With several recent studies highlighting different aspects of the harm mobile phones, tablets and computers can cause toddlers, children and young people using, Aether takes a look at whether more needs to be done to safeguard the youngest in our society from barely known dangers.

Life has altered immeasurably in the Digital Age. In just a couple of generations, the life experiences of today’s parents are vastly different to that of their offspring. If you are 50 today, you most likely didn’t see a computer until your mid-teens. Today, your mid-teen has been fully aware of mobile phones, tablets and computers since before their earliest memory.

And with that alteration in experience, today’s scientists are looking more closely than ever at the idea of the potential damage such early immersion into the digital world can have. In recent weeks several studies have been published where researchers looked at different aspects of the digital/ child interface, furthering our understanding and providing yet more evidence that the way in which we allow our children to use digital media can have a sustained impact on the rest of their lives.

Here, Aether looks at four recent studies that shed light on different aspects of the lives of children growing up in the Digital Age. We start with a study from the University of Illinois Urbana-Champaign which looked at the overall health of toddlers, before moving onto potentially terrifying research from Turkey that suggests too much ‘blue-screen’ use can impact on puberty and possibly sexual health in later years.

A third study looks at the need to help ‘tweenies’, those aged between 8 and 12, build digital resilience to online threats, and how to help them thrive if they have been targeted, and, finally, we look at a tragic realisation in Australia that there are cases of children who have died during video gameplay, making that activity no safer for undiagnosed heart conditions than playing sports.

Study 1: Less screen time aids toddlers’ executive function

A new study explored whether adherence to American Academy of Pediatrics’ guidelines for diet and physical activity had any relationship with toddlers’ ability to remember, plan, pay attention, shift between tasks and regulate their own thoughts and behaviour, a suite of skills known as ‘executive function’.

Reported in The Journal of Pediatrics, the study found that 24-month-old children who spent less than 60 minutes looking at screens each day, and those who engaged in daily physical activity had better executive function than those who didn’t meet the guidelines.

“Executive function underlies your ability to engage in goal-directed behaviours,” said University of Illinois Urbana-Champaign kinesiology and community health professor Naiman Khan, who led the study with graduate student Arden McMath and food science and human nutrition professor Sharon Donovan.

“It includes abilities such as inhibitory control, which allows you to regulate your thoughts, emotions and behaviour; working memory, by which you are able to hold information in mind long enough to accomplish a task; and cognitive flexibility, the adeptness with which you switch your attention between tasks or competing demands.”

McMath added: “We wanted to test the hypothesis that healthy weight status and adherence to the AAP guidelines for diet and physical activity would extend to greater executive function in 24-month-old children.”

toddler danger

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minimise or eliminate

Through its Bright Futures initiative, the AAP recommends that children spend less than 60 minutes looking at screens each day, engage in at least 60 minutes of physical activity, consume five or more servings of fruits and vegetables and minimise or eliminate the consumption of sugar-sweetened beverages.

Previous studies have linked adherence to guidelines for physical activity levels, screen time and diet quality with executive function in school-aged or adolescent children.

McMath advised: “We focused on an earlier period in child development to see whether and how early in life these relationships begin.”

The families of the 356 toddlers in the new research are participants in the STRONG KIDS 2 cohort study, a long-term look at the interdependent factors that predict dietary habits and weight trajectories of children who are followed from birth to five-years-old. The study uses parental surveys and data on the children collected at eight time points over the five years, including when the children are 24-months-old.

“The surveys asked parents to report on several aspects of their child’s daily habits, including how much time they looked at screens, how physically active they were, whether they had at least five servings of fruits and vegetables and whether they refrained from drinking sugar-sweetened beverages,” McMath said.

The parents also responded to a standard survey designed to measure executive function in toddlers. These questions asked them to evaluate their child’s ability to plan and organise their thoughts, regulate their emotional responses, inhibit impulses, remember information and shift attention between tasks.

The team used a structural equation modelling technique to assess the direct and indirect relationships between adherence to the AAP guidelines and executive function in the toddlers.

greater inhibitory control

“We found that toddlers who engaged in less than 60 minutes of screen time per day had significantly greater ability to actively control their own cognition than those who spent more time staring at phones, tablets, televisions and computers,” McMath said. “They had greater inhibitory control, working memory and overall executive function.”

Toddlers who engaged in daily physical activity also did significantly better on tests of working memory than those who didn’t, the researchers found.

While the study found no significant relationship between the children’s weight status and executive function, it suggested that “associations between health behaviours and executive function may precede observed relationships between executive function and weight status” in older children, the authors wrote.

“The influence of engaging in healthy behaviours on cognitive abilities appears to be evident in early childhood, particularly for behaviours surrounding physical activity and sedentary time,” Khan said.

Study 2: Mobile and Tablet use linked to earlier onset of puberty

early onset puberty

Exposure to ‘blue-light’, via regular use of tablets and smartphones, may alter hormone levels and increase the risk of earlier puberty, according to data from a new rat study.

Longer duration of blue-light exposure was associated with earlier puberty onset in the female rats, which also showed reduced levels of melatonin, increased levels of some reproductive hormones and physical changes in their ovaries.

