From phones and tablets to computers and TVs, screens are everywhere, making it easy for many people to spend most of the day looking at one. Yet growing evidence shows that too much screen time can take a toll on both physical and mental health, contributing to eye strain, sleep disruption, reduced activity and even heightened stress.
But decreasing screen time is not about avoiding technology altogether. It’s about finding balance. Limiting daily device use and building in regular breaks can help improve focus, restore sleep quality and support overall well-being.
AMA policy encourages primary and secondary schools to incorporate into their health class curricula the topic of balancing screen time with physical activity and sleep. The AMA also encourages primary care physicians to assess pediatric patients and educate parents about amount of screen time, physical activity and sleep habits.
The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.
In this installment, three AMA members took time to discuss what they wished all patients knew about reducing screen time. They are:
- Patrice A. Harris, MD, MA, a child-and-adolescent psychiatrist from Atlanta and former president of the AMA.
- Danielle Grant, MD, a pediatrician and associate medical director at Texas Children’s Pediatrics in Austin, Texas.
- Maurice G. Sholas, MD, PhD, a pediatric physical rehabilitation physician in New Orleans at Ochsner Health.
Ochsner Health and Texas Children’s Pediatrics are part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Too much screen time has consequences
“Excessive screen time can have consequences for someone’s physical, mental, social and emotional health, as well as overall well-being,” said Dr. Grant. For example, children can get fixated on their screens, and find it hard to break away, which can cause temper tantrums and emotional dysregulation.
“Other physical impacts include neck strain, eye strain and back pain from being sedentary,” she added. Meanwhile, reduced physical activity can lend to obesity.”
“Mental health effects can include sleep problems, and increased risk of anxiety and depression. There can also be an impact on attention, focus and executive functioning,” Dr. Grant said, noting that “passive screen time can cause social isolation and can interfere with developing emotional intelligence.”
“Behavioral regulation problems are seen more in the age range of toddler to preteen, whereas anxiety and depression can be more common in the preteen to teenage group,” she said.
Not all screen time is created equal
“It’s important to define screen time as not just one category,” as the term encompasses “time spent on schoolwork, TV, video games and social media,” Dr. Harris said. “There are several of subcategories of how we all use screen time and that of course goes to the fact that not all screen time is created equally.”
Dr. Grant agrees, noting “there are certain types of screen time that are better than others. For example, screen time should be tailored for specific ages in regard to programming and the amount of time spent using different devices.”
“Screen time that promotes educational opportunities, skill development and creative expression may offer benefits,” she said, noting that “active screen time promoting educational games or interaction with friends can help support social development and skills.”
Meanwhile, passive screen time, such as watching a movie or show, can be relaxing,” Dr. Grant said. But too much passive screen time could interfere with social development and can be consumptive.”
Screen time recommendations vary
Dr. Sholas noted that “the American Academy of Pediatrics recommends no screen time at all for kids until they're 18 to 24 months old, except for video chatting.”
“For the 18-month to 24-month age range, media use should be limited to a brief amount of high-quality programming consisting of age-appropriate educational content, with parents watching alongside the child to foster engagement,” Dr. Grant said. “For 2 to 5 years old, limit screen time to one hour per day of high-quality programming.”
“For 6 years or older, it is important to limit the amount of screen time to two hours or less per day,” she explained, noting that “while unique situations for educational needs may expand this duration, make sure the screen time does not interfere with sleep, school and other activities.”
Dr. Sholas added that “screen time is like sugar—you shouldn't cut it all the way out because there is a need and a purpose for it. What if you give them too much? You'll be sorry.”
It's all about balance
“Screens are everywhere these days, and with the development of new technology there can be benefits if used appropriately,” said Dr. Grant. “Parents can develop a media plan for their family to set expectations and create healthy habits.”
“There's no one right answer when it comes to either defining screen time as good or bad or managing screen time,” said Dr. Harris, noting that she likes “to look at it in terms of context and even a checklist, particularly when you are talking about children, but it is applicable to adults too.
“The questions should be: Is screen time interfering with some of the pro-health, pro-wellness activities that we should all be engaging in?” she added. “For example, sleeping and eating. Is screen time overtaking our ability to get the adequate amount of sleep or interfering with adequate nutritional intake? What about physical activity, quality time with family?”
“If you see that all screen time is video games and not connecting with friends and family, that's a worry,” Dr. Harris explained.
“That is why it is important to avoid negative content and programming that is not age-appropriate,” Dr. Grant said. “Overall, it is a good goal to balance non-screen time activities, as well as passive, active and educational screen time to foster connection and critical thinking.”
Avoid doomscrolling
“Doomscrolling is a term used to describe excessive and compulsive screen time, often with news or social media,” Dr. Grant explained. “Doomscrolling can create a cycle of endless scrolling, often of negative content, which can lead to anxiety, stress and depression, or worsen symptoms for patients who already struggle from these illnesses.
“It can also interfere with sleep and create social isolation,” she added. “Recognizing this pattern and breaking away to limit exposure to negative content is important for promoting the well-being of a teenager or child.”
Dr. Harris added that “we have these constantly updating newsfeeds right on our mobile devices and so once we click on that newsfeed, we might continue to click through all of the negative news of the day.”
