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For years I've been trying to limit my children's time in front of screens and encouraging my patients to do the same. But guidelines for limits were developed before tablets and smartphones, and may be as outdated as Family Ties is to Netflix and as Atari is to X-box, according to a recent American Academy of Pediatrics report.

Parents should play video games with their kids, quantity may not be as important as quality, and parents need to put down their smartphones, says Dr. David Hill, chair of the American Academy of Pediatrics Council on Communications and Media, one of the authors of the report.

Children spend an average of seven hours a day using screens. More than one-third of American toddlers use a mobile device before they are even out of diapers, according to Common Sense Media, a non-profit media education and advocacy organization. A Canadian survey in 2013 by the not-for-profit media educational organization MediaSmarts found that nearly half of Grade 4 students have their own cellphone or access to someone else's; by Grade 11, the number of kids with their own phones jumps to 85 per cent. Adding to the exposure, many Canadian schools use iPads as early as kindergarten and some are even utilizing virtual-reality field trips to explore the world.

"The media have proliferated in ways that are surprising and unprecedented since we created our last set of guidelines," Hill says. "A lot of parents have questions about how to use the new media in the healthiest possible way for their kids."

It's an uphill battle for all of us, but here are the latest recommendations on managing screen time in the digital era:

1) The family that watches together...

In the 1950s and 60s the whole family would gather around the television. In many households today, every family member has their own device. Children who view media unsupervised may be more likely to be exposed to age-inappropriate content, such as violence, which has "a strong risk factor for increasing aggression and in some cases violent behaviours," says Hill.

Viewing media together can open up important discussions about sex, drugs, alcohol, tobacco and violence. "When we talk about educating kids about high-risk behaviours as they grow up, I don't encourage them to watch age-inappropriate material with their parents, but there are a lot of opportunities for discussion by sitting down with your kid and helping him or her interpret what they're seeing on television, or in a movie," says Hill.

2) Be the curator

Media ranges from passive to interactive, from educational to pure entertainment. "One of the great challenges is serving as a curator in your child's digital media," Hill says. "It's not always easy to get accurate and reliable information on the quality."

He points out that while there are tens of thousands of apps for children advertised as being educational, "there are in most cases no data to support those assertions." One site he recommends for media education and content reviews is MediaSmarts is a similar Canadian website:

3) Real world, virtual world: both need plans

"We have to be aware that media are one of the main environments in which children spend time," says Hill. Consistency is important. Some parents "feel helpless around limit-setting in the realm of media," says Hill. "It's important for parents to know that they have every right and every need to set limits around media. You would not send your child out into the neighbourhood to play without a time to come home or a check-in plan, and you wouldn't send your child out into the digital world without some plan to see what he or she is doing."

4) The more interactive, the better

All the research still suggests that "kids learn best face-to-face," says Hill – especially infants, toddlers and preschoolers.

When the television is on in the background, fewer words are spoken in households. "We now have strong evidence that hearing fewer words during the first few years of childhood has a negative impact on school performance for years after that," Hill says.

Interactive forms of media, such as Skyping with a grandparent, may hold higher value than passively watching media.

5) Put down your own smartphone

"Since we are the best teachers for our kids," Hill says, "it's important that we think about what might be distracting us from those interactions."

One widely cited observational study showed that parents who use a mobile device during mealtimes interact less with their children and in some cases treat them more harshly or even neglect them. Hill suggests parents set up media-free times for the entire family. Being attentive encourages those important face-to-face interactions and shows children they matter.

6) No screen time before or in bed

There's strong data showing the blue-enriched light that we get from screens disrupts healthy sleep patterns, says Hill. "Likewise, if a phone is going off under your pillow every 30 minutes that's obviously disruptive to sleep."

"We know from some of the older literature that kids who have TVs in their bedrooms are more likely to watch age-inappropriate content and more likely to spend more time in general watching TV, they can also interfere with sleep."

Eliminating screen media prior to bedtime and keeping media out of the bedroom is important for healthy sleep hygiene.

As the science of screen time races to keep pace with digital advancements, the AAP and the Canadian Pediatric Society are updating recommendations for the digital era. An AAP policy statement and new guidelines on media use are expected later this year. The CPS has formed a task force to develop an evidence-based position statement on media in the digital era, expected next year.

Dr. Joelene Huber is a developmental pediatrician at St. Michael's Hospital in Toronto, an assistant professor in the University of Toronto Faculty of Medicine and a Fellow in Global Journalism at the Munk School of Global Affairs, University of Toronto. On Twitter @DrJoeleneHuber

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