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Toddler screen time
Nolan Young, 3, front, looks at a smart phone while his brother Jameson, right, 4, looks at a smart tablet at their home, in Boston. Credit: AP Photo/Steven Senne

NEW YORK — In an episode of ABC’s popular sitcom Modern Family, Gloria, the fiery Colombian trophy wife, is fumbling with a smart phone while shouting at her husband, Jay. “I thought your phone was stolen,” he snaps. She says the phone actually belongs to Joe – their infant son.

There’s no question that American families are attached to their mobile devices. At least 75 percent of households with children under eight own one. Two years ago, the figure was 25 percent. These new electronic babysitters are hip and highly portable, making it easy to rely on them. But what effect does this exposure to digital screens have on children’s health?

Parents are in a bind today because they have don’t have answers to that question, and the places they would traditionally turn to for help don’t have them, either. The American Academy of Pediatrics (AAP) advises against any screen time at all for children under two – but that policy was written in 1999, and hasn’t been revised since. The first-generation iPad came out in 2010.

Some doctors say that the AAP’s continued push for total screen-media abstinence is not only misguided, but counterproductive, given the widespread use of smartphones, tablets and other devices by children today. Even respected preschool programs are letting toddlers play with tablets and phones, using educational apps. In part because of the possible educational uses of these devices, the AAP in 2013 changed its recommended limit on screen time for older children to specify that the limit (two hours daily) applied to “entertainment screen media.”

While the subject is only beginning to be adequately researched, the debate about what the effects of these devices might be on the health of young children offers some valuable insights.

“We need to recognize that screens are vectors of education or harm, and then be more directed and thoughtful about their usage,” said Dr. Michael Rich, a pediatrician and associate professor of pediatrics at Harvard Medical School. “Unfortunately, we often use screens as pacifiers and distracters rather than tools.”

“Unfortunately, we often use screens as pacifiers and distracters rather than tools.”

Dr. Dimitri Christakis, a pediatrician and director of the Center for Child Health, Behavior & Development (CHBD) at Seattle Children’s Hospital, believes the focus should be on content, not on the type of device.

“To be sure, an iPad or other interactive device can function as nothing more than a video screen, in which case the data acquired from research on televisions surely applies,” he wrote in the Journal of American Medicine. “But if it is being used in the context of one of the thousands of interactive applications currently designed for children, there are significant theoretical and practical differences that warrant consideration.”

The pediatrician who wrote the 1999 AAP policy acknowledges the criticism of the ban as outmoded. “As a society,” Dr. Victor Strasburger said, “we’re clearly hooked on media.”

He supports the Academy’s position that, while electronic media by itself is not the leading cause of any health problem, it can contribute to numerous health risks. The key to mitigating those risks is to set the rules early. “If you start regulating media consumption from the get-go,” he said, “it pays off year after year as children get older.”

Related: Glued to the screen: A third grade class where kids spend 75% of the day on iPads

The AAP does differentiate between using media for meaningful connection and for banal entertainment. “We’re not talking about active interaction with family via media,” Dr. Strasburger said.

Still, in the years since those television recommendations were written, he said, “there have been a dozen studies showing a risk of language delays when babies under two are exposed to screens” instead of engaged in human interaction, he said, and the Academy will not change its position until it sees proof of the educational or developmental benefits of media use by children younger than two.

“If you start regulating media consumption from the get-go, it pays off year after year as children get older.”

Long-term studies on media use by children are complicated due to cost, the constant development of new technology and various ethical concerns with experiments involving children. Most of the research available is about television exposure. Drs. Rich and Christakis are working to find ways to measure the use of new technologies and the outcomes. Clinical studies are underway, but it will be years before the most of the results are known.

In part because of what he calls the AAP’s “strategic errors” in advising the public, Dr. Rich helped establish the Center on Media and Child Health (CMCH), an academic research center at Boston Children’s Hospital, to provide another resource for parents.

Dr. Rich said there is some evidence that too much screen time may have harmful side effects on early brain development. Kids can have a harder time paying attention at ages seven through nine if they’ve had a lot of screen exposure in the years before, studies suggest.

“If a child is given media which offers easy gratification,” he said, “he or she could have trouble reading Moby Dick when they get older, because they haven’t developed the skills to sit, read and process that kind of material. It’s about practice.”

