Kids and Screen Time with Dr. Noah Schwartz

Podcast Transcript

Speaker 1: There's so much health advice out there. Lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough intimate health question. So you get the answers you need. This is the Health Essentials Podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Annie Zaleski: Hello, and thank you for joining us for this episode of the Health Essentials Podcast. I'm your host, Annie Zaleski. And today we're talking with pediatrician, Noah Schwartz about kids and screen time. From a very young age, your kids have probably begged to play with your phone or tablet or watched their favorite movies on TV. As they grow older, maybe they've received devices their own or started playing online games with friends. During the pandemic, many students also started attending virtual school on their computer. Unsurprisingly, all this activity adds up to a lot of screen time. Dr. Schwartz is here to discuss whether screen time is bad for kids, how much screen time kids should be having and how and when to introduce screen time limits. Dr. Schwartz, thank you so much for being here.

Noah Schwartz: It's a pleasure.

Annie Zaleski: So first off, tell everyone, what is your role at the Cleveland Clinic?

Noah Schwartz: So I'm a general pediatrician. I see kids from the first newborn visit all the way to late adolescent/early adulthood for well visits, sick visits and everything in between.

Annie Zaleski: Excellent. Very nice. So today we're talking about screen time, so let's start off by what is considered screen time.

Noah Schwartz: So anything with a screen is screen time. I mean, that includes your TV. That includes your phone, the tablet, the computer. There's no specific thing that is included in screen time or isn't, and it's just about a child or anybody, even an adult, just looking at screen time. What we're doing right now technically is screen time.

Annie Zaleski: Wow. So there are all those different types then, but when you're measuring screen time, is watching TV the same as chatting, like what we're doing right now, or is it the same as playing a game on a laptop? In other words, all forms of screen time created equal?

Noah Schwartz: So yes and no. I mean, for the most part they're not. And the studies have been pretty clear, video chatting, meetings, interacting with people via screens is very different than just sort of sitting and watching something. So talking to grandparents on FaceTime or doing something else, like a meeting or school on Zoom is totally different than watching TV, playing video games or doing some sort of app on your phone, very different.

Annie Zaleski: That goes right into my next question then. How does kids playing or chatting online kind of fit into screen time then? Why is it so different?

Noah Schwartz: Well especially with younger kids, they need back and forth interaction. Little kids under the age of two, really don't get a lot of benefit from screen time just watching TV because at that stage in their life, from a developmental standpoint, it's all about watching their environment, learning, understanding, hearing things back towards them once they get when they do something, hearing someone repeat back to them. And so looking for that responsive, emotional connection. It’ not really there when you're watching a TV show or playing a video game necessarily.

Annie Zaleski: That's really interesting. If you're getting that interaction, if they're that young through video chatting, does that actually happen then? Or does it need to be in person?

Noah Schwartz: So, obviously in person, face to face when you can play off of someone's subtle cues is totally better than doing things over a video. But in today's world, even before the pandemic people are spread out in all sorts of places. They're away from family. And so having that ability to connect, even if it's not physical or in person is still super important and it can be helpful. I mean, and better than just mindlessly watching something.

Annie Zaleski: So I think what you described there is why, especially during the pandemic in the last couple years, kids have been on devices more. So does group virtual-play, like maybe with games, fall under kind of the same category as screen time?

Noah Schwartz: I mean, it's all screen time, but not all screen times are created equal like we said before, and so certainly it's better than nothing. And in the beginning of the pandemic, when there was no school and everything was closed, for the kids to have those interactions online, to look at and see their friends to talk to people is clearly beneficial, and it's better than nothing. I know that there have been a lot of studies even in adults that have been done over the pandemic that have shown that people's loneliness was a lot better too, because over the pandemic, we were all connected. And so you weren't just sitting at home alone, but you were able to sort of talk to people. And if anything, we were more eager to connect to other people online and it did help with making people feel a little more happy, making people feel less lonely in the adult population. And it makes sense that that would apply to kids too, especially if they're away from their peers and not in school all the time.

