Anna Baker M.A., OTR/L BCP SIPT

LKS & Associates, Occupational Therapist

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Common Sense Media has examined the amount of screen time in children and adolescents since 2015 and their most recent findings in 2021 indicate rising levels of screen time for entertainment content over the past six years1.  Children aged eight to twelve years are spending five hours and thirty-three minutes a day using a screen for entertainment while teenagers aged 13 years to 18 years are using a screen for eight hours and thirty-nine minutes a day2.  

In 2016, the American Academy of Pediatrics created highly specific guidelines on screen time including no screen time for children under 18 months, one hour a day for children aged two years to five years, and for children six years and older the amount was up to the family’s discretion3.  These recommendations led to a lot of confusion and controversy.  What about FaceTime with a parent who’s on a business trip?  What about an educational app?  What about online educational videos for toddlers? 

In June 2021, the American Academy of Pediatrics (AAP) changed these guidelines to reflect the current use of screens and media4.  There is now an acknowledgment that “Media is everywhere.  TV, Internet, and video games all compete for children’s attention”5.  Instead of specific guidelines, there are now general recommendations to engage in healthy habits around screen use.  Making healthy habits around screen time use includes setting boundaries and making sure that basic health and educational needs are met.  There is also a recommendation for the evaluation of media content and co-watching to support parent and child interactions.  

What is Screen Time?

The AAP notes that “today’s children are spending an average of seven hours a day on entertainment media, including televisions, computers, phones and other electronic devices”6.  It’s important to note that there is a distinction between entertainment and educational media.  Entertainment media includes broadcast information from television and/or movies, social media, and video games. The ease of access to entertainment media has significantly increased with streaming services that support varied types of content.  Video games are also easy to access with 4 of 5 households reporting ownership of a device for video game play7

Educational media “refers to channels of communication that carry messages with an instructional purpose”8. Educational media may take the form of social media with programming to encourage wellness habits, increase awareness of current issues, and create opportunities for social and civic engagement.  Educational media may also consist of apps and websites to support instructional engagement.  At times, there may also be educational benefits to certain movies and television shows like Sesame Street or PBS Kids.  

The biggest area of challenge for a child is knowing the difference between entertainment media and educational media.  An adult may be beneficial here to make that distinction and assist to create that boundary for screen time use.  

How Young is Too Young?

A recent study by McHarg et al. (2020) focused on infant exposure to screen time.  This study found that “regular exposure to screen-based media at 4 months predicted poorer performance on a test of inhibition at 14 months”9.  This means that infants who have regular exposure to screen content may have negative effects during their later toddler years.  These negative effects may be in the area of cognitive development and executive functioning.  Executive functioning (EF)  is higher-order thinking that consists of decision-making, judgment, and critical thinking skills. 

There was also a longitudinal study that examined screen time and toddlers aged 24 months10.  In this study, it was found specifically that “increased screen time was associated with worse EF”.  This same study found this was not the case for older children at 36 months.  The study authors indicate that screen time may be replacing important real-life growth activities in the area of cognitive development for a 24-month-old, like engaging in play with physical objects and using symbolic as well as imaginative play.  The replacement of these enriching activities with screen time may be a large factor in decreasing later executive functioning. 

Another longitudinal study examined how media use at the age of two years may affect self-regulation skills11.  Self-regulation is the ability of a child to match their emotional responses to the demands of a task.  Children with poor self-regulation skills may become frustrated easily, frequently disengage from difficult tasks, and experience a greater number of tantrums. The longitudinal study results indicated that high levels of video game and television use, as well as overall media consumption, may lead to lower self-regulation skills at the age of four years12

The AAP notes that “Children younger than 2 years need hands-on exploration and social interaction with trusted caregivers to develop their cognitive, language, motor, and social-emotional skills”13. It is further specifically noted by the AAP that “because of their immature symbolic, memory, and attentional skills, infants and toddlers cannot learn from traditional digital media”14.  This means that just watching content alone is not enough for a toddler to have a benefit.  Per the AAP, “the chief factor that facilitates toddlers’ learning from commercial media (starting around 15 months of age) is parents watching with them and reteaching the content”15.  This means that a child and caregiver together need to view the content and interact together regarding the content for learning to occur.  The AAP insists that the same is true for video chatting with family members as a caregiver will need to put the video chat information into context16.  For digital books, the AAP also recommends that the parent is present and interacting with the child just as with a real book for any substantial benefit to be gained.  

What About Older Kids and Teens?

Older children and teenagers can benefit from educational media across a variety of areas including access to instructional information on school platforms, increased social awareness of issues or news information, and promotion of community or civic engagement in social media17.  There are downsides, however, with respect to health and psychological concerns with excessive use of media.  

