Is screen time safe for young children?

It seems like every year the topic of screen time is in the news. In the last twelve months alone, the BBC ran an article with the headline “No sedentary screen time for babies, WHO says” (I’d argue it’s difficult for a baby to have non-sedentary screen time, let’s be fair, young babies just sort of lie there a lot). The NHS had one called “Guidelines issued on activity and screen time for babies and toddlers” NCT had an optimistically-titled “Screen time for babies and toddlers: the evidence.”

Across the pond, where everything is sensationalized and politicized as outrage seems to have become a national pastime, which must be like living amongst the pages of the Daily Mail, WebMD gives us “too much screentime may stunt toddlers’ brains” and The Cleveland Clinic boldly asserts “too much screen time harmful for kids’ development” while a published article in “Intractable Rare Diseases” on the NIH website examines “Early electronic screen exposure and autistic-like symptoms” which (predictably) the regrettably local rag (but for some reason very popular in the US) the Daily Mail seized upon with “Babies Glued to tablets or telly ‘could develop autism-like symptoms’ controversial study warns”. I’m not linking to that one because it only improves their standing with search engines, so if you want to read it, Google it.

First I want to deconstruct the news coverage of this topic, then I’m going to look at the actual evidence, including scientific studies on development and language.

So the headlines, then, are pretty grim. If we believe the titles of all these articles, my child should be so developmentally challenged that he is trying to breathe through his own eyeballs. He isn’t, in case anyone is in any doubt.

These headlines aren’t constructed to inform you about the latest scientific developments. News sites have a vested interest in getting lots of hits, because it pushes their content up Google’s search algorithm, so it’s in their best interests to pump out as many clickable (dare I say, “clickbaity”) article titles to make sure they get lots of traffic. They make a lot of money off their advertising revenue, as well, and they want as many eyes as possible on those adverts.

It’s funny how the more drama-y and sensationalist an article is, the less important the issue is, in the grand scheme of things.

So what makes people click on these articles? Human interest. The vast majority of parents want the very best for their child. When they see something that claims to warn them of the dangers of something they let their kids do, they will click on it. Other people with a vested interest in a child, such as aunts, grandparents, or friends, will also click on these articles, thinking they can “warn” the hapless parents before they accidentally turn their baby’s brain to jelly with the old 60 inch plasma Radiation Queen. The news outlets manipulate you and play on your fears to try and make you read their articles. They don’t actually care if you believe the article or not. Every click means more people seeing the adverts that pay for the news sites to stay profitable. And no one is easier to manipulate and scare than first time parents, so articles targeting their worries and magnifying them are big money for news sites.

It’s an old news article that basically goes around and around and has done since television was invented. Before that, there were fears about radios damaging children (which is now being reported again but the hysteria is linked to baby monitors, instead). In its current form, a fear of baby monitors being dangerous, the story isn’t as newsworthy as fears surrounding screen time. Video (news) killed the radio (news) star. Before that? Well you only have to read Anne of Green Gables or Little Women to see the Victorians feared that reading books as a child would ruin your eyes.

It’s a pretty common comment for an adult to make to a child (or about a child) in Victorian literature. There were even studies done by Victorian scientists where they claimed that too much schoolwork caused children’s eyes to “weaken”. This study from 1885 even goes so far as to claim that, since working-class children were more at risk of this than middle class children (the author’s test results being separated into grammar schools and secondary schools), they ought to send working-class children to special schools where they weren’t slowing down the rest of the class with their “weak eyes”.

He also claimed that less intelligent children were more at risk of eye damage than more intelligent children, evidenced by the fact that children with “good eyes” did better at school and were therefore more intelligent. This is a perfect illustration of the problem with any scientific research that only looks for correlation between two variables. Correlation doesn’t imply causality. We know, for example, that lung cancer doesn’t cause smoking. Additionally, the class bias against working class children is still a huge issue, and working class parents are more likely to put their kids in front of the TV because they don’t have the time or money to entertain them any other way.

Sadly, the same nonsense about reading damaging eyes is currently doing the rounds in East Asia, as this article shows, and still nobody has questioned the glaring problem with correlating glasses-wearing and children who read more, which is that children who read less might have undiagnosed and uncorrected eye problems (or refusing to wear glasses, families can’t afford eye tests etc) that is skewing the results.

Hold that whole concept in your mind while we look at what the articles believe to be the danger of screen time more deeply, because it all stems from the same insecurity.

First let’s tackle the BBC article I mentioned above: “No sedentary screen time for babies, WHO says.” This article has absolutely nothing to do with any dangers from the screen time itself, and can be boiled down to “sitting still makes children obese.” So from that point of view, including healthy diet and exercise in your day is a better solution than banning televisions. But as I’ve noted earlier on, that doesn’t get people to click. In the BBC’s case, while they don’t have advertising revenue to worry about, they still have to justify (to the government) the level of funding they get. So the clicky title is basically just a spin on “children need exercise”.

