COMMENTARY www.jpeds.
com • THE JOURNAL OF PEDIATRICS
Conflicting Guidelines on Young Children's Screen Time and Use of
Digital Technology Create Policy and Practice Dilemmas
Leon Straker, PhD1, Juliana Zabatiero, PhD1, Susan Danby, PhD2, Karen Thorpe, PhD3, and Susan Edwards, PhD4
A
cross the globe, many children live in a digitally en-
meshed world. Education and industry authorities en-
courage the use of digital technology by children to
prepare them to thrive in a digital world. Health authorities,
in contrast, discourage young children’s use of digital tech-
nology and raise concerns about the potential negative effects
on children’s physical, cognitive, emotional, and social well-
being. This paper articulates the differing perspectives of edu-
cation and health authorities that result in a dilemma for those
charged with providing for young children’s health, care, edu-
cation, development, and well-being—that of conflicting advice
regarding the use of digital technology in early childhood. We
highlight the consequent need for clear and balanced infor-
mation regarding appropriate digital technology practices for
families, doctors, educators, and other professionals working
with young children—so that young children may gain ben-
efits from digital technology use while minimizing the poten-
tial for harm.
The Context of Contemporary Digital
Screen Technology Use by Young Children
The introduction of intuitive touch-screen user interfaces on
Internet-enabled mobile devices, including smartphones and
tablet computers, has created the opportunity for more ex-
tensive technological engagement by young children and at even
younger ages than was seen previously. Access to, and use of,
mobile touch-screen devices by young children has grown
rapidly since the 2000s. For example, 98% of homes in the US
with young children had a mobile touch-screen device in 2017,
compared with just 52% in 2011.1 Mobile touch-screen device
use constituted 35% of all screen use by 0- to 8-year-old chil-
dren in the US, with average weekly screen time reported as
14.2 hours for those younger than 2 years and 25.9 hours for
those 2-5 years in Australia.1,2 By 14 months of age, 78% of
French children were using a mobile touch-screen device, in-
creasing to 90% by 2 years of age.3 Parents of children aged
3-8 years across 5 countries in Southeast Asia reported that
66% of children use their parents’ mobile touch-screen devices,
and 14% of children owned their own device.4 In 2017, 21%
of British 3- to 4-year-old children owned their own tablet
device.2,5 In postindustrialized countries, increased digital tech-
nology use by young children has resulted in the production
of guidelines by education and health authorities on technol-
ogy use in early childhood.
The Dilemma of Conflicting Guidelines
Parents, doctors, educators, and other professionals inter-
ested in child health, well-being, and educational development
300
currently are faced with a dilemma: On one hand, education
and industry/employment/innovation government and non-
government authorities promote expanded use of digital tech-
nology by young children for a range of reasons.6-9 These include
enhancing learning, promoting children’s digital skill set, en-
gaging in STEM (ie, Science, Technology, Engineering, and
Mathematics), ensuring productive workforce membership, en-
abling competition in a globalized economy, and creating com-
petence in social interaction.
On the other hand, public health agencies advocate for
minimal use of digital technology by young children as the
result of concerns about the effects on physical, cognitive, emo-
tional, and social health, well-being, and development.10-13 Physi-
cal concerns include poor and sustained postures, repetitive
movements and accidents during use, and increasing seden-
tary time with displacement of gross motor activities that
impact on bone and muscle growth, motor skill, and energy
expenditure and obesity. Cognitive concerns include limita-
tion of time for learning opportunities, shortened attention
spans, and fewer contexts for verbal interactions, problem-
solving, and creativity. Emotional concerns include addic-
tion, depression, and access to inappropriate content and
advertising. Social concerns include isolation, restricted face-
to-face discourse, cyber-bullying, and predatory pedophiles.
The dilemma of authoritative guidelines providing con-
flicting messages to the same audience can be illustrated in the
Australian context. The Australian national curriculum, the
Early Years Learning Framework,6 and the Australian 24-
Hour Movement Guidelines for the Early Years13 each con-
sider digital technology use by children aged birth to 5 years.
