Transcription:
Managing Your Child's Screen Time

Melanie Cole (Host):  There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And we're talking today about managing our child's screen time and their eyes. Joining me is Dr. Christopher Starr. He's the Director of Refractive Surgery and Associate Professor of Ophthalmology at Weill Cornell Medicine. Dr. Starr, I'm so glad to have you join us. And for every parent listening, this is going to be an amazing episode. I can tell. So, our kids, in the time of COVID now they're doing Zoom class, they're doing tele everything. And I must admit Dr. Starr, as we get into this podcast, I have seen my children literally on their phone, on their iPads, watching Tik Tok or something and doing their Zoom class at the same time. What are our kids doing to their eyes while they are staring at sometimes as many as three different screens at once?

Dr. Christopher Starr (Guest): Yeah, I agree with you. I've got an 11 and a 13 year old who are also doing a lot of virtual school and spending a whole lot of time doing other things on their digital devices during school and outside of school, Tik Tok, certainly being one, YouTube and all the other apps that they're on. So, yes, it is extraordinary how much screen time is going on in kids these days.

And for so many reasons, there are many, many issues around that social, health related issues and it's a quite complex topic. And I think we're all in agreement, all parents are in agreement that they'd like to see their kids on devices less throughout the day. But I will say this, that virtual school is better than no school. And virtual school can be reasonably effective, certainly nothing will ever take the place of kids going into school and being in person in classrooms and the social interaction and all the benefits of all of that. And certainly getting out of the house and getting away from digital devices can certainly help with eye health as well.

But I do think that this virtual school is still better than them not being in school at all and not learning anything. So, there are some pluses to current situation we're in. But computers staring at digital devices all day long impacts kids in a lot of the same ways that it impacts adults. And the immediate issues to the eyes are things like eye strain, which even kids who have very strong eye muscles that can you know, we've all as adults, and as parents, we've all had our kids show us something on their phones and they it an inch in front of our eyes and expect us to be able to see it because they can see it that close up.

And of course we have to move it far away from our eyes so that we can actually see things in focus as we get older. And even though the kids have that robust ability to focus it on little tiny objects and right in front of their eyes, they are still susceptible to eye strain and eye fatigue as the day goes on, when they stare at these devices in front of their face.

And so they will also complain occasionally of headaches as the day goes on after the ninth or 10th hour of looking at these digital devices all day. You see them scrunching their eyebrows and maybe squinting a little bit and rubbing their foreheads. And that's all this sort of fatigue, and eyestrain, and eye fatigue that is a very common when we stare at these devices all day and don't take breaks. Similarly, kids can have the dry eye and irritated red burny, stingy, teary eyes that one gets when you stare at a computer and you don't blink as much. Kids don't blink either when they're staring at computers.

And so we know that the blink rate could decrease by up to 50% when we're staring at devices. And that leads to these eye dryness and irritation as the day goes on and kids experience that just like adults do. So, we'd still recommend the same 20, 20, 20, 20 rule for adults, we recommend the same thing in kids take the breaks every 20 minutes. Look away into the distance. Let the eye muscles relax for 20 seconds or more. And look into the distance, out a window, or down the hallway at an object that's 20 feet away or further, and use that fourth 20 to kind of close the eyes or blink rapidly or put in lubricating drops to re-lubricate the surface of the eye, just as important for kids as it is for adults. But one of the things that is kind of unique to kids and the maturing eye that school-aged children are going through, and that is, and this is astonishing, really, when you look at the data, lots of studies have been published.

We know that the rates of childhood myopia, near-sightedness are increasing dramatically and they have been for years, even before COVID. But in the post COVID era with lockdowns and quarantine and people being indoors, especially kids with virtual education, we are seeing a dramatic threefold rise in prevalence of near-sightedness in school-aged children.

