July 22, 2022
Screens in all forms have become a part of our daily lives, and a part of the world that all kids are navigating. How do we as pediatric clinicians help families navigate the world of screens? What does the data tell us about the impact of screens (and types of screens) on child development? Join host Dr. Angela Kade Goepferd and Kid Expert and director of psychological services, Dr. Sarah Jerstad in this conversation about how to approach screen time at different ages, what traps to avoid, and how to help parents navigate screen time with their kids..
Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the Kid Experts where the complex is our every day. Each week we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge and perhaps change how you care for kids.
Welcome to Talking Pediatrics. I’m your host, Dr. Angela Kade Goepferd. Summer is here, which, for many kids, means they are not in school and often have less structured time while parents are busy. So it’s easy for them to end up with more time on screens. We already know that about half of all kids eight years and under have their own tablet device, and most kids have access to one or more screens in the household.
According to the American Academy of Child and Adolescent Psychiatry, on average, kids ages eight to 12 spend four to six hours per day on screens and teenagers spend up to nine hours per day. The fact is that screen time is a part of our lives and it affects kids and it’s not going away. So it’s important for us to understand, “How do screens affect kids and how can we help families navigate them this summer?”
Joining me to help answer that question today is Dr. Sarah Jerstad, child psychologist and Kid Expert at Children’s Minnesota and director of our psychological services. Sarah, thanks for joining me today.
Dr. Sarah Jerstad: Thanks for having me.
Dr. Angela Kade Goepferd: So let’s start off with how screens impact kids. We know they’re everywhere, we know they’re a part of our daily life. So particularly for that childhood development, how are screens impacting how kids are developing?
Dr. Sarah Jerstad: Kids as young as one week old end up somehow interacting with screens at times. And what we know is, under the age of three, it’s actually important to really limit and minimize the amount of screen time, because the way kids learn in those early years is through interaction; interaction with adults, interaction with their environment, interaction with toys and with other kids.
So if a child is put in front of a screen in a way that’s passive that brain development isn’t going to happen in the way that it’s meant to. So it is a big deal to figure out ways to limit the amount of time the kids have in front of a screen at those really young years.
Dr. Angela Kade Goepferd: And a lot of times I hear from parents that they’re young children, their 18 month olds like “watching TV,” and there is a sort of passive engagement that kids will do.
What advice would you give those of us who are in a room with a family and they have a screen in front of their very young child under three? How might we approach that conversation to say, “Actually they’re not watching the TV,” or how to redirect that.
Dr. Sarah Jerstad: Yeah. It’s hard, because when you look at a child and their eyes are faced at that screen, they do look engaged, but up until a year to 18 months, they’re really not learning or processing that information. It’s entertaining to them because their eyes are drawn to it.
What we know about learning is it’s interactive. So even if a family says, “But sometimes we just have that screen on. We’ve got three kids,” or, “We’re busy,” what I would say to the parent is, “Then pretend the screen is a story that you are reading to the child.” So maybe you point to the screen, you say something, you look at them, they look back at you, you have an interaction, a conversation.
Dr. Angela Kade Goepferd: Sure.
Dr. Sarah Jerstad: That’s where the learning’s going to happen.
Dr. Angela Kade Goepferd: So if we move from those young kids into kind of the preschool early elementary age, there’s a lot of stuff on screens that’s geared for kids at that age. They’re supposed to be pointing at things and playing different games, and there’s specific television programming that’s geared for kids that age. What advice or how should we be talking to families about that type of age?
Dr. Sarah Jerstad: Those programs are great. And I think it’s important in this conversation to say from the outset screens are not the enemy. There are a lot of good and positive things that can come from it. So there are many great educational programs or learning programs and opportunities for kids. I think parents don’t want to assume that more is better.
Dr. Angela Kade Goepferd: Right.
Dr. Sarah Jerstad: So that four hours in front of a TV of educational programming is great because it’s better than one hour. I think you want to limit the amount of time. Kids are still going to learn better when they interact with somebody live.
Dr. Angela Kade Goepferd: Mm-hmm (affirmative).
Dr. Sarah Jerstad: If parents sit down with their child and watch that program together, it is an opportunity for some of that live interaction. And I recognize for parents, everybody is busy and you can’t, 24/7, be interacting with your child. Sometimes you need that half an hour to get something done and putting a six year old child in front of an educational program is a great opportunity.