The Early Years Learning Framework is the Australian gov-
ernment’s guiding curriculum document for educators of young
children aged from birth to 5 years.6 It informs the evalua-
tion and accreditation of early learning centers nationwide. The
Early Years Learning Framework is intended to support chil-
dren’s learning across 5 key outcomes, with 2 outcomes having
From the 1School of Physiotherapy and Exercise Science, Curtin University, Perth,
Western Australia; 2School of Early Childhood and Inclusive Education, Queensland
University of Technology, Brisbane, Queensland; 3Institute for Social Science
Research, University of Queensland, Brisbane, Queensland, Australia; and 4Learning
Sciences Institute of Australia, Australian Catholic University, Melbourne, Victoria,
Australia
L.S. and S.E. are co-chairs of the Digital Policy Group of Early Childhood Australia,
and S.D. is a member of the Digital Policy Group. L.S. is also on the Executive of
Active Healthy Kids Australia, a nongovernment advocacy group promoting physical
activity by children, and the Australian Council on Children and the Media, a
nongovernment advocacy group promoting appropriate media for children. K.T. was a
panelist contributing to the development of the Australian 24-Hour Movement
Guidelines for the Early Years. The authors declare no conflicts of interest.
0022-3476/$ - see front matter. © 2018 Elsevier Inc. All rights reserved.
https://doi.org10.1016/j.jpeds.2018.07.019

explicit guidance on digital technology use. For example,
Outcome 5 recognizes that children are effective communi-
cators and states that “Children use information and commu-
nication technologies to access information, investigate ideas
and represent their thinking.”6 Stated advice for using digital
technology with children includes: “introduce appropriate tools,
technologies and media and provide the skills, knowledge and
techniques to enhance children’s learning”; “provide chil-
dren with access to a range of technologies”; “integrate tech-
nologies into children’s play experiences and projects”; and
“teach skills and techniques and encourage children to use tech-
nologies to explore new information and represent their ideas.”
The Early Years Learning Framework recognizes the role of
digital technology in young children’s lives for communica-
tion purposes and indicates that digital technology use should
be considered a core learning outcome for children aged birth
to 5 years. With a focus on hands-on learning and inten-
tional teaching, this inclusion of digital technology in early
childhood education is framed within an expectation that digital
technology use will be active and occur in collaboration with
adults and peers. Furthermore, digital technology is put to pur-
poseful use—for representing ideas and exploring informa-
tion. This perspective recognizes that digital technology is
evident in children’s everyday worlds and seeks to develop
young children’s capacity to use it for learning and social
interaction.
This educational perspective on digital technology use by
young children contrasts with the public health guidelines.
These guidelines seek to “minimize screen time” based on a
perspective that screen time is sedentary and passive.11,13 For
example, the Australian government’s 24-hour Movement
Guidelines for the Early Years13 state that for children younger
than 1 year of age, “screen time is not recommended,” for chil-
dren younger than 2 years of age, “sedentary screen time is not
recommended,” and for children 2-5 years of age, “sedentary
screen time should be no more than 1 hour; less is better.”
The reasons for these conflicting positions from the one na-
tional government are many but are likely to include differ-
ing philosophies, priorities, and processes underpinning the
development of each set of guidelines. For example, the Aus-
tralian 24-Hour Movement Guidelines for the Early Years were
published by the Department of Health and evolved from physi-
cal activity guidelines and the evidence of insufficient physi-
cal activity being detrimental to health. There was a clear
intention in these guidelines to reduce the growing burden as-
sociated with noncommunicable chronic diseases. Although
the current guidelines13 are based on new systematic reviews,
no evidence was included in those reviews on mobile touch-
screen device use.14 The included evidence mainly focused on
television viewing, which has different use options com-
pared with mobile touch-screen devices. The current Austra-
lian 24-Hour Movement Guidelines for the Early Years also
retained existing suggestions unless there was clear evidence
to change. Given the limited available research on health out-
comes associated with mobile touch-screen device use by young
children, this meant that the guidelines retained recommen-
dations originally developed in the previous century, before
Volume 202 • November 2018
the significant uptake of mobile digital technologies by young
children worldwide.
