By John J Reilly, Professor of Physical Activity and Public Health Science at the University of Strathclyde.
High screen time in early childhood – far exceeding World Health Organization (WHO) 2019 guidelines – is now the norm. This harms physical and mental health, impairs development and learning, and contributes to long-term inequalities in health and education. It also reduces vital family interaction and may establish unhealthy habits that persist into later life.
Between 2017-2019 I chaired a UK Chief Medical Officers (CMOs) working group tasked with developing evidence-based guidelines for physical activity, screen time and sleep in the under-fives.
The group concluded that the WHO 2019 screen time guideline should be adapted slightly then adopted across the UK: no screen time at all for those under 12 months, and less than one hour per day for those from 12 -48 months.
Scientific evidence
The scientific evidence was both strong and clear: regardless of whether or not screen time guidelines are being met, less screen time is better for the under-fives, producing healthier body fatness, better motor development, brain development, social and emotional development, and wellbeing. Towards the end of the guideline development process the CMOs voted that the WHO physical activity guideline should be adopted across the UK, but not the guidelines on screen time or sleep. An important opportunity to improve public health and reduce health inequalities in Scotland was wasted.
Many years on, policy inertia persists in Scotland. Screen time in the under-fives remains absent from Scottish population health and obesity policy. How should we proceed? Scottish guidelines on screen time for the under-fives, long overdue, would be a start. New English screen time guidance for the under-fives, not evidence based, was published at the end of March.
New guidelines
Scotland should adopt the WHO 2019 Screen Time Guidelines with appropriate adaptions, then turn the new guidelines into action using all the other key stages of policymaking – education and awareness raising among the public and professionals in health and education; health policy development and policy implementation, evaluation and monitoring. Clear frameworks to help policymakers do all of that for screen time in early life are already available.
The science and evidence have been settled for some time – high levels of screen time in early life are both very common and very harmful. Great damage has been done by the reluctance to tackle early life screen time in Scotland, and we can no longer afford to delay action.