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Dave’s Story: “He has a meltdown when we tell him screen time is over.”

Normally, Dave is a calm yet active child who enjoys getting outside and playing with his friends. Since the pandemic however, there has been less time with friends, and lately, he has been using more screen time. Unfortunately, when his time is up, he is now having meltdowns and refuses to give up the screens.

Parents are at a loss -- What should parents do?

Introduction

Prior to the COVID pandemic lockdown in spring 2020:

• Many parents had concerns that some kids were spending too much time in front of a screen;
• According to one survey, most parents (77%) said they enforced household rules about screen time and the use of technology as of February 2020.

Prior to COVID, guidelines on scream time recommended:

• For children aged < 1 → No time on digital devices.
• For children aged <5 → 1-hr or less per day on digital devices
• Children age 6-18 → Max 1-2 hrs/ day on recreational screens

Pre-COVID Screen Time Guidelines

Adapted from ¹Canadian Sedentary Behaviour Guidelines (2011); ²Canadian Pediatric Society (2017) ; ³Canadian Association of Optometrists; ⁴Xiong, 2017

Since the COVID pandemic lockdown however:

• Many parents have been under immense stress as they struggle to manage their households, provide income for the family, while parenting and homeschooling at the same time.
• According to the same survey, most parents (76%) reported they suspended those rules, thus allowing their kids more screen time; and more use of types of media such as social media or online entertainment.

Screens: The Good, The Bad, The Ugly

The good about screens

• Since the pandemic lock down, we have lost many routines, activities and things that we had previously. Loss of extra-curricular activities. Loss of face-to-face time with others. And so on. Screens help to fill that gap. 
• Screens can provide entertainment, distraction and an escape from real life, particularly when options have been more limited under COVID.
  
• Screens can provide a means for people for social connection (e.g. real-time video chat), especially given that under COVID, in-person interactions have been limited.

The bad and the ugly about screens

• Pandemic or not, however, our children’s brains still have certain needs for optimal mental wellness which include: 
  • Face-to-face time with other human beings;
  • Nature time, ideally at least 1.5 hrs/daily outside, in order to prevent myopia;
  • Physical activity, which tends to happen naturally when people are outside;
  • It has been harder for many families to meet these needs during COVID.
• Screens are designed to be addictive by giving our primitive hunter-gatherer brains a dose of pleasure chemicals, and the more we get used to the easy dopamine/adrenaline of screens, the harder it can be for to return to doing non-electronic activities, as they do not provide that easy fix of dopamine/adrenaline.

• Excessive screen time is linked with problems, for example:
  • > 2 hrs / day of recreational screen time causes more problems with cognitive development (Walsh et al., 2018). A Montreal study (2019) showed that children and adults do best with mental health and overall health when they use less than 2-hrs/day of recreational screen time. 
  • > 30-minutes of social media use is associated with more depressive symptoms (Hunt et al., 2018).
• Excessive screen time is linked to less nature time
  • Studies show however, that children/youth need at least 10-hrs /week outside in nature, in order to have optimal development of their eyes, in order to prevent myopia.
• While some children / youth will be able to self-regulate their use, others will require more active intervention from parents.
• Without active intervention, some children and youth are vulnerable to screen addiction, which is defined as excessive use to the point where it crowds out healthier activities (such as sleep) and/or causes problems with home, school (or work). Issues which can make a child/youth more vulnerable include having conditions such as:
  • Attention-deficit hyperactivity disorder (ADHD),
  • Autism spectrum disorder (ASD),
  • Anxiety disorders, or other issues which make it harder to connect to real world activities.

• The online world can be dangerous for children (and adults), as it can expose children to predators, scams, phishing and fraud.

Pandemic Screen Time: Recommendations for Families

Accept There Has been More Screen Time for Most Families

• Instead of feeling guilty about increased screen time, accept that there has been more screen time for most families.

Focus on Mental Wellness (i.e. connection to people and activities that give belonging, purpose, hope and meaning)

• Do remember that mental wellness is not simply about cutting screen time, but about ensuring that your kids are connected to positive people and activities that give a sense of connection, purpose, hope and meaning.
• Don’t overly focus on hours of screen time or cutting screen time -- cutting screen time alone will not make a difference unless your kids are also connected to that which they need for mental wellness.
• Consider allowing screen time if it permits connection to people or activity that might not otherwise be possible under COVID, such as
  • E.g. Face Time with grandparents (when face to face time is not possible)
  • E.g..educational app for learning piano (when a human teacher is not available, either due to cost or other factors).
  • If so, then consider allowing the tech.

