Screen time interventions for children

There is strong evidence that screen time interventions reduce sedentary screen time among children under 14^1, 5, 6. 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^1, 5, 7. Overall, screen time interventions have small but significant effects on stationary screen use with or without nutrition and physical activity components^1, 5, 7; additional evidence is needed to confirm effects on mobile device use.

Screen time interventions may be especially effective for children under the age of 6^5, 6. 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 obese¹.

In many cases, children who participate in screen time interventions with nutrition and physical activity components reduce their body mass index (BMI). Such interventions can also decrease the number of participating children who are obese¹. High levels of TV viewing are associated with higher BMIs as early as age 2⁸.

Family and parental support significantly increase the effectiveness of screen time interventions, reducing sedentary behavior and fostering long-term healthy screen time habits^{1, 6, 9}. 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^1, 5. 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, and fostering family communication about media use^{9, 10}. Parental reductions in personal screen time can also decrease children’s screen time⁹.

In schools, screen time interventions can be incorporated into existing curricula. Teacher training may increase effectiveness of these interventions¹. 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 time¹¹.

States and cities can regulate screen time in various settings, especially child care centers and home-based child care settings, as in Maryland¹² and New York City¹³. State health agencies often provide information, resources, and technical assistance to support the implementation of screen time interventions¹⁴.

There are several school-based screen time interventions that include physical activity and nutrition components. Many public middle schools in Boston, for example, implement the Planet Health curriculum¹⁵. Several elementary schools in South Orange and Maplewood, New Jersey implement a week or year-long TV Turnoff Challenge¹⁶.

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 Maine¹⁷, and has expanded to cities and states across the country, for example Florida¹⁸; New Hampshire¹⁹; Baton Rouge, LA²⁰; Chesterfield County, VA²¹; and Palo Alto, CA²².

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^{4, 23}.