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Last year I had a lively debate with my literary agent about children’s screen time. She had mentioned that there was a gap in the market for a book about the toxic effects of screen time for children and did I want to write a book about this? Many parents worry about the negative effects of screen time and really want to know about safe levels of screen time.

Being an evidence-based science nerd, I mentioned to her that I had not seen any good evidence for there being any negative impact on children of screen-time (based on length of time, not content). I admit, that I am not doing research in this area and so have not been ploughing journals and databases for evidence on this area, but in general, I go to conferences and child psychiatry meetings and get to hear about important research that is brewing (if there is any) before results are released to the press and general public and I had seen nothing on screen-time ‘being toxic’ that was definitive or evidenced based and that would warrant a book. I myself love the telly and happily watch anything from Newsnight to Love Island. On my days off, I’m quite happy to watch Flog it! and Cash in the Attic too. I’m good at putting boundaries on my phone, but admit to watching videos of pug dogs and dancing cats first thing in the morning or late at night. I am not ashamed to say I love screen time, it’s how I relax and I certainly don’t feel that my life is being ruined by screens.

There are many confusions in the screen-time debate that deserve clarification:

1. Different people mean different things when they talk about ‘screen time’. Screen time could mean any TV, smart phones, internet, gaming, social media or any time doing anything on a computer. Most adults who spend their day working on a computer are in effect spending most of the day on ‘screen-time’. Is this detrimental? Excel can certainly drive me crazy at times, but I’m not sure this is what is meant when most people say that ‘screen time is bad for your health’. What about cooking with a YouTube video – is this screen time? What about my children’s favourite (not)…playing piano to ABRSM practice partner? Does this count? As screens are used for a myriad of activities which are getting more and more interactive, these days defining ‘screen time’ is rather more tricky than it sounds and we should be specific when we (particularly ‘experts’) talk about ‘the ills of screen-time’ and what it is exactly that we mean.
2. Most of the weariness about screen time seems to be a judgement call on content rather than the fact that entertainment is brought by a screen itself. I think that we can all agree on children staying away from pornography and having age-appropriate certificates for internet content because beyond a doubt exposure to inappropriate content is harmful to children (violence, sex, aggression, extremist content, websites on how to build bombs and slit wrists etc.) – I don’t think anyone finds this contentious. But beyond this judgements on screen time being detrimental seem to be related to our own personal sense of ‘good’ and ‘bad’ content. I’m sure most parents would not complain about their children watching the news or Blue Planet. What about YouTube? Does it make a difference if your children are using YouTube videos to make loom bands or bake cakes or if they are watching YouTube videos of YouTubers watching other YouTubers play video games? Does it make a difference if your children are playing chess on the computer as opposed to MarioKart? If so, what we are really saying here is not that screen time is bad, but we should raise the standard of programming or that there should be parental control over access to content. How children use social media is a separate debate to absolute screen time usage and relates again to content rather than screen time-limit discussions. The best way to be aware of and happy about the content of what your children are accessing is to have an open, respectful and trusting relationship with your children. This takes time and energy to build but will make everything in your life easier, not just reduce screen time arguments.
3. Association does not mean causation. Type in negative effects of screen time into Google and I am sure you will get a whole list of science-sounding information about the ills of screen time. But the same can be said if you type in vaccination and autism, deodorant and cancer and any number of absurdities. There are association studies between screen-time and health factors for sure e.g. obese children watch more TV and depressed children use more social media, but these do not mean that the screen-time is CAUSING negative effects on health. Is it because children that don’t like exercise like to watch TV, or did the TV ‘make’ children stop exercising? Does social media ‘make’ children depressed or do depressed children get drawn to social media due to their existing insecurity? Does TV make children behave badly or do parents of badly behaved children struggle more to get children off TV? Does gaming stop children doing their homework or do children that don’t want to do their homework play computer games? It is difficult to untangle and at present, the jury is still out, but my wager would be that simply removing screens from households of obese children would not miraculously lead to the child suddenly taking up sports, nor would removing the screen from the gamer lead to more homework being done.
4. It’s not what children are doing, it’s what they’re not doing. The only evidence for the ills of the screen is that it takes up time that children could be doing something more worthwhile. But in this regard, the screen is no different for instance than an intense sedentary hobby like stamp-collecting or knitting. Both of these hobbies have some merits (as does watching TV), but done for hours at a time can lead to inactivity and lack of social interaction. The solution is not to ban screens but to encourage other interests.

The reality is that it is difficult to do any proper ‘gold standard’ research in this area, as this would require an ‘experiment’ where large cohorts are required to reduce or stop screen time altogether and measures of before and after are taken and confounders are taken into account (e.g. socio-economic status, parental educational level, child’s innate personality). These experiments are generally expensive and unpopular (most people will not react well to being randomly told to stop screen-time and if they volunteer to do this, they are de-facto a biased sample) and very hard to enforce (it’s difficult to check study participants are not having sneaky peeks at their TVs and phones), but I am sure that some researchers may try and do this kind of study in the future.