Related: Teaching pre-schoolers to use computers – along with their parents

Dr. Christakis claims one of the biggest problems with mobile devices is that they can be habit-forming. The addiction comes from the actual mechanics of operating mobile devices, not just from the content displayed on them.

“The delight a child gets from touching a screen and making something happen is both edifying and potentially addictive,” he wrote last year in the Journal of American Medicine. “In much the same way as we have seen the emergence of problematic Internet use in older children and adolescents, we may now begin to see compulsive use of iPads among our youngest patients.”

Technology leaders seem to be ahead of doctors in recognizing the side effects of technology use. In May, The Guardian interviewed a number of tech leaders about how much screen time they allow their own children. Some executives acknowledged that while apps and social media sites may not be advertising Fruit Loops or Big Macs, they are still commercial products, intended to promote habitual use. Executive after executive said that they limit their own children’s use of devices because they’re designed to be addictive.

“In the late 90s, when I was working at Intel and my first child was born, we had what was called the ‘war of the eyeballs,’ ” said Pierre Laurent, a former Microsoft and Intel marketing manager, currently working on a Silicon Valley startup. Companies “don’t want you to wander and start playing with another product, so it has a hooking effect,” he said. “It looks like it’s soothing your child and keeping them busy so you can do something else, but that effect is not very good for small children.”

Laurent has three children, and he set 12 as the age when he let them start interacting with computers and smartphones. “It stops them discovering the world with their senses, and there’s a risk to attention,” he said. “It’s not scientifically proven yet, but there’s an idea that attention is like a muscle that we build. It’s about being able to tune out all the distraction and focus on one thing. When you engage with these devices, you don’t build that capacity. It’s computer-aided attention; you’re not learning to do it.”

Ryan Swigart, a web designer at Vine, has an infant son. “Technology enhances your ability to do all kinds of good things, but also passively to absorb stimulation,” he said. “When you’re young, especially, learning happens better when you’re physically active: not only because it gets the blood flowing, but also because you’re using all your senses, which helps you remember things.”

Sleep is another concern. A number of studies show that when kids have cell phones in their bedrooms, they sleep less well and less long. “Lack of sleep,” said Dr. Rich, “produces an inability to move information from short-term memory centers into learning centers, since this is done only during stage four deep-REM sleep.”

Related: Doctors offer a prescription for early literacy

Bright screens have an alerting affect that can throw off circadian rhythm. In a study for the Lighting Research Center at Rensselaer Polytechnic Institute,

“In much the same way as we have seen the emergence of problematic Internet use in older children and adolescents, we may now begin to see compulsive use of iPads among our youngest patients.”

Dr. Mariana Figueiro found that “self-luminous devices, such as computers, tablets and cell phones, emit short-wavelength (blue) light, which maximally suppresses melatonin,” the hormone that signals darkness and sleep to the body.

A 2013 study conducted by CMCH looks at the association between body mass index (BMI) in young adolescents and screen media use. It breaks the data down by screen type, duration of use and attention paid to the medium. The study found that “the more participants paid primary attention to television, the higher their BMI.” (In part it blamed commercials for “nutritionally questionable foods and/or eating while distracted by TV.”) By contrast, using computers or playing video games for a long time, either with full attention or while doing other things, were not associated with increased BMI.

Pediatricians, parents, educators and technology executives are all grappling with questions about the health effects of mobile devices. Too much screen exposure might lead to speech or memory impairments, problems concentrating, inability to self-regulate, addictive behavior or sleep difficulties. But we don’t know for sure.

Even experts who write about health for the general public give parents conflicting advice. Some say, flat out, “heavy use of electronic media can have significant negative effects on children’s behavior, health and school performance” (Jane E. Brody, The New York Times). Others argue that it depends on the type of screen and the type of content: “To judge what impact TV has on children, we have to think about tradeoffs — what would kids be doing with their time if they weren’t watching” a screen? (Emily Oster,

Rather than worrying about unknown risks, leading researchers and pediatricians say, the priority should be placed on paying attention to behavior. “We learn from technology, but we need to be aware of what we’re learning,” said Dr. Rich. He recommends discussing technology consumption with your family much as you would nutrition and health. We know, for example, the difference between giving your child a salad and a Big Mac. “We have to be more aware and nuanced.”

This story was written for The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Read more about Blended Learning.

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