• Children & Screen Time Information – ACBO

    Vision Guidelines – produced by ACBO.

    Children & Screen Time Information for Parents & Professionals

    Recommendations Scientific evidence strongly recommends that childrens’ use of computer screens, mobile phones, tablets and other devices should be limited. Excessive computer and screen use has been shown to be associated with a greater risk of developing shortsightedness as well as increased symptoms of eyestrain, headaches, blurred vision, dry eyes, and neck and shoulder pain, due to our eyes focusing and aiming close-up for very long periods(i)

    Reading from electronic devices requires more effort and is more fatiguing than from hard copy such as books(ii). The Australasian College of Behavioural Optometrists (ACBO) recommends the following guidelines for children using near vision screen equipment

    0 – 2 Years None None, with the possible exception of live videochatting (e.g., Skype, Facetime) with parental support, due to its potential for social development.
    2 -5 Years 1 hour per day or less, 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 3dimensional real-world environment. Excessive screen time before the age of 5 may cause delays in development, cognitive delays and poorer academic performance(iii).
    5 – 18 Years 2 hours per day or less
    Ideally recreational screen time should be limited. Individual screen time plans for children between the ages of 5–18 years should be considered based on their development and needs.

    Screen Time Tips
    ACBO recommends the following guidelines to help prevent vision and other problems from excessive screen use:
    Encourage moderation in near vision screen time. Studies show that children who spend more than 2 hours a day on screens, and less than 1 ½ hours outdoors, are more likely to become shortsighted. Consider reducing your own screen time as an example to your children.

    • Ensure Good Posture – Your child’s posture and working distance are so important as they grow, and device should be no closer than the distance to your elbow. Never read lying on your stomach, as the viewing distance will be much closer(iv). Excessive, extremely close smartphone use can cause severe eye coordination problems(v&vi).
    • Change Focus – When reading an electronic document or book, encourage your children to look up and away as they turn the page.
    • Take a Break – When using screens, have a short break at least every hour.
    • Consider Lighting – Avoid using computer, phones or tablets outside or in brightly lit areas, as the lighting and glare differences can create strain.
    • Take Care in Cars – Limit the use of computers, phones or tablets while traveling in a car – use the opportunity to look far, play games and enjoy your surroundings.
    • Not Too Bright – Adjust the brightness of the device your child is using for the light and circumstances.
    • Use a Clock or Timer – Remind them to take a break. We recommend looking away every 20 minutes of continuous near focusing, and a physical break every hour for children under the age of 9 years of age.
    • Distract – Create a distraction that causes your child to look up every now and then. Interrupt them with (healthy) snacks occasionally.
    • Stop screen use for an hour before bed time. Studies show that screen use just before bed can increase the risk of a child failing to fall asleep and staying asleep(vii).

    Screen Time and Myopia (Short-sightedness):

    Evidence shows that:

    • Children who spend more time outdoors are less likely to be, or to become myopic, irrespective of how much near work they do, or whether their parents are myopic(viii).

    • Outdoor time has a significant protective effect against developing some types of myopia(ix).

    • Increased study time of more than 2.5 hours per day can increase the risk of myopia(xxi).

    Screen Time and Eye Development:

    Evidence suggests that:

    • Half of children and youths exceed the public health screen time recommendation of 2 h per day or less(xii).

    • More than 2 hours of smart phone use produces greater chances of vision problems, and greater chances of multiple problems(xiii).

    • Most studies on the effects of screen time in children indicate that the odds of visual symptoms increase after 2–4 hours of use(xiv).

    i Coles-Brennan C et al. Management of digital eyestrain. Clin Exp Optom2019;102:18-29.

    ii Hue JE, et al. Reading from electronic devices versus hardcopy text. Work 2014;47:303-7.

    iii Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatr. Published online January 28, 2019. doi:10.1001/jamapediatrics.2018.5056

    iv Yoshimura, M., et al. Smartphone viewing distance and sleep: an experimental study utilizing motion capture technology. Nat Sci Sleep 2017 9: 59-65.

    v Mehta, A., et al. Acute Onset Esotropia From Excessive Smartphone Use in a Teenager. J Pediatr Ophthalmol Strabismus 2018;55: e42-e44.

    vi Lee, H. S., et al. Acute acquired comitant esotropia related to excessive Smartphone use. BMC Ophthalmol 2016;16: 37.

    vii Cheung, C. H. M. et al. Daily touchscreen use in infants and toddlers is associated with reduced sleep and delayed sleep onset. Sci Rep 2017;7:

    viii Xiong S, Sankaridurg P, Naduvilath T, Zang J, Zou H, Zhu J, Lv M, He X, Xu X. Time spent in outdoor activities in relation to myopia prevention and control: a meta-analysis and systematic review

    ix Huang HM, Chang DS, Wu PC. The Association between Near Work Activities and Myopia in Children-A Systematic Review and Meta-analysis. PLoS One. 2015 Oct 20;10(10):e0140419. doi: 10.1371/journal.pone.0140419

    x Po-Wen Ku et al The Associations between Near Visual Activity and Incident Myopia in Children – A Nationwide 4-Year Follow-up Study. Ophthalmology. 2018 Jun 19. pii: S0161-6420(17)33464-4. doi: 10.1016/j.ophtha.2018.05.010. [Epub ahead of print]

    xi Gopinath B et al. Influence of physical activity and screen time on the retinal microvasculature in young children. Arterioscler Thromb Vasc Biol. 2011 May;31(5):1233-9. doi: 10.1161/ATVBAHA.110.219451.

    xii Saunders TJ, Vallance JK. Screen Time and Health Indicators Among Children and Youth: Current Evidence, Limitations and Future Directions. Appl Health Econ Health Policy. 2017 Jun;15(3):323-331. doi: 10.1007/s40258-016-0289-3.

    xiii Kim J, Hwang Y, Kang S et al. Association between Exposure to Smartphones and Ocular Health in Adolescents. Ophthalmic Epidemiol. 2016;23:269-76.

    xiv Coles-Brennan C, Sulley A, Young G. Management of digital eye strain. Clin Exp Optom 2019;102:1829.

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