Conflicting Guidelines on Young Children's Screen Time and Use of Digital Technology Create Policy and Practice Dilemmas
2018; Elsevier BV; Volume: 202; Linguagem: Inglês
10.1016/j.jpeds.2018.07.019
ISSN1097-6833
AutoresLeon Straker, Juliana Zabatiero, Susan Danby, Karen Thorpe, Susan Edwards,
Tópico(s)ICT in Developing Communities
ResumoAcross the globe, many children live in a digitally enmeshed world. Education and industry authorities encourage the use of digital technology by children to prepare them to thrive in a digital world. Health authorities, in contrast, discourage young children's use of digital technology and raise concerns about the potential negative effects on children's physical, cognitive, emotional, and social well-being. This paper articulates the differing perspectives of education and health authorities that result in a dilemma for those charged with providing for young children's health, care, education, development, and well-being—that of conflicting advice regarding the use of digital technology in early childhood. We highlight the consequent need for clear and balanced information regarding appropriate digital technology practices for families, doctors, educators, and other professionals working with young children—so that young children may gain benefits from digital technology use while minimizing the potential for harm. The introduction of intuitive touch-screen user interfaces on Internet-enabled mobile devices, including smartphones and tablet computers, has created the opportunity for more extensive technological engagement by young children and at even younger ages than was seen previously. Access to, and use of, mobile touch-screen devices by young children has grown rapidly since the 2000s. For example, 98% of homes in the US with young children had a mobile touch-screen device in 2017, compared with just 52% in 2011.1Rideout V. The common sense census: media use by kids age zero to eight. Common Sense Media, San Francisco (CA)2017Google Scholar Mobile touch-screen device use constituted 35% of all screen use by 0- to 8-year-old children in the US, with average weekly screen time reported as 14.2 hours for those younger than 2 years and 25.9 hours for those 2-5 years in Australia.1Rideout V. The common sense census: media use by kids age zero to eight. Common Sense Media, San Francisco (CA)2017Google Scholar, 2Rhodes A. Screen time and kids: what's happening in our homes? Detailed report. The Royal Children's Hospital Melbourne, Melbourne (VIC)2017Google Scholar By 14 months of age, 78% of French children were using a mobile touch-screen device, increasing to 90% by 2 years of age.3Cristia A. Seidl A. Parental reports on touch screen use in early childhood.PLoS ONE. 2015; 10 (e0128338)Crossref PubMed Scopus (95) Google Scholar Parents of children aged 3-8 years across 5 countries in Southeast Asia reported that 66% of children use their parents' mobile touch-screen devices, and 14% of children owned their own device.4Unantenne N. Mobile device usage among young kids: a Southeast Asia study. The Asian Parent and Samsung Kids Time, Singapore2014Google Scholar In 2017, 21% of British 3- to 4-year-old children owned their own tablet device.2Rhodes A. Screen time and kids: what's happening in our homes? Detailed report. The Royal Children's Hospital Melbourne, Melbourne (VIC)2017Google Scholar, 5Ofcom Children and parents: media use and attitudes report.2017Google Scholar In postindustrialized countries, increased digital technology use by young children has resulted in the production of guidelines by education and health authorities on technology use in early childhood. Parents, doctors, educators, and other professionals interested in child health, well-being, and educational development currently are faced with a dilemma: On one hand, education and industry/employment/innovation government and nongovernment authorities promote expanded use of digital technology by young children for a range of reasons.6Department of Education Employment and Workplace Relations Belonging, being & becoming: the early years learning framework for Australia. Commonwealth of Australia, Canberra (Australia)2009: 39Google Scholar, 7United States Department of Education Policy brief on early learning and use of technology. Office of Educational Technology, Washington (DC)2016Google Scholar, 8Department for Digital Culture Media & Sport UK Digital Strategy. 