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Folded into the goals of making American children healthy again is the realization that even preschoolers are spending hours each day in front of screens in one form or another – hours that could be spent in active play that could ultimately reinforce a healthier lifestyle.

“Our children get one childhood, and we cannot allow screens to replace the real-world experiences they need to grow and thrive,” said Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. as his agency last week convened health, technology, and education leaders at a “Live Real Life” Symposium to address the harms of screen use in children.

Kennedy added that the Surgeon General office’s “Live Real Life” initiative is helping to give families “practical tools to put technology in its proper place and get children back to playing, exploring, connecting, and experiencing the world around them.”

The symposium expanded on the Surgeon General’s advisory and toolkit on the “harms of screen use.”

The nation has grown accustomed to harmful screen use among young children and adolescents – even as it has become “a public health concern.”

In the advisory – which Kennedy describes in his opening letter as “evidence-based, but also forward-looking and action oriented” – he asserts that, [w]hile screen use can have some benefits, the evidence of a range of risks to children’s overall mental and physical health is mounting.”

“Social media is only one aspect of this ongoing screen time problem,” the secretary details. “Behavior patterns involving gaming, online gambling, and other forms of virtual interaction are emerging.”

“While this report uses ‘screen time’ as a widely understood shorthand, we want people to understand that we are referring to the entire digital ecosystem of apps, smartphones, tablets, chatbots, and other screen-associated devices and interfaces,” Kennedy said.

The advisory warns parents and other concerned adults of signs that children are in harm’s way because they have lost control over screen use and have reached a stage of compulsive or addictive behavior. These signs include:

• Spending too much time on screens or constantly thinking about them.
• Repeatedly asking to use screens, often while whining, crying, or sulking.
• Using screens to feel better and becoming upset or moody when screen time ends.
• Hiding or lying about their overall screen use.
• Getting defensive when asked about their screen use.
• Trying unsuccessfully to reduce screen use.
• Showing symptoms like emotional withdrawal when screens are not accessible.
• Not fulfilling their responsibilities by prioritizing screen time.
• Not engaging in in-person interactions or activities.
• Continuing use despite negative consequences.

In his effort to educate American families about the dangers of compulsive screen use, Kennedy also asserted that “no company should profit from keeping a child compulsively engaged on screens.”

According to the advisory, research findings show “early exposure to screens carries developmental and cognitive risks,” with screen use early on in a child’s life associated with “poor language outcomes.”

Continued excessive screen time as children enter school has been found linked to poor educational and health outcomes, sleep problems, and other physical health risks such as poor eating habits.

When children hit their teen years, excessive screen use often translates to mental health issues, including anxiety, depression, higher incidence of family conflict, aggression, peer relationship problems, drug and alcohol abuse, exposure to online sexual exploitation, and cyberbullying.

The toolkit, nevertheless, points to some promising interventions that can encourage a healthier lifestyle for American children and teens.

As HHS urges: “It’s time to stop scrolling and start living.”

The best interventions clearly involve a commitment from parents over time – and one that includes the modeling of healthy behavior.

“Be present in the moment and use screen-free time to connect with children without distraction,” the Surgeon General’s office advises. “Create experiences that can displace screentime, such as going for a walk outside, cooking a healthy meal together, or checking out books and programming at the local library.”

“Ask permission from family members before sharing images or information about them online,” the advisory recommends to parents as they model to their children the importance of privacy online. “Demonstrate priorities by fulfilling your own responsibilities before engaging with digital media. Model and create opportunities for good, sufficient sleep, access to healthy, real foods, and physical activity. Find families with similar values around digital media and exchange ideas and best practices.”

The advisory recommends the “5 D’s of Healthy Screen Use in Children”:

• “Discuss” with your family about everyone’s screen use. Share the benefits and concerns around digital media, and establish healthy family priorities together.
• “Do” connect with your children without distraction from your own devices. Create active experiences that can substitute for screen use time.
• “Delay” children’s access to screen use and use parental controls. Also delay access to different devices by age.
• “Divert” by providing alternatives without setting up screen time as the default when children express boredom. Redirect children’s attention with opportunities for healthy physical activity, and prioritize responsibilities, such as home chores and homework, or music and sports, before granting screen use.
• “Disconnect” by ensuring all family members have “regularly scheduled, screen-free times” during the day, especially during mealtimes.

“Practice screen-free time before bedtime for better quality sleep and avoid sleeping next to devices,” the Surgeon General’s office advises. “Avoid multitasking with screens during activities. Detox completely from certain devices, media, or platforms when they have become a problem or when another goal is more important.”

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