When it comes to toddlers, even an hour of screen time can lead to developmental delays: How much is too much?

Too much screen time can cause developmental delays in toddlers, according to a new study published in Pediatrics this August.^[]

The study, conducted in Japan, consisted of more than 7,000 mother-child pairs. The children were around one year old at the beginning of the study, at which time they were assessed for screen time exposure and given a ranking based on their exposure. The researchers scored children based on their amount, not quality, of screen time (eg, whether screen time was for educational or recreational purposes), which they noted as a limitation.

When the children were 2 and 4 years old, they were assessed on five developmental skills: communication, gross motor skills, fine motor skills, problem-solving abilities, and personal and social skills. The researchers found that screen time was associated with developmental delays in several of these categories, including communication, fine motor, problem-solving, and personal and social skills categories for 2-year-olds and communication and problem-solving for 4-year-olds.

Ilan Shapiro, MD, MBA, FAAP, FACHE, a pediatrician and the Chief Health Correspondent and Medical Affairs Officer at AltaMed Health Services, says that this study adds to existing research on screen time.

“We are witnessing the first generation learning how to use screens appropriately, and we need to leverage this knowledge to create a healthy development path for children,” Dr. Shapiro explains.

The study findings may demonstrate the importance of sticking to screen time limits. Researchers say that the findings call for more individualized investigations into how screen time impacts each of the five categories. 

While parents and pediatricians don’t have all the answers yet, Dr. Shapiro says that available information can guide best practices. For starters, he stresses the importance of balancing screen time with face-to-face interactions. He adds that more studies are needed to better understand—and address—how screen time impacts adolescent health.

“We have to recognize that kids live in two worlds: the physical and virtual,” Dr. Shapiro says. “For pediatricians and parents, it's important to avoid substituting physical activity like outdoor activities for screen time. When we use virtual technology, we can't forget physical activities like reading a book and playing with toys.”

Reading books, playing with toys, and interacting with other children and adults can help children engage and strengthen their brains, which is essential for healthy development, Dr. Shapiro adds.

“Learning requires active engagement, including discussion and interaction with other individuals,” he explains. “Without these experiences, learning becomes limited. When children isolate themselves, they might not engage in physical movement like stretching, crawling, [and] walking. If kids don't use the muscles or the brain, it can result in a delay in learning and development.”

“We have to look at the brain as a muscle,” Dr. Shapiro adds. “If we neglect the brain and fail to engage it, especially during the early years of development, it can risk [delaying] the important development of social skills, communication abilities, and motor skills.”

With older children, meaningful conversations can help encourage physical activity alongside screen time, he says. For younger children, parents and pediatricians can help direct activities, engage with the child, and lead by example.

“We need to focus on how we can use the time to learn, interact, and have fun with technology without losing the human touch,” Dr. Shapiro says. “When we lose human interaction, it can lead to a decline in meaningful conversation, relationships, and our health.”