2017Google Scholar, 9National Association for the Education of Young Children and the Fred Rogers Center for Early Learning and Children's Media at Saint Vincent College Technology and interactive media as tools in early childhood programs serving children from birth through age 8.https://www.naeyc.org/sites/default/files/globally-shared/downloads/PDFs/resources/topics/PS_technology_WEB.pdfDate: 2012Google Scholar These include enhancing learning, promoting children's digital skill set, engaging in STEM (ie, Science, Technology, Engineering, and Mathematics), ensuring productive workforce membership, enabling competition in a globalized economy, and creating competence in social interaction. On the other hand, public health agencies advocate for minimal use of digital technology by young children as the result of concerns about the effects on physical, cognitive, emotional, and social health, well-being, and development.10American Academy of Pediatrics Council on Communications and Media Media and young minds.Pediatrics. 2016; 138: e20162591Crossref PubMed Scopus (414) Google Scholar, 11Tremblay M.S. Chaput J.P. Adamo K.B. Aubert S. Barnes J.D. Choquette L. et al.Canadian 24-hour movement guidelines for the early years (0-4 years): an integration of physical activity, sedentary behaviour, and sleep.BMC Public Health. 2017; 17: 874Crossref PubMed Scopus (301) Google Scholar, 12Canadian Paediatric Society Digital Health Task Force Screen time and young children: promoting health and development in a digital world.Paediatr Child Health. 2017; 22: 461-468Crossref PubMed Scopus (145) Google Scholar, 13Department of Health Australian 24-hour movement guidelines for the early years (birth to 5 years): an integration of physical activity, sedentary behaviour, and sleep. Commonwealth of Australia, Canberra (Australia)2017Google Scholar Physical concerns include poor and sustained postures, repetitive movements and accidents during use, and increasing sedentary time with displacement of gross motor activities that impact on bone and muscle growth, motor skill, and energy expenditure and obesity. Cognitive concerns include limitation of time for learning opportunities, shortened attention spans, and fewer contexts for verbal interactions, problem-solving, and creativity. Emotional concerns include addiction, depression, and access to inappropriate content and advertising. Social concerns include isolation, restricted face-to-face discourse, cyber-bullying, and predatory pedophiles. The dilemma of authoritative guidelines providing conflicting messages to the same audience can be illustrated in the Australian context. The Australian national curriculum, the Early Years Learning Framework,6Department of Education Employment and Workplace Relations Belonging, being & becoming: the early years learning framework for Australia. Commonwealth of Australia, Canberra (Australia)2009: 39Google Scholar and the Australian 24-Hour Movement Guidelines for the Early Years13Department of Health Australian 24-hour movement guidelines for the early years (birth to 5 years): an integration of physical activity, sedentary behaviour, and sleep. Commonwealth of Australia, Canberra (Australia)2017Google Scholar each consider digital technology use by children aged birth to 5 years. The Early Years Learning Framework is the Australian government's guiding curriculum document for educators of young children aged from birth to 5 years.6Department of Education Employment and Workplace Relations Belonging, being & becoming: the early years learning framework for Australia. Commonwealth of Australia, Canberra (Australia)2009: 39Google Scholar It informs the evaluation and accreditation of early learning centers nationwide. The Early Years Learning Framework is intended to support children's learning across 5 key outcomes, with 2 outcomes having explicit guidance on digital technology use. For example, Outcome 5 recognizes that children are effective communicators and states that “Children use information and communication technologies to access information, investigate ideas and represent their thinking.”6Department of Education Employment and Workplace Relations Belonging, being & becoming: the early years learning framework for Australia. Commonwealth of Australia, Canberra (Australia)2009: 39Google Scholar Stated advice for using digital technology with children includes: “introduce appropriate tools, technologies and media and provide the skills, knowledge and techniques to enhance children's learning”; “provide children with access to a range of technologies”; “integrate technologies into children's play experiences and projects”; and “teach skills and techniques and encourage children to use technologies to explore new information and represent their ideas.” The Early Years Learning Framework recognizes the role of digital technology in young children's lives for communication purposes and indicates that digital technology use should be considered a core learning outcome for children aged birth to 5 years. With a focus on hands-on learning and intentional teaching, this inclusion of digital technology in early childhood education is framed within an expectation that digital technology use will be active and