Another reason for the differing positions is the focus on
screen time by health authorities and on the nature of use by
education authorities. The context, content, and connections
of digital technology use by children are likely to be highly in-
fluential in determining cognitive, emotional, and social
outcomes.15 This implies that screen time may be only a useful
construct for some outcomes, such as sedentariness and the
prevention of related chronic diseases.
Conceived from alternative perspectives, these 2 guide-
lines offer conflicting advice that leaves parents, doctors, edu-
cators, and other health professionals caught in the middle
regarding digital technology decision-making. Parents may feel
guilty about their children using digital technology and dis-
enfranchised from making decisions,16 educators also may be
conflicted about whether to use digital technology,17,18 and
doctors and other health professionals are not adequately sup-
ported to deal with the responsibility entrusted to them of
guiding parents of young children on the appropriate use of
digital technology.10,12
The imperative is for clear information on appropriate digital
technology use that addresses health, well-being, and educa-
tional development of the whole child and supports in-
formed decision-making by parents and professionals.
We argue that adults responsible for young children have
an ethical responsibility to prepare them for life in a digital
world. Assisting children to develop an understanding of the
benefits and risks of digital technology alongside appropri-
ate ways of using digital technology is an adult responsibility.
Parents are seeking clear and consistent information on ap-
propriate ways in which digital technology can be used by young
children from sources that they trust. Currently, information
of this type is limited. For example, the Australian 24-Hour
Movement Guidelines for the Early Years provides no guid-
ance for “good” use of screens.13 In contrast, the American
Academy of Pediatrics guidelines mention that video chat is
permissible for infants (0-2 years), and that screen use by 2-
to 5-year-old children should be “quality programming” and
involve coviewing with family members.10 These guidelines also
suggest the avoidance of fast-paced programs with distract-
ing or violent content and keeping screens out of bedrooms
and also strongly promote the value of adults in collabora-
tive engagement with children when using digital technol-
ogy. Similarly, the Canadian Paediatric Society guidelines suggest
coviewing and encourage “mindful” use and prioritizing edu-
cational, age-appropriate, and interactive programming.11 They
also recommend avoiding screen use before bedtime. However,
the guidance on “good” use of screens from the American
Academy of Pediatrics and the Canadian Paediatric Society is
focused mainly on cognitive and social well-being, leading to
criticism for not paying sufficient attention to physical
well-being19 and the growing evidence of digital technology
use impacting on musculoskeletal,20 cardiometabolic,14,21 and
other aspects of physical health.14,21
There has been limited success in attempts at providing
evidence-based guidelines for previous generations of digital
301
THE JOURNAL OF PEDIATRICS • www.jpeds.com
technology use by children.22,23 This limited uptake may be due
to the implicit, and sometimes explicit, messaging in the health
guidelines that screen time is “bad”—“choose healthy
alternatives,”12 “too much screen time means lost opportuni-
ties for teaching and learning,”12 and “limit screen use to 1 hour
per day.”10 Indeed, a recent report from the United Kingdom
stated that “‘screen time’ advice for parents remains over-
whelmingly focussed on risk and harm” with little on the op-
portunities “to learn, connect and create.”15 In their review of
advice available from authoritative and parent sources, Blum-
Ross and Livingstone15 found an overwhelming majority
focused on risks compared with opportunities. This bias in mes-
saging may inhibit the receipt and implementation of sugges-
tions within these guidelines by families. The American
Academy of Pediatrics and the Canadian Paediatric Society
guidelines do provide more balanced advice, including report-
ing on potential benefits to cognitive and psychosocial devel-
opment, the ability for technology to be used in social and
creative ways, and even noting that digital media use can en-
courage physical activity.10,12 The overall tone of interna-
tional health guidance, however, is one of risk management,
exemplified by language such as “minimize” and “mitigate the
risks.”12 Nonconflicting and more neutral advice about ap-
propriate digital technology use, with suggestions for how and
why adults can use digital technology with young children, may
be a better way forward.24 For example, doctors and other health
professionals could frame messages along the lines of “a healthy
way to play with your 3 year old using digital technology
is . . ..”
