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December 2, 2019

Digital Media Use in Children: Clinical vs Scientific Responsibilities

Author Affiliations
  • 1Centre for Mental Health Research and Treatment, Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  • 2Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
  • 3Department of Psychology, University of Calgary, Calgary, Alberta, Canada
  • 4Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
JAMA Pediatr. 2020;174(2):111-112. doi:10.1001/jamapediatrics.2019.4559

In the wake of the dramatic shifts in the landscape of digital media, there has been an uptick in research examining its putative consequences. In the public arena, the implications of this research have often been presented as consequential or trivial. Those who argue that there are consequential links between child “screen use” (ie, television, device or application use, and/or gaming) and delays or deficits in child developmental health (ie, physical, socioemotional, or cognitive)1,2 support the need for screen use guidelines to help moderate its use in children. Conversely, some researchers have argued that the magnitude of the associations is trivial3 and call for no limits on screen use. As is often the case in public discourse, these respective camps have become polarized and a moderate stance is lacking. That is, digital media is a remarkable and exciting tool for human advancement, but like many good things, it can also be problematic or harmful when used in certain ways.

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    1 Comment for this article
    Finally, a balanced viewpoint that takes primary care clinicians into account. Thank you!
    Rebecca Soskin, MD, FAAP, IBCLC | Mosaic Medical, Bend, OR
    I am very appreciative of the ideas brought forward in this Viewpoint. Over the past 10 years of practice, it has become increasingly clear to me that excessive screen time for individual children and youth quite often has significant detrimental effects on their development and well being. Through direct impacts on neurobiology of young children, displacement of activities that are more important to healthy development, and other mechanisms like FOMO, reinforcing spirals, and cyberbullying, excessive screen time is impacting individual children and teens that I see in clinical practice on a daily basis.

    But the broad sweeping
    messaging about the unimportance of screen time limits for kids by both researchers and popular media alike, are actively misleading and inhibit progress towards helping families find a healthy balance.

    I take pride in practicing evidence based medicine, and I follow and review the literature that is published on this topic closely. In this time, when research scientists focused on this area are so contradictory, it is important for clinicians like myself to remember what evidence based medicine is and more importantly, what it isn't.

    Evidence based medicine means integrating individual clinical expertise with the best available external evidence from scientific research. It means taking both your proficiency and judgment gained over years of clinical practice together with evidence from research studies to decide whether that evidence is applicable or appropriate to apply to and inform care for your individual patient. External evidence can inform, but should never replace clinical expertise.

    But when research scientists publish their analysis of data weighing heavily on a statistic that is of questionable significance to clinicians and then interpret their findings to say that screen time limits are not important for children and teens, they are really overstepping their bounds. Evidence based medicine does not exist when clinical expertise and individualized decision making is left out of the picture.

    Constant access to smartphones and tablet devices poses a significant risk to the health and well being of children and teens that I take care of. This risk should not be prematurely dismissed based on a research scientists controversy over how to measure and analyze data. A thorough answer to this controversy that is accepted by both clinicians and research scientists is likely quite far off in the future. Offering parenting advice based solely on these conflicting reports is dangerously short sighted.

    When I counsel families, I aim to help their children lead balanced lives which benefit from screen media but leave ample room to engage in non screen experiences. I emphasize the importance of relationships, face to face interactions, time spent in nature and in movement and with imagination. I ask parents to keep in mind that there is some room in everyone’s day for activities that bring us just short term pleasure, but most of our day should be spent in activities that bring us closer to long term health.

    It doesn’t take a medical degree to understand that giving kids and teens unlimited access to entertainment screen media without limits is a bad idea. We don’t need to look to scientific studies to answer most of the questions that parents have about screen media experiences. As one of my medical professors at Stanford once told me "evidence based medicine is intended to enhance our knowledge from experience, intuition and common sense...it is not intended to replace those things."