occur in collaboration with adults and peers. Furthermore, digital technology is put to purposeful use—for representing ideas and exploring information. This perspective recognizes that digital technology is evident in children's everyday worlds and seeks to develop young children's capacity to use it for learning and social interaction. This educational perspective on digital technology use by young children contrasts with the public health guidelines. These guidelines seek to “minimize screen time” based on a perspective that screen time is sedentary and passive.11Tremblay M.S. Chaput J.P. Adamo K.B. Aubert S. Barnes J.D. Choquette L. et al.Canadian 24-hour movement guidelines for the early years (0-4 years): an integration of physical activity, sedentary behaviour, and sleep.BMC Public Health. 2017; 17: 874Crossref PubMed Scopus (301) Google Scholar, 13Department of Health Australian 24-hour movement guidelines for the early years (birth to 5 years): an integration of physical activity, sedentary behaviour, and sleep. Commonwealth of Australia, Canberra (Australia)2017Google Scholar For example, the Australian government's 24-hour Movement Guidelines for the Early Years13Department of Health Australian 24-hour movement guidelines for the early years (birth to 5 years): an integration of physical activity, sedentary behaviour, and sleep. Commonwealth of Australia, Canberra (Australia)2017Google Scholar state that for children younger than 1 year of age, “screen time is not recommended,” for children younger than 2 years of age, “sedentary screen time is not recommended,” and for children 2-5 years of age, “sedentary screen time should be no more than 1 hour; less is better.” The reasons for these conflicting positions from the one national government are many but are likely to include differing philosophies, priorities, and processes underpinning the development of each set of guidelines. For example, the Australian 24-Hour Movement Guidelines for the Early Years were published by the Department of Health and evolved from physical activity guidelines and the evidence of insufficient physical activity being detrimental to health. There was a clear intention in these guidelines to reduce the growing burden associated with noncommunicable chronic diseases. Although the current guidelines13Department of Health Australian 24-hour movement guidelines for the early years (birth to 5 years): an integration of physical activity, sedentary behaviour, and sleep. Commonwealth of Australia, Canberra (Australia)2017Google Scholar are based on new systematic reviews, no evidence was included in those reviews on mobile touch-screen device use.14Poitras V.J. Gray C.E. Janssen X. Aubert S. Carson V. Faulkner G. et al.Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0-4 years).BMC Public Health. 2017; 17: 868Crossref PubMed Scopus (198) Google Scholar The included evidence mainly focused on television viewing, which has different use options compared with mobile touch-screen devices. The current Australian 24-Hour Movement Guidelines for the Early Years also retained existing suggestions unless there was clear evidence to change. Given the limited available research on health outcomes associated with mobile touch-screen device use by young children, this meant that the guidelines retained recommendations originally developed in the previous century, before the significant uptake of mobile digital technologies by young children worldwide. Another reason for the differing positions is the focus on screen time by health authorities and on the nature of use by education authorities. The context, content, and connections of digital technology use by children are likely to be highly influential in determining cognitive, emotional, and social outcomes.15Blum-Ross A. Livingstone S. Families and screen time: current advice and emerging research. Media Policy Project, London School of Economics and Political Science, London (UK)2016: 4Google Scholar This implies that screen time may be only a useful construct for some outcomes, such as sedentariness and the prevention of related chronic diseases. Conceived from alternative perspectives, these 2 guidelines offer conflicting advice that leaves parents, doctors, educators, and other health professionals caught in the middle regarding digital technology decision-making. Parents may feel guilty about their children using digital technology and disenfranchised from making decisions,16Livingstone S. Sefton-Green J. The class: living and learning in the digital age. New York University Press, New York2016Crossref Google Scholar educators also may be conflicted about whether to use digital technology,17Nikolopoulou K. Gialamas V. Barriers to the integration of computers in early childhood settings: teachers' perceptions.Educ Inform Tech. 2015; 20: 285-301Google Scholar, 18Zabatiero J. Mantilla A. Edwards S. Danby S. Straker L. Young children and digital technology: Australian early childhood education and care sector adults' perspectives.Aust J Early Child. 