Just before the COVID-19 pandemic, Dr. Glen Steele, a professor at the Southern College of Optometry in the Pediatric Service, gave a lecture on the negative effects excessive device use can have on children, which include vision impairment, as well as negative impacts on social, psychological, and physical development.
Dr. Steele says he started to become aware of the negative effects when he noticed an increase of patients coming into his office with significantly larger pupillary sizes.
“I used to see maybe one congenitally large pupil a semester,” he says. “Now I’m seeing five or six a day.”
At first, he attributed this issue to the use of prescribed attention-deficit/hyperactivity disorder medications. But he found out that many of his patients weren’t on medications of any kind. “So I started looking at other things, and sometimes things just dawn on you,” he says.
“One day, I happened to go into a room for an exam on a young child, and he was there on his device. And he was playing with it. It took me a minute or two just to get his attention away from the device. When he looked up at me, his pupils were huge.”
He started surveying other parents whose children were exhibiting large pupils, and they all confirmed that their children spent way too much time on their devices. From there, Steele realized that he had to dig deeper into the effects of device use on children.
“The more I looked at that, the more I began to read outside of just eye care and look at a lot of the things that people were seeing with kids who were on devices,” he says. “And one of the things that just shocked me was, there’s an article that shows that increased screen time by 24 months of age shows poor responses on developmental screening tests at 36 months of age.”
Steele says that these responses can include reductions in fine motor skills, vocabulary and communication skills, eye contact, decision making, and cognitive control, as well as an increase in ADHD symptoms.
The good news for families isolated in their homes during the pandemic is that children don’t need to cut out screen time completely. Rather, they should follow a few guidelines and tips to maintain children’s health and growth.
“We can’t take them away, because our future is going to be based on that,” he says. “So my goal in working with parents and patients is to try to get them to understand the importance of taking a break.”
Steele recommends that children take breaks from their screen every few minutes, preferably every five minutes for toddlers and preschoolers and every 10 minutes for older children. To do this, he suggests using a timer or a screen time monitoring app like Zift, Screen Time, or Qustodio.
“They don’t even have to get up and move around,” he says. “Even just looking up and looking around will break that intense use of the device.”
During breaks, Steele recommends that parents check the size of their child’s pupils. “The larger they are, the more often and more consistently parents need to reinforce [taking a break],” he says.
Steele also recommends ways of handling devices so that children aren’t looking too close at the screen, which can cause problems with depth perception, headaches, eye discomfort, and possibly even myopia (nearsightedness). “So many kids bring them up so very close, but the hand that is holding the device needs to be in their lap,” he says.
Steele references guidelines written in the World Health Organization’s 2019 “Physical activity, sedentary behavior and sleep for children under 5 years of age,” which states that children should not be introduced to sedentary screen time until they are 2 years old and that children ages 2-4 should not receive more than one hour of screen time a day.
“Kids are not moving, and the kids are on their devices, and the younger they start on the device, the greater the potential for long-term complications and consequences,” he says.
Steele recommends plenty of movement and play wherever and whenever possible — while keeping a safe distance during this time — including running, throwing, and catching. He also suggests searching online for screen-free activities and games kids and families can play.
Steele emphasizes that, while he’s certainly not suggesting taking screen time out of children’s lives, he wants to bring awareness and provide guidelines to parents so they know how to best mitigate the risks of overexposure.
“On the one hand, we need to embrace, but on the other hand, we need to use caution,” he says. “We’re in a stage where we don’t know how they’re going to evolve over time. It is so widespread and there are so many different professions that are reporting on the consequences out there. So I want to be proactive and give guidelines and support for parents to be able to help their kids.”