And the reason why that's significant, it's not just, you know, oh, you can put on eyeglasses to correct it. With a progressive myopia, near-sightedness when the eye elongates especially to very advanced degrees, high myopia or pathologic myopia, that increases the risk of retinal tears, retinal detachments, glaucoma, cataracts at younger ages, myopic, what we call myopic degeneration, which is essentially macular degeneration, but in younger people.

So, pathologic myopia is a real scary thing. And it is on the rise in large part due to kids spending all their time indoors on computers and digital devices. And while there are genetic predispositions, and while there is a component of just kind of staring at near targets and computers throughout the day, one of the strongest correlates with this increasing prevalence is actually believe it or not, the lack of natural light, getting outdoors into the sun, into the natural outdoor light. And the theory is that light turns on dopamine, dopamine in the eye can actually prevent the eye from elongating. And if you're not getting that exposure to natural light, you don't get enough dopamine in the eye.

And the eye continues to grow through that sort of critical period as kids are developing and their eye can get longer and longer and more near-sighted without that dopamine, without that exposure to sunlight. And that is what's leading to these increased rates of near-sightedness. So, the recommendation for us, in addition to that 20, 20, 20, 20 rule is throw in another 20 and go on outside if you can.

If you have the time during the day, take your breaks, do that outside. Go outside, get in the backyard. If you live in the city, like I do, on a balcony or on the sidewalk, but get outside, make the effort to get outside and stretch, move around and get some natural sunlight to hopefully prevent this increased rate of myopia that we're seeing so commonly.

Host: That is so interesting. And while you and I would like to get outside and get some of that sunlight, the kids almost look at that as a punishment. Back in the day, it was like, you can't go outside. That was your punishment. But now they're like, oh, please make me stay in my room. Please let me stay in my room. Right? It's a whole different time. So, all of this great advice and you're a parent as well. How do we get our kids to do that? Maybe they are complaining of headaches. Maybe they say, oh, I need to nap now. My eyes are so tired. And also you and I have done a podcast for adults on Back to Health. Listeners, you can check out that one where we discussed the blue light glasses. And is that something we do with kids as well? When they're looking at different screens of different sizes? How do something like that even help them. So, can you just kind of give us a few red flags for parents? A little great advice on shoving our kids out of their bedroom for a few minutes and then whether or not we should look to things like glasses for them.

Dr. Starr: Well, certainly, if the kids are nearsighted and are having difficulty seeing, well, certainly they should be evaluated by an optometrist or ophthalmologist and have their vision checked and be fit for glasses if they need it. If they're at the age of 10 or older, usually contact lenses are reasonable at those ages and then 21 or older, laser vision correction, if they want to get free of glasses and contact lenses. Interestingly, if you think about the way kids learn, education is very visual, right? Everything that we learn, whether you're in a classroom or on a computer, there's a visual aspect to it.

And it is astonishing sometimes that certain kids who might seem like they're behind in school, or having difficulty learning, or maybe even labeled as having a learning disability or dyslexia or ADHD, things like that, sometimes that can just be simply that they need glasses, that they're not seeing, things are blurry for them.

And sometimes kids don't have the vocabulary to bring that to the attention of their parents. They may not say gee, everything's blurry. That's their baseline. And that's all they know. They might not know what clear vision is. So, it is important, especially in those parents who might be sort of scratching their heads as to why their kids are having difficulty in school. Well, you know, think about having their eyes checked because it could be as simple as putting on a pair of glasses. You asked about blue light. Blue light is very stimulating. And so certainly if kids are having trouble sleeping at night after all these hours on the computer. Well, we should be decreasing their exposure to blue light. That can be done with light glasses. IT can be also done in most computers by just flicking a switch and decreasing the blue pixel intensity. And in some cases it's just turning the blue pixels off. Usually the screen has a yellow tint when that happens just as it would happen if you put on a pair of yellow glasses. It blocks the blue light. With my kids, I have their night shift mode on their Apple devices set for 8:00 PM and everything goes yellow at that time to help them get ready for sleep and to feel relaxed and less stimulated.