Dr. Angela Kade Goepferd: Yeah.
Dr. Sarah Jerstad: But you won’t want to take the whole afternoon and do that.
Dr. Angela Kade Goepferd: Right. I often tell families that it’s not that the screens themselves are bad, it’s what is being displaced in a child’s life by the screen. So if we’re not going to the park because we’re watching TV, if we’re not getting together with our friend down the street because we’re watching TV, if we’re not having time to just sit and be bored and use our imaginations because we’re on an iPad, that’s where we need to be cautious. We don’t want to leave those other things out of kids’ lives.
Dr. Sarah Jerstad: You make such a great point there. That is one of the biggest problems with screen time, is when it displaces appropriate activities and behaviors, especially physical activity.
You know, kids are very structured these days. They have a lot of things happening and going on, and then parents are busy. And when a child sits in front of a screen, maybe it would be after school time where they might be outside playing, or maybe it would be time when they would be in a sport or at a camp. And if screen time replaces that, they’re not getting it anywhere else.
Dr. Angela Kade Goepferd: Yeah.
Dr. Sarah Jerstad: I think another thing that’s important, especially at this age that you just described, is what we don’t want to teach kids is that screen is comfort or a solution to a problem.
So if a kid is sad or upset or having a tantrum, then the parent gives them a screen and they feel better. That’s learning that isn’t going to be helpful for the child. They really do need to learn to solve those problems and resolve the feelings.
Dr. Angela Kade Goepferd: Yeah. Kind of learning that emotional regulation without relying on a screen.
I often … And I’m sure those listening have seen this several times, where a child maybe gets immunizations in an exam room and then a parent will hand the child the phone to comfort them. And there’s not anything wrong with distracting a child with a screen from where I sit, and I’m not a psychologist, but I would love to see the child getting a hug and some reassurance to help with that emotional regulation rather than just getting the screen.
Dr. Sarah Jerstad: Absolutely. That kind of physical interaction, that hug, that comfort or those words, you know, recognizing how they feel and giving them reassurance that the parent is there, you can’t replace that.
I think it is easy to put a screen in front of a kid, it’s kind of what we’re used to, so we don’t always think about using that reassurance.
Dr. Angela Kade Goepferd: Yeah. So if we move into the age of my kids, who are finishing second grade today, about to be third graders, so kind of those older elementary school kids into the tween or young teenage years, what do we need to be thinking about with them and screens? I’m noticing my own children doing a lot of independent exploring on YouTube and things like that. What’s the guidance around how much monitoring or how involved we should be with kids in screens at those ages?
Dr. Sarah Jerstad: Even at those ages, what they’re not doing very well is probably regulating the amount of time that they’re spending doing it. So a child that age actually gets very curious and very interested in an activity and might end up being in that activity much longer than they had realized if they don’t have someone from the outside kind of helping them separate from that.
I do think, at these ages, it’s okay to give opportunities for a little bit of self exploration, this is where some of those independent skills start, but supervision should still be quite close, because on the internet, there’s a lot of places kids can lapse into a website or a program that’s not going to be something that’s helpful for them or that they don’t understand, or that’s probably above their developmental level.
Dr. Angela Kade Goepferd: Yeah.
Dr. Sarah Jerstad: So parents can be helpers there, but you also want to encourage some of that exploration. You know, screens are a great place to learn and to challenge and to kind of provoke some curiosity, but again, it’s probably going to take a little more just kind of guidance and supervision at those ages.
Dr. Angela Kade Goepferd: As a parent myself, I was surprised at what my eight year olds could get into online, even on Amazon Fire tablets that have parental controls and things like that. YouTube is just this Pandora’s box of content.
And some of the stuff they found was really cool; found this program called Bright Side that is really great and has really interesting educational activities; but they also found some YouTube videos that seemed geared for kids, maybe had Peppa Pig in them, but in the video, there was blood coming from Peppa Pig’s eyes, and it was very scary, and in my opinion, very inappropriate for eight year olds. And so I’ve learned the lesson the hard way of really keeping a close monitor on what my kids are watching, and having them do more frequent check-ins about what they’re seeing and making it safe for them to have that conversation.
And I wonder what advice you might have for us as we’re trying to counsel parents around this check-in; good tips for how to have the conversation about what kids are seeing online, or how to help prepare them, or making it a safe space for kids to ask questions.