Do Teach Your Kids How To Self-Regulate (i.e. Meet Their Needs) Without Electronics

• Do teach your kids how to self-regulate (e.g. cope with boredom, pain, frustration) without electronics, which may include teaching them explicitly or by role modelling. Otherwise, they may naturally start using technology to meet all their self-regulation needs, whether they are bored, upset or overwhelmed.
• Example
  • Teach them what to do when bored, e.g. read a book, build something, call a friend; write a letter to a friend; playing a board game; going outside.
  • Teach them what to do when upset, e.g. distraction, talk to someone about your feelings
  • Teach them what to do when overwhelmed, e.g. taking a time out, going somewhere to chill out
• Don’t simply assume that your kids will be able to learn how to deal with boredom, frustration, pain, etc. on their own.

Do Train Their Brains to Tolerate Boredom or “Slow dopamine/adrenaline”

• Do ensure that your children have ample opportunities in their schedule when they are exposed to electronics (and thus having “easy dopamine/adrenaline”).
• Activities that give them “slow dopamine/adrenaline” such as
  • Chores / responsibilities, e.g. helping out with family meals, laundry, garbage, sorting recycling, gardening, etc.
  • Mindfulness

Do teach them digital citizenship and safety and how to stay safe online

• What are healthy ways to use your cell phone, tablet, computer?
• What are unhealthy, acceptable ways to behave online?

Pandemic Screen Time: Recommendations for Families using the 4 M’s

M)anage Use, i.e. Parents Should Set Limits

Do Continue Having Limits on Technology

• Ensure the kids understand that recreational screen time is a privilege that must be earned, with limits and restrictions.
  • Give them a ‘media contract’ which can help emphasize this point -- many examples exist online.
• Install parental controls on your children’s devices, which allows parents to:

• Restrict them from seeing the App store (and wanting to play all the games)
• Set a screen curfew and downtime which is the time when the screens turn off, and stay off until the next day.
  • For most people, a screen curfew should be at least 1-2 hrs before bedtime.
  • For example, if you want your school-aged child asleep by 9 PM, probably screens should be off by 7-8 PM, depending on the child.
• Set specific times for apps, e.g. recreational apps only in the evening; educational apps for anytime.
• It is much easier to have settings you can control on your device, as opposed to having to physically take the device away.
• With younger children, it can be easier to enforce a “screens must be given back to parents by 8 PM”, but with teens, this can be harder.

Discourage Apps and Websites that Have Been Shown to Be Harmful to Mental Health

• Discourage your kids from using apps that have been shown the worst for your mental health such as Instagram, Facebook and Youtube (#StatusOfMind report, 2017).

• If they absolutely must use these, they try to encourage healthier ways to use such as:
  • Setting limits such as using specified times rather than checking all day,
  • Setting a limit of no more than 30-minutes a day. (Parents can use parental controls to allow usage of apps at certain times).
  • Giving exceptions to using for educational purposes (e.g. watching educational video on Youtube)

Do Set Limits with Endless Streaming Videos

• Streaming video services tend to be quite addictive, as they are designed to be addictive. Unlike a generation ago, where there was one new TV episode a week, and it had a start and stop time, today’s videos are designed to encourage binging, watching video after video.
• Do’s
  • Build in limits such as:
    • Watch specific shows or videos that have a start and end time (e.g. on CBC or other streaming service) (vs. simply surfing Youtube endlessly)
    • Go physically to the local DVD store (if you are lucky enough to still have one!) and getting a video;
    • DVD by mail services such as Netflix. Yes, Netflix still offers DVDs through mail.
  • Limit Youtube for younger kids. Consider doing this with parental controls. You can set it so that they cannot simply surf the internet freely, and thus can allow visiting only permitted websites. Or you can block certain websites.

• Don’ts
  • With younger kids, don’t simply let them surf video websites such as Youtube. Websites are designed to purposely addict people to watching their videos through sophisticated algorithms.
• Looking for family friendly content?

• Organizations such as MediaSmarts and Common Sense Media have rated various TV shows and movies and content for family friendliness.

M)ake it Meaningful

I.e. Use Tech for Good, Encourage Positive Uses

Use Technology to Connect to People

• Do allow technology if it genuinely seems to foster healthy human connection.
• When face-to-face in person connection is not possible, encourage

• Real-time video chat (e.g. Facetime/ Skype, Google hangout, Zoom, etc.),
• Telephone calls (which convey tone of voice)

• Discourage texting, chat, email as they lack facial contact, and lack non-verbal cues such as tone of voice, unless there is no alternative (i.e. relatives are in a different time zone).
• Don’t automatically assume that all newer ‘social’ technologies are actually helpful. Studies show many types of “social media” can easily be “antisocial” media and harmful for social connections.

Use Technology to Help Them Get Outside or Move

• Are you struggling to get them to play outside?