Annie Zaleski: Well, I think just kind of having that connection and maybe not being as lonely is one reason why kids gravitate towards screen time. What are some other reasons why kids really enjoy that so much?

Noah Schwartz: The same reason why we enjoy it. It's addictive. It's designed to stimulate you and to draw you in and to keep you watching because I mean, that's ultimately how that system works is the more views that they get, the more revenue is generated. And so screen time when you're talking about TV, video games and apps is designed to keep you in. And so for kids, I mean, it's flashy, it's bright, it's colorful, it's the music and the sounds that they love. And so why wouldn't they want to watch it?

Annie Zaleski: Yeah, absolutely. Yeah. So when kids are having the screen time, does that have a physical impact on kids?

Noah Schwartz: I think it can have a physical impact in a lot of different ways. I mean, certainly if kids are watching screen time for a long time, they'll be more sedentary. They won't be moving as much, so less physical activity and exercise. We know that screen time affects sleep in a big way. There's been a lot of studies showing that screen time can affect children's academics. Depending on how deep you go, there's a lot of different areas where screen time can really affect kids physically and emotionally as well.

Annie Zaleski: Well, that's what I was going to ask, what are kind of the emotional and even mental health aspects on screen time on kids?

Noah Schwartz: Yeah. So there have been a lot of studies connecting higher rates of screen time to decrease mood in teenagers. In little kids, like we talked about developmentally when you think about their emotional ability, they can't really communicate well, they can't tell you what they want and what they don't want. And so screen time doesn't teach them those cues of how to communicate, because they're just watching something. They're not watching how you react to “how does my parent react when I do this? How does my caregiver react when this happens?” and they miss that. And I think that affects their emotion intelligence and how they learn to adapt in a changing world.

Annie Zaleski: Wow. Have doctors put together kind of recommended screen time limits for kids of varying ages? What's the prevailing wisdom at the moment about that?

Noah Schwartz: Yeah, so the American Academy of Pediatrics recommends minimal to no screen time in children under the age of 18 months. Kids between 18 and 24 months, it's really minimal. And if you do watch it, it should be age appropriate and something that you do with them as you go up the allowance, so to speak gets a little bit more. So kids two to five, it's maybe less than an hour, but the important thing that sort of travels through their recommendations is that the screen time is always age appropriate. As involved as you can be when you're watching it and explaining it to them or talking about it with them is the biggest thing. And then as you get closer to your younger kids to your adolescence, it's all about sort of preemptively setting boundaries and setting limits so that screen time is not the thing that they do all day and every day.

Annie Zaleski: Well, that's something we're definitely going to get into later because that's very familiar to a lot of parents, especially in the last couple years.

Noah Schwartz: Yeah. Absolutely.

Annie Zaleski: So are there signs that if your child is having too much screen time? How can you tell if there is just too much computer time, or maybe too much TV time?

Noah Schwartz: Yeah. Not always, right? It's not like every kid that watches a lot of screen time has some specific symptom. I think one thing that parents need to do is sometimes if you're thinking about the problem, take a step back and say, "OK, let me think about how many hours a day my child watches TV." And if you realize, "Wow, that's a lot," that's a first step. Certainly like we said before, excessive screen time can have other effects on kids. So there's been studies showing it has decreased cognitive function, decreased attention, changes their energy. They're just glued to the screen all the time. I think it's just things that you see. Some kids do complain. We see kids complaining of headaches or other physical complaints and then we talk to them in the office, it's like, "Yeah, you're spending 50% of your day on a screen. Whether it's your phone or TV or computer, that might be part of the problem." But I wouldn't say that there's one specific symptom that would stick out for each child.

Annie Zaleski: I'm glad you mentioned headaches, because I think that's one of the things that comes up. Can dizziness and even seizures also be symptoms of potentially too much screen time?

