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Screen time interventions for children

Evidence Rating

Scientifically Supported

Health Factors

Screen time interventions encourage children to spend time away from TV and other stationary screen media (e.g., computers and video games); such interventions typically do not address use of mobile screens (e.g., smartphones and tablets). Screen time interventions teach self-management skills to initiate or maintain behavior change using tracking and monitoring, classroom-based education, counseling sessions, and/or family-based or peer social support. Screen time interventions can also include physical activity and/or healthy diet components (CG-Obesity). Children and adolescents spend an average of 6 and 8 hours per day, respectively, in sedentary behaviors (ALR-Lou 2014). Although parent-reported average TV viewing time has decreased in recent years among preschoolers and children ages 6-11 (), overall screen time averages have increased and are substantially more than the recommended limit of 2 hours per day (ALR-Lou 2014, AAP-Media, CG-Obesity).

Expected Beneficial Outcomes (Rated)

  • Reduced sedentary screen time

  • Increased physical activity

  • Improved dietary habits

  • Improved weight status

Evidence of Effectiveness

There is strong evidence that screen time interventions reduce sedentary screen time among children under 14 (CG-Obesity). Interventions that include nutrition and physical activity components have also been shown to increase physical activity and improve dietary habits and weight-related outcomes for participating children (CG-Obesity). Overall, screen time interventions have small but significant effects on stationary screen use with or without nutrition and physical activity components (CG-Obesity); additional evidence is needed to confirm effects on mobile device use.

Screen time interventions may be especially effective for children under the age of 6 (). Such interventions can benefit children in urban and suburban settings, children from a variety of socio-economic and racial and ethnic backgrounds, and children who are of healthy weight, overweight, and obese (CG-Obesity).

In many cases, children who participate in screen time interventions with nutrition and physical activity components reduce their body mass index (BMI). Such interventions can also decrease the number of participating children who are obese (CG-Obesity). High levels of TV viewing are associated with higher BMIs as early as age 2 (Wen 2014).

Family and parental support significantly increase the effectiveness of screen time interventions, reducing sedentary behavior and fostering long-term healthy screen time habits (CG-Obesity, Xu 2015). Screen time interventions that include family-based social support and electronic monitoring devices (e.g., low cost apps for mobile devices or time limits for TV or e-readers) reduce sedentary screen time (CG-Obesity). Parents can increase the effectiveness of such interventions by enforcing consistent rules about media use with a family media plan, being a role model balancing screen time and other activities, and fostering family communication about media use (Chassiakos 2016, Xu 2015). Parental reductions in personal screen time can also decrease children’s screen time (Xu 2015).

In schools, screen time interventions can be incorporated into existing curricula. Teacher training may increase effectiveness of these interventions (CG-Obesity). In child care settings, higher levels of education for care providers is associated with lower levels of screen time for children; screen availability and attending home-based child care are associated with higher levels of screen time (Vanderloo 2014).

Impact on Disparities

No impact on disparities likely

Implementation Examples

States and cities can regulate screen time in various settings, especially child care centers and home-based child care settings, as in Maryland (NCSL-ECE) and New York City (Nonas 2014). State health agencies often provide information, resources, and technical assistance to support the implementation of screen time interventions (ASTHO-Screen time).

There are several school-based screen time interventions that include physical activity and nutrition components. Many public middle schools in Massachusetts, for example, implement the Planet Health curriculum (CDC PRC-Planet health). Several elementary schools in Maplewood, New Jersey implement a week or year-long TV Turnoff Challenge (TV Turnoff).

The 5-2-1-0 childhood obesity prevention program is an example of a multi-component intervention for reducing screen time, improving diet, and increasing physical activity; the program encourages developing daily habits that include 5 servings of fruits and vegetables, 2 hours or less of screen time, 1 hour or more of physical activity, 0 sugary drinks, and increased water consumption. The 5-2-1-0 program started in Maine (MMC-5210), and has expanded to cities and states across the country, for example Florida (FL DOH-5210); Kentucky (KY DPH-5210); New Hampshire (FHC-5210); Baton Rouge, LA (MHCI-5210 plus 10); Chesterfield County, VA (CCHD-5210 everyday); and Palo Alto, CA (PAMF-5210 resources).

Families can also regulate screen time; for example, through family media plans, media free meals, media “curfews”, or designating one day/evening a week cell phone free for family fun time (CSE-Families, AAP-Media). 

