This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Well, our kids love their devices, there's no doubt about it. But is all that screen time taking a toll on their health? Welcome. I'm Deborah Howell. And today, we'll be talking about the effect that too much screen time can have on children's physical and mental health. Joining us is Dr. Ioana Pal, a clinical psychologist at the Stramski Children's Developmental Center at MemorialCare Miller Children's and Women's Hospital, Long Beach. Welcome, Dr. Pal.

Dr Ioana Pal: Thank you so much for having me, Deborah.

Host: What a pleasure, what a pleasure. So, what is considered screen time?

Dr Ioana Pal: Generally speaking, it is the use of any digital screen, such as a phone, tablet, computer or TV, but there are definitions. One of them, by the American Academy of Pediatrics, actually excludes video chatting for kids who are in contact with, let's say, relatives in a different state. So, kids who are video chatting for very brief periods of time are not considered to be actually using screen time, but generally any kind of device where we're looking at, staring at, is considered screen time.

Host: Okay. Fair enough. How long would you recommend is a safe to excessive amount of screen time? And what's the important distinction between the two?

Dr Ioana Pal: Not an easy question to answer, because there's always if, then, maybe. It doesn't apply to everybody. But there are guidelines in place, like I said, and parents can definitely check out CDC, NIH, World Health Organization websites. I know, still screen time, but they can read more about it.

However, the consensus is that kids under one year old should not have any exposure to screen time. Those a bit older and up to five years of age can have anywhere between 30 minutes to two hours of exposure. It varies very much on many other factors, but babies and toddlers in general need real interactions. They need touch. They need conversations and looking at people's faces. They need to learn from their environment and interactions so that they can actually develop social emotional development skills and just verbal skills in general.

So, a safe amount, I would say, is anything that is spent on educational apps or shows, something that's teaching specific skills, modeling specific skills, anything that's socially appropriate or age appropriate, anything that's teaching kids, let's say, relaxation or problem-solving skills. Some games and apps are actually excellent for improving hand-eye coordination and teaching kids with, let's say, pre-existing social difficulties or shyness, how to begin or end conversations, how to exist in social situations.

You know, there's a lot on virtual reality now where it could be a good thing if it's limited in time. But excessive, it would have to be any amount of time that is beyond that, when it's no longer educational, when it takes time away from other activities and family exchanges, when it interferes with school and sleep. And again, not all screen time is negative, but parents need to be aware what they're allowing in terms of exposure to screens when that screen time exposure starts, because it also starts a pattern and it tells kids what is okay and why we're in front of a screen, right?

So, it's not just contact, and that's why it's not an easy question to answer. Everything is taken into consideration, timing, reasoning behind all of that. A lot of parents hand a kid, a small child a phone because they need to talk to a doctor or they need to pick up something in aisle three, right? So, they sometimes just use it and I don't want to sound judgmental, but they use it as a pacifier, right? Because we need the child to cooperate. We don't have time and it's okay, but it is teaching a child early on that if you get the phone, it's okay, and children learn behaviorally based on what they're rewarded with. So, it is a pattern that we need to be aware of and how much we want to reinforce that pattern of looking, staring, scrolling, we want to call it. So, we're all guilty, I mean, I'm sure you use your phone. I use my phone more than I should. But we just need to be aware and then, can make a decision of what's healthy, what's safe and what may be excessive.

Host: And since you said the word excessive, how can excessive screen time have a physical and mental health impact on a child?

Dr Ioana Pal: So as I said, when we use or encourage screen time like a pacifier or escape, when we're not aware of what we're actually allowing kids to do, when screen time is sort of just passive scrolling, it can lead to a variety of problems. So first of all, we need to think about the sedentary nature of looking at a screen. More kids are sitting or laying while they're playing on the phone, on a tablet, on a console. So, lack of mobility can lead to more caloric intake, more snacking, less exercise. So, there's a lot of data out there that says too much screen time can lead to obesity, cardiovascular problems; back, neck and posture problems. There are even articles out there that say there could be a higher risk of diabetes and blood pressure and cholesterol going high.

So, there's a lot of data out there. You know, not all of it applies to everybody. And there isn't a specific number where X amount of time in front of the screen leads to diabetes. So, I'm not trying to say that, but there is a correlation. There's also a correlation between too much screen time and vision problems in terms of eye strain, especially with young kids who are still developing. Eyesight develops all the way into like 20s. So, we need to be aware of that. Obviously, It leads to sleep difficulties, not just the blue light that disrupts melatonin production and kind of the sleep cycle. But in general, especially with teens, some teens are in bed, scrolling through or catching up with friends, so they're not going to bed on time or they're waking up because they're hearing their phone buzz or something like that, or they're chatting or playing with friends from different continents on different timelines. So, it disrupts sleep in many ways, which can cause a slew of other problems like academic and memory problems. And if we have time, we can go into that. But basically, sleep disruption is big when it comes to screen time.

And then, all these kind of together can lead to more anxiety, depression, mood changes. There's some connection between too much screen time and early on and continuing into adolescence and adulthood, leading to poor impulse control, inability to delay gratification, more disappointment, which in turn, you know, if we take it all the way, it could lead to more suicidal ideation and suicidal thoughts.