2018; 43: 14-22Crossref Scopus (23) Google Scholar and doctors and other health professionals are not adequately supported to deal with the responsibility entrusted to them of guiding parents of young children on the appropriate use of digital technology.10American Academy of Pediatrics Council on Communications and Media Media and young minds.Pediatrics. 2016; 138: e20162591Crossref PubMed Scopus (414) Google Scholar, 12Canadian Paediatric Society Digital Health Task Force Screen time and young children: promoting health and development in a digital world.Paediatr Child Health. 2017; 22: 461-468Crossref PubMed Scopus (145) Google Scholar The imperative is for clear information on appropriate digital technology use that addresses health, well-being, and educational development of the whole child and supports informed decision-making by parents and professionals. We argue that adults responsible for young children have an ethical responsibility to prepare them for life in a digital world. Assisting children to develop an understanding of the benefits and risks of digital technology alongside appropriate ways of using digital technology is an adult responsibility. Parents are seeking clear and consistent information on appropriate ways in which digital technology can be used by young children from sources that they trust. Currently, information of this type is limited. For example, the Australian 24-Hour Movement Guidelines for the Early Years provides no guidance for “good” use of screens.13Department of Health Australian 24-hour movement guidelines for the early years (birth to 5 years): an integration of physical activity, sedentary behaviour, and sleep. Commonwealth of Australia, Canberra (Australia)2017Google Scholar In contrast, the American Academy of Pediatrics guidelines mention that video chat is permissible for infants (0-2 years), and that screen use by 2- to 5-year-old children should be “quality programming” and involve coviewing with family members.10American Academy of Pediatrics Council on Communications and Media Media and young minds.Pediatrics. 2016; 138: e20162591Crossref PubMed Scopus (414) Google Scholar These guidelines also suggest the avoidance of fast-paced programs with distracting or violent content and keeping screens out of bedrooms and also strongly promote the value of adults in collaborative engagement with children when using digital technology. Similarly, the Canadian Paediatric Society guidelines suggest coviewing and encourage “mindful” use and prioritizing educational, age-appropriate, and interactive programming.11Tremblay M.S. Chaput J.P. Adamo K.B. Aubert S. Barnes J.D. Choquette L. et al.Canadian 24-hour movement guidelines for the early years (0-4 years): an integration of physical activity, sedentary behaviour, and sleep.BMC Public Health. 2017; 17: 874Crossref PubMed Scopus (301) Google Scholar They also recommend avoiding screen use before bedtime. However, the guidance on “good” use of screens from the American Academy of Pediatrics and the Canadian Paediatric Society is focused mainly on cognitive and social well-being, leading to criticism for not paying sufficient attention to physical well-being19Straker L.M. Howie E.K. Young children and screen time: it is time to consider healthy bodies as well as healthy minds.J Dev Behav Pediatr. 2016; 37: 265Crossref PubMed Scopus (6) Google Scholar and the growing evidence of digital technology use impacting on musculoskeletal,20McVeigh J. Smith A. Howie E. Straker L. Trajectories of television watching from childhood to early adulthood and their association with body composition and mental health outcomes in young adults.PLoS ONE. 2016; 11 (e0152879)Crossref Scopus (36) Google Scholar cardiometabolic,14Poitras V.J. Gray C.E. Janssen X. Aubert S. Carson V. Faulkner G. et al.Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0-4 years).BMC Public Health. 2017; 17: 868Crossref PubMed Scopus (198) Google Scholar, 21Straker L. Howie E.K. Cliff D.P. Davern M.T. Engelen L. Gomersall S.R. et al.Australia and other nations are failing to meet sedentary behaviour guidelines for children: implications and a way forward.J Phys Act Health. 2016; 13: 177-188Crossref PubMed Scopus (16) Google Scholar and other aspects of physical health.14Poitras V.J. Gray C.E. Janssen X. Aubert S. Carson V. Faulkner G. et al.Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0-4 years).BMC Public Health. 2017; 17: 868Crossref PubMed Scopus (198) Google Scholar, 21Straker L. Howie E.K. Cliff D.P. Davern M.T. Engelen L. Gomersall S.R. et al.Australia and other nations are failing to meet sedentary behaviour guidelines for children: implications and a way forward.J Phys Act Health. 