What did the American Academy of Pediatrics concluded about screen time and children under the age of two years?

By the time research on screen time reaches the public, it’s often framed in black-and-white terms: guidelines setting out strict time limits, or news reports with titles like “Are Screens Bad for Kids?” 

In reality, though, screen time research has been less than definitive, mainly owing to a lack of strong longitudinal studies to date. That’s now beginning to change as psychologists and other child development experts take a deeper and increasingly nuanced look at children’s and teens’ use of tablets, phones and other screens. Researchers are now paying close attention to the kinds of content kids are consuming via digital devices. They’re looking at the environment that surrounds screen time, including parenting and socioeconomic status. And they’re buckling down for the long haul, building new longitudinal studies that will help answer complex questions about kids, teens and screens.

In particular, they’re studying both the potential benefits of screens—if they can be used as teaching tools—and the potential physical and mental health drawbacks.

The picture that has emerged suggests that the youngest children don’t learn well from screens. As kids get older, they can learn meaningful information from screens, but the ubiquity of digital devices also means that children can easily spend far too much time being sedentary. Nevertheless, total abstinence from recreational screen time may backfire for older kids and teens.

Meanwhile, many questions remain about how much screen time is too much and about the effects of different types of activities that involve screens.

“As psychologists, it’s really important for us to have scientific­-based evidence behind what we’re recommending. We’re not there yet,” says Jerri Lynn Hogg, PhD, a media psychologist at Fielding Graduate University. “We have ideas, but the problem is that the technology is getting more and more sophisticated and more ubiquitous.”

The challenges of screen time

In all the popular-media hubbub and scientific debate over screen time, it’s easy to forget how quickly these issues have evolved: The first-generation iPhone was introduced only 13 years ago, in 2007, the same year Netflix introduced streaming services. The iPad just saw its 10th birthday. Television and video games have been around for decades, of course, but never so portably and easily accessed.

Amid this rapid change, professional organizations such as the World Health Organization (WHO) and American Academy of Pediatrics (AAP) have stepped in with recommendations. AAP calls for no screen time at all for children until 18 to 24 months, except for video chatting, and says kids ages 2 to 5 should get an hour or less of screen time per day. It has also developed the Family Media Use Plan for older kids, in which parents and children negotiate limits and boundaries around screen usage. In its guidelines on physical activity, sedentary behavior and sleep for young children, WHO similarly recommends no screens for kids under 2, and less than an hour a day for kids 2 to 5.

However, some critics charge that much of the research backing up the guidelines is correlational, cross-sectional or based upon self-report—though there are longitudinal studies in the mix, too. And not all research effectively differentiates between different types of screen time. Many studies lump all screen time together into one category, though it seems unlikely that video chatting with Grandma, for example, would have much in common with playing “Grand Theft Auto V.”

Isolating the effects of screens from all the other experiences kids are exposed to is a challenge as well. It would be difficult indeed to run a long-term, randomized study in which children were assigned to different amounts of screen time each day and then tracked over their life spans to measure well-being outcomes. Imagine the look on a parent’s face when told their child would be required to watch six hours of television every day—or that they could never watch a screen at all.

What is clear is that many parents often don’t enforce the screen time limits suggested by the guidelines. For example, a study led by economist Weiwei Chen, PhD, of Florida International University, found that, as of 2014, children age 2 and under in the United States averaged 3 hours, 3 minutes a day of screen time, up from 1 hour, 19 minutes a day in 1997. Three- to 5-year-olds got 2 hours, 28 minutes a day of screen time, on average, during that time period ( JAMA Pediatrics , Vol. 173, No. 4, 2019 ).

Qualitative studies suggest several reasons for the widespread screen use. One survey of 133 parents of preschool-age kids led by Rutgers University professor of nutritional sciences Carol Byrd-Bredbenner, PhD, for example, found that many parents reported lacking affordable alternative entertainment for their kids. Others cited factors such as their own exhaustion, the need to get things done around the house and bad weather for excess screen time ( Journal of Nutrition Education and Behavior , Vol. 47, No. 4, 2015 ).

Babies, toddlers, preschoolers and screens

Research has, however, turned up evidence to support limiting screen time for babies and young children. One longitudinal study of 2,441 mothers and children, led by University of Calgary psychologist Sheri Madigan, PhD, found that more time per week spent on screens at ages 24 months and 36 months was linked with poorer performance on screening tests for behavioral, cognitive and social development at 36 months ( JAMA Pediatrics , Vol. 173, No. 3, 2019 ). The opposite association (poorer development leading to more screen time) was not seen, suggesting that the linkage wasn’t a matter of parents leaning on screen time to handle a challenging child. Instead, the excessive screen time seemed to precede the developmental difficulties.

