The study below appears to be a well-performed study. The commentary below is also fair, noting this is the beginning of future long term, large-data, studies which are needed to piece together the answer to the universal question, “How much is too much for my child?” The editorial by Nature also notes that this paper is hardly the final word.

I could not agree more. The fact that they found that eating potatoes frequently was correlated with a negative “well-being” almost to the extent noted for screen time indicates this dataset is woefully subjective and should not be used to direct policies for countries or school systems or family households.

Also to say, “However, it does suggest that dire warnings are not warranted,” is also a jump: the authors and the editorial staff of Nature are doing our children a great disservice to make such a comment until they have more objective pieces of hard data with larger datasets ideally before making such a statement. “Well-being” is such a amorphous term that it pains me to read the abstract (still waiting for the full paper to posted to Johns Hopkins Pubmed). Do the researchers know what doctors are seeing in the trenches. Do they have any idea of what a meibomian gland is and how this, as an objective data point, could help answer these questions better?

It is a tough question to precisely answer the question “How much is too much for my child?” based on research to date.

What would be more compelling? 
What world researchers need to urgently do is to evaluate more objective data points, such as Meibomian Gland Scores of all these 355,358 children and compare them over time based on how many hours they spend per day on an electronic screen.  The issue being that adolescents will report they are doing well and feeling dandy as they spend up to 16-18 hrs on electronic screens like some of my patients do, but then hit a wall of meibomian gland disease and dry eye disease when they are older that can turn their lives upside down with chronic pain.

If we could capture the meibomian gland scores of these thousands of kids, we would be doing a great service to the world to really evaluate the effect of electronic screens over time on the eyes. And we could look at divorce rates, ability to maintain a job, diabetes rates, cancer rates, etc.

Currently, I recommend children do not use smart phones (with a max time of any screen use of 4 hours) until they are juniors or seniors in High School. Many parents will just laugh as their kids have had their own smart phone since they were 5. Dumb phones are excellent in helping your child stay in contact with you. I have friends who only use a dumb phone as the smart phone became too addictive.

Parents should talk to their eyeMD and pediatrician to discuss how much screen time is too much for their child as the answer should be directly correlated with Meibomian Gland Scores. If a 6 year old does not have meibomian glands, I know they will have dry eye problems in the future. I know they should limit screen use. I even tell the parents, do not encourage a profession of computer programming. If a child has normal glands, there is more wiggle room. If the child has an autoiummne disease, I recommend less than 2 hrs per day as I believe (this has not been proven yet and is a hypothesis I am trying to illustrate) there is an additive effect of excessive screen time and autoiumme disease with meibomian gland destruction.

Studies have shown that less than 4 hours per day is ideal for EVERYONE.
For children younger than 6, I recommend minimal screen time. Less than 1year old: none.
For children older than 6 and less than 16: I recommend limiting screen time to only what is necessary; ideally less than 2 hours per day.

For children older than 16: ideally no more than 4 hours per day.

Many caregivers and parents will be shocked by these low numbers as electronic screens have become a babysitter for many, including me. I understand.

Still, right now we do not have a good way to get children and adults to fully blink at regular intervals and this prevents the milking of the oil from the meibomian gland which leads to dysfunction which can lead to dry eye symptoms, corneal scar tissue, infection, and worse.

For now, I would not rely on medical researchers to set a limit for your child and family. I would not rely on Apple and IBM to set a limit either. I would do research to determine what is best for your child and your family. At the very least, if you are going to allow your child to be on an electronic screen more than 2 hrs per day, I would recommend a baseline meibography every year.

As a colleague said, “not getting a meibography for your child while these big issues are worked out and battled with datasets, may be considered child abuse in future when it is shown that electronic screens increase the rates of future chronic eye pain, divorce rates, etc.”

This is a pretty radical statement, but it is worth protecting your child and encouraging your child to look away from the screen periodically and avoid screens for only “eye worthy” activities and, most importantly….BLINK!

SLC

References:

These papers have demostrated that electronic screen use decreases blink frequency which increases tear evaporation, increases local inflammation and contributes to dry eye symptoms.  What I am trying to prove is that this local increase in inflammation is destroying meibomian glands at an alarming rate. The problem is that we do not have meibomian gland scores of kids back in the 1940’s or even 50’s when there were no cell phones as meibography only became available in 2016.

