Early Childhood Mental Health and Media Use

Much of the concern about media use with young children involves the fact that time on screens often means less time spent interacting directly with a parent or caregiver, also known as “displacement.” This child-caregiver interaction is of “fundamental importance” to critical social-emotional developmental “tasks” for the young brain in the first years of life, says Joan Luby, MD, Samuel and Mae S. Ludwig Professor of Child Psychiatry at Washington University School of Medicine. “These tasks require in-person live interactions with human caregivers and they are things that screens cannot provide and will likely interfere with,” notes Luby. These developmental tasks include:

• • Learning to identify and label emotions in oneself and accurately perceive expression in others;
  • Learning to regulate intense emotions through co-regulation with caregiver;
  • Learning empathy, helping, and other pro-social behaviors; 
  • Practicing social problem-solving; and
  • Developing regular circadian rhythms and sleep critical for cognitive and emotion regulation and healthy brain development.

Dimitri Christakis, MD, MPH, Director of the Center for Child Health, Behavior and Development, Seattle Children’s Research Institute and Chief Science Officer of Children and Screens, emphasizes the primary importance of the caregiver-child relationship as well. “Even in a scenario where a particular screen or particular app was harmless or reported to have some benefits, the simple displacement of other essential interactions and activities on balance poses risks for children.” 

While it may seem that giving a young child a digital device in the moment may be helping them focus or calm down, “there’s a big price to pay for it” and it can have serious impacts, says Gilbert Foley, EdD, Consulting Clinical Psychologist at the New York Center for Child Development and Clinical Co- Director at the NYC Early Childhood Mental Health Training and Technical Assistance Center. Foley summarizes research findings on the effects of media use in very young children:

• • High media users at this age show less curiosity, self-control, and emotional stability.
  • Children with persistent self-regulation problems were more likely to consume media at age two.
  • Screen time at age two is negatively associated with the development of executive functions in toddlers ages 2-3.
  • Screen time at age 4 is connected to higher levels of dysregulation and lower mathematics and literacy grades at age 8.
  • Exposing babies and toddlers to TV and other digital media has been linked to a heightened risk for dysfunctions known as “sensory processing disorders.”
  • Children’s emotion regulation challenges have been partially accounted for by the link between screen exposure and behavior problems.
  • Tech-based distractions have been strongly linked with ADHD. 
  • High screen use can wear out the brain’s pleasure centers.

Early childhood represents a “sensitive” period of brain development with heightened “brain plasticity,” says Luby. What the child experiences (or is exposed to) powerfully shapes and influences brain development both structurally and functionally. This means that  “outcomes and the way the child behaves, sees the world, and perceives the world later is very much influenced by the exposures in the first three years of life,” she says.

Screen experiences are among these experiences that can significantly influence the brain in this sensitive period, says Luby.  “The brain is like a sponge. It’s very receptive to being informed or changed by experiences. So one can imagine that a screen experience could have a tremendous influence on the sensitive period of the developing brain.”

Exposure to violence early in life is a robust predictor of negative outcomes, says Luby.  While caregivers may take care to avoid violent content online for their young children, today’s algorithms are often written such that children can rapidly become exposed to violent content, even if that’s not what the parent thinks they’re setting the child up with on a device, she says.

“I never say ‘never’ except for this: Never, never have unmonitored access to media content,” says Lisa Linder, PhD, a licensed Clinical Psychologist and Professor of Child and Family Development at San Diego State University. “This is so common and it shows up in our clinic all the time. Would you give your child unmonitored access to a shed full of power tools? No, because tools are powerful, and in the wrong hands, are dangerous. The same principle applies with media.”  If it’s completely impossible to preview the content your child will see, make sure you are nearby when they are watching or doing something new on a digital device so you can jump in and course-correct, says Linder.

A “great deal” of evidence shows that stressful experiences can negatively affect the development of deliberative brain functions like executive function and self-regulation and contribute to negative child behavioral outcomes, says Stephanie Jones, PhD, Gerald S. Lesser Professor of Child Development and Education at Harvard Graduate School of Education.  Rapid stimulation from digital media can be this type of stressful input into a developing brain that creates a chronic, elevated, reactive state of the brain’s “fight or flight” system.