Dr. Sarah Jerstad: Yeah. This is a really important topic, because it can quickly go to kids feeling ashamed or bad about themselves, or embarrassed. And really, anything they run into isn’t their fault. The internet is a vast ocean of lots of things.
So to make the conversations feel safe, parents need to just start by giving kids an opportunity; “Tell me what you saw today”, and, “Was there anything that felt scary or that you didn’t understand? I can help you figure that out.” Then you’re partnering with your child.
And if there is something that’s scary, or if they come to you and bring the image and you look at it and think, “Oh my goodness, that is so scary,” stay calm as you talk to them about it. Let them know that sometimes we run into things that maybe aren’t a good fit for your age, and just give a developmental explanation. And then again, up that supervision.
Again, a lot of kids at those ages you’re talking about are not trying to seek out content that’s inappropriate, but they end up running into it.
Dr. Angela Kade Goepferd: Yeah. My kids are very into things right now that are scary and spooky. So I could see them searching for those words, and then they encounter content that they’re not really ready for.
I was at a conference several years ago and heard a woman speaking about kids and sexualized content and pornography online, and she quoted that the average age for boys in particular to encounter pornography online was nine. And with two kids about to turn nine this fall, that has really been seared into my brain. So we’re often having conversations about encountering sexual content online. Or the question I actually ask them is, “Well, what would you do if you saw a naked person online? That’s something we should talk about.” But I wonder if you have particular recommendations around that kind of sexualized content that kids might encounter, or how to navigate that.
Dr. Sarah Jerstad: I think it is important to bring those things up at the ages that you’re talking about, because it’s likely they might run across something like that and then you’re normalizing this conversation.
Dr. Angela Kade Goepferd: Right.
Dr. Sarah Jerstad: It is easy for, I think, us as a society to feel fearful about having conversations like that, but what you’re doing is saying, “It’s okay to talk about it, it’s okay to wonder, and I’m a safe person for you to have that conversation with, and I will help protect you and figure out what makes sense for you and what’s right for you.”
And sometimes kids feel embarrassed or they laugh or giggle, and that is okay too. You know, it can feel awkward, but we just kind of normalize that, “Oh, sometimes it feels kind of silly and we just keep having that conversation.”
Dr. Angela Kade Goepferd: Right. There’s a book for kids about sexuality called Sex is a Funny Word that I purchased to kind of help having those conversations with my kids. And it is. It is a funny thing to talk about, particularly with younger kids, but in my opinion, really important.
As we kind of move into the teenage years, kids are really becoming a lot more independent. They often are on their phones constantly, they’ve got independent social media profiles. How would you have us counsel parents who are trying to navigate that space with their kids, that kind of teenage years; independent, lots of screen time?
Dr. Sarah Jerstad: Independence is so important at that age, and respect of your child’s independence.
So I’ve had, in the past, you know, parents kind of say, “Should I be jumping in and kind of checking their text messages or checking what they’re doing?” And to me, that’s developmental. If you have a kid who’s a tween or a younger teen, I think that’s okay. But always, no matter what you do, you should tell your child, “I’m going to be checking in periodically, and here’s what I’m going to be looking for. If you have anything that you’re worried about, just bring it to me.” When kids get older, when they’re older teens, I don’t encourage that. Instead, I encourage open dialogue.
Dr. Angela Kade Goepferd: Sure.
Dr. Sarah Jerstad: Part of that is actually just engaging your teen on their opinions. Teens love to share their opinions and their beliefs about things. “What are you reading on Reddit? What are you seeing on YouTube?” They might have their opinions and thoughts, and that’s a way to start to gather what it is they’re seeing and how they’re spending their time on online, and then being able to have a dialogue about it.
With teens though, you do still have to set limits. Even though they’re 16 or 17, those kids still might want to spend way more time yeah on their phone or on screens than might be appropriate for them and compared to the other activities they should be doing.
Dr. Angela Kade Goepferd: One of the other things I think about with teenagers is their underdeveloped frontal cortex and their impulsivity, and some of the content that adolescents put online and not necessarily having the forethought to understand the permanence of that content, the way that content can be shared with others, wanting to get likes and approval from friends by maybe compromising their integrity with a particular pose or clothing they’re wearing, and things like that. So I think engaging in those conversations is really important.
