It’s hard to avoid screens these days – tablets, televisions, laptops, cell phones, you name it. We are constantly surrounded by technology and even infants are being exposed to digital media. But in a world that’s becoming increasingly digital, in what ways is it taking a toll on your child’s body? Two experts at Johns Hopkins All Children’s Hospital break it down for us.

Tech or Text Neck

Gregory Hahn, M.D., the division chair of orthopaedic surgery at Johns Hopkins All Children’s Hospital, has seen a trending increase of neck and back pain in kids in his more than 20 years of practicing medicine. The likely culprits? Heavy backpacks and technology.

“When you walk around now you notice that nobody’s actually looking straight ahead and making eye contact, instead everyone is walking and looking down at their phone. This is how society has evolved,” Hahn says. “We know that surgeons often develop neck problems because they spend their careers looking down while operating; and I suspect that technology is likely creating the same problem.”

Study habits and length of screen time

Many kids and teens have study habits of sitting on the bed or floor working on tablets or laptops for hours at a time. This position results in a hunched posture with no support for the back and causes the child to hold the neck flexed while looking down at the study materials.

Hahn: “We try to encourage kids when they come to be cognizant of that habit and to take multiple breaks. I suggest sitting at the kitchen table or a desk so that the chair can provide some back support and if possible, prop the screen up so that the child is looking straight ahead as opposed to looking down.”

Breaking bad habits: temporary vs. permanent damage and pain

Hahn: “These are habits that are hard to break. We know that over a long period of time this may result in neck arthritis that sometimes requires surgical intervention. Fortunately, we haven’t seen that in kids because they haven’t been doing it long enough, but over the course of an academic career this may become a chronic problem and potentially irreversible. Our approach is to educate and counsel the kids and their parents to improve their study habits early on, so they don’t have a problem 10, 15, 20 years down the road.”

When to see an orthopaedic expert

Hahn: “Usually families are coming to us because the child or teen has persistent neck or upper back pain. I find it interesting because often the parents say, ‘They don’t listen to me. Maybe they’ll listen to a medical professional.’ The parents will clearly see the problem, but they find value in us reinforcing and confirming their concerns, so it doesn’t just appear as if the parents are nagging their children. In clinic, we also provide instructional exercise booklets to help the kids maintain their neck motion and to strengthen the muscles around the neck and upper back. Occasionally, a referral for physical therapy may also be beneficial. Our ultimate goal is to relieve their pain and most importantly prevent permanent problems.”

Psychological Setbacks

Jennifer Katzenstein, Ph.D., ABPP-CN, is the director of psychology and neuropsychology at Johns Hopkins All Children’s Hospital and says screen time can definitely take a toll on children’s mental health and notes that kids and teens are using technology more than ever before.

Staggering statistics

Katzenstein: “Studies show that from toddlerhood to early school age, kids are at least seeing two hours of TV every day. Kids are not only getting accustomed to playing on screens more, but kids are seeing other people on screens, too.”

• Babies as young as 4 months old are being exposed to digital media
• Kids 8 or older: four out of five households have a video game device
• 75 percent of teens have smartphones
• 50 percent of these teens with smartphones say they feel addicted to their phone
• Teens send a median of 100 texts a day

Screen time usage – how much is too much?

Katzenstein: “If we’re trying to limit our kids’ screen time, we have to limit our own, too.”

• Stick to two hours or less of screen time a day and parents set that example
• Don’t use screens when getting ready for or before school
• Put screens away during homework and meals and at least one hour before bedtime
• Find the happy medium – too much screen time and too little screen time leads to higher levels of depression

Katzenstein: “There could be a component of social withdrawal when teens are not on social media and that prevents them from engaging with their peers the way that other peers are. Alternatively, there’s also data that suggests if you’re on screens or social media more, then you’re not playing outside as much or doing other activities that otherwise might protect you from depression.”

Social media do’s and don’ts

Katzenstein: “For parents, it’s all about a higher level of monitoring. Kids should only be friends with or follow people that they know in real life because people put their best lives out on social media. When we follow people we don’t know, we start to think people look like this or live like this and we feel inferior in some way, when that’s not the reality of those people’s lives.”

• Typically ages 10, 11 and 12 is an appropriate age for your child to join social media if it’s developmentally appropriate and you feel like he or she can be trusted
• Parents should know each app their child is on and exactly how it works
• Know who their child is following on social media
• Take the phone every night to check every text and app and decrease regular checks with trust and time
• There are apps available to set up parental controls and monitor your child’s social media usage

Gregory Hahn, M.D., is on the medical staff of Johns Hopkins All Children’s Hospital, Inc. (“JHACH”), but is an independent practitioner who is not an employee or agent of JHACH.