12 THE STRAITS TIMES AUGUST 7 2014

Five-year-oldKristy gets towatch TV foran hour or soduringlunchtime

and for about twohours during dinner.

“After dinner, her ‘reward’ is at least11/2 hours of time on an Apple iPadbefore she washes up for bed. Then, wetake her through some educational appsor games before she sleeps,” said hermother, Mrs D Lee, 39, who holds anoffice job.

“It is effective as a babysitting tool aslong as we set the rules. We will warnher before we take back the iPad. Sheknows that if she doesn’t cooperate, itwill be confiscated for a couple of days.”

Mrs Lee said she first allowed Kristyto play with the tablet when she wasaround two, but the time spent on it wasa lot shorter.

“It’s really a case of bo pian (Hokkienfor no choice) now as I have athree-month-old baby. Otherwise, I will gomad. She’ll keep bugging me and I haveto express milk most of the time.”

Mrs Lee is aware of the possibledangers of too much “screen time” butis not overly worried.

Screen time is the time spent on anymedia device with a screen, such astelevision, computers, video gameconsoles and handheld screen devices,including mobile phones and tablets.

She is among the many parents todaywho whip out their smart devices toentertain their children.

Indeed, a recent study by studentsfrom the Yong Loo Lin School ofMedicine, National University ofSingapore (NUS) called Project iBabyfound that nine out of 10 children in the18 to 24 months age group are exposedto screen devices.

As part of a community health project,the fourth-year students interviewedparents of 800 children in February tofind out how often young children usescreen devices and the attitudes,practices and beliefs of their caregiverstowards such use.

SCREEN TIME OVERLOADWhat is of concern is the amount ofscreen exposure young children areexperiencing. The Project iBaby studydiscovered that almost half of thesechildren under the age of two spend anhour or more on screen devices a day.

The study also found that there was alack of parental knowledge when it cameto the subject matter of screen timeexposure. Eight in 10 parents wereunaware of any guidelines put forth byprofessionals regarding screen time foryoung children while four in 10 parentsfailed to supervise their child’s screenusage all the time.

“This is the first time in Singaporethat screen viewing behaviour of veryyoung children has been investigatedcomprehensively,” said Dr FalkMueller-Riemenschneider from the NUSSaw Swee Hock School of Public Health,who is the supervisor of Project iBaby.

“Our findings highlight that exposureto screen devices is highly prevalent andthat awareness about the detrimentalhealth effects is limited.”

The excessive use of screen devicescan be harmful.

It can cause speech delays andbehavioural issues in young children,and attention problems in school-goingchildren, apart from the possible weightgain that can accompany sedentarybehaviour.

Mr Readon Teh, 23, thestudent-in-charge of Project iBaby’sresults, said: “We also found out thatkids below the age of two, who areexposed to screen time, are more likelyto have less than the recommended 13hours of sleep a day.”

IMPACT CAN DEEPENEarly and heavy screen-time exposurecan result in a higher rate of attentiondeficit when a child is of school-goingage and result in language delays ifparent-child interactions arecompromised as a result of screen time,said Dr Jennifer Kiing, consultant,division of neurodevelopmental andbehavioural paediatrics at thedepartment of paediatrics, NationalUniversity Hospital.

“There is also a link between screenviolence and aggressive behaviour inchildren,” she said.

In older children and adults, thosewho show addiction-like behaviour ontheir smartphone use can exhibit socialeffects such as declined performance inwork or study and neglect of family orimportant relationships or socialengagements, said Dr Tan Hwee Sim, aspecialist in psychiatry and consultant atRaffles Counselling Centre.

They can also be affectedpsychologically. For instance, they mayfeel anxious when they are unable toaccess their devices, or depressed whenthey read negative remarks on socialnetwork sites.

Furthermore, their health may beaffected as they could suffer from sleepdisturbances, eye strain and neck pain,said Dr Tan.

Problematic use can even causelong-standing issues such as familybreak-ups and poor academic results,she added.

One reason why the parents ofAngeline (not her real name), 16, tookher to see Dr Tan recently was becauseher academic results had deteriorated.She was also highly irritable and herrelationship with her parents was

strained. “It turned out that she hadbeen spending increasing amounts oftime on her smartphone: watchingvideos, following updates on varioussocial media sites and playing games,”said Dr Tan.

Her anxiety about her poor results hadled her to use her smartphone evenmore to escape from her problems.

Dr Tan assessed Angeline and ruledout any underlying mood or anxietydisorders. She then counselled her androped in her parents when she devised a

plan to help the student gradually reduceher smartphone use.

Problematic smartphone use oftenoccurs in the context of other underlyingconditions, such as anxiety anddepression, said Dr Tan.

That is why it is still not clear whether“smartphone addiction” is truly aseparate disease entity or amanifestation of other issues, she said.

She added that there is currently noconsensus among psychiatrists,although some want it to be formally

recognised as a disorder here.Those who are vulnerable to

addiction-like behaviour are people withpoor social skills, low self-esteem, or aresuffering from negative emotions, suchas anxiety, depression and anger, andwho have limited coping skills, she said.