Sedentary behaviors are those that require little energy and include screen use18. Excessive screen time may be setting up a habit for sedentary behaviors, which in adults puts physical health at risk for medical conditions such as cardiovascular disease and diabetes19.  The 2021 estimates of screen time in children indicate that with age, screen time is increasing and as a result, sedentary habits may also be increasing.  A meta-analysis of studies relating to childhood obesity in 2019 found that rising levels of screen time could be a risk factor for obesity.  

Increasing screen time during the day will decrease time spent in other activities whether they are physical or needed downtime activities such as sleep. The benefits of sleep have been widely explored, and it is noted that “adequate sleep is essential for growth, learning, mood, creativity, and weight control”20.  A systematic review of screen time and sleep found that screen time may be associated with decreased duration of sleep as well as difficulty initiating sleep routines21.  This means that children are not sleeping as long and are having trouble getting to sleep.  An additional study noted that the quality of sleep may also be affected by screen use22.  This study showed that electronic communications such as emails or text messages were sent after going to bed by 14% of children aged 12-14 years and 44% of teenagers aged 15-17 years.  This indicates that instead of initiating a night of good sleep, kids were messaging instead.  The study additionally reviewed that light from screen devices may also be affecting sleep, as the light coming from the screens may essentially trick our brains into resetting our sleep clock.  Furthermore, the content within the screen itself potentially further activates other parts of the brain that interfere with sleep23.  

Increased screen time may also be associated with behavioral problems. Another study noted that increased screen time was associated with behavioral problems such as rule-breaking, social difficulties, aggression, and “thought problems”24.  

An additional area of concern with screen time is the presence of cyberbullying.  The extension of the schoolyard bully into the internet world has resulted in the cyberbully, who still depends on “traditional bullying behaviors,” but has extended these into the screen realm via emails, messaging, and online platforms25.  The effect of cyberbullying on mental health has been established according to a systematic review, and may include “emotional stress, social anxiety, substance use, and suicide attempts”26.  As cyberbullying may occur through a variety of media, increased screen time may potentially place a child or adolescent at greater risk of contact with a cyberbully.  

How Can Parents Help?

Parents are modeling screen use to children every day by how devices, computers, and entertainment media are used.  As the child is exposed to parent screen use, routines around the child’s actual screen use may be affected.  In a study examining screen time effects on sleep, 53% of children who sent emails or texts after going to sleep “had a parent who reported doing this as well”27.  In another study of screen use in mothers, approximately 23% of mothers “spontaneously used a mobile device” during a structured home task that resulted in decreased verbal and nonverbal communication with their child28.  This means that parents just picking up a phone or device may turn their attention away from a child and have less opportunity to engage socially and emotionally during typical daily activities.  Screen time use then, may run both ways with parent use and child use both affecting overall family relationships. 

To increase family engagement, the AAP recommends the use of “media-free times” and “media-free locations”.  Suggestions from the AAP include a family meal without devices and no device use in bedrooms.  This may contribute to healthy eating and sleeping habits. 

Viewing media together as a family is called “co-viewing” and is encouraged by the AAP.  The benefits of co-viewing may include awareness of child media content and may create the opportunity to discuss content.  This has the potential for both learning and bonding opportunities.  

How to Set Boundaries on Screen Use

The first part to setting a boundary is defining the boundary.  The AAP has several recommendations regarding this boundary, including:

  • Use one hour a day for physical activity for children and adolescents
  • Use 8-12 hours for sleep  (Note that the American Academy of Sleep Medicine recommends children 6-12 years have 9-12 hours, teenagers 13-18 years have 8-10 hours) 
  • No use of entertainment media while completing homework
  • No use of devices in bedrooms
  • Use of media-free times for family activities such as “reading, teaching, talking and playing”
  • Use of media-free locations in homes (such as bedrooms)
  • Creation of a family media plan with limits on types as well as duration of media usage. 
  • Use of screen time boundary guidelines with other caregivers such as grandparents
  • Discussion of problems in media usage as a family
  • Creation of a group of trusted adults to engage with a child through social media
  • Use of co-viewing of media to create shared experiences

You can find out more about screen time by checking out the websites below.  


The American Academy of Pediatrics information on media and children

The American Academy of Pediatrics Family Media Plan

If there are other issues concerning your child’s development and speech, occupational or physical therapy plan you may also contact the LKS office at 310-739-9337 or by email at 


American Academy of Child & Adolescent Psychiatry.  (2020).  Screen time and children.

American Academy of Pediatrics. (2021). Beyond screen time: A parent’s guide to media use.

Barnett, T.A., Kelly, A.S., Rohm Young, D., Perry, C.K., Pratt, C.A., Edwards, N.M., Rao, G., & Vos, M.B. (2022).  AHA Scientific Statement: Sedentary behaviors in today’s youth: Approaches to the prevention and management of childhood obesity.  Circulation (138): . DOI: 10.1161/CIR.0000000000000591

Buxton, O.M., Chang, A. Spillsbury, J.C., Bos, T. Emsellem, H., & Knutson, K.L. (2015).  Sleep Health 1(1): 15-27. 