We do need to, as parents, enforce limits on the devices. Now, of course, with school that's unavoidable. They have to be on for those eight hours of school a day or whatever it may be. But we really, should try our best to get them outdoors during their lunch break. And their PE breaks or whatever it breaks they have throughout the day to try to get them outside, if the weather appropriate to get them outdoors and to put those devices down. One of the things that I find as a parent, that my kids hate but do it I have a screen time limits that I can control. So again, I'm a big Apple person.

So, all I really know is the Apple ecosystem, but with the iCloud screen time function that I control, I have access to both of my kids' devices and I have limits on Tik Tok and YouTube and just screen time in general. I can track their screen time. It gives me exact numbers of daily screen time, hours, and weekly time hours.

I can see if it's up or down depending on the week. But most importantly, at 10:00 PM, everything shuts down. Downtime goes on all of their devices turn off. They can't use them unless they ask me for permission. And then I can allow 15 minutes here, or 30 minutes here, depending on the day of the week and what's going on. If they're on vacation, I'll give them a little bit more. But that's I find the best way to control screen time without that, it's the wild, wild West. They'd be on these things, probably 20 hours a day if they were allowed to do that. So, I find that, that's pretty easy. I'm sure other, non-Mac, non-Apple, ecosystems have similar controls for parents. And I would encourage all parents to investigate that and start using those.

Host: What great advice and something that I think not only for parents, but we can all really use this information because our eyes I mean, they're so important right now. They're how we're doing our work. And certainly how our kids are learning and doing their schoolwork in so many ways. So, Dr. Starr wrap it up for us. The best advice you would like parents and their teens who we're going to all make listen to these podcasts with you. What do you want us to know about the many screens, the different sizes, the different you know, distances, everything that our kids are doing right now with their eyes, with these screens and how we can help protect them while they're doing everything virtually.

Dr. Starr: Yeah, I think most importantly, take the breaks, take the breaks, put the computer down, force it, get outside. Ideally get some exercise, walk around, get some natural sunlight, especially if it's a kid before the age of say 12, a young kid, the sunlight is important. We want to prevent near-sightedness. If the kid is having trouble in school, if a kid is squinting a lot at home, if you're finding that they're having difficulty reading with fluidity, you taking breaks, losing their place on the page, just in general, having trouble with school and with education and learning, have their eyes checked, have the eyes checked.

There's a good chance that they don't have a learning disability. They might just be nearsighted or farsighted or have some astigmatism. That's easily corrected with glasses. And the only way to really figure that out is in some screening programs at schools, they'll check vision. But that's pretty rough. If the kid is having trouble, they really should see an eye doctor, pediatric ophthalmologist, pediatric optometrist and have a thorough eye exam where the prescription can be checked. And if glasses are needed, a prescription can be given and they can get their glasses.

And that is remarkably huge for kids who might be feeling just down and out because their vision is not clear and they're falling behind in everything, social interactions, school, schoolwork, and grades. Often, something as simple as just blurry vision that's easily corrected. And I think those are probably the biggest tips for the kids. And, of course, limiting screen time, you know, with any way you can, if your kids listen to you as a parent, great. I wish I could say the same, but I do it by just forcing limitations on their devices via the central app that I control and I can limit their screen time on a day-to-day basis.

Host: That's awesome. Being a parent really isn't a democracy, is it? I mean, we do have to put those limits and it's a fine line now. Those limits between the screen time that's Tik Tok, and Instagram and Snapchat and everything else. And the screen time that is Zoom class and Televisits or whatever they're doing.

So, thank you, Dr. Starr for such great information. Parents, let your teens hear this show because I think they need to hear from an ophthalmologist about what they're doing so they can protect their eyes and get outside for a few minutes every day. Thank you so much for joining us and Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. Thank you so much to our listeners. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download subscribe, rate, and review Kids Health Cast on Apple podcast, Spotify and Google podcast. For more health tips, go to weillcornell.org search podcasts. And don't forget to check out Back to Health. I'm Melanie Cole.