Noah Schwartz: I'm not so sure about seizures or dizziness. I think headaches makes a lot of sense. There's been a lot of talk about blue light and how that affects vision and things like that. And just giving your eyes a rest is really important. And just that strain of staring at something, whether you're too close to it or not, I think can certainly make you not feel great. And it probably not moving a lot too, if you're not active as much not going outside, getting enough sunlight will make you not feel good as well. And so that can kind of tie into this.

Annie Zaleski: So a lot of it is just all interrelated then it's kind of a snowball effect in a sense.

Noah Schwartz: Yeah. Yeah. And I think one of the biggest areas, especially with kids that we've seen screen time affect them is with sleep. Sleep is so important to growing children, but like we said before, screens are constant stimulation. And so there's been a lot of good studies about how screen time close to bed really affects kids. It stimulates you. And so when you're in bed watching your phone or looking at videos, your brain is chugging along processing all that stimulation. And it wants to keep going and these things are designed to nonstop. When you watch YouTube, it just rolls right to the next video. And so we find that some kids are just locked into their phone for hours, even though they're in their bed and that also affects their sleep hygiene because then your brain associates your bed with phone and screen time. And every time you sit in your bed, your brain's like, "Where's my phone? Let's go, let's get it out." And I mean it happens. It's really hard to break that habit as well.

Annie Zaleski: I think a lot of adults will find that scenario very familiar as well. I know that that's a very common thing that adults also mention.

Noah Schwartz: Yeah. And there's been some studies about how blue light can affect your body's circadian rhythm that sort of helps you control when your body gets sleepy and your melatonin release. I heard about an interesting study that came out recently that checked in adults that sort of monitored people with exposed to light when they went to sleep and people that went to sleep in a dark room or people that had the light on all night and people that slept with the light on had a harder time controlling their blood sugars the next day. I know there's a lot of variables and I can't say what caused what, but certainly there's a lot of research going into that. How strongly does it affect when you have lights on in the room, when the screen's on, what that really does to your body from a health standpoint? And I think that's a very important area especially for kids.

Annie Zaleski: Does having that excess screen time affect kids differently depending on their age, like would an older child maybe have different symptoms or be more affected than a younger child or vice versa?

Noah Schwartz: Yeah. So I mean, and it's all about development, right? So younger children, like we said before, they can't communicate. And so if they're having trouble, if they're having a hard time expressing themselves, that might lead to more tantruming. Sometimes when you try to take away this screen time in younger kids, they're getting more upset because they can't tell you what it is they want. And they get frustrated about that. And older kids we've certainly seen more depression and things like that. In the last few months, there was that story of the information leak from Instagram about how they had information knowing that their product was negatively affecting especially teenage girls. So we know that screen time can be very harmful, but it can be also very beneficial. And so it's really all about finding a balance and working with each kid to sort of make sure we address their needs specifically.

Annie Zaleski: Well, like we kind of mentioned before, during the pandemic kids may have increased screen time because they've been doing virtual schooling and then staying home. Should parents have extra concerns about how much more screen time their kids have been getting overall?

Noah Schwartz: Yeah. I mean, so it depends. I mean, if kids are doing virtual school, what choice do you have? I mean, it's important. We got to educate our kids. But then that increases the importance to sort of provide them with unplugged activities to sort of offset that increased screen time because that, I mean, that's intensive, that's learning and that's discussions. They still may need a little bit of that just sort of watching TV, taking a break kind of thing, but all the more so, they need more time off perhaps.

Annie Zaleski: And that makes sense, because school can be also very intense and you're trying to pay attention to something and learn. And that's a very different thing than maybe you're hanging out with your friends or you both are playing video games across your camera.

Noah Schwartz: Right. Yeah. Absolutely. Yeah.

Annie Zaleski: So when kids are online playing games, is it better if they're also kind of communicating maybe with voice or text back and forth, is it better than maybe if they're just kind of hanging out gaming alone?

Noah Schwartz: I think so. I think there was a study that came out in the pandemic that showed that increased virtual interactions was associated with better mental health and like we said before, less loneliness. And so the more connected that you can be when you're doing any of this stuff I think is better, no matter what.

