Screen time for children: WHO's new approach may do little to curb obesity

while increasing physical activity to combat the global obesity crisis is clearly vital, the WHO guidelines on screen time may not achieve this.

Business Standard : Get children more active. That’s the aim of the World Health Organisation’s new guidelines on physical activity, sedentary behaviour and sleep for children under five years of age. The guidelines make specific recommendations about the amount of sleep, physical activity and screen time children should have each day. For screen time, the guidelines state that children under two years old should get no screen time and children aged two to five should get no more than an hour a day.

While childhood obesity is a global crisis, cuts lives short and has significant economic costs the WHO guidelines on screen time are oversimplified.

The main evidence the WHO guidelines draw on is a 2017 review of evidence looking at the relationship between sedentary behaviour and health in children under the age of five. Of the 96 papers identified in this review, 54 focused on the association between obesity and screen use. Of these, the authors of the report rate all but one as “very low-quality evidence”, using the GRADE framework – a widely used tool for rating medical evidence.

There are two main reasons for the evidence being rated as low quality. First, almost all the studies are observational, meaning they can’t show cause and effect, only associations between screen time and obesity. Second, the findings are not consistent. Of the 54 studies, 25 found no association between screen time and obesity, 13 found that higher amounts of screen time were related to higher levels obesity and 16 found a mixture of results, depending on the type of screen time and obesity measure used.

There are better guidelines

Other guidelines on children’s screen time published by health professionals, such as the UK Royal College of Paediatrics and Child Health (RCPCH) and the American Academy of Pediatrics (AAP), do a better job of reflecting the complexities of the evidence and refrain from making recommendations based on time alone.

The first UK guideline on screen time was published in 2019 by the RCPCH. They aim to help parents make healthy choices for their families, suggesting that parents should consider four key questions: is screen time controlled? Does screen use interfere with what your family wants to do? Does screen use interfere with sleep? And, are you able to control snacking during screen time? This approach of encouraging parents to reflect on the screen time use of their children acknowledges that a one-size-fits-all approach doesn’t support parents.

WHO says maximum one-hour screen time per day for kids under 5: Key points

Infants under 1 year old should not be exposed to electronic screens and that children between the ages of 2 and 4 should not have more than one hour of "sedentary screen time'.

Young children should not spend more than an hour a day watching television and videos or playing computer games and infants less than one year old should not be exposed to electronic screens at all, the World Health Organization (WHO) said on Wednesday.

Limiting, and in some cases eliminating, screen time for children under the age of 5 will result in healthier adults, said WHO, adding that quality sedentary time spent in interactive non-screen-based activities with a caregiver, such as reading, storytelling, singing and puzzles, is very important for child development.

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Taking away iPads and other electronic devices is only part of the solution. Children under 5 should also get more exercise and sleep in order to develop better habits, said WHO. Failure to meet current physical activity recommendations is responsible for more than 5 million deaths globally each year across all age groups.

Physically active and good sleep key for kids under 5

The United Nations agency, issuing its first such guidelines, said under-fives should also be physically active and get adequate sleep to help develop good lifelong habits and prevent obesity and other diseases in later life.

Kids between the age of 1 and 3 should spend 3 hours a day doing physical activity

In its guidelines to member states, the WHO said children between one and four years old should spend at least three hours in a variety of physical activities spread throughout the day.

No screen time for children below the age of 1

Infants under one should interact in floor-based play and avoid all screens, it said.

Being inactive is fueling a rise in the numbers of obese or overweight people worldwide, the WHO said. Excessive weight can lead to premature death from heart disease, diabetes, hypertension and some forms of cancer.

Preventing these deaths needs to start in very early life

One in three adults today are overweight or obese, and one in four adults does not do enough physical activity, she said.

“In this age group of under 5s, it is currently 40 million children around the world (who) are overweight. Of that (figure) 50 percent are in Africa and the southeast Asia region,” Bull said. That translates into 5.9 percent of children globally.

Addicted to digital devices? Focus on how you use tech, not screen time

With increasing attention to the effects of technologies, we should not only be concerned with their potential harms.

Many Americans find themselves bombarded by expert advice to limit their screen time and break their addictions to digital devices – including enforcing and modeling this restraint for the children in their lives. However, over 15 years of closely observing people and talking with them about how they use technological tools, I’ve developed a more nuanced view: Whether a technology helps or hurts someone depends not just on the amount of time they spend with it but on how they use it.

I’ve found many people who have found impressively creative ways to tailor the technologies they have to serve their values and personal objectives, improving their relationships and even their health.

In my forthcoming book, “Left to Our Own Devices,” I introduce readers to people who pushed products beyond their intended purpose, creating their own off-label uses. Some of them turned self-help products, like smart scales and mood apps, into mechanisms for deepening relationships; others used apps like Tinder, designed to spark interpersonal connection, as an emotional pickup – gathering data to feel better about themselves without the hookup. And still others have pieced together different tools and technologies to suit their own needs.

Looking beyond the rules

A few years ago, for instance, my colleagues and I created an app to help people manage stress as part of a health technology research project. Psychotherapy and other mental health services have traditionally been offered as individual treatments, and so we expected people would use our app on their own, when they were alone. We put a great deal of effort into assuring privacy and instructed people who participated in our research that the app was for their use only.

But many of the participants ended up bringing the app into their conversations with others. One woman used it with her son to process a heated argument they had earlier in the day. She sat down with him and together explored the visuals in the app that represented stages of anger. They followed the app’s cognitive therapy cues for thinking about feelings and reactions – their own and each other’s. She shared it with him not as a flashy distraction, but as a bridge to help each understand the other’s perspectives and feelings.

The app was intended to help her change the way she thought about stress, but she also used it to address the source of her stress – making the app more effective by, in a certain sense, misusing it.

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