Screen time interventions for children

There is strong evidence that screen time interventions reduce sedentary screen time among children under 14 (CG-Obesity, Jones 2021, Downing 2018, Wu 2016, Biddle 2014, Marsh 2014). Interventions that include nutrition and physical activity components have also been shown to increase physical activity and improve dietary habits and weight-related outcomes for participating children (CG-Obesity, Wu 2016, Biddle 2014, Friedrich 2014). Overall, screen time interventions have small but significant effects on stationary screen use with or without nutrition and physical activity components (CG-Obesity, Jones 2021, Biddle 2014, Friedrich 2014) and may improve sleep outcomes (Martin 2021, Janssen 2020). Additional evidence is needed to confirm effects on mobile device use.

Screen time interventions may be especially effective for children under the age of 6 (Downing 2018, Biddle 2014, Marsh 2014), but have been shown to be effective up to the age of 18 (Jones 2021). Such interventions can benefit children in urban and suburban settings, children from a variety of socio-economic and racial and ethnic backgrounds, and children who are of healthy weight, overweight, and obese (CG-Obesity).

In many cases, children who participate in screen time interventions with nutrition and physical activity components improve weight-related outcomes (Wu 2016). Such interventions can decrease the number of participating children who are obese (CG-Obesity). High levels of TV viewing are associated with increased weight status as early as age 2 (Wen 2014) and poor sleep outcomes in infants, toddlers, and children from 2 to 14 years old (Martin 2021, Janssen 2020). Screen time interventions may improve sleep outcomes (Martin 2021).

Family and parental support significantly increase the effectiveness of screen time interventions, reducing sedentary behavior and fostering long-term healthy screen time habits (CG-Obesity, Marsh 2014, Xu 2015). Screen time interventions that include family-based social support and electronic monitoring devices (e.g., low cost apps for mobile devices or time limits for TV or e-readers) reduce sedentary screen time (CG-Obesity, Biddle 2014). Parents can increase the effectiveness of such interventions by enforcing consistent rules about media use with a family media plan, being a role model balancing screen time and other activities, fostering family communication about media use (Chassiakos 2016, Xu 2015), and not using screen time as a reward (Neshteruk 2021). Parental reductions in personal screen time can also decrease children’s screen time (Xu 2015).

Screen time interventions appear to be more successful when they have a shorter duration, less than a year and sometimes shorter than 3 months (Jones 2021, Martin 2021, Wu 2016), are based in the community or home (Downing 2018), and use the Goals, Feedback, and Planning behavioral techniques (Jones 2021). In schools, screen time interventions can be incorporated into existing curricula. Teacher training may increase effectiveness of these interventions (CG-Obesity). In child care settings, higher levels of education for care providers is associated with lower levels of screen time for children; screen availability and attending home-based child care are associated with higher levels of screen time (Vanderloo 2014). Experts recommend timing screen time intervention implementation to account for seasonal shifts in sleep and physical activity levels for children, potentially targeting the winter and summer months (Weaver 2022).

It is unclear what impact screen time interventions have on disparities among youth across populations. Evidence shows programs are effective for students of various ages, socioeconomic status, and ethnicity (CG-Obesity). Significant racial and ethnic and socioeconomic differences appear in screen time usage; Black and Hispanic children (Lang 2024) and children living in poverty (Kwon 2024) are more likely to exceed screen time guidelines, which suggests interventions could help reduce those disparities. However, there is also some evidence that the effectiveness of screen time interventions can be impacted by socioeconomic status, race and ethnicity, and neighborhood context (e.g. access to green space). These findings suggest addressing racial inequities in screen time use is challenged by inequities in green space access and implementation of screen time interventions may further perpetuate inequities (Lang 2024).

