The Hidden Costs of Screen Time: A Pediatrician’s Perspective

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By Peyton Martin, D.O., MD Pediatric Associates

It is clear that in recent years, children and teenagers are spending much more time in front of screens. School work that was once done with pen and paper is now entirely digital. Today’s youth have easy access to cell phones, tablets, personal computers, and social media. According to the American Academy of Child and Adolescent Psychiatry (AACAP), “Children ages 8-12… spend 4-6 hours a day watching or using screens, and teens spend up to 9 hours.”1 This rapid increase in screen use raises an important question:

How is this constant, often unlimited, screen access affecting our children’s development and overall health?

Even though the body of research is still growing, several well-designed studies have found that digital device use is a double-edged sword. On one side, high-quality, engaging, and educational programming can help build academic and cognitive skills when parents are involved.2,3,4 On the other side, the fast-paced, brightly colored, and non-educational programming that makes up much of what children watch can harm various aspects of cognitive development, such as problem-solving, communication, and language skills. Additionally, too much screen time has been linked to a higher risk of obesity, negative effects on mental health, and a possible connection to ADHD.

The purpose of this post is to examine these issues and offer evidence-based insights on the risks of excessive screen time. I also aim to provide practical advice for parents.

Early Childhood Development and the Role of Experience

Early childhood is a vital period for development when the brain is forming new connections at a rapid pace. We often think of milestones like rolling over, crawling, or walking, but there is much more going on beneath the surface. For instance, even infants start developing problem-solving and critical thinking skills when they learn about “object permanence” – the idea that an object still exists even when it is hidden out of sight. This is why peek-a-boo is so entertaining for babies!

As children grow into toddlers, they begin experimenting with balance and their sense of space by stacking blocks and throwing balls. In preschool, their imaginations bloom as they engage in role-play, creating stories with their stuffed animals. In early elementary school, they start learning teamwork such as playing on their first soccer team. Each of these steps builds on the one before, forming a foundation for problem-solving, critical thinking, and decision-making skills that start developing in infancy.

The Negative Impact of Excessive Screen Time

Unfortunately, too much screen time, even when the content is educational, can deprive young children of these essential learning experiences. A 2023 study published in the pediatric section of the Journal of the American Medical Association found that more screen time at age 1 was linked to a higher risk of delays in communication and problem-solving skills at ages 2 and 4. These delays became more pronounced as screen time increased.5 Without regular face-to-face communication and interactive play, children may struggle to develop these skills later in life.

Another study from 2024, which reviewed over 150 peer-reviewed articles, showed that excessive or unstructured screen time negatively affects children’s attention spans and makes it harder for them to make decisions, remember things, make plans, and control their emotions and impulses.3 Many digital media programs for children are designed to capture and hold their attention with constant stimulation, similar to how TikTok grabs adults. This constant overload of information makes it challenging for a child’s still-developing brain to focus on less stimulating tasks, causing problems in school and other areas where concentration is needed.

A separate 2024 article, reviewing 14 studies, found that too much screen time can weaken children’s ability to understand and express spoken language, leading to a smaller vocabulary and difficulty communicating.2One study even suggested that excessive screen exposure might harm the brain’s white matter, which is important for language and literacy skills.6 Learning language is not a one-way process; children need interactive, face-to-face conversation to learn how to effectively listen, speak, make eye contact, and understand non-verbal cues. This cannot be achieved with the passive consumption of digital media.