To help build the skills that children need to independently cope with screen time as older children, parents and caregivers can help young children engage in in-person, interactive play that provides lots of opportunities to practice executive function and regulation, Jones says. “The critical thing here is that relationships and interactions provide a buffer.”  Parents and caregivers can build on what children love doing and find types of play that draw them in – music, arts, sports, playing outside – all of those types of in person play count. she suggests.

Rethink handing a device to a small child who needs to be calmed down. While it may seem that the screen is helping the child emotionally regulate, Luby cautions that it in fact is not doing so effectively. “What it essentially does is it provides a distraction from an emotional experience. And what children instead need to do is they need to learn how to process and regulate the emotion, which is not something a screen is going to provide – it requires another human being.”  Bypassing the opportunity to learn this skill, as difficult as it may be at the moment, will long-term impair the child’s ability to experience and process emotions. This puts them at risk for emotional delay and other poor emotional outcomes.

Jones concurs –  “We don’t want to displace the opportunity to learn something by putting a screen in just because it’s a really tough moment.”

“Joint” or shared attention between caregivers and children, where both caregiver and child are focusing on the same thing and interacting with it and each other, “allows the parent to plug in to the child’s cues and sync their responses to the child’s needs,” says Linder. This positively affects the child’s neural development.

“When we plug in through shared attention with our child, it facilitates a back and forth exchange in which we model for and coach the child to learn to engage within our culture. Over time, they move from learner to partner, and this lays the foundation for communication and building a lot of the critical social capacities. When we respond sensitively, when we plug in in the right place at the right time to a dysregulated child, we’re overlaying our nervous system, plugging it into theirs to calm their nervous system. And this over time develops the neural pathways to calming strategies,” she says. 

Over time, the well-worn neural pathway overlaid by the parent or caregiver allows the child to begin to independently regulate.  Use of digital media interrupts this process where the child can develop skills to self-regulate.  “When we provide media as a tool to calm a dysregulated child instead of ourselves, we’re restricting their capacity to cope with emotion,” says Linder.

The American Association of Pediatrics recommends no media use for children under 18 months of age, and our panel of experts concurs. “I do think that screen time should probably be avoided altogether before 12 months of age and then, you could introduce it in short and very selective content from 12 to 24 months of age,” says Luby.

Developmentally, most children won’t be able to benefit from media use at this time, notes Christakis. “The developmental window where the benefits of Sesame Street apply require that a child is cognitively and socially able to be receptive to it.”  In the period under 12 months of age, the child is getting all their information from the world through the parent relationship, touch, and movement, says Foley. “I don’t think there’s a place for media use [in that time].”

If you must use screens with very young children, intentionally engaging in the media content together, interactively, should be prioritized, say several experts. This means not just watching TV or videos together but actively engaging and talking about the content with a child, says Linder.   Additionally, holding or touching the children, providing extra tactile information and communication, is optimal, says Foley.

“Spend as much time as you can asking for comprehension with your kids – ‘What’s happening there? What are they doing? Why is he laughing like that? That seems mean, right?’” suggests Linder. “Get them to explain and connect with you around what they’re doing and when they don’t understand, explain everything that you can. Kids are sponges. Help them connect what they’re seeing to real life and to their own experiences. The more that you do this, the more that they’ll begin to see the digital world as a shared world.”

One effective way to deal with young children who may be constantly begging for media time is to make media use times very predictable, says Linder. “Children aren’t able at this age to effectively manage or gauge time, and they do really well with clear and consistent boundaries.” Linder suggests planning “show time” or “media time” that is consistently at the same time of day for the same amount of time, and always give transitional warnings when the time is almost up instead of suddenly shutting it down.  When giving transitional warnings, make eye contact and “plug in” to the child so that you can help manage their emotional response to the end of media time. Linder provides this example of transitional preparation with follow-through: “It’s going to be 5 more minutes. Okay? More media, and then we’re going to go to dinner. Okay, Five more minutes. I don’t want any yelling or screaming or we’re not going to get media tomorrow. Five more minutes.”  When the five minutes are up, you calmly and consistently follow through on the time you promised to end the media.

Be mindful of how you engage with your own media use in front of your child – they are watching and learning from you.  “As a working parent, I notice myself walking in the door as an opportunity to reunite and have a quick connection and moment of interaction with my children,” says Jones.  If the first thing you do at home is to pick up your phone, checking social media or an email, you are letting your child know that you find this behavior acceptable, do-able, and something that works for you. “We, the adults, are the cornerstone and setting up the model for how kids might understand how screens play a role in their own lives,” she says.