Dr. Sarah Jerstad: Similar to what you talked about with your younger kids; to start having those conversations at a developmentally appropriate level.
Dr. Angela Kade Goepferd: You know, you’re probably going to have people asking for those kind of photos, or you might see that someone might send one to you of someone else. Yeah.
Dr. Sarah Jerstad: Those things could happen, and let’s talk about what to do if that does.
Dr. Angela Kade Goepferd: I often think of giving teenagers ways out of those moments. I remember going to parties when I was … Obviously, there was no cell phones when I was a kid, but parents giving me a safe way to get out of a situation if I needed to.
And I often think of my kids now and how am I going to help them get out of a situation in which they were sent a link to something that they know that they shouldn’t be on or that they don’t feel comfortable looking at, and giving them some language and tools to help them get out of those situations, which we never had to do, so it’s all new?
Dr. Sarah Jerstad: Parents are navigating kind of a new territory, but I like that idea of giving those opportunities to them. And also having conversations with them about, “Sometimes you might feel like you have a really difficult decision. You might not want to get someone in trouble or you might really be friends with this person or like this person and feel conflicted. Let’s talk about what a good friend is,” and those kind of conversations too.
Dr. Angela Kade Goepferd: Yeah. We’ve spent a lot of time talking about kind of how to protect kids from screens, how to encourage parents to have some oversight. Are there things that are positive about screens? In what ways do different types of screens enrich our kids’ lives?
Dr. Sarah Jerstad: There are so many great things about screens actually. You know, first, there are many, many learning opportunities. When you and I were kids and we went to do a report, we would either pick up the Encyclopedia Britannica or go to the library and probably had limited access to information,
Dr. Angela Kade Goepferd: Search the microfiche at the library.
Dr. Sarah Jerstad: Yes, yes.
Dr. Angela Kade Goepferd: Yeah.
Dr. Sarah Jerstad: So one is there’s so much access to a lot of great information. During the pandemic and other periods of time where kids have to be either locked down or kind of separated from peers, first of all, there’s great ways to socialize with one another and stay connected, or ways to kind of explore other things, you know, go to museum websites or things like that.
We’ve also seen data on some gaming, so some video gaming, where problem solving skills are used. You can actually see sort of activation in the brain that’s similar to problem solving tasks academically. So there really are a lot of positive things.
For younger kids, for example, I’ve talked to parents about, you know, “If your younger kid is really enjoying this game and that feels important to them, why don’t you take some time to learn it and sit down and play it with them? That way, you’re going to have an interaction about it that doesn’t feel like you’re the police necessarily. So then when you do set a limit on that game, they kind of know, ‘Hey, you’ve enjoyed it too and you approve of the game. It’s just that you’re kind of putting some structure around the time.'”
Dr. Angela Kade Goepferd: Yeah.
Dr. Sarah Jerstad: So there are a lot of really good things about screens and positive, and just fun things too.
Dr. Angela Kade Goepferd: Yeah. I can’t tell you how many Minecraft worlds I’ve been shown on my kids’ devices. They make me a little seasick to look at them, but I kind of force myself to look at them as much as I can, because it’s something they’re proud of. They build it, so they’re proud of it and they want to show it to me.
Dr. Sarah Jerstad: Yeah.
Dr. Angela Kade Goepferd: I’m not that interested in seeing it, but yeah, I think that advice about kind of getting in that world with them a little bit, and it can help you navigate it with them of you do encounter things that seem a little questionable.
Let’s talk about sleep. We can’t talk about screens without talking about sleep. It’s probably the number one reason that I see in my primary care practice of kids having bad sleep, is that screens are interfering with that. Talk to us about how screens interfere with kids’ sleep and then how we can counsel families around that screen time.
Dr. Sarah Jerstad: The biggest way actually that they interfere is that screens are in the bedroom. For a lot of families and kids, they’re in the bedroom all the time, and so it interferes because kids are not at all getting the amount of sleep that they ought to, and that interferes with development and learning and mood significantly.
You know, there are many teenagers who, if you kind of talk to them and listen a little more, you start to realize that a lot of the social interaction they’re having with one another that is very desirable is happening late at night.
Dr. Angela Kade Goepferd: Mm-hmm (affirmative).
