key: cord-0745482-bso0gtj1 authors: Nagata, Jason M.; Abdel Magid, Hoda S.; Gabriel, Kelley Pettee title: Screen time for children and adolescents during the COVID‐19 pandemic date: 2020-05-28 journal: Obesity (Silver Spring) DOI: 10.1002/oby.22917 sha: a55605e088a6d0f62f24963273c019b5452fdbc7 doc_id: 745482 cord_uid: bso0gtj1 The coronavirus 2019 (COVID‐19) pandemic has led to laws and policies including national school closures, lockdown or shelter in place laws, and social distancing recommendations that may translate to higher overall screen time among children and adolescents for the duration of these laws and policies. These policies may need to be periodically re‐instated to control future COVID‐19 recurrences or other national emergencies. Excessive screen time is associated with cardiovascular disease risk factors such as obesity, high blood pressure, and insulin resistance because it increases sedentary time and is associated with snacking The coronavirus 2019 (COVID-19) pandemic has led to laws and policies including national school closures, lockdown or shelter in place laws, and social distancing recommendations that may translate to higher overall screen time among children and adolescents for the duration of these laws and policies. These policies may need to be periodically re-instated to control future COVID-19 recurrences or other national emergencies. Excessive screen time is associated with cardiovascular disease risk factors such as obesity, high blood pressure, and insulin resistance because it increases sedentary time and is associated with Though prior policy statements from organizations such as the American Academy of Pediatrics suggested specific limits on screen time (i.e. <1 to 2 hours per day) for entertainment purposes (2), the most recent policy statement published in 2016 advocates for families to make an individualized family media use plan (3), without specifying universal daily screen time limits. Mitigating the potential adverse health consequences of screen time may be important considerations in a family's media use plan. While excessive screen time may be associated with health risks including poor sleep and higher accumulated time spent sedentary (1), given current laws and policies during COVID-19, rises in screen time may be inevitable and even beneficial for education and socialization. These increases in overall screen time may result from non-discretionary or discretionary activities that foster positive youth development or are purely entertainment. Higher accumulation of screen time may also be an unavoidable reality among children whose parents are working remotely from home. Developing an adapted family media use plan (3) during COVID-19 may be especially important, and should leverage screen time for its strengths and benefits while This article is protected by copyright. All rights reserved Accepted Article mitigating known risks. Although screen time is traditionally associated with sedentary behavior and snacking, which may promote obesity and cardiovascular disease risk factors (1), screen time does not have to be sedentary. During shelter-in-place, screen time can be used to promote physical activity (4), such as online physical activity classes, exercise applications on mobile devices, or video games that have a physical activity component (5) . A recent systematic review among adolescents found that digital interventions that included education, goal setting, self-monitoring, and parental involvement led to significant increases in physical activity (5) . Amidst national school closures, many schools and universities have transitioned to virtual or online curriculums, which necessitates students to use screens and will support important educational benefits. Most remote learning (including teaching, assignments, submission, and feedback on materials) is conducted on screens. While this constitutes a large proportion of the day that is specifically required for school work and instruction, this time is largely equivalent to in-school instruction. Greater years of education is associated with longterm health benefits, through multiple factors including economics, access to health services, health-related practices, and coping with stress (6). In addition, social media may be an ideal platform for children and adolescents to keep connected with their friends and peers while practicing social distancing. One study prior to COVID-19 found that social media use of <2 hours per day was associated with high levels of school connectedness in high school students (7) . During periods of school closure and social This article is protected by copyright. All rights reserved Accepted Article distancing, children and adolescents who already have familiarity with social media may have an advantage in weathering the period of social distancing given their fluency with interacting with others via social media. Children and adolescents may also use virtual games and online activities to keep socially connected during shelter in place or stay at home orders issued by federal or local governments. Excessive screen time is associated with poor sleep through a number of mechanisms including nighttime exposure to bright light which may suppress melatonin production and displacing other activities beneficial for sleep such as physical activity (1) . Given these associations, the American Academy of Pediatrics recommends avoiding screens at least 1 hour before bedtime (3). This practice may mitigate sleep disturbance, especially given that sleep quality may be poorer due to stressors or anxiety related to the COVID-19 pandemic (8) . Increased screen time may also further exacerbate risk for depression, anxiety, suicide, and inattention among children and adolescents (1) . However, during the COVID-19 pandemic, many mental health educational resources and support services are being offered via online platforms (e.g. mobile applications) which would necessitate the use of screen time (9) . Furthermore, mental health practices may offer counseling and therapy sessions exclusively via telehealth which would be conducted on screens (10) . Screen time may become more ubiquitous during periods of school closures, lockdown or shelter in place, and social distancing and these policies may need to be periodically re-instated to control future COVID-19 recurrences. Professional societies should update their current guidance regarding screen time to support families trying to adhere to arbitrary screen time limits This article is protected by copyright. All rights reserved Accepted Article or experiencing guilt over excess screen time during the COVID-19 pandemic. For instance, the American Academy of Pediatrics could provide specific examples of family media use plans (3) during COVID-19 that adapts to current needs and benefits of screen time by emphasizing activities that foster physical activity, education, socialization, and positive youth development, but still sets some limits to mitigate risks such as poor sleep or excessive sedentary time. Moreover, screen time guidelines need to account for the upcoming summer months during shelter in place, in which case many children and adolescents will not have classes but may still be under shelter in place restrictions. These screen time resources could be disseminated electronically or via mailings by professional societies, health care practices, and clinicians. Clinicians can also ask parents about family media use during COVID-19 and distribute these resources during any clinical visits. Communities and schools can promote beneficial uses of screen time such as educational resources, physical activity, and mental health support (8) . This article is protected by copyright. All rights reserved Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study Children, adolescents, and the media Media and young minds Stay physically active during self-quarantine A Systematic Review of Digital Interventions for Improving the Diet and Physical Activity Behaviors of Adolescents How Education Makes Us Healthy[1]: Ingenta Connect Social Media Use, School Connectedness, and Academic Performance Among Adolescents Mitigate the effects of home confinement on children during the COVID-19 outbreak Online mental health services in China during the COVID-19 outbreak Rapid Scale-Up of Telehealth during the COVID-19 Pandemic and Implications for Subspecialty Care in Rural Areas