MONITOR USAGEThe students who took part in ProjectiBaby have developed educationalmaterials, such as brochures andposters, as well as held baby fairs at

KK Women’s and Children’s Hospitaland National University Hospital to raiseawareness of harmful effects of toomuch screen time.

But more needs to be done.Dr Mueller-Riemenschneider said morewidespread and comprehensiveapproaches, involving childcare centresand teachers, the health-care sector andother institutions, will be needed to raiseawareness on a larger population level,as well as to overcome misperceptionsabout the beneficial effects of screenviewing in the very young.

Some parents believe that certain TVprogrammes or apps will benefit theirchildren cognitively but, in fact, there isno evidence to show that these arebeneficial for very young children belowtwo, he said.

“There also remains a need to betterunderstand why so many children engagein excessive amounts of screen viewingbehaviour and what the barriers toreducing such behaviour in children are,”said Dr Mueller-Riemenschneider, whosearea of speciality is in public health.

There are currently no officialguidelines on the length of screen timechildren should be exposed to inSingapore, but several health-careorganisations in the United States havediscouraged media use by children up tothe age of two.

For years, the American Academy OfPaediatricians (AAP) has beenrecommending that TV and otherentertainment media be avoided forinfants and children under the age oftwo, and that older children and teensshould engage with entertainment mediafor no more than one or two hours perday.

Experts say children under the age oftwo learn best through real-lifeinteractions and not through videos.

In general, children under the age oftwo are more likely to have speechdelays and behavioural issues if they areexposed to excessive media screenexposure before they turn two, saidDr Tan Kuanyang from ThomsonPaediatric Centre.

That is why the general stand ofpaediatricians is to discourage the useof media devices below the age of two,he said.

The recommendation also applies toeducational apps. “An app speaks to youand does not require you to interact,resulting in speech and behaviouralissues,” said Dr Tan.

Mrs Lee said she will monitor Kristy’sbehaviour. If there are any issues, shewill “moderate Kristy’s time with theiPad”.

joyceteo@sph.com.sg

For more info on Project iBaby, goto http://doctorsoftomorrow.me/

projectibaby

It is not only young children who are at risk ofbecoming too attached to smart devices. Olderchildren and adults can become hooked on suchdevices too.

The main difference between a heavy smartphoneuser and a problematic smartphone user is that forthe former, the use does not interfere with his work,relationships or life, said Dr Tan Hwee Sim, aspecialist in psychiatry and consultant at RafflesCounselling Centre, who has clinical interests inaddictions.

“There is no universal agreement as to the specificcriteria for ‘smartphone addiction’, whether it is amental disorder or, indeed, whether it is a disorder atall,” she said.

As smartphone addiction is not an establishedmental disorder, the criteria for substance usedisorder can usually be applied to problematicsmartphone use, she said.

These include:● The person using the device more than he intendedto. For instance, he would tell himself that he wouldspend only an hour on the device but ends upspending the whole night on it.● Showing a desire to cut down on or control howmuch he uses the device but is unable to.● Craving the use of the device.● Continuing to use the device despite negativeconsequences, such as deteriorating academicresults.● Neglecting important activities, such as schoolworkor housework, because of time spent using thedevice.● Using the device in situations in which it isphysically hazardous, for example, when driving orcrossing the road.● Experiencing withdrawal symptoms, such as anxietyor irritability, when withdrawing from the use of thedevice.

NIP IT IN THE BUDDr Tan suggested the following ways to help parentsstem problematic use of smartphones.1. Recognise that the usage is out of control“Some people are able to modify their behaviour oncethey have an insight into the negative consequencesthat their behaviour causes,” said Dr Tan.

“If there is any underlying issue that may cause orsupport the problematic usage, it needs to beaddressed. Examples include depression, anxiety,stress or self-esteem and social skills issues.”

A formal consultation may be needed to assesswhat issues are involved, she said.2. Modify usageBy keeping a log on how much time is spent using adevice for non-essential activities, a person can setgoals to reduce such usage.3. Set rulesLay down some guidelines for not using thesmartphone in certain situations. For example, whendriving, eating, spending time with the family or whenin the bedroom.4. Eliminate data planIf a person is still unable to control his usage despitethese efforts, he should consider using a device withno data plan, so he cannot surf the Internet on it, inorder to break the habit.

Warningsigns

Screen time may be unavoidable today but parents have the powerto manage their children’s exposure to tablets, TVs and computers

Screen time should not compromiseparent-child interactions, saydoctors.

Here is some advice frompaediatricians and Project iBabyresearchers on how parents canmanage their children’s screen time.1. Discourage children below the ageof two from using screen devices.2. For children above two years old,limit the time spent on screendevices to no more than one or twohours a day.3. Review the content that your childis watching and watch it with him.4. Make and enforce rules to limitscreen time.5. Encourage other interactiveactivities which promote proper braindevelopment, such as playing andreading.6. Watch TV or use other devices inthe living room only and not in thechildren’s bedroom.

JOYCE TEO

Turn off that tech toy

PHOTO: ISTOCKPHOTO

How tomanagescreen time

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