. Bullies can access your child from pretty much anywhere in the world. Cyberbullying is the most common online risk for tweens and teens, and it can happen to anyone with online access, which ultimately can lead to depression, anxiety, isolation. According to one national survey of fourth to eighth graders, 42% have been bullied while online and one in four had it happen more than once, 35% have been threatened online and nearly one in five had it happen more than once.

21% have received mean or threatening email or other messages. 53% admit to having said something mean or hurtful to another person online. And finally, 58% have not told their parents or an adult about something hurtful that happened online. Certainly it's not unusual for kids to say mean things or make fun of each other, but technology and social media can significantly magnify the problem. And unfortunately, the screen allows anonymity that can protect the bully from suffering any consequences for the behavior. So it's a parent's job to foster and protect the emotional wellbeing of their children, and part of that includes being aware of some of the warning sides of cyberbullying. And some of the signs that I would encourage parents to be mindful of are noticeable increases or decreases in their device use. If they're exhibiting emotional responses to what they're seeing on their device, and this can include both like laughter as well as anger. If your child is hiding their device when you're around, or if they're avoiding discussion about what they're doing on their device, that should be a red flag.

If they shut down social media accounts or if new ones appear, that could also be a symptom of cyberbullying. Avoiding social situations that they used to enjoy. That can be a sign. And then also becoming withdrawn or depressed or losing interest in people, and activities that they used to enjoy is another potential sign of cyberbullying.

If your child has their own electronic device or has access to social media, I would encourage you to establish a few guidelines about bullying behavior, and one should be to tell them to tell you to report any incidents of bullying that they might experience. You should also tell your child to block bullies and never respond to their comments.

You also want to talk to your teenager about not attacking other people online, you know? Are they the bully? And then you also want to teach your child to never post anything that they wouldn't be comfortable sharing with you.

Host: Yeah, it, it's all great advice and it really does seem Jorie, like we just, you know, can't avoid screen time. The parents are working, going to school. Sometimes, you know, grandparents watching or even maybe raising grandchildren. It just becomes this sort of habit to put kids in front of a screen. What advice do you have for families about how to break these habits?

Jorie Moberley, RN, PHD, CPNP: It, it can certainly be very tempting to use the TV or an iPad as an electronic babysitter, but what's easy is not necessarily, what's best for your child. The time you invest with your child will determine what type of an adult they will become. And there's no better substitute than good old fashioned hands-on parenting.

So reading books, playing games, riding bikes, taking an active interest in the thing your child is interested in is really, really important. You can even include them in your daily chores by asking them to help you prepare a meal or set the table or fold laundry. It may not be particularly fun for them, but it's time you can spend with your child and time when you can engage them in conversation. I think, and you had mentioned it before as well, Scott, one of the most important things parents need to do is take an honest look at their own use of electronic time and how much time they spend in front of a screen. You know, parents who constantly check their phone or have their nose buried in a screen are modeling the same behavior for their children and can contribute to the child's overuse of electronics.

You can help your children control their electronic use by controlling your own. You know, you want to ask yourself the following questions regarding your child's electronic use to get a feel if your child is overusing electronics and how it's affecting their health. So things you want to ask yourself is, does your child get upset when you ask him to stop his screen activity?

Does your child keep asking you to buy a digital device like an iPad after you've already said no? Does your child have trouble finishing his homework because they're busy watching TV or playing a video game? Does your child refuse to help with chores around the house because they're busy playing an electronic device? Does your child keep asking you to play a video game or another screen activity after you've told them no? Does your child have good eye contact? Would your child rather play a video game than go outside and play with friends? You know, does your child enjoy anything that doesn't involve screens? And finally, you know, if you restricted all screen use for a full day, would your child be whiny and irritable? If you answer yes to any of those questions, then your child's probably being negatively affected by the amount of screen time that they have.

Host: Yeah, they probably are. And we could do an entirely separate podcast probably on parents and you know, how much we love our devices and how it just sort of rings hollow to children when we tell them they spend too much time staring at screens when they see us doing the same thing. But, maybe we'll have you back on and we'll do a separate one about

Jorie Moberley, RN, PHD, CPNP: That could take a long time.