Despite experts’ concerns, media for babies and toddlers has been on the market for years, often with promises of stimulation and education—the "Baby Einstein" videos are one prominent example. But the evidence is strong that screens aren’t an effective teaching tool for the baby and toddler set, and they could displace the kinds of face-to-face interactions that actually help young kids learn. A 2005 review led by developmental psychologist Daniel Anderson, PhD, now a professor emeritus at the University of Massachusetts, Amherst, found that television viewing consistently failed to teach kids age 2 and younger as much as live interaction ( American Behavioral Scientist , Vol. 48, No. 5, 2005 ). This “video deficit” was seen in simple imitation tasks, in language learning and in emotional learning.

“The basic pattern that has been found in dozens of studies is that children learn better from a person who is with them face-to-face than from a person on a screen, even if it’s the exact same person doing the exact same thing,” says Georgene Troseth, PhD, a psychologist at Vanderbilt University.

More recently, researchers like Troseth are trying to understand why this screen learning gap occurs in toddlers. That toddlers struggle to learn from videos does not seem to be perceptual, Troseth says, but conceptual: Until they’re around age 3, kids seem to view video as irrelevant to real life. In numerous studies, toddlers shown video of an experimenter hiding a toy in the room next door are terrible at finding that toy in the real room immediately afterward. In one study co-authored by Troseth, however, toddlers who watched a toy being hidden on a screen disguised to look like a window were much better at finding the toy than toddlers who saw the toy hidden on a regular screen ( Child Development , Vol. 69, No. 4, 1998 ). “When they were told they were watching through a window, they were willing to take in the information,” Troseth says. “The idea when they’re watching on TV seems to be, ‘You’re not going to fool me, I know that’s not real.’”

Though screen time recommendations for the youngest kids now make exceptions for video chatting, the evidence also suggests that toddlers find this medium confusing and that they struggle to make sense of video chat unless they have help from an adult who is physically present. In one study by Troseth and her colleagues, for example, 2-year-olds were assigned to either watch a prerecorded video intended to teach them new words or to engage in a word-learning video chat session with an experimenter. In half of the cases, the child’s parent simply sat with the child. In the other half, the parent followed the experimenter’s directions, modeling interactions with the video screen. A live video chat kept the kids’ attention better than a prerecorded video, but only kids whose parents participated alongside them were able to learn new words from the screen ( Journal of Experimental Child Psychology , Vol. 166, 2018 ).

Three- to 5-year-olds, on the other hand, are a bit more savvy. Since the early days of “Sesame Street,” research has found that this age group can learn from slow-paced, thoughtfully designed children’s media. For example, in tests of prereading skills such as alphabet recognition and letter sounds, kids who were randomly assigned to watch a 20-episode run of the literacy show “Super Why!” outperformed kids who were assigned to watch an educational science series, according to a study of 171 preschoolers conducted by Deborah Nichols, PhD, the director of the Children’s Media Lab at Purdue University ( International Journal for Cross-Disciplinary Subjects in Education , Vol. 6, No. 1, 2015 ). Children from low socio­economic backgrounds generally saw greater gains than children in the wealthiest families, possibly because the more privileged children were already exposed to more literacy enrichment than the less-advantaged group.

Television’s educational potential isn’t limited to academic skills: A study of the PBS show “Daniel Tiger’s Neighborhood” led by Texas Tech University media researcher Eric Rasmussen, PhD, found that kids who were randomly assigned to watch the program showed greater emotion recognition, empathy and self-efficacy—if those children also came from homes where parents consistently talked to their children about their TV viewing ( Journal of Children and Media , Vol. 10, No. 4, 2016 ). As with toddlers, preschoolers seem to benefit from adults co-viewing their media.

Co-viewing may seem a steep price to pay for parents who are desperate to use their child’s screen time to make dinner or pack tomorrow’s lunch, but it doesn’t have to be a full-time job, Hogg says. Rather, she recommends parents should aim to scaffold their child’s screen time, first watching a few episodes with them and talking about the content, then stepping back and checking in as the child becomes familiar with how media works.

Growing up digital

As children mature, they’re exposed to more screens, with more diverse content via television, video games and social media. A report released in October 2019 by the nonprofit organization Common Sense Media found that 8- to 12-year-olds in the United States now use screens for entertainment for an average of 4 hours, 44 minutes a day, and 13- to 18-year-olds are on screens for an average of 7 hours, 22 minutes each day ( The Common Sense Census: Media Use by Tweens and Teens , 2019 ). These numbers don’t count time using screens for schoolwork or homework.

Common Sense Media’s data also reveal a substantial disparity in media use based on socioeconomic status, with 8- to 12-year-olds from high­income families using 1 hour, 50 minutes less of media each day than kids of the same age from low­income families. Teens show a similar gap. Previous research has suggested that increased screen time in poorer families may be an attempt by parents to protect their children; studies in multiple countries have found that parent anxiety about neighborhood safety and actual neighborhood safety are linked to more screen time and less physical activity. For example, health researchers Valerie Carson, PhD, of the University of Alberta, and Ian Janssen, PhD, of Queen’s University in Kingston, Ontario, found that kids who lived in neighborhoods with the highest social and physical disorder (such as crime, graffiti and gang activity) had a 40% to 60% higher likelihood of high screen use ( International Journal of Behavioral Nutrition and Physical Activity , Vol. 9, No. 66, 2012 ). Higher-income families may also have more alternatives to screen time available, in the form of extracurricular activities and safe recreation areas.

