Editor's note: Of all the worries on parents’ minds, their children’s health often tops the list. Considering this, we’re presenting a three-part health series in our April, May and June 2017 editions. Each installment will tackle a common health challenge faced by today’s families.

Part one examined the issue of kids and sports injuries, exploring how to prevent and treat the aches and pains that often plague young athletes.

Part two looks at the impacts technology has on our health, while part three will delve into the sensitive topic of mental health. 

We hope this series will serve as a helpful resource for families facing complex health issues and striving toward wellness. Learn more at LowcountryParent.com/Health.

Like so many kids today, brothers Julian and Cameron Monsell love playing video games on their iPads. Julian even marked his 9th birthday with an electronics-inspired celebration: His friends came over with their iPads to play their favorite video game, Clash Royale.

But while the boys enjoy their screen time, their parents make sure there’s a structure in place that ensures a balance of technology, school work, outside play and family time in their West Ashley household.

“It’s important for kids to learn how to use computers and technology, but they still have to know how to interact with people, too,” says their mom, Jessica Monsell, who admits that she spends a lot of time in front of screens herself in her role as a social media manager and writer.

That’s why the Monsell kids are only allowed to play games on their iPads on weekends. During the week they must focus on school work. You’ll also never see this family sitting at a restaurant with their mobile devices in hand, or the kids hanging out in their rooms watching TV or playing video games.

The Monsells are on the right track with their approach to technology, health experts say. 

The American Academy of Pediatrics (AAP) recommends that families limit the time kids spend in front of screens, including televisions, computers, tablets and handheld devices. This is especially important for very young children who are actively working to develop skills they’ll use the rest of their lives.

The AAP recommends no screen time at all for children younger than 18 months, an hour a day or less of educational media for children ages 2-5, and limited digital media for children ages 6 and older based on the individual child. The organization defines “screen time” as time spent "consuming" media. It doesn't count activities such as doing homework in front of a computer.

In its latest recommendation, updated in 2016, the AAP also cautioned against using the television and other forms of digital media as a babysitter. The more interaction a parent can have with a child, no matter the age, the better. 

That can be a tough pill to swallow in a world where the demands on parents are at an all-time high, with pressure from work to answer emails around the clock.

Dr. Lisa Lopez thinks many parents are unaware of how much time their kids are spending in front of screens. “It’s easy to get busy doing something when your kid is quiet and calm, and you look up and they’ve been on your phone for an hour and a half,” says Lopez, a pediatrician at Sweetgrass Pediatrics, which has seven locations around the Lowcountry.

Sliding social skills

While Lopez hasn’t noticed significant developmental delays from too much digital media consumption, she has noticed a decline in social skills in her young patients. Now that kids are using mobile devices so frequently, they haven’t had to learn to sit still or wait in public settings. They also haven’t had to learn how to engage in conversations.

"I’ve noticed that kids will not put down their phone when the nurse or doctor comes into the room. They don’t even look up and say 'Hi,' " Lopez says. "Sometimes even the parents won’t look at me or address me."

To improve social skills, Lopez recommends that families have at least one meal around the table together daily, engaged in conversation as a family — something she insists on with her own children, who are 5 and 8. Having that time when the whole family puts away their electronic devices forces them to find new and interesting things to talk about, and strengthens their relationships, she says.

"I’ve noticed in successful families with well-adjusted teenagers, they almost always sit down and have a meal together as a family," Lopez says. "There should be some media-free zones, and your table should be one of them."

While older kids may feel like they’re socializing through social media, online relationships and communities will never replace healthy, in-person friendships. The threats of cyberbullying, online predators and inappropriate adult content are among other reasons parents should limit and monitor their kids' screen time, Lopez adds.

Weighty issues

It’s not just a child’s ability to make small talk that’s impacted by too much screen time. Too many sedentary hours can lead to health troubles as well, such as increased body mass index, sleep deprivation, eyesight problems and impaired motor skills.

Rebecca Doolittle, a pediatric occupational therapist in Mount Pleasant, says screen time is one of the things she assesses in her patients.

“When kids are engaged with screens, they’re quiet and still, but that’s the problem,” says Doolittle, rehabilitation manager at the Pediatric Rehabilitation Center at East Cooper Medical Center. “They’re quiet and still when they’re supposed to be moving, playing, bouncing a ball, figuring out new ways to use their bodies and teach their brain new things.”

With childhood obesity at an all-time high, it’s more important than ever to make sure that children get the recommended hour of exercise daily — something that’s difficult to do when kids are already sitting at a desk for long periods at school.

In her practice as an occupational therapist, Doolittle says she sees many kids who don’t know how to use their hands well because they’ve spent so much time using a touch screen instead of working on fine motor skills. She also sees many kids who have a hard time transitioning from one activity to another, or who show signs of sleep deprivation — all things that could be caused by too much media use.

