How much screen time is OK for a 5 year old?

By Dr. Ananya Mandal, MDApr 25 2019

The World Health Organization has come up with new set of recommendations regarding the amount of screen time to be allowed for children less than five years.

The guidance mainly recommends more play time and less sedentary time for kids and toddlers and says that babies under the age of one should not be allowed any screen time at all. Children between ages 2 and 4 should have an hour or less of sedentary screen time per day. In the announcement by the United Nations health agency this week, it says that removing screen time and reducing them to the recommended limits and increasing physically active hours in children would result in a population of healthy adults.

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Dr. Tedros Adhanom Ghebreyesus, the director-general of the WHO, said in a statement, “Achieving health for all means doing what is best for health right from the beginning of people’s lives. Early childhood is a period of rapid development and a time when family lifestyle patterns can be adapted to boost health gains.”

Researchers have found that there is inadequate evidence regarding the long term effects of excessive screen time in children. The National Institutes of Health thus sponsored a project with $300 million. It is called the A.B.C.D. Study (for Adolescent Brain Cognitive Development). The study looks at the impact of various factors on brain development of teenagers. This includes screen time, concussions and also substance abuse. As of now, preliminary data has arrived from following 9 to 10 year old children into their adulthood.

Before these recommendations from the WHO, in 2016, the American Academy of Paediatrics (AAP) also issued guidelines to say that for children under 18 months there should be no exposure to screen time other than video chatting. For children between 18 to 24 months of age only “high quality programming” should be allowed and even in that case, the parents and caregivers should watch the programmes with the children. The AAP recommended that children between ages 2 to 5 years should be allowed to watch only one hour of approved and suitable programming per day.

Dr. David Hill, a paediatrician who had led the AAP’s 2016 guidelines said that under the age of 18 months, there are no known benefits of screen time on babies. He added that there is inadequate evidence as to what impact screen time can have in the long run on the child’s brain. As a caveat he added that technology is developing fast and we still do not know the possible positive impact of certain programming on the child’s brain development. Dr. Hill said that the WHO is adopting a “precautionary principle, and saying: ‘If we don’t know that it’s good, and there’s any reason to believe it’s bad, why do it?’” “It’s certainly possible as we revise our recommendations and as further data becomes available, we may skew that direction in the future,” Dr. Hill said adding, “But it’s hard to say without a comprehensive literature review, which is what informs our policy.”

The WHO team that came up with the recommendations was headed by Dr. Fiona Bull, a program manager for surveillance and population-based prevention of noncommunicable diseases at the WHO. She said in a statement, “Improving physical activity, reducing sedentary time and ensuring quality sleep in young children will improve their physical, mental health and well-being and help prevent childhood obesity and associated diseases later in life.”

The recommendations from WHO says that children below the age of five years should be left free to play and not be strapped into a high chair, stroller or the back of a care giver for more than one hour at one go. All children aged 1 to 5 need at least 3 hours of physically active time says the guidelines. This should be followed by at least 10 hours of uninterrupted sleep at night.

The report adds that there is an obesity epidemic with nearly thrice the number of obese persons across the globe when compared to the population in 1974. Childhood obesity was earlier seen only in developed nations and now is becoming increasingly prevalent in low and middle income countries such as those in Africa and Asia says the WHO. The main reason behind this is more sedentary time and less physically active time. WHO warns that lack of physical activity is killing over five million people of all ages around the world. At present more than 23 percent adults and 80 percent teenagers are not meeting the requisite physical activity recommendations says the report. Establishing physical activity in children and ensuring healthy sleeping routines in childhood can help shape a healthy adulthood say experts. Dr. Juana Willumsen, from the childhood obesity section in the WHO says, “What we really need to do is bring back play for children. This is about making the shift from sedentary time to playtime, while protecting sleep.”

Summary of recommendations

• Babies below 1 year of age –
  • Physical activity several times a day in various ways (interactive floor plays, at least 30 minutes of tummy time several times a day etc.)
  • Not be restricted or restrained for more than 1 hour at a time
  • No screen time
  • If sedentary then reading or story telling could be other options
  • For babies between 0 to 3 months – 14 to 17 hours of sleep including naps
  • For babies between 4 and 11 months – 12 to 16 hours of uninterrupted sleep including naps
• Children aged 1 to 2 years
  • At least 180 minutes of physical activity which can include moderate-to-vigorous-intensity physical activity throughout the day
  • Not be restricted or restrained for more than 1 hour at a time
  • No screen time including TV, videos or computer games for 1 year olds
  • For 2 year olds sedentary screen time of not more than 1 hour per day
  • If sedentary then reading or story telling could be other options
  • Recommended 11 to 14 hours of good quality sleep including naps with regular sleep wake times
• Children between ages 3 and 4 years –
  • At least 180 minutes of physical activities of which at least 60 minutes is moderate-to-vigorous-intensity physical activity throughout the day
  • Not be restricted or restrained for more than 1 hour at a time
  • Sedentary screen time of not more than 1 hour per day
  • If sedentary then reading or story telling could be other options
  • Recommended 10 to 13 hours of good quality sleep including naps with regular sleep wake times

Systematic review of harm of excess screen time in children

Authors Neza Stiglic and Russell M Viner from the Population, policy and practice research programme, UCL Institute of Child Health, London, UK, recently reviewed evidence that looked at effect of screen time on the development of children. Their paper titled, “Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews,” was published in the British Medical Journal Open this January.

The author duo systematically looked at all the evidence available on possible harm and benefit of screen time on health of young people and children. They gathered information from 6 reviews of other studies. These studies looked at the effects of screen time on body composition, mental health, heart disease risk, phsycial abilities and fitness, pain, asthma and sleep.

Results from collating all the available data shows that increased screen time is associated with more obesity in childhood as well as depression. There is also a strong association of more screen time with intake of more energy dense foods and more sendentary habits that could lead to obesity. There was a weak association between increasing screen time an behavioural problems such as inattention, lack of concentration, hyperactivity, poor well being and self esteem, and poor psychosocial health. There was a weak association between screen time and general fitness, heart disease risk, risk of metabolic syndrome and poor sleep and cognitive development. No association was found between screen time and eating disorders, asthma, pain, suicide ideation and heart disease risk factors.

The authors drew certain conclusions from the reports of over 150,000 participants in the various studies. Their conclusions were;

• Longer screen times are associated with harmful effects to health such as obesity, depressive symptoms and poor quality of life
• No health benefits were noted from screen time exposure
• Small amounts of screen time was not found harmful but no threshold of screen time could be determined from this study
• The authors support the recommendation of reducing and restricting screen time in children and young people
• There is a lack of understanding of impact of screen time such as those associated with social media for the teenagers. More data is necessary to understand the impact of social media and mobile digital device screens on young ones.