“Traditional” play is imperiled right now, says Foley, partially because of screens. “Children really need to have experience with real objects in the real world and real people. Afford your child ample opportunities to engage in traditional play,” he says.  Traditional play is by nature unpredictable and therefore is more effective at teaching self-regulation. “You don’t know what’s going to happen. You start, you stop,  you’re fast, you’re slow,  you’re loud – all of that modulation really gives practice in regulation.”

Traditional play can involve extremely simple materials such as blocks, water, paint, and clay. Other traditional play like”muscular play” with the body provides a child with a lot of information through the muscles, the joints, and the balance system. 

Jones notes that there isn’t much evidence that electronic toys are generating better outcomes with children compared to traditional toys. In addition, many electronic toys are “excessively loud” for children’s ears, and are programmed to regain your child’s attention in a developmentally inappropriate way by interfering with the cause-effect interaction.  Just because a toy is expensive and engaging does not mean that it’s of good quality or good for the child. “I don’t think the toys should be able to do more than the child can do. It prevents the child from discovering and exploring and developing,” says Foley.

While conversations about digital addictions usually focus on older children and adolescents, “we’re finding that even toddlers will show signs of compulsive use if exposed to enough content, particularly content that’s designed to command their attention,” says Christakis. “There’s no reason to believe that they would function any differently than older children. In fact, there’s every reason to believe they would be more at risk because they don’t actually have the superseding prefrontal cortex ability to try to modulate their use.”

Caregivers looking to make changes to their family’s media diet may feel “abandoned” by suggestions to suddenly and drastically remove media time from children for their health in an “everything, everywhere, all at once” way, notes Linder. This can keep the parent or caregiver from making any changes at all. Linder instead suggests beginning with a step-by-step approach, testing minor changes  and problem solving before moving on to subsequent changes. This has an added benefit of slowly increasing confidence in making changes or coming up with alternative activities when children are bored.

Research has “continually shown” that the idea that more academics earlier in life will lead to better outcomes with children is a myth, says Linder.  “Children are going to learn best in play and interaction with their peers. What we need is more open-ended play, more interaction, more scaffolding of social interactions, because those form the foundation for the ability to function once they’re in an academic environment.” In addition, apps marketed as “educational” for young children are largely unregulated and self-proclaimed rather than proven to be effective for learning purposes.

Almost anything can be discussed with a young child in a developmentally-appropriate way, says Linder. Parents and caregivers often forget that they can involve their children when setting limits, and there is benefit to explaining the “why” behind limits and getting their buy-in, she says. “What if we just stopped hiding things from children and we say ‘Hey, here’s why I don’t want you to have media all the time. Here’s what it’s doing to your brain, and it’s making it so you can’t think and can’t come up with your ideas. When I tell you to stop and you say ‘No!’ that’s because your body thinks you need this and it’s more exciting, but it’s not. It doesn’t help you think and I don’t want you to get this thing called addiction.”

By introducing concepts like addictive use earlier in life, parents can reference it when worrisome behavior is occurring, suggests Linder. “At that point you can say  ‘Let’s calm down. Let’s think about making a transition because right now you’re needing this too much.’”

Many parents feel that they’ve already missed the “critical” window for limiting media use and it’s “too late” to try to rein it in.  Jones cautions against this way of thinking. “I wouldn’t ever say that there isn’t an opportunity to learn skills, to grow, and change. It might be harder at one time than at another, but we would never give up. And there’s always a chance to practice something, try new routines, put a wedge in things that we aren’t happy with.”

“Eighty two percent of children on the [autism] spectrum do have at least one kind of sensory atypicality,” notes Foley. These children are already at risk for having difficulty with sensory regulation. While screens can be an immediate way to help child behavior, “the problem is that sensory integration is a multisensory process,” he notes. Screens put emphasis on just a few sensory systems like the visual and auditory systems. “When you’re using a screen, you’re primarily using visual and auditory systems. It’s not using the touch system; it’s not using the balance system; it’s not using the messages we get through muscles and joints,” he says.  Neurodivergent children may need targeted occupational therapy to help gain self-regulation skills through a more multisensory approach. (For more information on neurodivergent youth and digital media use, see our Tip Sheet on Neurodivergent Youth and Digital Media.)