Use of blue-light emitting mobile devices has previously been linked to disrupted sleeping patterns in children but these findings suggest there could be additional risks for childhood development and future fertility.

The escalating use of blue-light emitting devices, such as tablets and smartphones, has previously been implicated in reducing sleep quality in both children and adults. This is thought to be through disruption of our body clock as blue-light inhibits the evening rise in levels of the hormone, melatonin, which prepares our bodies for rest and sleep. Melatonin levels are overall higher during pre-puberty than in puberty, which is believed to play a role in delaying the start of puberty. Puberty is a complex process that involves co-ordination of several body systems and hormones.

significantly earlier

In recent years, several studies have reported increases in early puberty onset for girls, particularly during the COVID-19 pandemic. The link between blue-light exposure and reduced melatonin levels suggests that increased screen time, such as during the pandemic restrictions, may be playing a role in this reported increase. However, it is very difficult to assess this in children.

In this study, Dr Aylin Kilinç Uğurlu, of Ankara City Hospital, Turkey, and colleagues used a rat model to investigate the effects of blue-light exposure on reproductive hormone levels and the time of puberty onset. Female rats were divided into three groups of six and exposed to either a normal light cycle, six hours or 12 hours of blue-light.

The first signs of puberty occurred significantly earlier in both groups exposed to blue-light, and the longer the duration of exposure, the earlier the onset of puberty. Rats exposed to blue-light also had reduced melatonin levels and elevated levels of specific reproductive hormones (oestradiol and luteinising hormone), as well as physical changes in their ovarian tissue, all consistent with puberty onset. After 12 hours of exposure, rats also showed some signs of cell damage and inflammation in their ovaries.

Kilinç Uğurlu said: “We have found that blue-light exposure, sufficient to alter melatonin levels, is also able to alter reproductive hormone levels and cause earlier puberty onset in our rat model. In addition, the longer the exposure, the earlier the onset.

“As this is a rat study, we can’t be sure that these findings would be replicated in children, but these data suggest that blue-light exposure could be considered as a risk factor for earlier puberty onset.”

Minimised in pre-pubertal children

It is difficult to mimic blue-light exposure equivalent to a child’s tablet use in rats but the time-point of puberty in rats is roughly equivalent to that of humans, if adjusted for rats’ lower life expectancy. The hormonal and ovulation changes that occur during pre-puberty and puberty in female rats are also comparable to humans. So, despite the study limitations, these findings support further investigation of the potential health impacts of blue-light exposure on hormone levels and puberty onset in children.

The team plans to investigate the cell damage and inflammatory effects detected after longer blue-light exposure, since this could have long-term impacts on reproductive health and fertility. They will also assess whether the use of blue-light minimising ‘night light’ mobile device features can reduce the effects observed in the rat model.

Kilinç Uğurlu concluded: “Although not conclusive, we would advise that the use of blue-light emitting devices should be minimised in pre-pubertal children, especially in the evening when exposure may have the most hormone-altering effects.”

online bullying

© Ryan Melaugh

Study 3: Collective effort needed to help children thrive following exposure to online risks

Helping children become more ‘digitally resilient’ needs to be a collective effort if they are to learn how to ‘thrive online’, according to new research led by the University of East Anglia.

Digital resilience is the capability to learn how to recognise, manage and recover from online risks – such as bullying and inappropriate content – and has the potential to buffer how these experiences may impact young people’s wellbeing. Until now, research has not examined how digital resilience can be built and shown by children beyond focusing on the individual child.

This new study argues that activating digital resilience needs to be undertaken as a ‘collective endeavour’, involving the child, their parents/ carers within home environments, youth workers, teachers, and schools at a community level, along with governments, policymakers, and internet corporations at a societal level.

The study focused on digital resilience among pre-teens – those aged 8 to 12 years old, who are transitioning into early adolescence and seeking more independence at home, school, within society and, increasingly, through online experiences.

The findings, published in the journal Education and Information Technologies, come as the latest draft of the Online Safety Bill makes its way through the UK Parliament. The Bill is not expected to place a clear requirement on platforms to co-operate on cross-platform risks and respond to cross-platform harms when discharging their safety duties, compromising the collective endeavour being called for in the study.

increasingly important

Current United Kingdom Council for Internet Safety (UKCIS) guidance highlights digital resilience at an individual level. The study’s lead author, Dr Simon P Hammond, said this places emphasis on the child, “marginalising how home, community and societies support children to learn how to navigate and grow from risky online experiences”.

“The need to support children in learning how to recognise, manage, and recover from online risks is an increasingly important process for all,” said Hammond, a lecturer in the School of Education and Lifelong Learning at UEA.

“By showing how digital resilience operates within and across different levels, we can provide more child-centred support to help children to thrive online. To raise digitally resilient citizens, we need to think beyond solely the child or their immediate family and think about how community and society work with these groups.

“There is also the idea here that just as with the offline world, we need to understand that learning by doing, which involves risky play, is a lifelong process. Mistakes will happen and children need support to learn from those.”