Screen Time, ADHD, Obesity, and Mental Health

ADHD has become more common over the past two decades. Data show that the rate of ADHD diagnoses in U.S. children and adolescents rose from 6.1% to 10.2% between 1997 and 2016—a 67% increase.7 While this is a complex issue that cannot be attributed to a single cause, research now suggests there might be a two-way relationship between too much screen time and ADHD symptoms. Excessive screen use can lead to fragmented attention, disrupted sleep, and less physical activity, which may worsen ADHD symptoms. At the same time, children with ADHD might be more drawn to high levels of screen time, creating a harmful cycle.8

There is also growing evidence linking excessive screen time with childhood and adolescent obesity and mental health problems. A 2020 article reviewing 38 studies found that too much screen time is a significant risk factor for obesity in young children, as well as for increased aggressive behavior.9 This trend continues into the teenage years, with a 2022 study showing a connection between screen time and the risk of being overweight or obese.10 Moreover, a 2016 study reported that many children who are obese remain obese into adolescence and adulthood, leading to chronic health issues.11

In terms of mental health, a large 2018 study of over 1 million adolescents found that teens who spent more time on digital devices tended to report lower levels of happiness, self-esteem, and overall mental well-being.12 Although this study couldn’t prove that screen time directly causes these issues, it highlights an important trend. Social media often gives the false impression of meaningful relationships, while in reality, these interactions are usually shallow. Constant exposure to idealized images and lifestyles can set unrealistic expectations and lead to feelings of inadequacy, making it harder for young people to develop resilience by learning how to cope with failure and conflict.

Practical Steps for Parents

Given these challenges, what can be done? Here are some practical recommendations from a pediatrician and a mom.

  1. Consider the American Academy of Pediatrics’ Screen Time Guidelines:
    • Children under 18 months should have very limited screen exposure.
    • Children 18-24 months can benefit from high-quality educational media with a parent present.
    • Children 2-5 years old should have no more than 1 hour of screen time per day, with parents co-viewing and actively engaging.
    • For children 5 and older, there are no strict limits, but screen time should not interfere with school, sleep, family time, or physical activity.
    • Parents should discuss media use with their teens, including what they see, read, and who they interact with.
  2. Encourage Independence:
    • Allow children time to play and explore on their own. They don’t need constant entertainment.
  3. Integrate Chores into Daily Life:
    • Involve children, even toddlers, in family activities. Even if chores aren’t done perfectly, they help children feel included and build a sense of responsibility.
  4. Let Them Fail:
    • Allowing children to take risks and experience failure builds resilience and confidence. For example, try not to intervene the moment your child begins struggling with a task and becomes frustrated. Allow them to experience that moment of failure, then offer them guidance.
  5. Accept Emotional Expression:
    • It’s normal for young children to become upset, especially toddlers. Toddlers are at a crossroads between knowing what they want but not having the language to express it. This can be frustrating for them, and learning to manage their emotions is an important part of development.
  6. Set Clear Boundaries:
    • Be comfortable saying no and be firm about limits. Clear boundaries help children understand expectations and develop conflict-resolution skills.
  7. Encourage at Least One Hour of Physical Activity:
    • Children of all ages need daily physical activity. This hour can be spread out throughout the day.

In Summary

While digital media has benefits when used carefully, too much screen time—especially low-quality content—can interfere with essential stages of our children’s cognitive, social, and emotional development. As parents, it is our responsibility to protect our children’s natural curiosity and wonder by setting appropriate limits, encouraging both structured and independent play, and involving them in everyday family activities. By taking these steps, we can help ensure that our children thrive in today’s fast-changing digital world.

Additional Resources:

https://www.healthychildren.org/English/family-life/Media/Pages/default.aspx

https://www.commonsensemedia.org/articles/how-much-screen-time-is-ok-for-my-kids

https://www.commonsensemedia.org/articles/are-some-types-of-screen-time-better-than-others