Annie Zaleski: That makes a lot of sense, and why I think a lot of parents turn to virtual play when maybe kids couldn't get together in person. So you could still get a little bit of that benefit seeing your friends and hanging out, but yet it's just a little bit different.

Noah Schwartz: Yeah. It's hard. I mean, having done a lot of this with my own kids, like they were definitely excited to jump on their Zoom class meetings, but at the same time, I mean, you miss all that personal stuff, engaging, sharing, playing with other kids, touching things, the subtle social cues are, I think are what's really missing, but certainly these virtual connections are better than no connection at all. And I think that's, hands down, the way it has to be.

Annie Zaleski: And I think that's a good way of looking at it. It's kind of it's on a continuum. Absolutely.

Noah Schwartz: Yeah.

Annie Zaleski: So you mentioned limits earlier in our conversation. I think that's probably one of the biggest concerns parents have, how do you know it's time to talk with your child to cut down on their screen time?

Noah Schwartz: Yeah. So similar to like we said before, I think if you take a step back and sort of think about how much time your kid or your whole family, or even yourself are spending watching TV or on your screen, and then sort of trying to start from that point is the way to go. Certainly if there's problematic issues like issues at school or things like that and then it becomes like, "Yeah, they're on their computer all the time. And that's why they're not doing their homework," or whatever the reason is, that's your starting point. I mean, typically it starts from day one when the kids are babies, but a lot of times we're jumping into this in the middle and we're trying to sort of navigate our way out of it.

Annie Zaleski: So what are some best practices or effective things that parents can do to help their kids limit or cut down on screen time?

Noah Schwartz: Yeah. So I think first and foremost, it's lead by example, if your kids see you on your phone, then they're going to be on their phone. If you're at the dinner table and you're scrolling through and you're looking at stuff, they're watching you, kids are sponges and they're absorbing their environment. And so they follow what they see. And so if in the house everyone's on the phone and the TV's on and things like that, that's all that they're going to know. So starting with your own practices, I think is a great way to begin. A lot of the recommendations, especially from the American Academy of Pediatrics and try to recommend co-watching, so as much as possible being a part of your child's screen time. So especially when you have little kids around the age of two being involved, talking to them, explaining things to them, trying to watch certain shows with them so that you can teach and things like that is the way to go.

And even as a teenager, when your kids are bigger, watching as a family and making it more of a family-time thing, I think is a great strategy. Having designated no screen time, we don't have screen time at the dinner table. We don't have screen time for X period of time in the day. I would recommend definitely no screen time at least an hour before bed for all the reasons like we said before and then either maybe having no screen zones and sticking to the limits. Kids will test you, adults will test you too, but if you're going to set a boundary, you better hold that boundary pretty firmly.

Annie Zaleski: Gosh. And that's all such great advice, but as we all know that even the best laid plans, kids will test those and kids will be very even sneaky sometimes and try to get their phone.

Noah Schwartz: Yeah.

Annie Zaleski: What can parents do when they're dealing with maybe some kids who are really resistant to cutting down on screen time or bending or breaking no screen time rules households might have?

Noah Schwartz: Yeah. It's hard. I mean, consistency is the only thing you can do. And this happens with anything with children, I mean, if they realize that they do X behavior and they get this result, they will continue to do that. And so every once in a while, and nothing's going to be perfect and you're going to have days where you need to do something and the rules will be broken, but I think just sticking to it, being consistent, being firm. If it means taking their phones physically away, hiding them, doing something like that, I think it's important, especially when it comes to sleep and academics and making sure your kids are getting enough exercise and getting outside.

Annie Zaleski: And parents have to do that. And kids will even do things they'll maybe even swap out phones, and so it is especially nowadays, it's definitely is a challenge for a lot of parents.

Noah Schwartz: Yeah, absolutely. They're pretty crafty.

Annie Zaleski: So what can parents say to help make kids understand why maybe cutting down on screen time is important?