“We are in a time of anxiety and sometimes it's just wanting to stay connected. But once we check that first news story, we tend to just continue that doomscrolling and that absorption of the negative news,” she said, advising that turning off or limiting mobile or email news alerts is just a start.
Develop a media plan
“You can minimize these risks by developing a media plan that includes ways to promote healthier use of media and screens,” said Dr. Grant. “Examples include no screens at mealtime or before bed.”
“Focus on balancing family time with screen time and have activities that do not involve screen usage,” she said. Also, promote activities that include physical activity, socialization and creative play.”
Don’t fixate on social profiles
“One of the things people talk about is that—especially when you do things via Instagram—you’re finding that people are really having a hard time comparing and understanding what’s normal,” said Dr. Sholas. That’s “because everything on these social media platforms is so curated. It makes everyone’s life look fabulous and fantastic and omits all their struggles and shortcomings.”
“When kids look at that out of context, they feel like they must be the only person in the world who had a spat with their parents yesterday,” he added, noting that “what happens is even though we’re hyperconnected in some ways in these social media platforms, we’re more isolated and self-doubting because we’re only seeing the curated selves of all these people rather than who they really are as full persons.”
“While the use of social media can foster connection and communication, excessive and inappropriate use can negatively affect mental health and body image,” said Dr. Grant, noting “it is important to teach children and teens the appropriate use of media with a focus on age-appropriate content and mindfulness to avoid harmful, negative and unrealistic portrayals.”
“That is why it is important to encourage activities that promote real-life connections,” she said.
Spend quality time with loved ones
“There should be a focus and a commitment to spending quality time with your family—however you define family,” said Dr. Harris. It’s about making “sure we are having that connection at least on this screen.”
Additionally, “find your village—and find ways to connect your village with your kids in some manner that represents something,” urged Dr. Sholas. “If you have a child who's into Minecraft and building things, there are some architectural hands-on interactive things that they can build in real life to match those things they build in a virtual universe.”
Pay attention to time spent on screen
“Be mindful about how much time you are spending and on what particular activities,” said Dr. Harris. “If it's three hours of school time, that may be appropriate, but we should be building in breaks even with screentime for schoolwork.”
That means paying attention to “how many hours a day you or your children are spending, and then substitute that time with another activity,” she said.
It’s also important for adults to “find what they’re loving about being on screen and some analogous thing that they can pivot to in real life,” said Dr. Sholas. “It can be small things. ... Those things have meaning and help people work it out.”
Set screen-time limits and turn off notifications
“If one’s education requires longer durations for online learning, it is important to regulate the use of media outside of the educational setting,” said Dr. Grant. For example, limit screen time before bed. Designate screen-free areas such as the dinner table and bedroom.
“Engage in activities that are screen-free including outdoor time,” she added, noting that “setting screen time limits and turning off notifications can be tricks to help regulate usage.”
Put the phone away before bedtime
“Screens can affect sleep quality, especially if used in the hours before bed,” said Dr. Grant. “Screens emit a blue light which can suppress natural melatonin production. This can make it harder to fall asleep and reduce overall sleep quality.”
“Some programming can also be overstimulating or anxiety-provoking, which could disturb sleep as well,” she said. “Poor sleep quality can contribute to anxiety and depression. Moreover, the content of what children and adolescents are viewing can also contribute to emotional distress.”
Substitute toxic behaviors
Screen time can be “toxic when you are not doing some of the social, pro-wellness things that we all need to do,” Dr. Harris said. “It may not be that you have to turn off the alerts forever, but if you find yourself in the place where you are ruminating, anxious, not sleeping, not eating and more depressed, then you want to substitute these behaviors and turn off those alerts and all of the things that you can do to make sure there's a balance.”
It is also about making sure “it's not impacting your ability to function and participate in social, wellness and helping behaviors,” she said.
Promote physical activity and creative play
“Screen time can be substituted with many different activities that promote physical activity, creative play and socialization,” Dr. Grant said. “Free play outside is a great go-to activity. Some ideas include bike rides, scooter rides, playing tag, swimming and building a fort.”
“Indoor activities can include puzzles, arts and crafts, building objects, trying a new recipe to make, and family games,” she said. “Overall, screens are all around us and while there are some great things we can gain from innovation and technology, it is important to remember to balance technology and electronic use with good old-fashioned activities.
“Having a plan for your family regarding screens and technology can be helpful and serve as a blueprint for navigating electronic use and expectations as your child gets older, which will allow them to learn how to be mindful and self-regulate appropriate usage at an older age,” Dr. Grant added.
Build breaks into your schedule
“Across this country, people are rethinking work, workplaces and commute time,” said Dr. Harris. “For the people who would be working from home, there are stresses there.”
“We find ourselves in Zoom meetings from 9 to 5 and that means we are potentially sitting for eight hours, and we don’t want to do that,” she said. “Just in the same way you want to think about social media and other issues, even if you are using screen time for school and work, you should build breaks into that.”
“Before COVID-19, many of us—and I have to say myself included—didn't always take a break for lunch,” Dr. Harris said. “That was not a good idea before COVID and it's not a good idea now … so try to build in some healthy habits as we all continue to work from home.”