Bottino, S.M.B, Bottino, C.M.C, Regina, C.G., Correia, A.V.L. (2015). Cyberbullying and adolescent mental health: Systematic review.  Cadernos de saude publica 31(3): 463-75.  Doi: 10.1590?0102-311×00036114.  

Cliff, D.P., Howard, S.J., Radesky, J.S., McNeil, J., & Vella, S. (2018).  Early childhood media exposure and self-regulation: Bidirectional longitudinal associations. 

Fang, K., Mu, M., & He, Y. (2019).  Screen time and childhood overweight/obesity: A systematic review and meta-analysis.  Child: Care, Health & Development 45(5): doi: 10.1111/cch.12701

Guerrero, M.D., Barnes, J.D., Chaput, J., & Tremblay, M.S., (2019) Screen time and problem behaviors in children: exploring the mediating role of sleep duration.  The International Journal of Behavioral Nutrition and Physical Activity 16(1): 105.  doi: 10.1186/s12966-019-0862-x

Hale, L. & Guan, S. (2015).  Screen time and sleep among school-aged children and adolescents: A systematic literature review.  Sleep Medicine Review 21(50):

Hill, D., Nushee, A., Chassiakos, Y.R., Cross, C., Hutchinson, J., Levine, A., Boyd, R., Mendelssohn, R., Moreno, M., & Swanson, W.S. (2016).  Media and Young Minds.  Pediatrics 138 (5).

Hill, D., Nushee, A., Chassiakos, Y.R., Cross, C., Radesky, J., Hutchinson, J., Levine, A., Boyd, R. B., Mendelssohn, R., Moreno, M., & Swanson, W.S. (2016).  Media use in school-age children and adolescents.  Pediatrics 138 (5).

Lenhart, A. Teens, social media & technology overview 2015.  Washington, DC: Pre Internet and American Life Project: 2015

McHarg, G., Ribner, A.D., Devine, R.T., & Hughes, C. (2020)  Infant screen exposure links to toddlers’ inhibition, but not other EF constructs:  A propensity score study.  doi: 10.1016/j.infbeh.2021.101595. Epub 2021 Jun 18.

McHarg, G., Ribner, A.D., Devine, R.T., & Hughes, C. (2020)  Screen time and executive function in toddlerhood: A longitudinal study.  Frontiers in Psychology 11: doi: 10.3389/fpsyg.2020.570392

Middlebrook, H. (2016). New screen time rules for kids by doctors.

Moreno, M.A., Chassiakos, Y., & Cross, C. (2016). Media use in school-aged children and adolescents.  Pediatrics 138 (5). DOI: 10.1542/peds.2016-2592 

Paruthi, S., Brooks, L.J., D’Ambrosio, C., Hall, W.A, Kotagal, S., Lloyd, R.M., Malow, B.A., Maski, K., Nichols, C., Quan, S.F., Rosen, C.L., Troester, D.O. & Wise, M.S.  (2016).  Consensu statement of the American Academy of sleep medicine on the recommended amount of sleep for healthy children: methodology and discussion.  Journal of Clinical Sleep Medicine 12(11): 1549- 1561

Radesky, J., Chassiakos, Y.R., Ameenuddin, N., & Navsaria, D. (2020).  Digital advertising to children.  Pediatrics 146(1).

Rideout, V., Peebles, A., Mann, S., & Robb, M.B. (2022) Common sense census: Media use by tween and teens.  San Francisco, CA: Common Sense. 

Ritakumar, S. (2019). Educational media in teaching learning process. Bhartiyam International Journal of Education & Research 8 (3) 7-14. 

1 Rideout et al, 2021

2 Rideout et al, 2021

3 Middlebrook, 2016

4 American Academy of Pediatrics, Media and Children Overview, 2021

5 American Academy of Pediatrics, Media and Children Overview, 2021

6 American Academy of Pediatrics, Media and Children Overview, 2021

7  Lenhart, A., 2015

8  Ritakumari, S., 2019

9 McHarg et al, 2020

10 McHarg et al, 2020

11 Cliff et al., 2018

12 Cliff et al, 2018

13 Hill et al., 2016

14 Hill et al., 2016

15 Hill et al., 2016

16 Hill et al., 2016

17 Hill et al., 2016

18 Barnett et al., 2022

19 Barnett et al., 2022

20 Buxton et al., 2015

21 Hale & Guan, 2015

22 Buxton et al, 2015

23 Buxton et al., 2015

24 Guerreo et al., 2019

25 Bottino et al, 2015

26 Bottino et al., 2015

27 Buxton, et. al, 2015

28 Radesky et al., 2015