• Consider augmented reality apps (e.g. Pokemon Go) to get them to go outside, or experience the real world.

• Are you struggling to get them to move?
  • The WHO has recommended online exercise classes such as yoga or aerobics; active video games (examples such as Wii, Dance Dance Revolution).

Use Technology to Learn by Encouraging Educational Content

• Encourage educational content such as
  • Educational websites
    • Consult your school’s website or school board for recommended content appropriate for your child’s grade level.
    • Common Sense Media has a curated list of more educational content
      • https://www.commonsensemedia.org/blog/free-online-events-activities-kids-at-home-coronavirus
  • Online classes;
  • Audio books online.
  • Educational apps
    • Install educational apps such as
      • Music learning apps, e.g. Simply Piano, Yousician
      • DuoLingo for languages
      • Khan Academy
      • Code Academy
• With parental controls, you can set which websites or apps are permitted and not permitted.
• Don’t assume that left to their own devices, your kids will find educational content. They will need your active intervention. The challenge with letting them find it on their own, is that the educational content is unfortunately drowned out by advertisements and search results for recreational content. The technology is designed to seduce them to entertainment apps and websites.

Do Use Technology to Create Content

• Instead of simply consuming content and looking at what others have created, encourage creation of content such as
  • Doing their own photography: Encourage them to actually learn about how to take good photographs, and make their own.
  • Writing their own content
  • Making their own music
  • Making their own videos

Encourage Apps that Might Be Helpful for Mental Health

• Top MH Apps for Kids https://www.educationalappstore.com/best-apps/5-best-mental-health-and-wellbeing-apps-for-kids

Encourage Audio as Opposed to Films

• Do you have pre-schoolers?
  • Consider read-aloud videos rather than videos. When a real live human reader is unavailable, consider a read aloud video.
  • For younger children such as 4-yo olds, one study confirmed that a read aloud video (with reading plus pictures) was optimal for their brains.
  • Other options studied included:
    • Cartoons: Overstimulation, in that they overloaded the child’s audio and visual brain networks.
    • Audio-only story: Gave too few clues to the brain’s developing ability to decode sentences.
    • Automated read-aloud with pictures was “just right”: Fostered the most connectivity across brain regions — a decent substitute for real lap-time stories.
  • Looking for read-aloud videos? 
    • YouTube has many read-aloud videos by the likes of the former first lady Michelle Obama and the actor Josh Gad (i.e. voice of Olaf from Frozen).
• For older kids
  • Consider audiobooks and podcasts (as opposed to simply watching a video).

Encourage Technologies that Are Less Exciting (thus Less Addictive)

• Are your children playing video games? Given that modern video games are designed to be quite addictive and engaging, we can try to purposely encourage less addictive and engaging video games.

• Consider:
  • Instead of the latest, addictive first person shooter, consider instead
    • “Retro” video games such as games based on board games such as Monopoly, Chess, Backgammon, Settlers of Catan, etc.
    • “Retro” arcade games;
    • Simulation and building games.

Ensure Enough Natural Light

• Mimic the natural light / darkness cycle from nature.

• During the day
  • Encourage your kids to go outside, including encouraging them to use their screens outside during daylight hours, which will give them sunlight (necessary for healthy eye development and prevention of myopia) and fresh air.
• During the evening
  • Limit screen activities, and/or use ‘blue light’ or ‘night shift’ settings on devices.
  • Dim the lights, or have low blue lighting (e.g. orange or red) in the bedrooms in the evening.

• Otherwise, some children/youth are vulnerable to using screens late into the evening, leading them to be up all night and sleep all day.

Use Screens in an Eye-Friendly Way

• The American Academy of Ophthalmology recommends

• Take a 20-second break from closeup work every 20 minutes
• Set a timer to remind people to take those breaks
• Keep digital media 18 to 24 inches away from the face

M)odel moderation

As parents, ensure that we are good role models for good use of technology.

Are you with your kids, and have an urge to check your phone?

• Consider getting an iWatch so you get quietly check your emails without pulling out a phone
• Consider going to the washroom and using the phone there, in private away from your kids.

M)onitor

Keep track of how your kids are using technology.

Use monitoring and tracking controls built into modern cellphones and computers.

Consider turning on parental controls to make your life easier.

In this way, when there is a limit to set (e.g. screen curfew), the device will simply automatically shut off, as opposed to you having to physically take the device away.

Warning Signs of Screen Addiction

Is your child/youth using screens to the point where it is getting in the way of healthier activities?

Examples include:

• Using screens for several hours a day;
• Screen use is getting in the way of sleep;
• Screen use is getting in the way of healthier routines such as sleep; engaging with family i.e. youth is just in his room all day playing video games.

If so, then consider seeing a health care professional in order to ask about next steps.