2016; 13: 177-188Crossref PubMed Scopus (16) Google Scholar There has been limited success in attempts at providing evidence-based guidelines for previous generations of digital technology use by children.22Straker L. Maslen B. Burgess-Limerick R. Johnson P. Dennerlein J. Evidence-based guidelines for the wise use of computers by children: physical development guidelines.Ergonomics. 2010; 53: 458-477Crossref PubMed Scopus (53) Google Scholar, 23Straker L. Abbott R. Collins R. Campbell A. Evidence-based guidelines for wise use of electronic games by children.Ergonomics. 2014; 57: 471-489Crossref PubMed Scopus (31) Google Scholar This limited uptake may be due to the implicit, and sometimes explicit, messaging in the health guidelines that screen time is “bad”—“choose healthy alternatives,”12Canadian Paediatric Society Digital Health Task Force Screen time and young children: promoting health and development in a digital world.Paediatr Child Health. 2017; 22: 461-468Crossref PubMed Scopus (145) Google Scholar “too much screen time means lost opportunities for teaching and learning,”12Canadian Paediatric Society Digital Health Task Force Screen time and young children: promoting health and development in a digital world.Paediatr Child Health. 2017; 22: 461-468Crossref PubMed Scopus (145) Google Scholar and “limit screen use to 1 hour per day.”10American Academy of Pediatrics Council on Communications and Media Media and young minds.Pediatrics. 2016; 138: e20162591Crossref PubMed Scopus (414) Google Scholar Indeed, a recent report from the United Kingdom stated that “‘screen time’ advice for parents remains overwhelmingly focussed on risk and harm” with little on the opportunities “to learn, connect and create.”15Blum-Ross A. Livingstone S. Families and screen time: current advice and emerging research. Media Policy Project, London School of Economics and Political Science, London (UK)2016: 4Google Scholar In their review of advice available from authoritative and parent sources, Blum-Ross and Livingstone15Blum-Ross A. Livingstone S. Families and screen time: current advice and emerging research. Media Policy Project, London School of Economics and Political Science, London (UK)2016: 4Google Scholar found an overwhelming majority focused on risks compared with opportunities. This bias in messaging may inhibit the receipt and implementation of suggestions within these guidelines by families. The American Academy of Pediatrics and the Canadian Paediatric Society guidelines do provide more balanced advice, including reporting on potential benefits to cognitive and psychosocial development, the ability for technology to be used in social and creative ways, and even noting that digital media use can encourage physical activity.10American Academy of Pediatrics Council on Communications and Media Media and young minds.Pediatrics. 2016; 138: e20162591Crossref PubMed Scopus (414) Google Scholar, 12Canadian Paediatric Society Digital Health Task Force Screen time and young children: promoting health and development in a digital world.Paediatr Child Health. 2017; 22: 461-468Crossref PubMed Scopus (145) Google Scholar The overall tone of international health guidance, however, is one of risk management, exemplified by language such as “minimize” and “mitigate the risks.”12Canadian Paediatric Society Digital Health Task Force Screen time and young children: promoting health and development in a digital world.Paediatr Child Health. 2017; 22: 461-468Crossref PubMed Scopus (145) Google Scholar Nonconflicting and more neutral advice about appropriate digital technology use, with suggestions for how and why adults can use digital technology with young children, may be a better way forward.24UNICEF The state of the world's children 2017: children in a digital world. United Nations Children's Fund, New York (NY)2017: 211Google Scholar For example, doctors and other health professionals could frame messages along the lines of “a healthy way to play with your 3 year old using digital technology is ….” The Australian case highlights debates currently underway at a global level. Doctors, educators, and other professionals are in positions of being trusted sources of advice to families. Today, advice about digital technology is integral to parents' decision-making in raising their young children. The overall goal for professionals working with families is to support them in developing digital technology use practices that are in the best interests of the child, supporting their health, well-being, and educational development. We suggest 5 steps to advance practice, policy, and research to provide greater consistency in advice regarding young children and digital technology.
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