Since mid-March, when most schools around the U.S. closed due to COVID-19 precautions, kids and teens have had to quickly adapt to learning virtually — which means more sitting and more screen time. Hanging out with friends after class or on weekends became a thing of the past as health officials called for social distancing measures.
The last pandemic occurred over a hundred years ago, well before “screen-time” became a thing. Though the health implications of increased screen time among young people has been studied over the past decade, the effects of more time spent online as a substitute for in-school learning, hasn’t yet been mined.
Doctors in many fields, however, such as physical medicine, psychology and ophthalmology, are already spotting signs and symptoms that could indicate future trends of how increased screen time for virtual learning, combined with a reduction of in-person interaction, is affecting young people’s lives.
Dr. Ronald Tolchin, medical director of Miami Neuroscience Institute’s Spine Center (part of Baptist Health Medical Group), says that sitting, especially for long periods of time, like for virtual learning, is far from optimal.
“We’re meant to be walking, changing positons,” he says.
“Kids are sitting for more than five hours at a time,” he says. Before the pandemic, he said, “they were moving to different classes, walking around, taking breaks, running around having recess and gym.”
“So now they’re sitting in front of a computer — they get fatigued and their muscles get tight and they’re getting neck pain and upper back pain,” he says.
Tolchin says that the lack of good posture while sitting for long stretches affects the hip flexors, which become shortened and can lead to hip, back and neck pain.
TIPS FOR PARENTS
▪ Make sure your feet are flat on the floor while sitting, keeping your back flush against the seat of the chair. Your hips and knees should be bent at a 90 degree angle and the trunk of your body should be upright. An angled foot stool can also help if your feet don’t quite reach the floor, like if you’re using a dining room chair. Books or a box can be used as a substitute for a foot stool if you’re on a budget.
▪ Limit your time sitting in your chair to 20 to 30 minutes at a time. Take a break. Move around and stretch. Lunges will help to stretch your hip flexors. Put your hand over your head and bend your head gently to each side to stretch the muscles in your neck.
▪ Use an adjustable full-length chair if you can, with an ergonomic design. It should have a little lumbar support or curve. If needed, use a rolled up towel and place between the small of your back and the seat of the chair for support. Your elbows should be supported at a natural height on the chair’s armrest.
▪ Your computer monitor should be eye-level or just below eye-level so that you have a neutral position in your neck.
▪ Work on a table or a desk, not on a sofa or a bed. Your body needs proper support.
“I think it’s important to be aware that we made major changes in our work style and we have to be adaptable and we have to include exercise because we’re sitting more than ever now,” Tolchin said.
He recommends regular cardio exercise as well as relaxation techniques to help reduce stress.
“It’s important to do some relaxation techniques, where you’re stretching and deep breathing to reduce stress and anxiety levels. We’re social beings and we’ve been cut off from a lot of socializing. Stress levels are high, time indoors is high; the time spent sitting is much higher. Even meditating would be good. A parent could do this with their child and lead by example,” he says.
Tolchin says that many of his young patients go on their cellphones or tablets when they take a break from their computer, between sessions of online learning. He says they are often looking down at their devices, causing further neck strain.
“Whatever device you’re using, you want to bring it up to eye level where you’re keeping your neck neutral instead of looking down so you don’t get what’s called “tech-neck.” (Also called text neck.)
Tolchin says that he’s been seeing more young patients lately via telehealth. They are complaining of pain in their necks and backs from sitting for many hours a day in front of a screen.
“I’m seeing teens with lower back pain and neck pain especially in the last few weeks — and adults as well. I’m seeing an uptick in the number of people coming in with neck and back pain related to posture,” he says.
“I think it’s an epidemic, actually. I think we’ll see more and more.”
He gives his patients the tips mentioned above along with printouts of stretching exercises. He also advises his patients to set an alarm on their phones as a reminder to get up and stretch. He recommends using a standing-desk, which he uses at work and which he says starts around the $300 range for a table-top version.
“I’m a big proponent of those,” he says. “A standing desk affords you the ability to change positions from sit to stand.”
“The important thing is to wear supportive shoes that have rubber soles, that are cushiony,” he says, if opting for a standing desk. “If not, you can use a rubber mat under your feet to help avoid back pain and fatigue in the legs.”
The alternative, budget friendly way to create a type of standing desk, he says, is to put the computer monitor on top of a crate or a sturdy box or books, which should be placed on a table or desk.