1. Tsubuta K, Nakamori K.  Dry eyes and Video Display Terminals.  Letter to the editor, New England Journal Medicine, 328(8):584, 1993.
2. Patel S, Henderson R, Bradley L, et al.  Effect of visual display unit use on blink rate and tear stability.  Optom Vis Sci, 68(11):888-892
3. Yaginuma Y, Yamada H, Nagai H.  Study of the relationship between lacrimation and blink in VDT work.  Ergonomics, 33(6): 799-809, 1990

5.

It has become a defining question of our age: do children and adolescents spend more time than is healthy staring at a phone, tablet or computer? Should parents limit their access? Should governments?

Nearly all US teenagers say they have access to a smartphone, and about half say they are online almost constantly, according to a 2018 Pew Research Center survey (see go.nature.com/2akajas). In the United Kingdom, the time young people spend online has almost doubled over the past decade, the communications-industry regulator, Ofcom, has found (see go.nature.com/2hd0c4p). Parental concerns about media use are rising, too — fuelled by headlines and political pronouncements. On 2 October 2018, Matt Hancock, UK secretary of state for health, issued an urgent warning, saying that the threat to children’s mental health from social media is similar to that from sugar to their physical health.

In cases of such significant public concern, it often falls to the scientific community to provide and assess evidence, and then make some recommendations. But scientific research in this field has its own challenges, and almost as many uncertainties.

Current evidence for an association between digital-technology use and adolescent well-being is contradictory and comes mainly from household panel surveys and other large-scale social polls, with thousands to millions of respondents. The questions represent a compromise between usefulness and not placing too much burden on respondents. They are simplified, are not standardized and often do not map straightforwardly onto the validated instruments that clinical or social scientists use to measure constructs such as ‘well-being’ and ‘technology use’.

So, researchers using these data to answer questions about the effects of technology need to make several decisions. Depending on the complexity of the data set, variables can be statistically analysed in trillions of ways. This makes almost any pattern of results possible. As a result, studies have suggested both the existence of and the lack of an association between screen time and well-being, even when analysing the same data set. Naturally, it’s the research that highlights possible dangers that receives the most public attention and helps to set the policy agenda.

A study published this week in Nature Human Behaviour (A. Orben and A. K. Przybylski Nature Hum. Behav. https://doi.org/10.1038/s41562-018-0506-1; 2019) introduces a different approach. The authors examine three key large-scale data sets, two from the United States and one from the United Kingdom, that include information about teenager well-being, digital-technology use and a host of other variables. Instead of running one or a handful of statistical analyses, they run all theoretically plausible analyses (combinations of dependent and independent variables, with or without co-variates) — in the case of one data set, more than 40,000. This allows the authors to map how the association between digital-technology use and well-being can vary — from negative to non-significant to positive — depending on how the same data set is used.

The authors’ overall calculations did find a statistically significant negative association between technology use and well-being: more screen time is associated with lower well-being in the young people surveyed. But the effects are so small — explaining at most 0.4% of the variation in well-being — as to be of little practical value.

To put this into context, the authors also looked at the associations between well-being and a range of other variables, such as binge drinking, being bullied, smoking, getting enough sleep, eating breakfast, eating vegetables, wearing glasses or going to the cinema. Well-being was more strongly associated, either positively or negatively, with most of these other variables than with digital-technology use. In fact, regularly eating potatoes was almost as negatively associated with well-being as was technology use, and the negative association between wearing glasses and well-being was greater.

This article is hardly the final word: its conclusions rely on the examination of associations, rather than on potential causal relationships. However, it does suggest that dire warnings are not warranted. And it is a reminder that limited evidence can distort public discourse when the issue is of pervasive significance — such as when parental decisions and the health of children are involved. This is also the conclusion reached by the UK Royal College of Paediatrics and Child Health, in guidance on the health effects of screen time that it issued earlier this month.

The digital revolution is without doubt changing modern life. We need more and better data to work out what impact that is having: in this case, whether media use causes reduced well-being, whether reduced well-being causes greater media use or whether a third variable underlies both. In the meantime, the findings of this study put the association between adolescent technology use and well-being in perspective, and highlight the importance of robust analytical techniques for social big data.

Nature 565, 265-266 (2019)