Noah Schwartz: Yeah, that's a tough one. I mean, I think having a conversation with your child in an age-appropriate manner is one way to do it. Trying to explain to them why you're doing what you're doing, that you're doing it as a family is one way to do it. I believe that the AP, the American Academy of Pediatrics has online resources for families. So there's like a whole form that you can sort of create with your family. Instead of doing screen time, we will do this and we get to do screen time at this time. And sort of just trying to be honest with them about why you're doing it and how you're going to do it, but trying to make them a partner in the decision, I think is going to be the most effective way.

Annie Zaleski: And I like that then, because if you're reducing screen time, you can say, "Look, this is not a punishment. We're all trying to be healthier. We're all trying to be better."

Noah Schwartz: Yeah. And there's a lot of things that I think parents can do, even if your kids are going to have screen time to make sure that that's positive screen time too.

Annie Zaleski: And I think that's really important, because if kids are maybe on social media, there might be some bullying going on, and maybe they're feeling bad about themselves.

Noah Schwartz: Yeah. And I think especially with your older kids, adolescents, teenagers, and honestly, starting from a young age is not a bad idea to discuss with your kids what appropriate behavior on screen time is. What does it mean when you read something online? Whose opinion is that? Where does it come from? Learning to just sort of understand the sources of things on the internet. They need to understand that cyber bullying exists. Talking to your kid about that, talking to your children about sexting and sharing inappropriate things online is important too. What you think you're sharing with your friend may get shared with everybody. And so you don't share things on the internet that you don't want other people to see.

And even with a lot of these online chats and a lot of these games that kids are playing, you don't necessarily know who you're talking to. And so it's important for parents to have those conversations with their kids, to let their kids know that they can come to them if they encounter inappropriate behavior or if there's something they're not comfortable with, or that seems dangerous is happening online. We need that open area of communication so we can stop that.

Annie Zaleski: And on the same token kids also need to understand if you say something that could be forever. Everything on the internet lives forever. So if you're mean to someone that'll get around at school. It's very complicated. It's much more complicated today.

Noah Schwartz: Yeah. And so that's why I think starting encouraging healthy online behavior, even in a young age is so important. So having these conversations, setting these limits, teaching your children how to effectively use the internet in a healthy manner starts from the beginning, or as soon as you can to really just make sure that they're being safe.

Annie Zaleski: And I like that it goes hand in hand with screen time too. It's not like it's a separate thing. Internet safety and screen time are kind of one and the same.

Noah Schwartz: Yeah. Absolutely. Yeah. I mean, the internet is growing every day. It's hard as a parent, it's hard as a doctor. I think even the people on the internet are having a hard time sort of keeping up with things. And so it's our job to just try and make sure that we're walking through it with our kids at the same time.

Annie Zaleski: So if you work on decreasing screen time, do kids bounce back? How soon might you see an improvement after limiting screen time?

Noah Schwartz: Each kid's different. I think you'll see eventually (assuming there are no other issues) grades are coming up, they're feeling happier, we're getting outside. We're moving more, maybe we're doing things as a family, we're being more social. So those things will come, you'll notice them, but they might take time. And certainly there's going to be a lot of adjustment, especially in the beginning when we first make a shift away from constant screen time to maybe more limited.

Annie Zaleski: And I like that because every child is different. So how you’re acting, you're bouncing back from screen time may look different than someone else's child bouncing back from screen time.

Noah Schwartz: Yeah, absolutely.

Annie Zaleski: So when parents ask you is screen time bad for kids, what is your typical answer?

Noah Schwartz: Just like the answer to most things. It depends. Inherently, no, but too much of anything is usually not good. Like we said before, not all types of screen time are created equal. Social interactions, talking to family members or friends over the phone or on FaceTime or video chatting, it's totally different than just watching TV or playing video games or doing apps on your phone.

Annie Zaleski: So is there anything else you want to add then? Are there any aspects of screen time we haven't covered that you feel are important to mention?

