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It is important to manage screen media use as part of a balanced diet of activities. Time for family, friends, nature, school, and sleep are all integral to a child’s healthy development. Integrating media as part of a balanced lifestyle in mindful and focused ways can also benefit and enrich the lives of children

What the Evidence Says
Social Connection Screen media have revolutionized how we stay connected with family and friends. Whether texting a friend in another room or video-chatting with a grandparent in another country, technology allows children to communicate with people close to them and can help foster meaningful relationships. Research shows that adolescents who are connected with their parents on social media feel closer to them in real life (Coyne, Padilla-Walker, Day, Harper, & Stockdale, 2014).

Learning/School Performance Screen media offer children a wealth of information that they can access nearly instantaneously. Studies have shown that these technologies can help children prepare for school, supplement school lessons, and enhance school curricula. However, managing the amount of time children spend with screen media is essential to success as having easy access to screen media can also take away from productive time spent on homework and allow for numerous distractions. Online video viewing was associated with less time spent on homework (Panek, 2013) and having smart phones in classrooms with ability to text and browse the internet provides an easy way to pay less attention and therefore benefit less from what is being taught.

Sleep Studies to date have shown evidence for a negative relationship with higher screen time and quantity and quality of sleep (Barlett, Gentile, Barlett, Eisenmann, & Walsh, 2012). Additionally, poor sleep habits can act as a mediator of other health problems such as obesity, stress and school performance (Brown, Nobiling, Teufel, & Birch, 2011; Hancox, Milne, & Poulton, 2004). Johnson et al. (Johnson, Cohen, Kasen, First, & Brook, 2004) showed that adolescents who watched TV for more than 3 hours a day were at a significantly elevated risk for frequent sleep problems by early adulthood even when controlled for potential confounding factors.

Obesity/fitness Excessive screen time has been shown in many studies to displace time that would have been spent on other activities. Television viewing in excess has been shown to be correlated with less physical activity and poorer overall fitness (Gingold, Simon, & Schoendorf, 2014; Hancox et al., 2004). Excessive screen time during childhood is also associated with higher BMIs, raised cholesterol in adulthood and smoking (Hancox et al., 2004; Mitchell, Rodriguez, Schmitz, & Audrain-McGovern, 2013; Wethington, Pan, & Sherry, 2013).

Parents influence Studies have shown that media use habits and preferences for different types of media are transmitted across generations. Subsequently, how much time parents spend watching TV, playing video games and staring at their phones will influence how their children behave around similar media (Yang, Yen, Ko, Cheng, & Yen, 2010). Children and adolescents who grow up in homes where screen media use is not regulated, use screen media more and are thus more susceptible to the negative health effects associated with excessive screen use.

During the Visit
If your patient screens “positive” on the Media History Survey and is expressing issues with time management, it is important to discuss managing media use and overall time management with the patient and his/her family.
  • Empower parents to set ground rules for media use as soon as possible. Remind them that it is easier to keep a TV or video game console out of a child’s bedroom than it is to take it away. Parents should also strategize about future media use and privileges for their children as they continue to develop and mature. Learning time management skills early will also help prepare children for future success through adolescence, early adulthood and beyond.
  • Help parents understand how screens can interfere with school performance and encourage them to talk with their child about prioritizing their time so that they are able to learn and complete their assignments in focused ways without multitasking with media. Help the patient and the family strategize how to incorporate media use into a balanced diet of activities. Start with setting aside dedicated time for essentials such as sleep, family meal time, school, homework, friends, and play/ exercise. From there, integrate extracurricular hobbies as well as media use. This will provide your patient and her family a framework for how to spend their time and help them use media both mindfully and purposefully.
  • If you have a patient or parent who is continually having difficulties managing time, or is resistant to change, explain that the process may take time and patience, especially if the problematic habits are ingrained. Identify small but crucial changes to make and set manageable and achievable goals. Use your knowledge about the patient’s age and developmental stage to inform the goals that you set with the family about this age group to offer alternative ways to approach the change.
Future Directions
As technology advances, we will continue to be faced with various screens. We need to monitor how much time youth spend in front of screen media, and focus on the prevention of the negative effects.