Conclusions
The Australian case highlights debates currently underway at
a global level. Doctors, educators, and other professionals are
in positions of being trusted sources of advice to families. Today,
advice about digital technology is integral to parents’ decision-
making in raising their young children. The overall goal for
professionals working with families is to support them in de-
veloping digital technology use practices that are in the best
interests of the child, supporting their health, well-being, and
educational development. We suggest 5 steps to advance prac-
tice, policy, and research to provide greater consistency in advice
regarding young children and digital technology.
First, we suggest a re-examination of the diverse perspec-
tives of health and education with a view to providing con-
sistent, neutral, and evidence-based messages to parents. This
is likely to require the development of new transdisciplinary
understanding about what matters for the early years devel-
opment in ways that connect health and education perspec-
tives and ensure consideration of the whole child in context.
Second, the discussions that doctors and other profession-
als have with families need to be based on a clear understand-
ing of the individual family and the importance of whole family
digital technology use practices. Discussions need to raise not
only child’s use of digital technology but also that the child
is learning how to use this technology from parental model-
ing with digital technology, including digital citizenship (eg,
302
Volume 202
online safety and behavior). Discussions also need to con-
sider the influence that digital technology use by parents, sib-
lings, and others may have on child–parent and child–sibling
relationships.
Third, there is a clear need for better evidence to support
doctors, early childhood educators, and other professionals on
the role and use of contemporary digital technology, such as
mobile touch-screen devices, in early childhood. This re-
search includes investigating the shorter- and longer-term effects
of digital technology use on children’s health and develop-
ment, including longitudinal studies. Instead of relying on the
oversimplistic “screen time” construct, such research will require
detailed assessment of the digital technology use in the family
home and other community contexts to include important fea-
tures such as type, content, and timing of digital technology
use.
Fourth, evidence is needed on how doctors and educators
effectively can assist families to develop digital technology prac-
tices that support children’s health and development. Re-
search should examine the nature and value of authoritative
guidelines, along with effective methods for implementing them,
including promoting and supporting sustained behavior change
within families. For example, research could examine the effect
of digital technology use messages phrased more positively and
provide examples of best practice to encourage better uptake
of family practices that support children’s overall health, well-
being, and developmental outcomes.
Finally, we suggest that sedentary behavior guidelines should
be separated from digital technology use guidelines. Cur-
rently sedentary behavior guidelines are being operationalized
as leisure “screen time.” Sedentary behavior conflated with
screen time may cause families to miss the physical activity op-
portunities for children, including those afforded by mobile
digital technology, and to reject implementation of screen time
advice. Guidelines that attend to sedentary behaviors should
focus on all sitting behaviors more clearly and may conse-
quently have a greater effect on sedentary-related chronic disease
risk. Consistent health and education digital technology guide-
lines then could more clearly articulate positive ways for chil-
dren to use technology that involve physical activity and
promote opportunities for children to learn with and through
digital technologies.
We argue that the current dilemma of conflicting guide-
lines undermines the potential influence of doctors, educa-
tors, and other professionals to promote best practice outcomes
for young children growing up with digital technology. Con-
sistent advice attending to outcomes for the whole child, within
their family context, together with stronger evidence on longer
term impacts of contemporary digital technology use and evi-
dence on effective methods of supporting positive family digital
technology practices would better enable doctors and educa-
tors to appropriately support families. Consistent and con-
temporary evidence-based guidance on what to promote and
what to avoid for children’s digital technology practices is a
more supportive approach for parents who seek to both protect
their children from potential harm and enhance health, well-
being, and educational development. Pediatricians and other
Straker et al
November 2018
pediatric health providers, family doctors, along with educa-
tors and other professionals, are ideally placed to help fami-
lies more successfully navigate through this rapidly evolving
digital world. ■
Submitted for publication Apr 17, 2018; last revision received Jun 13, 2018;
accepted Jul 5, 2018
Reprint requests: Leon Straker, PhD, School of Physiotherapy and Exercise
Science, Curtin University, GPO Box U1986, Perth, WA, Australia. E-mail:
l.straker@curtin.edu.au
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