Digital Media and Kids: Can We Find the Right Dose?

Digital Media and Kids: Can We Find the Right Dose?
William T. Basco, Jr, MD, MS

DISCLOSURES July 26, 2018

Many studies have examined the association between the degree of a child’s digital media exposure (DME) and health outcomes, finding that DME has negative correlations with measures of fitness, attention, violence and bullying behavior, and poor sleep.[1] A broader perspective on childhood “flourishing” might include measures of physical health, psychological and emotional health, and social development and behavior.

A recent study by Ruest and colleagues[1] used data from a 2011-2012 national survey collected by the National Center for Health Statistics at the Centers for Disease Control and Prevention to evaluate associations between DME and measures of flourishing in children. The criterion variable was combined DME time during an average weekday among children aged 6-17 years.

The outcomes were five measures of childhood flourishing, including (1) completes all required homework, (2) cares about doing well in school, (3) finishes tasks started and follows through with stated plans, (4) stays calm and in control when challenged, and (5) shows interest and curiosity in learning new things. Age, sex, race, primary language, financial status, and mothers’ education were control variables. Children were divided into three age groups corresponding to elementary school, middle school, and high school.

In this study, 30.6% of the children had a combined daily DME of < 2 hours, the goal based on recommendations from the American Academy of Pediatrics.[2] Another 35.7% had DME ≥ 2 to < 4 hours, 17.3% had ≥ 4 to < 6 hours, and 16.5% had ≥ 6 hours of daily DME. Overall, affirmative response rates to the five measures of flourishing ranged from 66% to 87.6%.

There was an inverse dose-response relationship between average daily hours of DME and the “failure” rate for each of the five measures of flourishing. For example, only 7% of the children with < 2 hours of daily DME failed to complete homework regularly compared with 24.2% of the children with ≥ 6 hours of daily DME. A similar pattern was noted for whether the children cared about doing in well school and whether they showed interest in learning new things, with failure rates of < 10% among the children with < 2 hours of daily DME compared with > 20% among the children in the highest exposure category.

Of note, approximately 30% of the children with < 2 hours of exposure each day had trouble finishing tasks that were started and failed to stay calm when faced with challenges, and these proportions rose into the low 40s among the children with the highest DME. Consuming > 6 hours per day of DME means that more than 25% of a child’s total daily hours are consumed by DME. That can’t be good.
The inverse dose-response relationship between DME and measures of flourishing remained in the adjusted model that controlled for age, sex, race, language, poverty level, and maternal education. Female sex was independently associated with flourishing. The study concluded that DME has an inverse, dose-dependent relationship with measures of childhood flourishing.

I doubt that many pediatric practitioners will be surprised by these results, but I thought it was worth reviewing the article because it measured non-diagnosis-based outcomes (eg, attention-deficit/hyperactivity disorder, obesity) and certainly looked at some outcomes that are important to family functioning and academic performance, such as homework completion and how well the child handles adversity. Of course, these are nonexperimental data, meaning that the children were not assigned to the different levels of DME exposure.

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