Screen time use in children has been increasing as screen technologies, including TV, computers, and video games, have become more prevalent throughout society. Data suggests the majority of children are exceeding screen time guidelines, with boys more likely to do so than girls (McArthur 2022). Excessive screen time in early childhood is associated with increased risk of childhood obesity (Lang 2024), internalizing (anxiety, depression) and externalizing (e.g. aggression, inattention) behavior problems (Eirich 2022), and poorer language skills in children (Madigan 2020). There is some evidence that screen time, especially television and video games, may have negative impacts on academic performance (Adelantado-Renau 2019). Additionally, excessive screen time appears more likely to increase anxiety and depression in girls and anger and aggression in boys (Eirich 2022).

Screen time interventions seek to encourage children to pursue alternative, less sedentary activities in their time outside of school; however, that may be more difficult to achieve in communities with fewer parks, with underdeveloped infrastructure, with disparities in public resources and services, and with more environmental injustices and pollution exposure concerns (Prochnow 2022, Shertzer 2022, NEJAC 2006). Throughout history, the intentional disinvestment in and unequal distribution of recreational facilities, parks, and green space means that communities with low incomes and communities of color have fewer places to engage in outdoor activities, have less access to cooling shade, and experience poorer air quality (CAP-Rowland-Shea 2020, TPL-Chapman 2021). The built environment in under-resourced communities is a significant contributor to health inequities for people of color with low incomes (Prochnow 2022, McAndrews 2022, Brookings-Semmelroth 2020).

• Are the children in your community meeting or exceeding screen time guidelines? When they are using screens, is the content educational and are adults co-viewing with the children?
• How can screen time interventions be implemented in your community, school, or home? Can they be implemented with nutritional or physical activity components to support other healthy behaviors?
• Are there opportunities to support effective implementation of screen time interventions, such as increasing access to green spaces?

States and cities can regulate screen time in various settings, especially child care centers and home-based child care settings, as in Maryland (NCSL-ECE) and New York City (Nonas 2014). State health agencies often provide information, resources, and technical assistance to support the implementation of screen time interventions (Dell Center for Healthy Living-Screen time)

There are several school-based screen time interventions that include physical activity and nutrition components. Many public middle schools in Boston, for example, used the Planet Health curriculum (Blueprints-Planet health). Several elementary schools in South Orange and Maplewood, New Jersey implement a week or year-long TV Turnoff Challenge (SOMSD-TV Turnoff).

The 5-2-1-0 childhood obesity prevention program is an example of a multi-component intervention for reducing screen time, improving diet, and increasing physical activity; the program encourages developing daily habits that include 5 servings of fruits and vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, 0 sugary drinks, and increased water consumption. The 5-2-1-0 program started in Maine (MH-Let's go) and has expanded to cities and states across the country, for example Florida (FL DOH-5210); New Hampshire (FHC-5210); and Palo Alto, California (PAMF-5210 resources).

Families can also regulate screen time; for example, through family media plans, media free meals, media “curfews”, or designating one day/evening a week cell phone free for family fun time (CSE-Families, AAP-Media).

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* Journal subscription may be required for access.

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FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH.

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MH-Let's go - MaineHealth (MH). Let's go!

NCSL-ECE - National Conference of State Legislatures (NCSL). Early care and education (ECE) 2014 legislative action.

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Neshteruk 2021 - Neshteruk, C. D., Tripicchio, G. L., Lobaugh, S., Vaughn, A. E., Luecking, C. T., Mazzucca, S., & Ward, D. S. (2021). Screen time parenting practices and associations with preschool children’s TV viewing and weight-related outcomes. International Journal of Environmental Research and Public Health, 18(14), 7359.

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WI DHS-Active early 2011 - Wisconsin Department of Health Services (WI DHS), Wisconsin Department of Public Instruction (WI DPI), Wisconsin Department of Children and Families (WI DCF). Active early: A Wisconsin guide for improving childhood physical activity. 2011.

Wu 2016 - Wu, L., Sun, S., He, Y., & Jiang, B. (2016). The effect of interventions targeting screen time reduction: A systematic review and meta-analysis. Medicine, 95(27), e4029.

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