Interactive screen time to prevent speech and language delay in toddlers

Children today are exposed to screen-based entertainment and information, which has become an integral part of their lives and hence screen time has increased even among very small children.

Screen time is the total time spent per day in viewing screens such as mobile phone, TV, computer, tablet, or any hand-held or visual device.

The pandemic-induced lockdown has further increased screen time because of the closure of daycare centres and/or preschools, as well as fewer opportunities to interact with other children, which has a negative impact on their development especially among very young children. In some cases, it may even go upto 6-7 hours per day which occupies the lion’s share of a toddlers’ awake time.

Undesirable effects on language development
Excessive screen exposure in very young children and its undesirable outcomes is being mentioned in numerous studies. It may lead to both receptive (understanding language) and expressive language delay (speaking) attention issues, obesity, visual problems like myopia, deprivation of sleep, eating problems, reduced social interaction and delayed language development.

In contemporary clinical practice, the majority of children who are presented with a complaint of poor language abilities were found to have a lot of screen usage.

Awareness among the public
Many parents are not aware of the fact that increased screen time will lead to language delay. In a survey on parents' awareness on the impact of screen time on communication in toddlers, language delay was the least reported impact and visual problems were the most reported impact which indicates the unawareness among the parents on the issue.

Many parents believe that by exposing their children to nursery rhymes and cartoons, they will learn to speak. However, studies have shown that older children may learn vocabulary simply by watching television, whereas younger children can learn vocabulary only when supported by social interaction.

Non interactive screen time Vs Interactive screen time
Screen itself is not the villain for children's delayed language development; rather, the lack of interactivity during screen time is the problem.

Children passively viewing screens without any interaction or interference from adults can be termed as non-interactive screen time whereas interactive screen time is when the caregiver/ the adult views the screen along with the child speaking about and enacting what they see.

Non-interactive screens are always one-sided and do not require the child to respond. Passive screen time will diminish parent-child interaction, which will have a substantial impact on a child's language development.

Background TV and parent’s screen time
When it comes to toddlers' language development, it is not only direct TV viewing but also background television viewing that has been found to disrupt 12- and 24-month-old children's sustained toy play.

It also decreases the quality and quantity of parent-child interactions when compared to interactions that take place with the television turned off. Parent’s screen time should be limited as well, because parental interactions with young children have been shown to decrease significantly as a result of parental use of mobile phones.

As a result, it appears that parental involvement with electronic devices may reduce the quantity and quality of parent-child interactions, which are critical for the development of cognitive skills, particularly language and executive function.

Screen time replaces time spent interacting, thereby reducing communication opportunities. Also, when screen time increases, the chances of reduced parent-child interaction are high.

Human-human interactions had a strong influence on a child’s language development for both speech perception and production. The first few years of a child’s life are the most critical period for the child’s language development. So the child should be provided with adequate language stimulation during that period.

Recommended Screen time guidelines
Both the World Health Organisation (2019) and the American Academy of Paediatrics (AAP) (2016) have advised children to limit their screen time. The Indian Academy of Paediatrics (IAP) recently released screen time guidelines for parents.

Delayed speech was mentioned as one of the negative effects of excessive screen time for children. According to the IAP (2021), children under the age of two should not be exposed to any type of screen, with the exception of occasional video calls with relatives.

Screen time for children aged 2 to 5 years should not exceed one hour in a day; the less time spent on screens, the better. In a recent study in Kerala, screen time was found to be above the recommended limits in the majority of preschool children.

Despite all of the recommendations and guidelines to restrict screen time, most parents find it difficult to limit screen time due to the lockdown imposed by the pandemic Covid 19. So, here are some pointers to help caregivers support their children's language development even when they are watching screens.

Tips for appropriate use of interactive screen time
1. Practice Coviewing. Coviewing strengthens the parent–child bond and allows you to monitor the content your child is watching. However, coviewing alone will not aid in the development of language. Parents can practise coviewing and describing what they see on the screen.

2. The various language stimulation techniques used during shared reading can be used in the context of screen time. The screen's visuals can be described in simple language so that children can understand what they see.

3. Recognize and respond to their communicative efforts. In the meantime, ask simple questions. Extend and broaden their utterances. Expansion and extension will aid in increasing the average length of utterances.

4. Relate visuals on the screen to real life. For example, if they see a girl eating a banana on the screen, they should assist her in recalling previous instances of eating a banana or show her the banana at home. If a child points to a flower, parents can encourage him or her to say the name of the flower, how it smells, where it can be found, and so on.

With more verbal children, parents can encourage imaginative play and role play scenarios in their children based on the cartoons they watch. For example, if the child enjoys the “Tom and Jerry” cartoon, parents can act as Tom and the child as Jerry, or vice versa, using appropriate dialogue.

5. Avoid background screens, while having quality time with your kids. Caregivers' attention may get divided when the screen is on in the background and it may affect the quality of parent child interaction. Also excessive background TV exposure to children has been shown to have a negative impact on language development, attention, and executive function in children under the age of five.

6. Caregivers can engage in games involving objects similar to those seen in the media, such as building blocks or catching balls. Introduce various strategies to extend children's media learning, such as acting out a story based on the content of a recent TV show they watched, or labelling the colours of common household items they learned from an app.

7. Parents should be aware that repetition can help children learn. For example, if the child learns about counting from a TV show, he or she should focus on counting on multiple occasions while watching different shows and in real life situations. This will also help in generalization of the learned skill.

8. Digital books are becoming more popular. E-books can be encouraged rather than animated videos as e-books are proved to have many of the benefits of traditional printed books. Visual and audio effects from e-books and animation helps in story comprehension and event sequencing in preschoolers.

9. Early literacy can be promoted by using interactive ‘learn-to-read' apps and e-books to practise letters, phonics, word recognition and reading.

10. Limit the caregivers screen time. Because parent child interaction will be limited when the caregivers screen time is high. This will have a negative effect on children’s language development due to the poor language stimulating environment the child is in. Provide a language rich environment for the child’s language development.

Hence screen time supports language development in children along with entertainment when quality content is co-viewed and discussed with a parent or caregiver (Linebarger and Walker, 2005).

Remember the screen has got its own limitations and many other detrimental effects if it crosses the limits. So whenever possible, avoid screen time especially during meal time and one- hour prior to sleep and have a language rich quality time with the young children.

(Authors are part of the Department of Neurodevelopmental Sciences, National Institute of Speech and Hearing (NISH). Vrinda R and Krishna A R are lecturers in Speech Language Pathologist, and Suja K Kunnath is professor)