In the meantime I was very pleased to see that earlier this month the Royal College of Paediatrics and Child Health Guidelines on screen-time took heed of available research (or lack of it) and stated that there is no evidence for a ‘safe’ screen time limit because screen-time has not been proven to be ‘unsafe’. Please read the report, but in summary the guidance was:

• Children should not use screens before bedtime ( this is as blue light can affect sleep)
• Children should not snack while using screens (to prevent obesity)
• Children should have other opportunities for exercise (to prevent obesity)

and

• Screen time should be under the control of parents, at a level that they feel appropriate

And so, this is the uncomfortable truth about screen-time. Instead of asking: ‘is screen-time toxic?’, we should spend more time asking ‘How can I support my child’s social skills?’, ‘How can I improve my child’s diet and exercise?’, ‘How can I support my child to read/ write/ draw?’, ‘How can I improve my relationship with my child so that they want to spend time with me?’, ‘How can I improve respect in my relationship with my child so that they will comply with my instructions?’.

It may be convenient to blame ‘screens’ for all the ills of our children, but ultimately, it is parental responsibility to control screen-time in younger children and ensure that they are accessing appropriate content and doing other activities that are enhancing their development (physical activity, creative activity, social activity) instead of/ or as well as screens. It is also parental responsibility to teach children to control their own screen-time so that as adolescents they can make their own appropriate life choices. All the above is really tough and not necessarily what we thought we were signing up for when we had kids, but the reality is that if we don’t do it, who will?

If you are having trouble starting on rules around screen-time in your primary aged children, here are my family’s house rules on screen-time (but of course you should develop your own that work for you):

1. Encourage other activities (play dates, reading, street dance, baking, swimming etc) from a young age BEFORE allowing access to lots of screen-time. This way, your child has formed good friendships and outside interests which they will want to continue and are willing to give up screen time for. Starting friendships and new activities can be daunting for some children and screen-time is a good excuse not to do things that are daunting, therefore: establish other strong interests first.
2. Be good with boundaries. Parents that are good at setting boundaries in general (e.g. for bed time, eating greens, homework) generally don’t have problems establishing boundaries for screen time. The issue for parents is usually about being able to set and stick to boundaries in general not anything specific to screen time. If you have difficulties with boundary setting, get help to improve this. The Incredible Years is a very good behavioural management book for parents.
3. Demonstrate your own ability to control screen-time. If you are always on your screen, then most children will do as you do rather than as you say.
4. No TV between 9am-5pm (enforced about 90% of the time in term time, less so in the holidays). Within this (as there are plenty of hours before 9am if your children are early risers like mine and after 5pm), my children regularly have access to between 2-4 hours screen-time a day (aged 9 and 11) and I do not feel it has made them morally corrupt/ aggressive/ obese/ brain dead/ socially inept children. I have however had to endure a rather tiresome programme called Nicky, Ricky, Dicky and Dawn – episodes of which could lead me to stick pins in my eyes. Unsanctioned TV use leads to no TV for any children for a week – once you’ve enforced this once or twice, they tend to learn not to break the rule .
5. No screen time until homework/ music practice/ chores are completed (enforced with 70% success). This rule both limits screen use and also ensures that there are no arguments hauling children off devices to do homework, the homework has to be done first.
6. iPad which can be used between 9am-5pm is locked by password under parental control so that I am largely in charge of when and where this is accessed and for what purpose.
7. No screens at the dinner table for any one including adults (enforced with 90% success rate by me and 50% by father), although as a family we do like a regular TV dinner all together watching Bake-Off or something similar. I work part time and generally have already gassed enough to the kids about their day and my day, but if this hasn’t happened and dinner is the only time to engage your children in chat, then I would recommend dinner table chat over a TV dinner.
8. Try and avoid giving a child a phone until secondary school. Believe me, if your children are losing friends solely because they don’t have a phone, these are not the best friends for your child to keep anyway. If they are struggling with friendships, the solution is to support this, not to buy them a phone/ trainers/ designer clothes to keep these so-called friends.
9. Keep going. Like with any family, there are occasional rows in my household about getting children off the TV/ iPad , but these are once in a while and part of life and no reason to abandon all control or feel like a failure. Remember, tomorrow is a new day to try again.

I’m told that the whole screens issue becomes worse as children become teenagers so I’m sure that the house rules will need revising, but for the time being this has worked so far. And as an avid viewer of reality shows like ‘Faking it’ and ‘The Real World’ as a teen, I’m now a psychiatrist: the ultimate real-world people watcher. My agent’s husband is also an advocate of avid film and telly watching as a child and he is now a film director – so go figure.

It’s not all bad…