A harm reduction approach for busy families.

Reviewed by Vanessa Lancaster

Key points

• The COVID-19 pandemic altered the childcare and workforce landscapes, and changes remain for many despite waning infection numbers.
• The AAP discourages screen time for babies under 18 months aside from video chat, yet young children still need to be occupied.
• Practitioners can support caregivers in enacting harm reduction strategies for times when screen time consumption runs high.

The pandemic continues even in the face of new vaccines and falling case counts. Caregivers of young children are still scrambling to meet their work commitments, run errands, and manage their homes. Given this ongoing upheaval, caregivers may need ideas for when they cannot keep screen time levels “ideal.” A harm reduction approach can help families stress less when they are not adhering to the recommended daily limits, which may feel impossibly strict.

Screen time, except for video chat, is not recommended by the American Academy of Pediatrics (AAP) for babies under 18 months old (Where We Stand, 2016). They suggest that toddlers ages 18- to 24 months are introduced to screens, apps, and other media with an adult to guide and interact with them (Where We Stand, 2016).

Children ages two years old and up recommend a limit of one hour a day—and even then, with adult guidance (Where We Stand, 2016). These are potentially challenging guidelines to follow, even in the best of times.

Many families allow their children to watch shows and play with apps and games when adult chores or work tasks need to be done. This situation is likely to have increased since the pandemic added a layer of stress to everyone’s lives. As a practitioner, it may feel necessary to back up the AAP recommendations. However, a middle path with suggestions to ensure that screen time’s impact is as positive as possible—and to make the very best of interactions when screens are put away—may also be possible. Here are some strategies to share with families:

• Ensure that programming is age appropriate. Rebecca Parlakian, senior director of programs at zero to three (2018), suggests trusted sources of high-quality content like PBSKids.org and Sesame Workshop. It’s great to stick with educational shows and apps, but if that is not an option, avoid content aimed at older children or adults (commonsensemedia.org is a good resource for determining the correct ages for specific content).
• As noted, engaging with young child when they have screen time is preferred, as it can improve the educational impact (Where We Stand, 2016, Parlakian, 2018). If that is not possible, caregivers can sit and engage with their toddlers for just a few minutes at the beginning of the program or game. This will allow for questions or a conversation afterward—an important social and language connection that isn’t otherwise feasible.
• Be strict about the times a child doesn’t need to be occupied by a screen. If a toddler ends up watching three hours of PBS while a caregiver works, but then the rest of the night is totally screen-free, that is better than if the TV remains on in the background or adults are distracted by their own devices throughout the evening. Too much screen time isn’t great, but it’s also not the end of the world—compensating with a digital/media diet after, along with lots of interaction, makes a difference.
• Engage in physical activity, play, and serve and return interactions once screen time is over—the quality of these interactions matters. A caregiver’s presence enhances play and child-led play—where the grown-up follows the child’s lead and responds with delight—bolsters the caregiver-child connection. Serve and return exchanges (back-and-forth interactions) can happen anywhere and anytime—while reading a book, during a transition, bath, or meal, or in the middle of a family dance party.
• Reduce negative self-talk—it is not helpful to shame or belittle when ideals are not met. Even when it has been one of those days, encourage caregivers to refrain from beating themselves up or labeling themselves a “bad parent.” Instead, they can acknowledge how things didn’t go as planned and work to do things differently next time.

Fascinating research on how babies learn language shows that instruction from another human is much less effective when delivered via video—even live video (Kuhl, 2007). There is something about how growing humans take in and process information that happens more successfully with an actual social interaction (Kuhl, 2007). This research underscores the importance of maintaining adult-child in-person connections to extend children’s learning.

Ongoing interactions and conversations—and integration of screen-free time, back-and-forth interactions, and physical activity into each day—are always welcome to a child’s understanding and development. As families (especially those with young children) continue to face significant pandemic-related challenges, we need to be empathic and realistic while advocating for policy changes that support and prioritize them.