The NHS article discusses the same WHO recommendation, explaining that experts point out there is actually no evidence that screens are harmful, and that the WHO recommendation is talking about physical activity levels, not some mysterious brain damage associated with screen time.

The NCT article tried to cover too much ground and it doesn’t look critically at the studies (they don’t mention their strengths and weaknesses, or how much of the focus was specifically to do with screen time, and they have lumped together a range of outcomes instead of looking at each separately). It says screen use has been linked in studies to poor sleep; it claimed “Some research in younger children (one to three year olds) who watched TV showed increased levels of attention deficit disorders at the age of seven.”

It then went on to add, “Although a more recent review found that evidence for this was weak.” Inline citations would have made this easier to verify. The article overall concludes that responsible screen time is beneficial, then they have a wall of quotes from NCT volunteers explaining why they put their kids in front of the TV. Because nothing rounds off a sensationalist article like some good old-fashioned anecdotal evidence.

The authors don’t look at the same evidence the WHO was using, and don’t reference the WHO report at all, which is a bit of an omission. They also claim there aren’t any NHS and NICE guidelines on screen use in babies, which is not true. There is no date on this article but it has to be later than 2019 because one of the references is 2019. Overall, it feels like the author of the article used the first 5 studies they found in Google, without weighing up the strengths of them, and then posted on Facebook in an NCT group to get the quotes.

The actual evidence:

This study from 2016 had a sample size of 715, and found that age of first touch screen use correlated with better fine motor control in toddlers. Of course, that could be because parents trusted children with better motor control to use expensive tablets/phones. The methodology was a self-reporting survey of parents, so the drawback is the information is not independently verified beyond what parents have said.

A 2015 meta-analysis found that “rapid visual and auditory changes can
distract young children from exploration and toy playtime as their attention is directed towards the screen numerous times during a play session” when the TV is on as background noise. There’s no evidence about whether this is an issue or not, but babies and toddlers do need to explore. This is unlikely to apply to pre-crawling babies though because they don’t really do much anyway.

We all want what is best for our children, but fearing new technology isn’t the way to prepare them for the adult world. Trusting children and teaching them to use devices responsibly is a far better solution. People don’t just unplug the TV when they give birth and turn it back on when the baby reaches age 2. It’s not realistic to tell people that the under twos shouldn’t be “exposed” to screens. I would also argue it’s quite antifeminist because it prevents women with young babies from working from home, in case the baby looks at the screen. We need to find ways to work sensibly with technology, and we need to stop being told stupid “parenting” advice because television isn’t going away and every decade, new devices are invented for us to worry about.

Does screen time cause ADHD?

I would be interested to see more studies on this, but my own childhood is a good example of how TV doesn’t always correlate with ADHD.

I have been diagnosed with ADHD after 5 years of investigation by psychiatrists, and I grew up in a house without a television until I was 5, then split my time between my grandma’s house where there was only a 12 inch black and white TV with four channels, and my parents’ house where my half-sister had unlimited TV time and usually put the same video on repeat (she didn’t get sent to grandma’s as much as I did), so from my point of view, there must be something else causing ADHD, because I have it and she doesn’t.

That’s not to say I don’t think there’s a connection between screen time/TV and ADHD, but I don’t think it’s a direct cause so much as that kids with ADHD get more screen time as a product of their hyperfocus. I hope there’s some good studies done about this soon.

Update: Since writing this article, I found this article from ADDitude, which explains the state of research into this topic in more detail. Basically, early TV shows an increased correlation, but since ADHD is something you are born with, it’s more likely that parents of ADHD children put them in front of the TV as they’re “too energetic” or “easily bored” or similar, or perhaps being made to sit still in front of a TV makes ADHD behaviors more easily expressed at which point they are diagnosed… remember folks, correlation doesn’t imply causality (after all, we know cancer doesn’t cause smoking).

How to increase your breastmilk supply? Power pump

Are you breastfeeding and worried about low supply? If you haven’t already properly established your breastfeeding relationship with your baby, this is not the info for you, but if you’ve been feeding at least four weeks and still think you don’t have enough milk, try this natural method that doesn’t require any supplementation or weird lactation foods! You can do something called power pumping which mimics the baby’s cluster feeding and is especially helpful if you’re exclusive pumping as I was when my baby was aged 3-7 months.

You will need: A double electric breastpump. If you don’t already have one, I recommend the Medela Freestyle Flex Double Electric Breastpump. I’ve tried a few breast pumps and this is hands down the best one you can buy for the money. If you can’t afford that, the Medela Swing Electric Breastpump is also fantastic, but apparently you can’t get the double Swing Flex in the US Medela Amazon Store for some reason? Weird. Get the Double Medela Swing Flex here in the UK (if you want this one in the US, you can probably import it from UK Amazon if you don’t mind the shipping costs/extra tax).

That’s it.

The very easy method:

Pump 20 mins

Rest 10 mins.

