In early 2016, I covered screen time for children in this column (Beal, 2016). Now more information is available to guide pediatric nurses in helping parents manage screen time with their children. In 2011, the American Academy of Pediatrics (AAP) Council on Communications and Media (2011) issued a policy statement recommending screen time be discouraged for children <2 years of age and limited to 2 hours per day for children >2. In late 2016, AAP updated their policy statement (AAP Council on Communications and Media, 2016) and offered an interactive tool to assist parents in developing a personalized social media plan for the family (AAP Healthy Children.Org, 2016). Until recently, there has been little research on effects of interactive media devices on development of young children. Within the past 2 years, two studies have been published that raise more serious questions about potentially deleterious developmental outcomes associated with screen time.

Madigan et al. (2019) reported on a longitudinal cohort study with 2,411 mothers and children. Higher levels of screen time at 24 and 36 months were significantly related with poorer performance on developmental screening tests at 36 months. There were associations between higher screen times with first-time mothers and with children in home-based day care settings. The earlier that screen time management was introduced and enforced, there was a significantly greater likelihood that screen time could be decreased.

Hutton et al. (2019) asked "Is screen-based media use associated with differences in the structural integrity of brain white matter tracts that support language and literacy skills in preschool-aged children?" In a cross-sectional study of 47 healthy preschoolers ages 3 to 5, researchers examined MRI scans of their brains, evaluated their cognitive thinking skills, and compared them with parental reports of amount of screen time spent. Results indicated children who had higher than the AAP Council on Communications and Media (2016) recommended screen times, had delayed white matter development, decreased ability to rapidly name objects, and poorer literacy skills.

The AAP Council on Communications and Media (2016) policy statement on media and the young mind provides a thorough background review of all of the potential health outcomes associated with excessive screen time, including developmental delays, obesity, and sleep deprivation. They conclude "evidence is sufficient to recommend time limitations on digital media use for children 2 to 5 years to no more than 1 hour per day to allow children ample time to engage in other activities important to their health and development" (AAP Council on Communications and Media, 2016, p. 3). "Encouraging parents to change to educational and prosocial content and engage with their children around technology will allow children to reap the most benefit from what they view" (AAP Council on Communications and Media, 2016, p. 3). This policy statement provides a comprehensive list of recommendations for pediatric providers, families, and the media industry.

Although more research is needed, pediatric nurses have an important role in 1) educating parents about healthy brain development and importance of unstructured hands-on play to build language, literacy, and social-emotional competence; 2) sharing the AAP recommendations on screen time limits and the importance of finding high-quality programming with parents; 3) encouraging parents to view any and all media with their children to enhance learning, interaction, and limit setting; and, 4) helping parents develop a family media use plan. Nurses can refer parents to AAP Healthy Children.Org (2016) to help them develop a social media plan.

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