I am writing this blog from the airport in Beijing where I have just been told that I have a five-hour delay of my flight to Boston. Five days ago, I left Boston to spend some time at Central South University School of Nursing in Changsha in the Hunan Province of China. A young women, whom I have mentored for almost 25 years, is a professor there and she asked me to present at a conference on research methods that she was organizing. As is usually the case with my trips to China, there are often multiple duties that go along with the primary request. This time, she asked me to teach one of her classes on a course on nursing roles and because I had some free time one morning, she scheduled several students to meet with me about their manuscripts. I may once have mentioned that if I am going to travel this far, I want to be busy and she took my words to heart. In truth, I love it.
It has been a great trip and I am more than ready to come home but having spent more time than anyone should in airports and in the process of traveling, I have made an observation that will come as no surprise to anyone: kids spend way too much time looking at screens of all kinds. Phones, tablets, iPads, learning toys—you name it, I have seen it on this trip. Now, as the grandmother of three very active young children, I realize that giving a child an electronic device is one strategy a parent might use to maintain their sanity during long travels. I am the last one to judge. But the kids I were watching were not novices. They were pros at using these devices. They were searching for the websites they wanted, they were navigating the sites, and they were mesmerized by the screens. I saw what looked like a two-year-old using her little fingers to move the screen back and forth on a phone until she found what she wanted. How does she know how to do that?
I decided to use some of my airport time to try and find out the impact of screen time on our children. I had read the lay literature and seen a news clip here and there. Both my daughter and my daughter-in-law have pretty strict rules on screen time for their children so I have seen the problem through their lens. But I wanted to know more about the impact of screens on kids. While the studies are not conclusive, and the correlations are complicated, they do show that children who have a significant use of screens over the course of a day have a premature thinning of the cerebral cortex, the part of the brain that is processes different types of information from the senses. The literature talked about inadequate sleep quality and quantity, changes in learning patterns and in older kids, problems with peers, depression, anxiety and conduct problems. In general, there are significant adverse health outcomes for children using screens that can have a lasting consequence. And it does not stop with children. Excessive screen use in adults (including graduate students in the health professions) has similar impacts on sleep and behavior as it does in children.
So, what are we doing as health care providers? Is screen use a routine part of all assessments we do on all of our patients, not just children? If so, what is the evidence that we use to educate our families and patients about best practices? There is some interesting literature that includes practice tips that can be used by clinicians to provide meaningful education. But we need more empirical evidence to guide our practice. Much of what I read suggested that the research in this area is in its infancy and we need more clinical trials and longitudinal studies to advance the science. Funding for this research is critical and needs to be supported by the NIH.
I close now, recognizing that I have spent entirely to much time using a screen in the last 24 hours. The next 24 hours don’t look much better. Perhaps one outcome of this trip is raising my consciousness about how much screen time I have in a day.