Screen Time and Healthy Digital Habits with Austin Greenhaw, M.D.

From smartphones and social media to gaming and streaming, screens are woven into everyday life for most families. In the latest episode of For Kids' Sake, Austin Greenhaw, M.D., child and adolescent psychiatrist at Cook Children's, discusses how parents can help children build a healthy relationship with technology, recognize signs of problematic screen use and the quality of digital content and create boundaries that work in the real world. He also challenges a common assumption among parents: just because something is labeled "educational" doesn't automatically mean it deserves a free pass. Here's an edited Q&A version of the conversation.

Q: How much screen time is too much for a child?

Dr. Greenhaw: In a new policy statement, “Digital Ecosystems, Children, and Adolescents”, the American Academy of Pediatrics has moved away from strict time limits because they often create conflict within families. That said, there are still some general guidelines.

For children younger than 18 months, screen use is discouraged except for things like video chatting with family. For toddlers and preschool-aged children, small amounts of high-quality content may be appropriate, but the recommendation is still to keep it fairly limited.

As children get older, screens become harder to avoid entirely, but probably not nearly to the extent most kids use them today. Research shows average screen use increased dramatically after COVID, and many children are spending far more time on screens than recommended.

Q: Why are babies and young children so captivated by screens?

Dr. Greenhaw: It's actually neuroscience.

A baby's job is to learn about the world, and their brains are designed to orient toward things that are new, exciting and stimulating. Screens provide a constant stream of novel stimuli, so they're almost perfectly designed to capture a baby's attention.

The challenge is that babies learn best from real-world experiences and interactions with other people, not from a two-dimensional screen.

Q: Is educational content really different from other types of screen time?

Dr. Greenhaw: Kind of.

Many parents assume educational content is automatically beneficial, but the research is more nuanced. Some studies show that educational content can be helpful in small amounts, but the benefits tend to plateau after about 30 minutes per day.

Beyond that point, children begin experiencing more of the same risks associated with screen use in general.

It's also important to examine how the app or platform is designed. If it's loaded with advertisements, endless scrolling, autoplay features or in-app purchases, it's probably focused more on keeping your child engaged than supporting learning.

Q: What should parents know about "engagement-based design"?

Dr. Greenhaw: Many platforms are intentionally designed to keep users engaged for as long as possible.

Social media platforms, videos that automatically play the next video and apps that constantly encourage purchases all use strategies that keep children coming back.

If an app's primary goal is holding a child's attention rather than supporting development, that's something parents should pay attention to.

Q: What are the biggest concerns associated with excessive screen use?

Dr. Greenhaw: One helpful question for parents is: “What are screens replacing?”

Sleep is probably the biggest concern. When screens interfere with sleep, that can affect learning, mood and overall health.

The effects can also look different depending on a child's age.

For younger children, excessive screen use has been linked to language difficulties and attention problems. For preteens, screens can begin replacing opportunities to learn emotional regulation and face-to-face social skills. For teenagers, excessive use is associated with increased risks for depression, disordered eating and suicidal thoughts.

Q: What about educational screen use for schoolwork?

Dr. Greenhaw: Most of the concerns involve entertainment-based media rather than school-related work.

If a child is genuinely using their device to complete assignments, that's generally not where we're seeing the biggest problems.

What I recommend is having homework happen in a common area of the home where parents can casually supervise how devices are being used.

Q: How can parents tell when screen use is becoming a problem?

Dr. Greenhaw: The framework actually looks a lot like addiction.

Warning signs include:

· Becoming preoccupied with devices

· Constantly thinking about when they'll get screen time again

· Significant meltdowns when screens are removed

· Irritability when they can't use a device

· Giving up other activities they previously enjoyed

· Declining school performance

· Pulling away from friends and family

When screens start getting in the way of everyday life, that's a signal that the relationship may be becoming unhealthy.

Q: Do parents' screen habits really affect their children?

Dr. Greenhaw: Absolutely.

Research consistently shows a direct relationship between parent screen use and child screen use. Some studies suggest that for every additional hour a parent spends on a smartphone, children spend about 20 more minutes on screens as well.

Part of that is modeling. Kids watch what we do.

There's also a relationship component. When parents become absorbed in devices, children naturally seek attention. That can create a cycle where parent stress increases, device use increases and children act out to reconnect.

Q: If screens feel like they've taken over family life, where should parents start?

Dr. Greenhaw: First, give yourself grace.

These platforms are designed to capture our attention. This isn't simply about willpower.

One of the easiest places to start is creating screen-free zones, especially bedrooms. Sleep is one of the biggest things screens interfere with.

I recommend creating a family charging station somewhere outside bedrooms and having everyone, including parents, charge devices there at night. Ideally, devices should be put away at least an hour before bedtime.

Q: What's the American Academy of Pediatrics' approach to reducing screen time?

Dr. Greenhaw: They talk about something called "crowding in."

Instead of focusing only on taking screens away, focus on adding activities that naturally replace screen time. Family dinners, sports, physical activity, board games, time with friends and family interactions all help crowd out unnecessary screen use while supporting healthy development.

Q: Why is the dinner table such an important place to put devices away?

Dr. Greenhaw: Conversation is how children learn to communicate.

Think of a conversation like a volleyball game. One person serves the ball, the other person sends it back, and the interaction continues. When a parent continually looks at a phone during that exchange, it's like letting the volleyball drop.

Screens interrupt opportunities for children to practice communication, social awareness and emotional connection.

Q: What's your advice for parents working from home?

Dr. Greenhaw: Keep work and family time as separate as possible.

Young children may not understand every detail of a parent's job, but they can understand simple, consistent messages like, "Mommy is working right now," and later, "Mommy is done working and available now."

Consistency helps children understand expectations and reduces confusion.

Q: Many parents feel guilty about screen time. What would you say to them?

Dr. Greenhaw: Most families are struggling with this.

The majority of households aren't perfectly meeting screen-time recommendations, and parents should know they're not alone.

The goal isn't perfection. The goal is being intentional about your screen use and being present when you're with your children.

Q: What's the one screen-time rule every family should have?

Dr. Greenhaw: No screens at the dinner table.

Q: True or false: Educational content gets a free pass on screen-time limits?

Dr. Greenhaw: False.

Q: What's the biggest myth about screen time?

Dr. Greenhaw: That the amount of time matters most.

What children are doing on screens and what those screens are replacing often matters more than the number of minutes they're using them.

Q: When should a child get their first phone?

Dr. Greenhaw: This is complicated, and every child is different.

Parents should start talking about digital media literacy early so children understand things like advertising, algorithms and how platforms are designed to keep users engaged.

If you're looking for a general guideline, most children 12 and younger probably don't need a smartphone. A basic phone that allows calls and texts may meet most families' needs without introducing all the risks that come with smartphones and social media.

Final Thoughts?

Dr. Greenhaw: Focus less on the amount of time and more on what the device is getting in the way of. Ask yourself:

· What is my child doing on the device?

· Is it causing problems at home, school or socially?

· What activities is it replacing?

We can all become anxious about screen-time numbers, but those broader questions often matter much more than the clock.