Screen time interventions for children
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 components1. Children and adolescents spend an average of 6 and 8 hours per day, respectively, in sedentary behaviors2. Overall screen time averages have increased and are substantially more than the recommended limit of 2 hours per day1, 2, 3.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced sedentary screen time
Increased physical activity
Improved dietary habits
Improved weight status
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved sleep
What does the research say about effectiveness?
There is strong evidence that screen time interventions reduce sedentary screen time among children under 141, 4, 5, 6, 7, 8. 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 children1, 6, 7, 9. Overall, screen time interventions have small but significant effects on stationary screen use with or without nutrition and physical activity components1, 4, 7, 9 and may improve sleep outcomes10, 11. Additional evidence is needed to confirm effects on mobile device use.
Screen time interventions may be especially effective for children under the age of 65, 7, 8, but have been shown to be effective up to the age of 184. 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 obese1.
In many cases, children who participate in screen time interventions with nutrition and physical activity components improve weight-related outcomes6. Such interventions can decrease the number of participating children who are obese1. High levels of TV viewing are associated with increased weight status as early as age 212 and poor sleep outcomes in infants, toddlers, and children from 2 to 14 years old10, 11. Screen time interventions may improve sleep outcomes10.
Family and parental support significantly increase the effectiveness of screen time interventions, reducing sedentary behavior and fostering long-term healthy screen time habits1, 8, 13. 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 time1, 7. 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, fostering family communication about media use13, 14, and not using screen time as a reward15. Parental reductions in personal screen time can also decrease children’s screen time13.
Screen time interventions appear to be more successful when they have a shorter duration, less than a year and sometimes shorter than 3 months4, 6, 10, are based in the community or home5, and use the Goals, Feedback, and Planning behavioral techniques4. In schools, screen time interventions can be incorporated into existing curricula. Teacher training may increase effectiveness of these interventions1. 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 time16. Experts recommend timing screen time intervention implementation to account for seasonal shifts in sleep and physical activity levels for children, potentially targeting the winter and summer months17.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact screen time interventions have on disparities among youth across populations. Evidence shows programs are effective for students of various ages, socioeconomic status, and ethnicity1. Significant racial and ethnic and socioeconomic differences appear in screen time usage; Black and Hispanic children28 and children living in poverty29 are more likely to exceed screen time guidelines, which suggests interventions could help reduce those disparities. However, there is also some evidence that the effectiveness of screen time interventions can be impacted by socioeconomic status, race and ethnicity, and neighborhood context (e.g. access to green space). These findings suggest addressing racial inequities in screen time use is challenged by inequities in green space access and implementation of screen time interventions may further perpetuate inequities28.
What is the relevant historical background?
Screen time use in children has been increasing as screen technologies, including TV, computers, and video games, have become more prevalent throughout society. Data suggests the majority of children are exceeding screen time guidelines, with boys more likely to do so than girls30. Excessive screen time in early childhood is associated with increased risk of childhood obesity28, internalizing (anxiety, depression) and externalizing (e.g. aggression, inattention) behavior problems31, and poorer language skills in children32. There is some evidence that screen time, especially television and video games, may have negative impacts on academic performance33. Additionally, excessive screen time appears more likely to increase anxiety and depression in girls and anger and aggression in boys31.
Screen time interventions seek to encourage children to pursue alternative, less sedentary activities in their time outside of school; however, that may be more difficult to achieve in communities with fewer parks, with underdeveloped infrastructure, with disparities in public resources and services, and with more environmental injustices and pollution exposure concerns34, 35, 36. Throughout history, the intentional disinvestment in and unequal distribution of recreational facilities, parks, and green space means that communities with low incomes and communities of color have fewer places to engage in outdoor activities, have less access to cooling shade, and experience poorer air quality37, 38. The built environment in under-resourced communities is a significant contributor to health inequities for people of color with low incomes34, 39, 40.
Equity Considerations
- Are the children in your community meeting or exceeding screen time guidelines? When they are using screens, is the content educational and are adults co-viewing with the children?
- How can screen time interventions be implemented in your community, school, or home? Can they be implemented with nutritional or physical activity components to support other healthy behaviors?
- Are there opportunities to support effective implementation of screen time interventions, such as increasing access to green spaces?
