Why parents must protect young children from excessive use of screen time

SINGAPORE - At KK Women’s and Children’s Hospital (KKH), doctors have seen children as young as 18 months who were exposed to screens for between two and six hours a day – and some of these children had been exposed to screens since they were six to 10 months old.

Spending multiple hours on screens may be the norm for many adults, but this should not be the case for children, particularly infants, as it can affect their overall development.

Excessive screen time use in children can lead to a myriad of issues, including myopia, speech delay, autism-like symptoms and obesity.

Dr Yvonne Ling, an eye surgeon specialising in adult squints and paediatric ophthalmology at the Singapore National Eye Centre, said that young children who spend hours indoors every day focusing on near work, such as viewing mobile devices and reading, may get myopia as early as in their pre-school years.

It may then progress to very high myopia, which is a complex condition that can lead to blindness in adulthood, she added.

“The younger you get it, the higher it will be when you become an adult because the eye is still growing,” said Dr Ling, who also sees young patients at KKH.

Children should be spending some time outdoors, preferably around two hours every day, she said.

“I used to agree with parents who are very busy and say, okay, you just take them out on weekends. But I realised that, actually, every day of the week, the eye is still growing.”

Near work induces the growing eyeball to elongate, resulting in a myopic or nearsighted eye. Activities outdoors under the sky and during daylight can stop, although not, reverse the elongation, Dr Ling said.

Looking into the far distance – at the clouds and sky, for instance – would also help, she added.

Children who spend too much time on screens may also experience other possible negative effects, including speech delay in toddlers, poor social interaction and reduced attention span, said Dr Christelle Tan, a consultant in paediatric medicine at KKH’s Department of Child Development.

She said KKH gets continual referrals of infants aged 18 months and older who experience speech delay.

“Their parents tell us that these children have been exposed to screens for two to three, sometimes, even five to six hours a day since they were six to 10 months old,” said Dr Tan.

While screen time can be beneficial for children, it is not the case for infants below 18 months of age. Local guidelines, as with those overseas, state that they should not be exposed to screens, unless it is for video chatting with a family member.

Earlier in June, Health Minister Ong Ye Kung and Minister for Social and Family Development Masagos Zulkifli also said measures to deal with device usage in Singapore will be released in the coming months.

Research has shown that exposing children at 1 to 1½ years to screens led to poorer cognitive development including language delay, social interaction difficulties and reduced attention span, Dr Tan said, adding that “content in screens is of no help to those below 18 months”.

“Some studies have seen effects lasting beyond eight years of age for these infants exposed when they were one year old,” she said.

At KKH, there are children, aged from three to 10, who have symptoms that look like attention deficit hyperactivity disorder (ADHD) such as reduced attention capacity.

“Excessive screen time use doesn’t cause ADHD, but it can lead to symptoms that are quite similar in that it can shorten the child’s ability to focus on a task and affect the child’s executive functioning, which is how he or she plans, organises and completes multiple stepped tasks,” said Dr Tan.

Unlike the symptoms of ADHD, which is a brain disorder that results from an imbalance of neurotransmitters (brain chemicals that help nerve cells communicate with each other), the ADHD-like symptoms gradually go away with controlled screen time use, she said.

Dr Ling and Dr Tan are guests in an upcoming ST Health Check podcast hosted by this reporter on the impacts of excessive screen time use on children and why parents must do something about this. The episode will be released on July 3 on the ST Health Check channel, the Straits Times website, Apple podcasts and Spotify.

What is screen time?

It is the time spent on devices with screens such as TVs, smartphones, tablets, computers and learning devices. It includes having the TV play in the background, which can also lead to a decrease in high-quality interpersonal communication and overstimulation. Screen time can support learning, development and play, but it must be balanced with other activities.

How much is enough?

Under 18 months: No screen time except for video callingFrom 18 months to six years old: Less than an hour a day, with co-viewing preferred
From seven to 12 years old: Make a collaborative screen use plan to ensure a healthy balance between screen exposure and other age-appropriate activities.

Screen time can support learning, development and play, but it must be balanced with other activities.  PHOTO: ST FILE

What are the negative impacts?

Myopia

Data shows that children in Singapore are becoming short-sighted from a younger age,even as young asin pre-school, putting them at risk of high myopia in adulthood. Those with veryhigh myopia are more vulnerable to serious complications that can lead to severe vision loss or blindness in adulthood.

Speech delay

This can happen to infants who are exposed to screen use from birth and do not have enough one-on-one communication with another child or an adult. As infants learn the most from human interaction, they should have opportunities to engage and play with people.

Autism-like symptoms

Some signs of too much screen time in children may be poor social interaction, decreased eye contact and a lack of response to their names. These symptoms, similar to those of autism spectrum disorder, can resolve with less screen time.

Obesity

Screen time can displace outdoor play and physical movement that strengthens muscles and bones. The lack of physical activity may also lead to obesity, putting children at increased risk of getting chronic health issues such as high blood pressure earlier in adulthood.

Dryness and fatigue

​Prolonged screen time can leave young eyes feeling dry and tired. Blurry vision and headaches can also occur. These are short-term problems that do not cause eye damage. However, a more serious condition of double vision due to misalignment of the eyes, or squint, is surfacing even among young children. This type of double vision occurs when both eyesare being usedand disappears when either eye is closed.

Reduced attention span

Children given too much screen time are easily distracted and have difficulty staying on a task. Parents may start to see this in their pre-school or lower primary children.

Poor sleep

The blue light from screens may affect the initiation of sleep, so screen use should be halted at least one hour before bedtime. Excessive screen use has also been associated with poorer sleep quality and sleep disturbances.

Aggressive behaviour

After viewing violent content or playing certain games, some children may exhibit violent behaviour, such as punching or making stabbing motions. This stems from a lack of maturity to filter out inappropriate content or understand context.

Neck and back strain

This is not a common complaint among children, but it can happen from too much time spent in a slouched position, with the head held forward. When this same position is held for very long periods of time, it can strain the muscles and joints in the back of the neck and in the back.

Mental health concerns

Depressive symptoms, such as low mood, may be seen in older children in upper primary or secondary school. Other issues such as anxiety can also develop.