  • Barlett, N. D., Gentile, D. A., Barlett, C. P., Eisenmann, J. C., & Walsh, D. A. (2012). Sleep as a Mediator of Screen Time Effects on US Children’s Health Outcomes. Journal of Children and Media, 6(1), 37-50. doi:10.1080/17482798.2011.633404
  • Brown, S. L., Nobiling, B. D., Teufel, J., & Birch, D. A. (2011). Are kids too busy?: early adolescents’ perceptions of discretionary activities, overscheduling, and stress. J Sch Health, 81(9), 574-580. doi:10.1111/j.1746-1561.2011.00629.x
  • Coyne, S. M., Padilla-Walker, L. M., Day, R. D., Harper, J., & Stockdale, L. (2014). A friend request from dear old dad: associations between parent-child social networking and adolescent outcomes. Cyberpsychol Behav Soc Netw, 17(1), 8-13. doi:10.1089/cyber.2012.0623
  • Gingold, J. A., Simon, A. E., & Schoendorf, K. C. (2014). Excess screen time in US children: association with family rules and alternative activities. Clinical Pediatrics, 53(1), 41-50. doi:10.1177/0009922813498152
  • Hancox, R. J., Milne, B. J., & Poulton, R. (2004). Association between child and adolescent television viewing and adult health: a longitudinal birth cohort study. Lancet, 364(9430), 257-262. doi:10.1016/S0140-6736(04)16675-0
  • Huesmann, L. R., Moise-Titus, J., Podolski, C. L., & Eron, L. D. (2003). Longitudinal relations between children’s exposure to TV violence and their aggressive and violent behavior in young adulthood: 1977-1992. Dev Psychol, 39(2), 201-221. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12661882
  • Johnson, J. G., Cohen, P., Kasen, S., First, M. B., & Brook, J. S. (2004). Association between television viewing and sleep problems during adolescence and early adulthood. Arch Pediatr Adolesc Med, 158(6), 562-568. doi:10.1001/archpedi.158.6.562
  • Marsh, S., Foley, L. S., Wilks, D. C., & Maddison, R. (2014). Family-based interventions for reducing sedentary time in youth: a systematic review of randomized controlled trials. Obes Rev, 15(2), 117-133. doi:10.1111/obr.12105
  • Mitchell, J. A., Rodriguez, D., Schmitz, K. H., & Audrain-McGovern, J. (2013). Greater screen time is associated with adolescent obesity: a longitudinal study of the BMI distribution from Ages 14 to 18. Obesity (Silver Spring), 21(3), 572-575. doi:10.1002/oby.20157
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  • Panek, E. (2013). Left to Their Own Devices: College Students’ “Guilty Pleasure” Media Use and Time Management. Communication Research, 41(4), 561-577. doi:10.1177/0093650213499657
  • Rideout, V. J., Foehr, U. G., & Roberts, D. F. (2010). Generation M2: Media in the Lives of 8- to 18-Year-Olds. Retrieved from Menlo Park, CA:
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  • Totland, T. H., Bjelland, M., Lien, N., Bergh, I. H., Gebremariam, M. K., Grydeland, M., . . . Andersen, L. F. (2013). Adolescents’ prospective screen time by gender and parental education, the mediation of parental influences. Int J Behav Nutr Phys Act, 10, 89. doi:10.1186/1479-5868-10-89
  • Turel, O., & Serenko, A. (2012). The benefits and dangers of enjoyment with social networking websites. European Journal of Information Systems, 21(5), 512-528.
  • van Rooij, A. J., Schoenmakers, T. M., van de Eijnden, R. J., & van de Mheen, D. (2010). Compulsive Internet use: the role of online gaming and other internet applications. Journal of Adolescent Health, 47(1), 51-57. doi:10.1016/j.jadohealth.2009.12.021
  • Weinstein, A. M. (2010). Computer and video game addiction-a comparison between game users and non-game users. American Journal of Drug and Alcohol Abuse, 36(5), 268-276. doi:10.3109/00952990.2010.491879
  • Wethington, H., Pan, L., & Sherry, B. (2013). The association of screen time, television in the bedroom, and obesity among school-aged youth: 2007 National Survey of Children’s Health. J Sch Health, 83(8), 573-581. doi:10.1111/josh.12067
  • Yang, G. S., & Huesmann, L. R. (2013). Correlations of Media Habits Across Time, Generations, and Media Modalities. Journal of Broadcasting & Electronic Media, 57(3), 356-373. doi:10.1080/08838151.2013.816711
  • Yang, Y. S., Yen, J. Y., Ko, C. H., Cheng, C. P., & Yen, C. F. (2010). The association between problematic cellular phone use and risky behaviors and low self-esteem among Taiwanese adolescents. BMC Public Health, 10(1), 217. doi:10.1186/1471-2458-10-217
  • Yao, M. Z., & Zhong, Z.-j. (2014). Loneliness, social contacts and Internet addiction: A cross-lagged panel study. Computers in Human Behavior, 30(0), 164-170. doi:10.1016/j.chb.2013.08.007

This toolkit was created with funding from Harvard Pilgrim Health Care