Dr. Sarah Jerstad: “Oh, everyone’s on a game until 1:00 or 2:00. If I leave, then I’m missing out on this,” or something like that. You know, limiting the amount of time in the place where kids sleep is critical.
For younger kids, it’s easier for parents to do. So I really suggest starting early by pulling those screens out of the room; parents kind of holding the phones or charging them, or the iPads or the tablets, and just having them out of the sleep space.
And then, as you very well know, screens right up until bedtime are going to kind of keep your mind stimulated and make it harder to fall asleep. So having that hour before bedtime without any screens.
Dr. Angela Kade Goepferd: Yeah. I think screens have become so much a part of adults’ sleep routine that we don’t pay as much attention to kids. We’re often looking at our phones right before bed and modeling that for our children.
I remember a child that I had in primary care clinic who had just gotten a tablet, and the grandmother, who was her guardian, was talking about it and how she worried that it was interfering with her sleep. And it was interfering with her sleep, but the other thing was that it replaced something really important, which was that they used to sit down and read together before she went to bed, and now she was spending that half an hour to 45 minutes before bed on her tablet. So not only was it keeping her awake longer, she lost that adult interaction with her caregiver that she was having. So we talked a lot about how we don’t want screens replacing that, in addition to having it keep her up at night.
Okay. Let’s talk about screen addiction. I think we throw loosely around this term of like, “Oh, my kid is so addicted to their iPad or their Xbox,” or whatever it is, and, “How much is too much?” How do we know when screens are causing a problem in a child’s life? How do we know if they’re having problematic technology use or internet use? How can we look for those signs?
Dr. Sarah Jerstad: Well, one is something that we’ve talked about, which is displacement of other activities. So if a child is, instead of … You know, “I don’t want to participate in my extracurricular activity,” or losing sleep, or not getting physical activity, grades dropping, not spending as much time with friends because they want to be on their game console; so when it’s replacing those important daily functions, that’s a red flag.
Second, we want to look at mood. So if you tell a child, “You’ve got to turn that screen off now,” and there’s a lot of mood dysregulation, anger, aggression, or if a child seems very anxious they haven’t had access to their screen or just sort of depressed when they don’t have access to it, what we can see then is it reminds us of addiction, that this is something that is needed, that they’ve kind of become accustomed to in order to feel okay.
And so obviously when we think of substance addictions, you can eliminate a substance from a child’s life; you can’t eliminate the screens. It’s a part of, often, school and everything else. So that’s where you really have to figure out, “How can I help my kid?”
Dr. Angela Kade Goepferd: Well, thank you so much, Sarah. This was really helpful. And I think the one thing I’ve learned is we can really do a lot in modeling through our own behavior. My kids were the first to call me out on my own problematic screen use with my phone and putting it away. And I think the more that, as a society, we can put our phones down, put our screens down, and interact with each other a little bit more, that will be helpful.
And I think we’re all doing the best we can. I think a lot of parents feel really guilty about screens, and we’re trying our best.
Dr. Sarah Jerstad: I do agree with both of those things. I think as parents, it’s easy to kind of always be looking at our phones, and it’s important to take time and set the right example. And we need to give ourselves a little permission to navigate through a day and know that sometimes, you know what, we’ve got to put our kid in front of a screen and stuff. So it’s a balancing act.
Dr. Angela Kade Goepferd: Yeah. And I think some of those same checks we put on our kids with, you know, now you can really set on tablets, they can actually shut off if you have them on for too long, or you can restrict sites; we can do that for ourselves. I just heard a speaker recommend putting your phone an airplane mode if you’re at your kid’s soccer game, which I’ve started doing now, and that’s really helpful. It really kind of helps me just get the notifications out so all I’m paying attention to is my kid at the time, which is all kids want, is their parents’ attention.
Dr. Sarah Jerstad: Absolutely.
Dr. Angela Kade Goepferd: Well, thank you so much, Sarah. This was really helpful advice, and we will continue our trek through the treacherous land of screens this summer.
Dr. Sarah Jerstad: Thank you.
Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. Our executive producer and showrunner is Ilze Vogel. Episodes are engineered, produced, and edited by Jake Beaver. Amy Juba is our marketing representative. For more information and additional episodes, visit us at childrensmn.org/talkingpediatrics, and to rate and review our show, please go to childrensmn.org/survey.