Implementation Resources

ChangeLab-Model childcare statute - National Policy & Legal Analysis Network to Prevent Childhood Obesity (NPLAN). Model childcare licensing statute for obesity prevention. Oakland: ChangeLab Solutions; 2013.

USDA-Screen time - US Department of Agriculture (USDA), Team Nutrition Healthy Meals Resource System (HMRS). Electronic media use/screen time.

MN DOH-Screen time - Minnesota Department of Health (MN DOH). Television/screen time and health: TV/screen time obesity report.

UW CPHN-Resources - University of Washington Center for Public Health Nutrition (UW CPHN). Early care and education: Trainings, tools, and resources.

HOST-PA - Healthy Out-of-School Time (HOST) Coalition. Resources: Physical activity (PA).

AAP-Media - American Academy of Pediatrics (AAP). Media and children communication toolkit: AAP recommendations and resources for parents.

Citations - Evidence

* Journal subscription may be required for access.

CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity.

Biddle 2014* - Biddle SJH, Petrolini I, Pearson N. Interventions designed to reduce sedentary behaviours in young people: A review of reviews. British Journal of Sports Medicine. 2014;48:182-186.

Friedrich 2014* - Friedrich RR, Polet JP, Schuch I, Wagner MB. Effect of intervention programs in schools to reduce screen time: A meta-analysis. Jornal de Pediatria. 2014;90(3):232-241.

Marsh 2014* - Marsh S, Foley LS, Wilks DC, Maddison R. Family-based interventions for reducing sedentary time in youth: A systematic review of randomized controlled trials. Obesity Reviews. 2014;15:117-133.

Vanderloo 2014 - Vanderloo L. Screen-viewing among preschoolers in childcare: A systematic review. BMC Pediatrics. 2014;14:205.

Chassiakos 2016 - Chassiakos YR, Radesky J, Christakis D, Moreno MA, Cross C. Children and adolescents and digital media. Pediatrics. 2016;138(5):e20162593.

Xu 2015 - Xu H, Wen LM, Rissel C. Associations of parental influences with physical activity and screen time among young children: A systematic review. Journal of Obesity. 2015;2015:546925.

Wen 2014 - Wen LM, Baur LA, Rissel C, Xu H, Simpson JM. Correlates of body mass index and overweight and obesity of children aged 2 years: Findings from the healthy beginnings trial. Obesity. 2014;22(7):1723-1730.

Citations - Implementation Examples

* Journal subscription may be required for access.

MMC-5210 - Maine Medical Center (MMC), Healthy Maine Partnerships (HMP). 5-2-1-0 Let's go!

PAMF-5210 resources - Sutter Health Palo Alto Medical Foundation (PAMF). 5-2-1-0 Resources.

FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH.

FL DOH-5210 - Florida Department of Health (FL DOH), FloridaHealth Lee County. The 5-2-1-0 plan for a healthier active lifestyle.

KY DPH-5210 - Kentucky Cabinet for Health and Family Services Department for Public Health (KY DPH). 5-2-1-0: Kentucky has the prescription for significantly reducing childhood obesity.

MHCI-5210 plus 10 - Mayor's Healthy City Initiative (MHCI). Healthy Baton Rouge: 5-2-1-0+10: Numbers for your children's health!

CCHD-5210 everyday - Chesterfield County Health Department (CCHD). 5-2-1-0 Everyday! Chesterfield County's Coalition for Active Children (COACH) promotes 5-2-1-0 message to help prevent childhood obesity.

CDC PRC-Planet health - Centers for Disease Control and Prevention (CDC), Prevention Research Centers (PRC). Reading, writing, and reducing obesity: The middle school curriculum Planet health.

Nonas 2014 - Nonas C, Silver LD, Khan LK, Leviton L. Rationale for New York City’s regulations on nutrition, physical activity, and screen time in early child care centers. Preventing Chronic Disease. 2014;11:E182.

ASTHO-Screen time - Association of State and Territorial Health Officials (ASTHO). Action sheet: Preventing obesity through reduced screen time interventions.

NCSL-ECE - National Conference of State Legislatures (NCSL). Early care and education (ECE) 2014 legislative action.

TV Turnoff - TVturnoff.net. Ultimate TV turnoff challenge: Program outline.

AAP-Media - American Academy of Pediatrics (AAP). Media and children communication toolkit: AAP recommendations and resources for parents.

CSE-Families - Common Sense Education (CSE), Common Sense Media. Connecting families: Our family toolbox.

Date Last Updated

Mar 8, 2017