Noah Schwartz: I think we covered a lot of things. Some other important areas that are important to just sort of remember background TV is a big one that I hear about a lot. The kids playing and the TV's on, but they're not watching it, but it's still on and they still know it's on. And so they're growing up in an environment where there's a TV on constantly and that's going to have an effect on their approach to screen time because, "It's always TV time." And so if a kid is not watching the TV, don't leave it on. I think that's an important thing. I think there's a lot of things that parents can do to sort of pick the screen time that their kids are watching. Before you download an app, look at what the app is. Before you let them watch a movie or a TV show, look at what it is, make sure that if you have parental controls enabled, that's a good thing to have, disabling the auto play for the next video so that it's not a constant cycle of videos is important.

There's a lot of resources online that can help families choose appropriate screen time. There's something called Common Sense Media, which is a website that parents can look at that rates apps and videos and TV shows and things like that they can go to. And so it's all about just trying to sort of stay a little bit ahead of the game, preview things, understand and talk to your kids and be honest about what they're watching and what's going on.

Annie Zaleski: And I think that's such an important point. What's nice is that their parents do have control over a lot of these things more than maybe they think sometimes.

Noah Schwartz: Yeah. And even if your kids are watching TV or watching a show, talk to them about it, "What did you watch? What happened? What are the things that happened in that show?" Or trying to pick especially for the younger kids, picking more educational based shows is really important. Things like Sesame Street or Daniel Tiger are shows that are meant to sort of engage kids in that sort of five-ish plus or minus year range that are designed to be educational, but also like trying to talk to the kids through the TV. And so you have a lot of control when it comes to screen time, especially with the younger kids. And I think that should not be overlooked.

Annie Zaleski: And that goes back to so much screen time is not created equal. Kids watching Sesame Street or PBS is much different than coming across a movie and they just happen to put it on and you don't know even what it is.

Noah Schwartz: Yeah. And there's some excellent quality programs out there for kids. And so it's important to start with those. And so lead with that example so that kids are engaged and at least they're not watching something that might be harmful for them or something scary.

Annie Zaleski: Are there any other questions that you tend to get from parents about screen time that you want to mention or misconceptions you want to clear up?

Noah Schwartz: I mean, I see a lot of patients that come to me with concerns that their kids are watching too much screen time. Oftentimes the area gets to, especially with the teenagers, is related to sleep and how it affects their school performance and what we can do to sort of cut down on that. And that's sort of something that has to be done on an individual basis with your doctor to sort of understand: what are the other factors. A lot of times it's me observing the families because a lot of people bring the screens everywhere with them and they're in the room. And so when you come to your doctor for their visit, it's often a nice time for us to sort of see a snapshot of maybe how screens are utilized outside of our office. And so that's really beneficial. Sometimes the conversation starts from my end more than the parents' end.

Annie Zaleski: And that's really interesting. And I think it can be kind of a collaborative process and that you guys, you pediatricians are there to really kind of help families with these things.

Noah Schwartz: Yeah. And it's a great time for us to sort of demonstrate some methods on how to use screen time. I know a lot of people when they're in the office and the kids are getting rowdy, use the screen time to help focus the kids and quiet them down and keep them calm. When in reality, it's more about maybe talking to your kid and letting them learn how to adjust in such a situation. If every time your kid gets frustrated or they're having a hard time, or they're bored and they start acting out and you give them the phone, that's all they're going to know how to do. But if we start to give them tools and teach them how to behave and how to adjust in those situations, I think that's far more valuable for them.

Annie Zaleski: And that also goes back to really starting early and kind of being very mindful about your actions and being very mindful about how you react to things.

Noah Schwartz: Yeah, absolutely starts from day one.

Annie Zaleski: Well, wonderful. Well, Dr. Schwartz, thank you so much for being here today. This has been really, really interesting, and I think this will help a lot of people.

Noah Schwartz: Yeah. This was fun. It was a pleasure to do.

Annie Zaleski: To learn more, visit clevelandclinicchildrens.org.

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