This week, the AAP hosted a national conference in San Francisco, where an estimated 10,000 pediatricians met to discuss new children's health recommendations for 2017. Children's screen time, social media and cyberbullying were key points of interest.
Previously the Academy set a general screen time limit: no more than two hours in front of the TV for kids over age 2. Today, in a world surrounded by digital media 24/7, defining screen time is difficult.
"It doesn't make sense to make a blanket statement [of two hours] of screen time anymore," said Dr. Yolanda Reid Chassiakos, lead author of the "Children and Adolescents and Digital Media Technical Report" and assistant professor at UCLA. "For some children, two hours may be too much."
For the new guidelines, the AAP identifies screen time as time spent using digital media for entertainment purposes. Other uses of media, such as online homework, don't count as screen time.
The academy recommends that for children 2 to 5 years of age, screen time should be limited to one hour per day. For kids ages 6 and older, parents can determine the restrictions for time spent using screen, as well as monitor the types of digital media their children use.
Babies are most vulnerable to screens. Infants aged 18 months and younger should not be exposed to any digital media, the academy says.
Infants 18 months and younger: No screen time
For parents with infants, cutting off technology completely can be challenging. But banning screen time for babies is hugely important for brain development and healthy parent-child connections, Chassiakos said.
"The noise and activity of a screen are distracting for a child," she said. Even if the baby isn't directly looking at the screen -- for example, if a mother is nursing her child on the couch while watching TV -- the baby can be overstimulated by the lights and sounds, which may cause distress and sleep problems.
Perhaps most negatively, screen time causes a disconnect between parents and children.
"When a mother is breast-feeding, that is a crucial bonding time," said Chassiakos. The more face-to-face interaction children have with mothers and other adults, especially eye contact, the better for the brain development of infants, she explained.
If parents' attention is fixed on a TV or phone screen, babies are deprived of that attention; and if they are repeatedly neglected in favor of digital media, children may develop behavioral issues in the future, Chassaiakos said.
"The TV should not be a babysitter," she said. "It's much better to talk to a child or read from a book."
Children 2 to 5 years: One hour per day
The AAP recommends that "parents prioritize creative, unplugged playtime for infants and toddlers," according to its press release. Children this age can be introduced to screens, but only for one hour a day. The type of media they are exposed to is critical: only high-quality programs, such as "Sesame Street" and other PBS shows should be viewed.
"Shows like 'Sesame Street' are much better than standard TV, because they don't have advertisements, which tend to overstimulate children," said Chassiakos.
Toddler-aged kids haven't developed the cognitive skills to understand advertisements or animations, she explained. Children at this age "can't interpret images like an older kid," meaning they can't decipher between real-world people and fictional cartoons.
While cartoons get a thumbs-down, the academy supports toddlers using face-to-face interactive media, such as Skype or Facetime. Including children in Skype video conversations with grandma, for example, can promote healthy development in kids, Chassiakos says. After the conversation ends, parents can supplement children's learning by repeating what grandma said on the screen.
Children 6 years and older: Limit digital media
Parents are in charge of setting limits on digital media for kids and teens six and older, the academy says. The amount of daily screen time depends on the child and family, but children should prioritize productive time over entertainment time.
For healthy kids, an average day includes "school, homework time, at least one hour of physical activity, social contact and sleep -- which is anywhere from eight to 12 hours for kids," said Chassiakos. "Whatever's left over can be screen time."
The academy agrees that digital media should never replace healthy activities, particularly sleep, social interaction and physical activity. In the press release, Dr. Jenny Radesky stated, "What's most important is that parents be their child's 'media mentor.' That means teaching them how to use it as a tool to create, connect and learn."
Kids and teens have access to thousands of apps, film streaming sites, video games and social media on multiple devices, from personal smartphones to public school-issued tablets.
"The environment of media has changed today," Chassiakos said. Many aspects of digital media are positive: it can be interactive; it facilitates communication; it allows people to create. Kids often view class lecture notes and do homework through a screen, she said.
However, parents have to talk to kids, especially teens, about the risks of digital media -- including "cyberbullying, engaging in sexting, and being accessible to advertisements and online predators," Chassiakos said.
For smaller children, discussing advertisements on TV is important, the academy reports. Many products, such as sugary cereals and fast-food restaurants, are marketed to children, and parents should help kids understand that these foods aren't healthy choices.
"Even though the media landscape is constantly changing, some of the same parenting rules apply," Chassiakos wrote in the academy's press release. "Parents play an important role in helping children and teens navigate the media environment, just as they help them learn how to behave off-line."
Tips for parents for healthy digital media use
Parents are children's main role models, so it's important for moms and dads to have healthy digital media habits. This means being conscious of setting down cellphones, turning off the TV and shutting laptops at night.
"Young children can tell when their parents' heads are always in their cells," Chassiakos said. The lack of attention from a parent can make "kids' levels of irritable behavior worse."
The academy recommends that families designate "media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms," according to the release.
With phones off the dinner table, families can have in-person conversations, which are very important for children's development. Parents benefit from media-free practices, too. Face-to-face interactions with family creates more intimate bonds, and tech-free bedrooms can promote better sleep, Chassiakos explained.
Keeping tech devices out of bedrooms is also a good way to monitor kids' digital media activity. Chassiakos recommends having children use computers in the living room, for example, to ensure they finish any online homework assignments before using entertainment media.
"This doesn't mean you can't play video games with your kids," she said. "What's most important is that families have media-free time, and when digital media is used, it's used mainly for communication rather than entertainment."
For help constructing a digital media plan for the whole family, the AAP recommends using the Family Media Plan
tool, which can be found at healthychildren.org.