Dave’s Story, Part 2

Dave’s parents learn to understand that when Dave is using a screen, he is getting a dosage of pleasure chemicals (such as dopamine and adrenaline), for no effort. When that screen ends, Dave is understandably upset -- because he has just loss his supply of easy dopamine and adrenaline.

What to do about it

Stay calm.

• Empathize with your child that it is not easy for their brains to tolerate cutting off the adrenaline, e.g. “Yes, I know it’s not easy.”
• Your goal is to help their brains get calmer. It’s probably better to be flexible and find a solution that everyone can compromise with, as opposed for you to be too rigid and risk a meltdown.

When you (and your child are calmer), try to proactively problem solve to prevent future episodes

• Start with doing some planning and thinking on your own about options.
• Try to talk about the problem and problem-solve with your child. “On one hand, I know that you have fun watching your videos and playing video games. On the other hand, I know that when you’re having fun, its really hard to stop. So hard that it causes these horrible meltdowns. Like a post-high hangover! Can we talk about this and try to come up with some ideas, so that we can avoid having meltdowns?”

Possible strategies to agree on might include:

Connection before direction.

• Is it time to turn off the devices?
  • Don’t just suddenly shut it off;
  • Consider giving a transition warning, to give enough time to save the game..
  • “Connect” with them first, e.g.
    • Sit down with them on the couch. “Looks cool. What are you watching / Where are you at?”
    • “Just wanted to let you know, there’s 15-minutes.”
  • Consider using visual timers, setting an alarm, or other means to help them see that it is time.
  • Use parental controls to automate limit setting and shut off -- having the device shut off automatically is often psychologically easier than having them see you turn it off, or having you have to physically take it away from them.

• Try to stay calm, i.e. even if they are being oppositional about screen time limits, try to stay calm, in order to model healthy self-regulation.
  • Empathize that it can be really hard to get off the screens. You might say: “Of course its hard to get off the screens. They’re designed to be addictive. Of course you aren’t going to feel very happy when I’m taking away your free dopamine.”

Is your child continuing to have tantrums when asked to stop?

• Some people are able to self-regulate their use of addictive substances (whether it is screen time, or marijuana or alcohol), whereas others have more struggles.

• Consider:
  • Reduce the amount of screen time; and/or
  • Switch to less addictive (I.e. more boring, less exciting screen time.
  • If stopping video games keeps triggering tantrums, perhaps suspend video games, and permit videos instead.

Is your child still struggling? 

• Ultimately, if your child continues to struggle, your child may need a technology detox. A detox consists of stopping all video games and screens for at least 3-weeks. Parents usually report their child has an improvement in mood and behaviours with a screen detox.

For More Information

General Recommendations

Create a Family Media Plan with the help of this interactive webpage from the American Academy of Pediatrics. It offers different screen time limits that you can customize to your family, and that can be checked off to create your own customized plan.

https://www.healthychildren.org/English/media/Pages/default.aspx#wizard

Non-Electronic Independent Play

Supporting Your Child to Play Independently
https://www.ahaparenting.com/blog/teaching-kids-to-play-independently

How to Encourage Your Child to Play Independently
https://www.melbournechildpsychology.com.au/blog/encouraging-independent-play/

Post-COVID Guidance

AACAP’s Screen Time During COVID

https://www.aacap.org/App_Themes/AACAP/Docs/resource_libraries/covid-19/Screen-Time-During-COVID.pdf

UNICEF Screen Time During COVID

https://www.unicef.org/globali... Time During COVID

https://childmind.org/article/screen-time-during-the-coronavirus-crisis/

Harvard Pilgrim Health Care

https://www.harvardpilgrim.org/hapiguide/how-to-handle-screen-time-during-the-covid-19-pandemic/

References

Hunt et al.: No More FOMO: Limiting Social Media Decreases Loneliness and Depression. Journal of Social and Clinical Psychology, 2018, 37(10): 751-768.

https://doi.org/10.1521/jscp.2018.37.10.751

Status Of Mind: Social Media And Young People's Mental Health And Wellbeing. [online] Royal Society for Public Health (2017). Available at: https://www.rsph.org.uk/our-work/policy/social-media-and-young-people-s-mental-health-and-wellbeing.html [Accessed 27 October 2020].

Walsh J et al.: Associations between 24 hour movement behaviours and global cognition in US children: a cross-sectional observational study. Lancet, Volume 2, Issue 11, p783-791, Nov 1, 2018.

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(18)30278-5/fulltext

About this Article

Written by the eMentalHealth.ca Team, composed of health professionals at the Children’s Hospital of Eastern Ontario (CHEO). No competing interests declared.

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Information in this fact sheet may or may not apply to your situation. Your health care provider is the best source of information about your health.