Consultant child and adolescent psychiatrist Dr Richard Graham, who co-chaired the UKCIS Digital Resilience Working Group, said: “This important hopeful research takes further the early thinking on digital resilience and gives a clear direction away from simplistic e-safety strategies, and highlights how individuals, families, and communities can flourish in the Digital Age.

“There is a clear call to action for us all to be better engaged with young people as they learn to navigate the mercurial online world, whilst not dispensing with our growing demands that technology companies create safer online spaces, more supportive of wellbeing and development.”

promote digital resilience

Since Summer 2021, England’s nine million school pupils have been learning about being safer online via Personal, Social, Health and Economic (PSHE) education. However, many existing resources, which lack a solid evidence-base, tend to take a universal rather than personalised approach to risk.

The study provides a platform to counter this by underpinning the creation of validated psychometric measures that will enable important contextual factors such as a child’s family and community support to be considered, enabling educators to offer tailored as opposed to one-size-fits-all approaches.

Co-author Dr Gianfranco Polizzi, of the University of Liverpool, said: “Our findings have the potential to help parents/ carers and educationalists promote digital resilience through formal and informal educational approaches that interact and show the importance of supporting pre-teens’ digital resilience within and across different areas of their everyday lives.”

Dr Kimberley Bartholomew, from UEA, added: “For policymakers, this study illustrates aspects that might otherwise be taken for granted. For example, that a child is assumed to be more or less digitally resilient as a function of their age, rather than a combination of their age plus their digital experiences and skills.

“This can shape new ways of teaching which promote controlled exposure to risky opportunities, to be used to help children build and show digital resilience as opposed to trying to avoid risky experiences altogether, which is both short-sighted and unrealistic in our increasingly connected worlds.”

online resilience

© mattwalker69

Study 4: Electronic gaming can trigger potentially lethal heart issues

Video games may not always be a safe alternative to competitive sports, according to a new study in Heart Rhythm.

Electronic gaming can precipitate life-threatening cardiac arrhythmias in susceptible children whose predisposition may have been previously unrecognised, according to a new report in Heart Rhythm. The investigators documented an uncommon, but distinct pattern among children who lose consciousness while playing electronic (video) games.

Lead investigator Dr Claire M Lawley of the Heart Centre for Children, Sydney Children’s Hospitals Network, Sydney, Australia, said: “Video games may represent a serious risk to some children with arrhythmic conditions; they might be lethal in patients with predisposing, but often previously unrecognised arrhythmic conditions.

“Children who suddenly lose consciousness while electronic gaming should be assessed by a heart specialist as this could be the first sign of a serious heart problem.”

frequent trigger

The investigators performed a systematic review of literature and initiated a multisite international outreach effort to identify cases of children with sudden loss of consciousness while playing video games. Across the 22 cases they found, multiplayer war gaming was the most frequent trigger. Some children died following a cardiac arrest. Subsequent diagnoses of several heart rhythm conditions put the children at continuing risk. Catecholaminergic polymorphic ventricular tachycardia (CPVT) and congenital long QT syndrome (LQTS) types 1 and 2 were the most common underlying causes.

There was a high incidence of potentially relevant genetic variants (63%) among the patients, which has significant implications for their families. In some cases, the investigation of a child who lost consciousness during video gaming led to many family members being diagnosed with an important familial heart rhythm problem.

Lawley noted: “Families and healthcare teams should think about safety precautions around electronic gaming in children who have a condition where dangerous fast heart rhythms are a risk.”

The investigators attributed adrenergic stimulation related to the emotionally charged electronic gaming environment as the pathophysiological basis for this phenomenon. Electronic gaming is not always the ‘safe alternative’ to competitive sports it is often considered.

At the time of the cardiac incidents, many of the patients were in excited states, having just won or lost games, or were engaging in conflict with companions.

Also, at the Heart Centre for Children, co-investigator Christian Turner added: “We already know that some children have heart conditions that can put them at risk when playing competitive sports, but we were shocked to discover that some patients were having life-threatening blackouts during video gaming.

“Video gaming was something I previously thought would be an alternative ‘safe activity.’ This is a really important discovery. We need to ensure everyone knows how important it is to get checked out when someone has had a blacking out episode in these circumstances.”

The study notes that while this phenomenon is not a common occurrence, it is becoming more prevalent.

Another co-investigator from Sydney, Jonathan Skinner, said: “Having looked after children with heart rhythm problems for more than 25 years, I was staggered to see how widespread this emerging presentation is, and to find that a number of children had even died from it.

“All of the collaborators are keen to publicise this phenomenon so our colleagues across the globe can recognise it and protect these children and their families.”

frequent trigger

The last word

Each of these studies has something in common; the fact that increased use of mobile phones, tablets and computers is having an impact on today’s generation of children. Each study highlights a small part of the wider debate, but for the children affected by any one of the areas of interest in these studies, it can be life changing. In the case of those children with heart rhythm issues, it could even prove fatal.

It would of course be draconian to bring about sweeping bans on what parents can allow their children to do regarding their on-screen time, but there is a growing recognition that, in the Digital Age, the issues manifesting in today’s generation of children is rarely something that has ever been seen before.