Tablets, phones, TVs and electronic games have permeated our homes leaving parents wondering if, how much, when and how closely these devices should be used by their children. Most office days we encounter children and adults patients with symptoms related to screen use, such as headaches, blurred vision or itchy, burning, tired eyes. The source of the problem may be a correctable underlying vision disorder or inappropriate use of the device. Nonvisual effects of excessive screen time can include increased risk of obesity, poor school performance, sleep disturbances, and delays in critical learning and social skills.

The Canadian Association of Optometrists and the Canadian Ophthalmological Society recently released a joint position statement to address these questions based on the current state of research. Below is an excerpt from the statement with the key recommendations.

Policy Position

It is our position that the safe use of electronic screens should encompass the following:

a) Recommended amount of screen-time for children:

–      0–2 years: None, with the possible exception of live video-chatting  (e.g., Skype, Facetime) with parental support, due to its potential for social development, though this needs further investigation.

–      2–5 years: No more than 1 hour per day. Programming should be age-appropriate, educational, high-quality, and co-viewed, and should be discussed with the child to provide context and help them apply what they are seeing to their 3-dimensional environment.

–      5–18 years: Ideally no more than 2 hours per day of recreational screen time. Parents and eyecare providers should be aware that children report total screen time use as much higher (more than 7 hours per day in some studies).  This is not unrealistic considering the multitude of device screens children may be exposed to in a day, both at home and at school. Individual screen time plans for children between the ages of 5–18 years should be considered based on their development and needs.

b) Breaks no later than after 60 minutes of use (after 30 minutes is encouraged). Breaks should include whole-body physical activity. The ideal length of break has not been identified for either children or adults.

c) Workstation ergonomics: Chair heights should be set such that the child’s feet can lay flat on the floor or on a stool underneath the feet to allow for support. Chairs should not have arm rests unless they fit the child perfectly, as should back rests.  Desks should be set at the child’s elbow height or slightly lower. There should be enough depth on the desk to allow for forearm support; this is specifically effective in preventing musculoskeletal strain. Displays should be set in front of the child. There is no official recommendation for the angle of screen inclination. For computers, it is recommended to place the top of the display or monitor at the child’s eye level, and then allow them to move the screen down into a comfortable viewing position as needed. Official recommendations regarding a screen’s distance from a child do not exist; the computer screen should be placed at arm’s length, and then moved as necessary. External devices such as keyboards should also be placed in front of the child, with the mouse close to the keyboard and appropriately sized. Workstation lighting should be equal throughout the visual field, so glare and reflections that inhibit screen viewing or cause visual discomfort are inhibited.

d) The use of screens should be avoided one hour before bedtime. Screens in the bedroom are not recommended.

e) Outdoor activity over screen time should be encouraged.

f) Children may or may not complain of electronic screen-associated discomfort. Regular eye exams, which assess a child’s visual ability to cope with their visual demands and offer treatments for deficiencies (e.g., glasses correction; treatment (other than glasses) of other contributing eye conditions, etc.) are recommended.

For the complete position statement, including references, click here.