Implementation Examples
States and cities can regulate screen time in various settings, especially child care centers and home-based child care settings, as in Maryland18 and New York City19. State health agencies often provide information, resources, and technical assistance to support the implementation of screen time interventions20
There are several school-based screen time interventions that include physical activity and nutrition components. Many public middle schools in Boston, for example, used the Planet Health curriculum21. Several elementary schools in South Orange and Maplewood, New Jersey implement a week or year-long TV Turnoff Challenge22.
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 Maine23 and has expanded to cities and states across the country, for example Florida24; New Hampshire25; and Palo Alto, California26.
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 time3, 27.
Implementation Resources
‡ Resources with a focus on equity.
APA-Kids and screens - Pappas, S. (2022, June 30). What do we really know about kids and screens? Monitor on Psychology, 51(3).
UW CPHN-Resources - University of Washington Center for Public Health Nutrition (UW CPHN). Early care and education: Trainings, tools, and 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.
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.
Footnotes
* Journal subscription may be required for access.
1 CG-Obesity - The Guide to Community Preventive Services (The Community Guide). Obesity.
2 ALR-Lou 2014 - Lou DW. Research review: Sedentary behaviors and youth: Current trends and the impact on health. Active Living Research (ALR); 2014.
3 AAP-Media - American Academy of Pediatrics (AAP). Media and children communication toolkit: AAP recommendations and resources for parents.
4 Jones 2021 - Jones WD, Phillips BN, Hartman E, et al. The relationship among demographic factors, transition services, and Individual Development Account (IDA) saving participation among transition-age youth with disabilities. Rehabilitation Counseling Bulletin. 2021;65(1):37-48.
5 Downing 2018 - Downing, K. L., Hnatiuk, J. A., Hinkley, T., Salmon, J., & Hesketh, K. D. (2018). Interventions to reduce sedentary behaviour in 0–5-year-olds: A systematic review and meta-analysis of randomized controlled trials. British Journal of Sports Medicine, 52(5), 314–321.
6 Wu 2016 - Wu, L., Sun, S., He, Y., & Jiang, B. (2016). The effect of interventions targeting screen time reduction: A systematic review and meta-analysis. Medicine, 95(27), e4029.
7 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.
8 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.
9 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.
10 Martin 2021 - Martin MA, Pugach O, Mosnaim G, et al. Community health worker asthma interventions for children: Results from a clinically integrated randomized comparative effectiveness trial (2016‒2019). American Journal of Public Health. 2021;111(7):1328-1337.
11 Janssen 2020 - Janssen, X., Martin, A., Hughes, A. R., Hill, C. M., Kotronoulas, G., & Hesketh, K. R. (2020). Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and meta-analysis. Sleep Medicine Reviews, 49, 101226.
12 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.
13 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.
14 Chassiakos 2016 - Chassiakos YR, Radesky J, Christakis D, Moreno MA, Cross C. Children and adolescents and digital media. Pediatrics. 2016;138(5):e20162593.
15 Neshteruk 2021 - Neshteruk, C. D., Tripicchio, G. L., Lobaugh, S., Vaughn, A. E., Luecking, C. T., Mazzucca, S., & Ward, D. S. (2021). Screen time parenting practices and associations with preschool children’s TV viewing and weight-related outcomes. International Journal of Environmental Research and Public Health, 18(14), 7359.
16 Vanderloo 2014 - Vanderloo L. Screen-viewing among preschoolers in childcare: A systematic review. BMC Pediatrics. 2014;14:205.
17 Weaver 2022 - Weaver, R. G., Hensing, C., Armstrong, B., Adams, E. L., & Beets, M. (2022). Seasonal shifts in children’s sedentary behaviors, physical activity, and sleep. Pediatric Clinics of North America, 69(4), 671–693.
18 NCSL-ECE - National Conference of State Legislatures (NCSL). Early care and education (ECE) 2014 legislative action.
19 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.
20 Dell Center for Healthy Living-Screen time - UTHealth Houston School of Public Health Michael & Susan Dell Center for Healthy Living. (2022, August 30). Child Screen Time Toolkit. Retrieved January 23, 2025.
21 Blueprints-Planet health - Blueprints for Healthy Youth Development. (n.d.). Planet Health program. Retrieved January 23, 2025.