Eye strain

Spending too much time staring at screens can also have a negative effect on your child’s eyesight, says Dr. Katie Davis, an optometrist with Draisin Vision Group in Charleston. “Because our visual system is biologically designed for distance vision, near vision is only a focusing reflex that helps us identify objects closely,” she says.

“Our eyes are not designed to interact with screens for hours on end,” she says. “Excess screen time can cause nearsightedness, eye strain, double vision, headaches and even changes to the health of the interior of the eyes.”

She points to a recent study published in the journal BMC Ophthalmology that linked new onset eye turns (sometimes referred to as crossed eyes) with smartphone use in pediatric populations. Eye turn was reduced in seven out of 12 patients after a reduction in screen time.

Screens and sleep

Too much screen time can also make it difficult for children to get enough sleep at night, especially if they’re looking at screens right before bedtime.

“We repeatedly see sleep cycle issues in the children who come to our clinic,” optometrist Davis says. “When we probe, we almost inevitably hear that they’re playing video games, using social media or watching TV for an extended period before they go to bed.”

Those issues with sleeping are likely due to the blue light emitted by LED screens on televisions and electronic devices. That light, which naturally occurs in sunlight, sends a signal to the body and brain to be awake and productive during the day. At night, it can suppress melatonin, the hormone that regulates circadian rhythms, and disrupt the natural sleep cycle — something that can contribute to ADHD and other mood and behavioral issues in children.

Though there are glasses available that can filter out some of the blue light, the best way to ensure children get the sleep they need is to reduce night time access to screens.

Setting limits

Aside from physical problems, parents should look for other warning signs that their child needs to unplug. Other potential effects of too much screen time include trouble focusing in school, difficulty transitioning from one activity to the next, issues socializing and behavioral problems.

Doolittle, the occupational therapist, says she sometimes asks families to keep a log of the amount of time their children are using technology. Often the parents are surprised by just how much time their kids are actually getting in front of screens, and that alone can be a powerful catalyst for change. Of course, if your child is still very young, it is better to never allow your child to spend that much time consuming media to begin with.

“Some of the greatest advice I can give is it’s much easier to never start high amounts of privilege with technology at an early age than it is to scale back,” she said.

If you are trying to limit screen time, Doolittle suggests starting with the mobile devices. Instead of allowing your children to watch videos or a DVD when you’re driving around town or waiting at a restaurant, pack a coloring book and crayons, or other non-screen distractions. Better yet, take advantage of the transitions between activities to have meaningful conversations with your kids.

“Technology use is such a challenge for parents, but it’s such a responsibility that we all need to own,” she says.“Nothing ever replaces human interaction and the back and forth sharing of language.”

Finding a balance

Of course, that doesn’t mean you need to make your family unplug completely. Technology is an integral part of the modern-day world, and children will need to know how to use it as they grow up.

While nothing can beat active, imaginative play to keep kids healthy, technology can also be used to improve their well-being.

Lopez, the pediatrician, points to mobile apps such as My Fitness Pal, which can help families monitor calorie intake and exercise and manage weight more effectively.

Wearable devices such as the Fitbit, or step-counting apps, can motivate kids to keep moving.

There are even video games, such as Nintendo Wii's "Just Dance," that encourage players to get off the couch and get active.

And, with limits, technology can be a useful diversion for kids when parents need some uninterrupted quiet time.

"My philosophy is always 'sanity first,'" says Gervase Kolmos, a mother of two girls, ages 3 and 9 months, and a life coach who specializes in working with mothers. "Whatever the thing is that’s going to lower your blood pressure in that moment is always the best thing."

In her home, that sometimes means her 3-year-old watches a TV show so Kolmos can work or do other things. She doesn’t worry about the recommendations or what other people think, she just tries to balance that TV time with finding ways to connect and have more face-to-face interaction.

“It comes in waves — some weeks it’s more TV than others,” Kolmos says. “The thing I notice is, 'How’s the quality of our connection?' If I feel like [our connection] is weaker after TV, I’m not beating myself up. I just work to improve the quality of our connection day by day.”

"Quality over quantity" is a good rule of thumb for choosing the types of screen time you allow your kids to have, too. Look for educational programming or games that will help teach kids in a fun way. And, when you can, watch with your kids so you can have a conversation about what they’re seeing or playing. Using Facetime to chat with an out-of-state grandparent, or huddling around the TV to watch a sporting event with the family can be a great way to use media in a productive way with kids.

"Everything in moderation," says Lopez. "A little bit (of screen time) can be good and healthy, but too much of it, like anything, is not healthy. They just need to get out there and play."

That's the game plan in the Monsell household, too. 

Limiting technology use has helped Julian and Cameron learn problem-solving and social skills because they’re spending more time interacting with each other, Jessica Monsell says. “Having a balance there allows them to be more compassionate and empathetic, and they learn how to share better and play well with others.” LCP