Pump 10 mins.

Rest 10 mins.

Pump 10 mins.

Do this for two weeks to increase supply or for a few days to give yourself a little boost e.g. after you’ve been ill or gone away for a weekend and missed some pumping times.

I found this out from an adoption/lactation group for women who had never breastfed, so this works even if your body isn’t currently lactating (although you will probably need other help if that’s the case, e.g. domperidone prescribed by your doctor).

I actually modified this as I didn’t have an hour every day. If you can’t get a pump that fits your boobs very well, and your nipples are sore, this will also be kinder to your poor nipples. You can also do this (for a mini version of power pumping) but your results will be less spectacular:

Pump 10 mins

Rest 5 mins.

Pump 5 mins.

Rest 5 mins.

Pump 5 mins.

The end.

Do you have any tips for increasing milk supply? Let me know in the comments!

The worst tests for bipolar

UPDATE October 2020: I’m just putting a little update here as people keep finding this post, I conclusively found out I have ADHD and PMDD, not rapid-cycling bipolar disorder, and since starting treatment for PMDD, my moods have been completely stable, after years of misdiagnosis and taking mood stabilizers. Don’t give up looking for your answers and if the meds don’t work, question your diagnosis.

So this question of bipolar disorder has reared it’s head again and I *still* don’t know if I actually have it or not. It’s very frustrating to not know what’s wrong with you except that you know you don’t function properly. I had post-natal depression 100% but when I look at the mood scale from Bipolar UK I literally only fluctuate between a 7 and a 3 most of the time.

Which I don’t think is necessarily clinically significant to necessitate a BD diagnosis. I also don’t have underlying “phases” (usually… that PND really brought this home to me). There’s some evidence that ADHD’s hyperactive side can look a lot like hypomania and there’s little to separate them.

As a side-note, I feel like that mood scale linked above ought to be mandatory for everyone who is trying to mood chart because without it you’re trying to draw a map without a key. I now know why I failed at mood charting back in 2015.

While I’m waiting to get hold of a psychiatrist (again… RIP salary), I looked online and basically all the “test yourself for bipolar” quizzes go like this:

  1. Have you had mania? (well, duh, if I knew the answer to this I’d surely know if I had bipolar)
  2. Have you had hypomania? (gosh golly, if I knew the answer to this surely I’d already have a diagnosis… the nuances of hypomania and the difference between hypomanic symptoms and a hypomanic episode are utterly lost on some people)
  3. Have you had depression? (again, what counts as clinical depression and if it’s very obviously Post Natal Depression or Complex Grief, do those count or not?)
  4. Insert a bunch more questions to make it look like we didn’t half-ass this quiz
  5. Give us your email address so we can harass you forevermore send you your results.

The cyclothymia tests are actually nonexistent. Indeed, it seems no two clinicians can agree upon what cyclothymia actually is. I did read a really good chapter on it in “The treatment of bipolar disorder” published by Oxford University Press. That chapter is basically the only thing I’ve seen that actually makes sense of cyclothymia as a clinical entity.

The best part is, cyclothymia is milder than bipolar disorder (but still comes with suicide impulsivity) yet despite the fact that it’s generally agreed these days that people with bipolar don’t always need lifelong meds, the NHS guidelines say people with cyclothymia need to be on meds (that aren’t even approved for use for cyclothymia because literally nothing is) for the rest of their life.

Whut?

“In case it develops into full-blown bipolar.”

Riiiiiiight.

So they’re proposing I take very serious meds that will take years off my life when I don’t actually need them, despite the fact that the latest research says people with cyclothymia have a distinctly different set of debilitating symptoms than people with bipolar, it’s not just “soft bipolar” as some idiot clinicians call it, and never mind that people with cyclothymia are very sensitive to meds in general.

Frustratingly, the NHS can say whatever they want about cyclothymia because there are no NICE guidelines for it. That’s right. NICE recognizes cyclothymia but couldn’t be bothered to actually write any guidelines for how to define, diagnose or treat it, and they clearly state multiple times in their bipolar guidelines that they are not dealing with cyclothymia.

My current therapist is adamant I have bipolar, she doesn’t seem to know what cyclothymia is, she has dismissed ADHD as “not relevant” to my problems, and she seems to think I have no insight which makes no sense because everyone else I’ve ever seen always tells me I have lots of insight into my condition.

This whole thing is such a mess. And my husband, the biggest voice of doubt, keeps saying “I don’t think you have bipolar” like, do I need to borrow an elephant with “she has bipolar” written on the side of… of… those rug things elephants wear?! And does anyone know what those rug things are called?

Arrrgh how did I end up here again with the bipolar stuff? Should I be on meds? Who knows! I wish Blahpolar was still here because I know she would have talked this through with me and helped me work out where to go from here.

Or maybe she would have just made an appropriately-timed bipolar vegetable joke.

That would also help.

To be fair, I wish she was still here even if she never liked or commented on anything I ever wrote again.