22 SOMSD-TV Turnoff - South Orange-Maplewood School District (SOMSD). Ultimate TV turnoff: TV Turnoff at Tuscan School.
23 MH-Let’s go - MaineHealth (MH). Let's go!
24 FL DOH-5210 - Florida Department of Health (FL DOH), FloridaHealth Lee County. The 5-2-1-0 plan for a healthier active lifestyle.
25 FHC-5210 - Foundation for Healthy Communities (FHC). 5-2-1-0 Healthy NH.
26 PAMF-5210 resources - Sutter Health Palo Alto Medical Foundation (PAMF). 5-2-1-0 Resources.
27 CSE-Families - Common Sense Education (CSE), Common Sense Media. Family engagement toolkit: Resources to support healthy media and tech use at school and home.
28 Lang 2024 - Lang, I.-M., Fischer, A. L., Antonakos, C. L., Miller, S. S., Hasson, R. E., Pate, R. R., Collie-Akers, V. L., & Colabianchi, N. (2024). Neighborhood environments underpin screen time intervention success in children: Evidence from a study of greenspace and community programming across 130 U.S. communities. Health & Place, 89, 103341.
29 Kwon 2024 - Kwon, S., Armstrong, B., Wetoska, N., & Capan, S. (2024). Screen time, sociodemographic factors, and psychological well-being among young children. JAMA Network Open, 7(3), e2354488.
30 McArthur 2022 - McArthur, B. A., Volkova, V., Tomopoulos, S., & Madigan, S. (2022). Global prevalence of meeting screen time guidelines among children 5 years and younger: A systematic review and meta-analysis. JAMA Pediatrics, 176(4), 373.
31 Eirich 2022 - Eirich, R., McArthur, B. A., Anhorn, C., McGuinness, C., Christakis, D. A., & Madigan, S. (2022). Association of screen time with internalizing and externalizing behavior problems in children 12 years or younger: A systematic review and meta-analysis. JAMA Psychiatry, 79(5), 393.
32 Madigan 2020 - Madigan, S., McArthur, B. A., Anhorn, C., Eirich, R., & Christakis, D. A. (2020). Associations between screen use and child language skills: A systematic review and meta-analysis. JAMA Pediatrics, 174(7), 665.
33 Adelantado-Renau 2019 - Adelantado-Renau, M., Moliner-Urdiales, D., Cavero-Redondo, I., Beltran-Valls, M. R., Martínez-Vizcaíno, V., & Álvarez-Bueno, C. (2019). Association between screen media use and academic performance among children and adolescents: A systematic review and meta-analysis. JAMA Pediatrics, 173(11), 1058.
34 Prochnow 2022 - Prochnow T, Valdez D, Curran LS, et al. Multifaceted scoping review of Black/African American transportation and land use expert recommendations on activity-friendly routes to everyday destinations. Health Promotion Practice. 2022.
35 Shertzer 2022 - Shertzer A, Twinam T, Walsh RP. Zoning and segregation in urban economic history. Regional Science and Urban Economics. 2022;94:103652.
36 NEJAC 2006 - The National Environmental Justice Advisory Council (NEJAC). Unintended impacts of redevelopment and revitalization efforts in five environmental justice communities. 2006.
37 CAP-Rowland-Shea 2020 - Rowland-Shea J, Doshi S, Edberg S, Fanger R. The nature gap: Confronting racial and economic disparities in the destruction and protection of nature in America. Washington, D.C.: Center for American Progress (CAP); 2020.
38 TPL-Chapman 2021 - Chapman R, Foderaro L, Hwang L, et al. Parks and an equitable recovery. San Francisco, CA: The Trust for Public Land (TPL); 2021.
39 McAndrews 2022 - McAndrews C, Schneider RJ, Yang Y, et al. Toward a gender-inclusive Complete Streets movement. Journal of Planning Literature. 2022;38(1):3-18.
40 Brookings-Semmelroth 2020 - Semmelroth L. How Wilmington, Del. is revitalizing vacant land to rebuild community trust. Washington, D.C.: Brookings Institution; 2020.
Related What Works for Health Strategies
To see all strategies:
countyhealthrankings.org/whatworks