As with young children, there are reasons for concern over large amounts of screen time in tweens and teens. Correlational studies have shown that 8- to 11-year-olds who exceed screen time recommendations scored lower on cognitive assessments, with compliance with recommendations explaining about a fifth of the overall variance in cognitive scores ( The Lancet Child & Adolescent Health , Vol. 2, No. 11, 2018 ). A combination of screen time and too little sleep has also been associated with heightened impulsivity in the same age group ( Pediatrics , Vol. 144, No. 3, 2019 ).

These studies weren’t designed to show causal relation­ships, though, says Gary Goldfield, PhD, a psychologist at the University of Ottawa who co­authored both studies. It could be that increased impulsivity or struggles with cognition drive the excess screen time. Nevertheless, in numerous studies, Goldfield and his team have consistently found the best mental health and cognitive outcomes in teens who do one hour of physical activity each day, sleep eight to 10 hours a day and use screens recreationally less than two hours a day.

Researchers have also found links between screen time and various health outcomes in teens, though again, establishing definitive causal relationships is difficult. The firmest associations are between screen time and obesity and screen time and depressive symptoms, according to a systematic review of reviews published by University College London (UCL) psychologist Neza Stiglic, PhD, and Russell Viner, PhD, a professor of adolescent health at UCL ( BMJ Open , Vol. 9, No. 1, 2019 ). Most research on obesity focused on television viewing and found that more time spent watching TV was associated with a higher body mass index or body fat composition. Multiple studies also found that screen use of more than two hours a day was correlated with depressive symptoms. The reviewers found moderate evidence linking screen time to poorer quality of life, higher caloric intake and less-healthy diets. Evidence linking screen time to other problems, such as behavior issues, anxiety, and low feelings of well-being and self-esteem, was weak, with studies on these outcomes returning mixed results.

A study led by psychologists Amy Orben, PhD, of the University of Cambridge, and Andrew Przybylski, PhD, of the University of Oxford, found that screen time as measured by time-use diaries (as opposed to retrospective self-reports, which many studies use) in large did not have noticeable effects on teen psychological well-being, according to nationally representative data sets in the United States, United Kingdom and Ireland ( Psychological Science , Vol. 30, No. 5, 2019 ). But other research points to complicated relationships between screen time and well-being. For example, a study led by physician Pierre-André Michaud, MD, of the Institute of Social and Preventive Medicine in Lausanne, Switzerland, found a U-shaped relationship between internet use and adolescent mental and physical heath, such that moderate users were the best off ( Pediatrics , Vol. 127, No. 2, 2011 ).

“A lot depends on how kids are using media, how much their parents are monitoring their use, how much time they’re spending and what exactly they’re watching and using,” says Victor Strasburger, MD, a pediatrician and professor emeritus at the University of New Mexico School of Medicine.

Future research and recommendations

Fortunately, a new longitudinal data set may help illuminate some of the outstanding questions about adolescents and screen time. In 2015, the National Institutes of Health began funding the Adolescent Brain Cognitive Development (ABCD) Study, the largest ever longitudinal study on teen brain and behavioral development in the United States. More than 10,000 9- to 10-year-olds have been recruited and are being followed to young adulthood. Screen time data are among the information being collected, and researchers are already using the first wave: Goldfield’s cognition and impulsivity studies drew from ABCD data. “We’re pretty excited about this database,” he says.

In the meantime, some experts recommend a mindful approach to media. Simply banning screens may backfire, says Jon Lasser, PhD, a psychologist at Texas State University and co-author, with Mike Brooks, PhD, of the 2018 book “Tech Generation: Raising Balanced Kids in a Hyper-Connected World.”

“It’s important for kids to develop the capacity to self­-regulate,” Lasser says, “and parents who try to micromanage screen time may inadvertently interfere with that self-­regulatory development.”

Lasser and Brooks include a tool in their book called the Family Assessment of Screen Time, or FAST, which family members can use to gauge their feelings about screen time—their own and each other’s. The tool is similar to AAP’s Family Media Use Plan, in which parents and children, 5 years and older, negotiate limits and boundaries around screen usage.

Finally, parents should keep co-viewing media with their kids. Keeping an open line of communication around media helps protect kids when they inevitably run into content they aren’t ready to see, Strasburger says. A healthy, nonrancorous relationship around media also makes it easier to enforce boundaries when required.

“The number one recommendation that we give to parents is [to] spend time engaged with their kids,” Lasser says. “It’s simple, it’s good parenting and it promotes a healthy relationship.”