Hunt, Gather, Parent. by Michaeleen Doucleff

No Drama Discipline. by Daniel J. Siegel and Tina Payne Bryson

References
  1. American Academy of Child & Adolescent Psychiatry. “Screen Time and Children.” American Academy of Child & Adolescent Psychiatry, May 24, 2024. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx.
  2. Bal, Mazhar, Ayşe Gül Kara Aydemir, Gülüzar Şule Tepetaş Cengiz, and Ahmet Altındağ. “Examining the Relationship between Language Development, Executive Function, and Screen Time: A Systematic Review.” PLOS ONE 19, no. 12 (December 26, 2024). https://doi.org/10.1371/journal.pone.0314540. 
  3. Clemente-Suárez, Vicente Javier, Ana Isabel Beltrán-Velasco, Silvia Herrero-Roldán, Stephanie Rodriguez-Besteiro, Ismael Martínez-Guardado, Alexandra Martín-Rodríguez, and Jose Francisco Tornero-Aguilera. “Digital Device Usage and Childhood Cognitive Development: Exploring Effects on Cognitive Abilities.” Children 11, no. 11 (October 27, 2024): 1299. https://doi.org/10.3390/children11111299. 
  4. Kostyrka-Allchorne, Katarzyna, Nicholas R. Cooper, and Andrew Simpson. “The Relationship between Television Exposure and Children’s Cognition and Behaviour: A Systematic Review.” Developmental Review 44 (June 2017): 19–58. https://doi.org/10.1016/j.dr.2016.12.002. 
  5. Takahashi, Ippei, Taku Obara, Mami Ishikuro, Keiko Murakami, Fumihiko Ueno, Aoi Noda, Tomomi Onuma, et al. “Screen Time at Age 1 Year and Communication and Problem-Solving Developmental Delay at 2 and 4 Years.” JAMA Pediatrics 177, no. 10 (October 1, 2023): 1039. https://doi.org/10.1001/jamapediatrics.2023.3057. 
  6. Hutton, John S., Jonathan Dudley, Tzipi Horowitz-Kraus, Tom DeWitt, and Scott K. Holland. “Associations between Screen-Based Media Use and Brain White Matter Integrity in Preschool-Aged Children.” JAMA Pediatrics 174, no. 1 (January 6, 2020). https://doi.org/10.1001/jamapediatrics.2019.3869.
  7. Xu, Guifeng, Lane Strathearn, Buyun Liu, Binrang Yang, and Wei Bao. “Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder among Us Children and Adolescents, 1997-2016.” JAMA Network Open 1, no. 4 (August 31, 2018). https://doi.org/10.1001/jamanetworkopen.2018.1471. 
  8. Thorell, Lisa B., Jonas Burén, Johanna Ström Wiman, David Sandberg, and Sissela B. Nutley. “Longitudinal Associations between Digital Media Use and ADHD Symptoms in Children and Adolescents: A Systematic Literature Review.” European Child & Adolescent Psychiatry 33, no. 8 (December 23, 2022): 2503–26. https://doi.org/10.1007/s00787-022-02130-3. 
  9. Li, Chao, Gang Cheng, Tingting Sha, Wenwei Cheng, and Yan Yan. “The Relationships between Screen Use and Health Indicators among Infants, Toddlers, and Preschoolers: A Meta-Analysis and Systematic Review.” International Journal of Environmental Research and Public Health 17, no. 19 (October 7, 2020): 7324. https://doi.org/10.3390/ijerph17197324. 
  10. Haghjoo, Purya, Goli Siri, Ensiye Soleimani, Mahdieh Abbasalizad Farhangi, and Samira Alesaeidi. “Screen Time Increases Overweight and Obesity Risk among Adolescents: A Systematic Review and Dose-Response Meta-Analysis.” BMC Primary Care 23, no. 1 (June 28, 2022). https://doi.org/10.1186/s12875-022-01761-4. 
  11. Simmonds, M., A. Llewellyn, C. G. Owen, and N. Woolacott. “Predicting Adult Obesity from Childhood Obesity: A Systematic Review and Meta‐analysis.” Obesity Reviews 17, no. 2 (December 23, 2015): 95–107. https://doi.org/10.1111/obr.12334. 
  12. Twenge, Jean M., Gabrielle N. Martin, and W. Keith Campbell. “Decreases in Psychological Well-Being among American Adolescents after 2012 and Links to Screen Time during the Rise of Smartphone Technology.” Emotion 18, no. 6 (September 2018): 765–80. https://doi.org/10.1037/emo0000403.