Close work and screen time in kids

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In one of my previous posts you can read all about the importance of outdoor time in childhood visual environment. In this post I’ll focus in on close up reading, near work and screen time – one of the biggest challenges of modern parenting. 

Spending time on near work and screens is unavoidable in today’s world, especially when children are exposed to screens almost from birth, and are using them at school from younger and younger ages. 

Handy rules for the indoor environment

There are three key rules for the childhood visual environment – indoors, which are important for both reducing the risk of a child becoming myopic (short-sighted) as well as reducing the risk of fast progression, or worsening, once a child is myopic.

  1. Take regular breaks from reading – the 20/20 rule
  2. Don’t hold reading material or screens too close – the elbow rule
  3. Try to limit leisure screen time to two hours per day in school aged children.

Watch this short video to understand more about promoting healthy children’s visual habits by striking the right balance between indoor close work and outdoor time.

When it comes to healthy visual development, the greatest evil of screens may not be the screen itself – it may be more how closely it’s held and the duration of use.

There have always been ‘bookworm’ children and has always been myopia; but the dramatic increase in myopia across the world indicates there’s an additional negative influence on the visual development of today’s children. This appears to be a combination of not enough time spent outdoors, and too much time spent on screens and/or looking up close. 

Children and adults appear to hold screens closer than books and print material. This makes sense if you think about trying to read a web page or an email from your phone screen! The closer a book or screen is held, the larger the demand on the focussing muscles of the eyes, potentially leading to greater fatigue. Research from Ireland (link) has shown that children using screens for more than three hours a day were almost four times more likely to be shortsighted than those spending less than one hour on screens daily. The biggest negative effects happen at younger ages – 6-7 year-olds who were heavy screen users were five times more likely to be shortsighted than light users, but the margin falls to 21 per cent among 12-13 year-olds. 

Research from China (link) showed that children who read or wrote at a distance of 20 cm or less showed faster progression, or worsening, of their myopia. This was also true if the television was closer than 3 metres, and the child regularly read continuously for more than 45 minutes. What can you do about it?

THE ELBOW RULE is where your child should try to keep an elbow-to-wrist distance between anything they are viewing up close, and their eyes. Try it yourself, and show them at home – make a fist, put it next to your eyes, and where your elbow sits is the closest any screen or book should get to your eyes when reading. 

THE 20/20 RULE is where you child aims to take a break from reading every 20 minutes, for 20 seconds. He or she should look across the room for that 20 seconds, to relax the focussing muscles in the eyes before recommencing reading or screen time. This can be managed as a break between book chapters, between Netflix episodes for tweens and teens, or timers set for younger children.

What can you do about screen time?

  • Set screen timers. This is easy to do in recent Apple iOS updates, and available on Android too. You can even customize it to lock out of certain apps after certain duration or times of day, and set passcodes for access.
  • Sign up for the MyopiaApp – this ingenious digital device app measures how closely the device is being held, and darkens the screen if it’s held too close, revealing the screen again when it’s held back at the ideal distance or further. How clever! Developed by an international partnership of scientists and optometrists, early research on this app has shown it effectively modifies screen time behaviour, making a dramatically positive difference to the demand placed on the eyes.
  • Be a good screen time role model yourself. Set your own timers and check in on your own habits. You may even find some extra time in the day which had previously been sunk down the screen time rabbit hole! Set up screen-free times in the family day (eg. meal times) and screen-free places in the family home (eg. the dinner table and kids’ bedrooms).

Screen time recommendations

When it comes to healthy childhood development in general, the Australian Government Department of Health and the American Academy of Pediatrics have clear recommendations for screen time and sedentary activity in children.

  • Children under two years of age should have no screen time. Watching a screen at a young age can limit time for active play and learning, reduce opportunities for language development, negatively influence their attention skills and affect the development of the full range of eye movement.
  • Children aged 2-5 years should have a maximum of 1 hour of screen time per day. Infants, toddlers and pre-schoolers should not be sedentary, restrained or kept inactive for more than one hour at a time – with the exception of sleeping. In this age group, excessive screen time has been associated with less active, outdoor and creative play; slower development of language skills; poor social skills and an increased risk of being overweight.
  • Children of school age (5-17 years) should be limited to 2 hours of sedentary, recreational screen time per day. Break up long periods of sitting as often as possible, and when using screen-based electronic media, positive social interactions and experiences are encouraged. Sleep is also so important in this age group, especially if screen time competes for sleep time. Children aged 5-13 years should have an uninterrupted 9 to 11 hours of sleep per night,and 8 to 10 hours per night for those aged 14–17 years. Consistent bed and wake-up times are very helpful, as are reducing screen time before bed and removing screens from the bedroom where possible. 

Remember you’re not on your own! Screen time is a struggle for every parent today, both for our kids and for us as screen users ourselves. If you need an extra push to get the family screen time sorted, numerous reasons and resources are available as detailed above.

Useful Resources

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Myopia control in children – what if it’s not working?

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