So, there's a lot. If we don't monitor, if we don't supervise, if we don't do it in moderation, they can lead to problems, including ADHD. A lot of kids are having difficulties with that impulse control, with time management. And when they're separating from their devices, it can look like impulsivity, it can look like inattention because they just can't wait to get back to their screen, right? So, it may be attention difficulties, but the primary problem is actually the screen, not ADHD in itself. So, good clinicians will be able to distinguish between the two, but it's very hard in the classroom for a teacher, for instance, to say, "Oh, this child is not sleeping well," versus this child is causing behavioral issues in the classroom, right?

Host: Exactly. exactly. So, a myriad of things. So, what steps can parents or caregivers take to reduce their child's exposure to all this excessive screen time?

Dr Ioana Pal: Modeling good boundaries and online behaviors, right? Kids observe us, kids see what we do, even if they're young, and they learn from us. So, we need to be aware of what we're doing and what we're showing as adults. Talking to kids about expectations, what's appropriate, what's permissible, what's healthy, so they can independently make better decisions when they get older. Talking about what they're watching, what they're learning, making observations, and actually having a conversation about the time they spent online. As things are going on, I mean, there's no way anybody can keep up with everything, right, on social media or anything like that. But sometimes watching some things together, discussing why is that happening, why was that comment made, how do you feel about it can definitely, one, bring parents and kids together and really encourage problem-solving. And then, it also informs the parents of the interests their kids, their teens are having, what they're gravitating towards.

And I would say most importantly, aside from all of that, is parents need to work on their own self-care and time management, so that they don't encourage the use of screen time as a way for them to kind of relax and take a load off at the end of the day. So if parents are able to manage their time and feel good about how they're handling everything else, I think it's a little bit easier for them to make decisions in terms of what's healthy and what's not. And you know what? Sometimes parents just have to say, "You know what? Go in your room, you have the phone. I really need to do X, Y, and Z, but come back to me in an hour." Sometimes it's okay to just let it go. It can be on all the time for anybody, but within moderation and just finding a balance and talking about things.

Host: I know a lot of parents set alarms for their kids. And, you know, that's good. And the kid knows, "Okay. Time's up." And they put away the laptop or whatever they're using. And they know it's over.

Dr Ioana Pal: Absolutely. Alarms work. Parental controls work. But like I said in the beginning, it really varies where a child is at emotionally when they're using devices. So, the kids who are more mature and are able to say, "Okay. The alarm went off. That means I put it down and I pick up a book or I go outside and play with the ball for a little bit," or "I go and meet my friend at whatever place for ice cream." So, the most important part about that is parents can do a lot, but if they know their child and if they're noticing difficulties separating from a device, that's when it's problematic. When the child is hiding their behavior in terms of being on the phone in the evening or taking the phone back into their room, that's when it's problematic. But parents can definitely use a lot of tools out there. You know, and if they're really concerned, there are certainly tracking apps out there. They can help them too. But you want to encourage independence, you want to encourage communication so that kids make those decisions for themselves. They're healthy scrolling. They alert parents when there's something going on or they notice any kind of bullying going on even online. So, we want to encourage parents to teach kids to make their own decisions.

Host: Yeah. And so, they want to be part of the change.

Dr Ioana Pal: Absolutely.

Host: And you mentioned some tools parents can use. Can you get into that further?

Dr Ioana Pal: In terms of keeping up with trends, I know it's hard. Everybody's got their own thing to keep up with and answer emails and talk to grandma. But I think if parents can do their own mini scrolling and find out what their child is looking at, if they have access to their children's accounts, that's definitely a tool, especially for younger kids. Educating themselves about current topics and conversations that are going on. Talking to other parents, I think that sometimes it's the best measure, like going to a meeting or going to a neighborhood barbecue and saying, "Hey, what are you doing with your child? How are you and Mike keeping up with what's going on? Have you heard about this girl who Posted this online?" So, just having conversations. Like I said, parental controls to limit content and time based on a child's individual needs and abilities. Being mindful of a child's electronics and their behaviors around electronics, transitions, ability to switch activities, and just time management. Because executive function skills that are time management, frustration tolerance, planning, all those things don't really develop very well until a child is maybe around 15, 17, and then they keep developing. So, we need to support parents to understand development sometimes, or to just remind parents, "Hey, I know you trust your child, but they're 12, so maybe just kind of check in here and there to see that they're really on track or that they're not being led to specific websites by their friends," that sort of thing.

Host: Okay. I've got a final question for you, Dr. Pal. At what point would you recommend that parents seek professional help with their child like they could get at the Stramski Children's Developmental Center?

Dr Ioana Pal: Definitely when sleep is minimal or disruptive, when mood changes or tantrums become more severe or frequent due to that separation from screens, that may be difficult. When academics are impacted, when kids refuse to go to school without having like their phone for five, 10 minutes before leaving the house, when our attention problems increase, any of those changes that parents are noticing or are having difficulties because fights or tension increase when they separate a child from screen time, whatever that screen may be.

Host: Okay. Is there anything else you'd like to add to our conversation?

Dr Ioana Pal: I think parents are doing their best. We are all doing our best. I don't mean to say that we can do without screen time at all, but I think there are definitely ways we can improve overall to find more balance and to get back to having more in-person conversations, especially now after the pandemic; having more games, more barbecues, you know, allowing kids to observe different natural occurrences between families without being stuck on a screen. So, we can all do a little better, but I hope information definitely helps us get there.

Host: Yeah, I agree. Well, this has been so, so interesting. For more subject matter like this, you can visit millerchildrens.org/stramski. We want to thank you so much, Dr. Pal, for your time and expertise today. It's been wonderful having you on the show.

Dr Ioana Pal: Thank you so much. It was a pleasure.

Host: And for more info or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.