“The important thing is to maintain the monitor level at eye-level or just below,” he says. “Make sure the monitor is about 20 to 26 inches away from your eyes.”
TOUGH ON THE EYES
Nicklaus Children’s Hospital’s pediatric ophthalmologist, Dr. Luxme Hariharan, referred to as “Dr. Lux” by her patients, says that she noticed an increase of virtual visits in kids and teens whose parents were concerned by their child’s newfound eye strain or irritation due to long hours in front of the computer from online classes.
“It’s long hours on the computer that they’re not used to because of all of the virtual learning,” Hariharan said. “And when they took breaks they would play video games or look at their phone. So that was the issue: The online hours were so long on devices.”
She came up with a slogan called BLINK 20-20-20 as strategy to help patients reduce eye strain and irritation from prolonged use on electronic devices.
Hariharan says the two main reasons why eye irritation from prolonged screen-time happens is because of ocular surface dryness due decreased blink rate and due to prolonged focus on screens that are close to the eyes.
“Blinking is our natural lubrication for the eye. So when you’re not blinking as much, tears will evaporate and then you’ll have surface irritation and that’s where you might experience redness, and burning,” she said.
“The other part of this is eye strain,” she says, “because you’re focusing on “near-focus” for so long and that’s where you get neck pain and headaches because your near muscles are overly focused.”
Hariharan says that most people blink about 20 to 25 times a minute, but when they’re using computer devices or doing anything on the computer, it goes down to five to seven times a minute.
“The decreased blink rate (ocular surface) and the over-burdened near-focus muscles of the eyes are causing a lot of these symptoms,” she says.
She points out that there isn’t enough evidence or data to support that blue light glasses and filters can reduce the effects of strain on the eye.
“Make sure that you look up the research on it and talk to us, your ophthalmologists, before you buy something like that,” she says.
Hariharan said that her department was getting an influx of calls toward with end of April, with the majority of complaints being about eye irritation.
“In the current circumstances, when we have to do a lot of virtual meetings and Zoom calls, the best thing to do is break it up and make sure that we’re taking breaks and make sure our eyes are lubricated. These are techniques you can use if you are stuck with being on the computer for hours,” she says.
THE MENTAL SIDE
Dr. Alan Delamater, director of the division of clinical psychology in the department of pediatrics at the University of Miami Mailman Center for Child Development, says that more screen time, combined with more time at home, takes an emotional toll on kids and teens.
“With prolonged home confinement, there’s both mental and physical health consequences,” he said.
“More and more screen time means less physical activity and more sedentary behavior,” he says.
“I think that parents and kids need to sit down and talk about how to structure their day,” he advises.
“A lot of teenagers are now on their own in the house. Parents have got to help kids have reasonable structure.”
He recommends reading, engaging in some sort of physical activity, and establishing healthy sleep habits.
“Parents and kids should have open communication about how they’re going to spend their time, but they’ve got to put limits on screen time. Parents should also know what their kids are doing while they’re online,” he warns.
He says that kids and teens are experiencing more irregularity in their sleep patterns due to increased screen time.
“Even pre-COVID, this was an issue,” he says.
Delamater says that late-night phone time and video games before bed fire up the brain. He adds that excessive time online also increases the risk of being overweight, and says that more time at home leads to irregularities in diet, often leading to more snacking.
He says that the lack of in-person interaction with peers has also taken a toll on kids and teens.
“The decrease in social contact is very significant for kids,” he says. “They’re not able to have the in-person social time that they’re used to, particularly with friends. There’s no substitute for in-person socialization.”
Delamater says that numerous studies have shown that too much screen time in kids leads to stress, depression, poor development of social skills and lower levels of academic achievement.
“But because of this pandemic, kids have been pushed into more screen time,” he says.
He says that the average amount of recreational screen time per day among teenagers is seven hours and that pre-adolescents (ages 8 through 11) average about 3.6 hours a day.
“Two hours a day is the upper limit of guidelines from the American Academy of Pediatrics and the World Health Organization,” he says.
He says that young people, like adults, have valid fears about the virus — of being infected or of loved ones being infected. He advises parents to ask their children about their concerns and to listen to what they have to say. He advises parents or caregivers to use reputable sources when communicating information relating to COVID-19 to their children.
“With increased exposure to family members, there’s increased conflict,” he adds. “Parents and kids aren’t used to being so much together.”
“It’s clearly a challenging time,” he says, “but it’s also a time to get closer with your kids because this is something they’re always going to remember, going through this pandemic.”