Host: Yeah. Just for parents. So, you know, speaking of parents, and as we wrap up here, Jorie, and this has been really informational, educational, helpful today. What can parents do immediately regarding screen time?

Jorie Moberley, RN, PHD, CPNP: So it kind of comes right back to unplugging. By that I'm not just referring to your child, but also to yourself. You know, we as parents have to decide to put our children before our devices. We have to give our kids more attention than we give to our electronic devices.

So you begin with an honest assessment of how you use screen time. You know, parents who constantly check and use electronics in front of their children are contributing to their children's overuse of the screen. Parents should be the most powerful role model in their child's life, and that means that your child will likely behave the way that you do.

You know, the good news is, that it's a lot easier to control your own behavior than it is to try and control someone else's. You know, children are constantly watching, learning and copying our behavior, and that includes our reliance on electronics. You don't have to immediately reply to every text or email or voicemail message that you get.

You know, if you take a call or answer a text while you're talking to your child, you're modeling bad behavior for them. You're sending the message that the electronic device takes precedence over them. So stepping away from your electronic device for the sake of your family is a really healthy idea.

Your child may not be angry because of the amount of time they're spending with the screen, but the amount of time that you're spending with the screen. Many children are frustrated and sad and angry that they have to compete with screens for their parents' attention. You know, and unfortunately, the presence of screens in the home is so widely accepted nowadays that many parents don't consider them a threat to strong family relationships.

So, you should have digital rules for your kids, but you should follow them yourself as well. You know, if your child is using an electronic device, when a person begins talking to them, teach your child to put the device down. Look the person in the eye and smile. People should be first, electronics should be second.

 You want your child to have the necessary skills to succeed in relationships. And like I said, you know, relational skills are not learned on a phone or a tablet. There is no app or game that will teach those social skills. Social skills have to be practiced in real life. Let's be a realistic, electronics are here to stay. So parents have to find practical ways to manage their use. And I think some good tips are if your child does have an, a phone or a tablet, set strict rules from the get-go and regularly check to make sure that those rules are being followed.

One good rule of thumb is to keep all electronics out of your child's room, and that includes TVs. Really, you should not have a TV in the bedroom. You don't know what goes on behind closed doors. And so you should have transparency. Computers should be used in an open location in the house where anyone can see what content is being accessed.

You know, if your child wouldn't look at it when you're with them, then they shouldn't be looking at it at all. You know, in addition to keeping tabs on where electronics are located, you should also keep tabs on what your child can access on the internet. Internet safety software can protect your family from hurtful content by blocking questionable websites, videos, music, instant messages, all that sort of thing.

Another good rule of thumb is to collect all electronics at the same time every night. So if your child knows that their electronics will be collected at the same time every night, they'll learn to delegate their time appropriately in order to get homework done, make time for recreational use, et cetera.

And I talked about not having electronics during mealtime, but I also think it's a good idea to prohibit electronic use in the car. You know, like mealtimes, car rides provide a good opportunity for connecting with your child. Use the time in the car to talk to your child and connect with them on an emotional level.

And I also think that if your child does have free time, schedule their free time with a lot electronic-free activities like sports, dance, Four-H, et cetera. You know, if your child doesn't participate in the sport, then at least set aside time each day for them to play outside. Or at least have time for them to read maybe before bedtime when they get their electronics turned in.

Maybe they sit with a book for half an hour and read. I think all of those things are good strategies. I will say that all the information that I, you know, presented here today, I actually got from two books that I think should be required reading for any parent. One is called Growing Up Social and the other is called Screen Kids and they were both written by Gary Chapman and Arlene Pellicane. I think these books are invaluable resources for parents regarding the impact of the electronic world on children. I, for one, am a huge fan of these books and I often recommend them to the parents of my patients because they really do open your eyes to just how damaging electronic use is on the health and wellbeing of children for sure.

Host: Yeah, definitely. Well, that's perfect. Like I said, this has been really educational today and it's just finding that balance and I think that we're all fighting the good fight, you especially, and trying to find that balance. So, thanks so much for your time today. You stay well.

Jorie Moberley, RN, PHD, CPNP: Absolutely. Thank you.

Host: And learn more about children in screen time at franciscanhealth.org and search pediatric medicine.

 And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.