How much television do you watch in a day? What about on the weekends? It may even be hard for you to count, since we spend so much time in front of screens, whether they be cell phones, tablets, computers, or televisions.

Screen time is beginning at younger and younger ages, as parents and guardians use screen time as a reward or distraction. This trend was very concerning to Dr. Linda Pagani, Professor at the University of Montreal in Canada. As a psychologist specializing in child development, Dr. Pagani spent a lot of time thinking about the home environment. For her, the most ubiquitous thing in the home was that the television was always on. And so, she wondered how television viewing during toddlerhood might affect those toddlers as they grew into adolescents and adults.

Meet the Children

To better understand the effects of television viewing on toddlers as they developed, Dr. Pagani spearheaded a landmark study that followed children born in the province of Quebec as they grew up. Any child born in Quebec between the Spring of 1998 and the Spring of 1999 was eligible to participate in this study, known as the Quebec Longitudinal Study of Child Development. Out of 2,837 newborns identified in Quebec during this time period, 2,120 enrolled in the study. Parents were interviewed when their child was 5 months old, then every year through preschool, and every two years during their school years.

To look at television viewing habits, the most important years for data collection were at age 2 and age 13 years. At age 2, the caregivers of 1,985 children responded, 986 girls and 999 boys. Parents were asked how many hours per day—both on weekdays and weekends—their child spent watching television or movies. At age 13, 1,234 children initially enrolled in the study in 1998-1999 responded to questions about their eating habits, engagement in school, and screen time use in a typical week.

Let’s explore the questions these 13-year-olds were asked. First, eating habits were assessed using a 10-item questionnaire that asked how often the child consumed unhealthy foods such as French fries, prepared meats or cold cuts, white bread, commercial drinks (energy drinks, fruit drinks, and sodas), desserts, or processed snack foods. The children responded for each food on a scale from 0 to 7, using the scale shown in Table 1.

The children were also asked how often they ate breakfast during the week, using the scale shown in Table 2.

To assess screen time, the children were asked to rate the amount of time they usually spend watching TV or videos, playing games on a console like an Xbox or PlayStation, and working on the computer (doing school work, playing internet games, online chatting, etc.) This was done on a scale from 1 to 8, using the scale shown in Table 3.

Finally, the children were asked four questions regarding school engagement:

1. Do you like school? (0 = I don’t like school at all; 3 = I really like school)

2. In terms of your school marks, how would you rate yourself compared with other students your age at your school? (1 = I am one of the weaker students; 5 = I am one of the stronger students)

3. How important is it for you to get good marks? (1 = Not important at all; 4 = Very important)

4. Based on your own wishes, how far do you plan to go in school? (1 = leave before completing high school; 5 = attend university)

In addition, a trained research assistant met with each 13-year-old and measured their height and weight to calculate their body mass index, or BMI.

Data Time

With all this information collected, it was time to start analyzing the results. Dr. Pagani and her team wanted to know how television viewing habits affected each of the questions the 13-year-old children were asked about. The team also wanted to make sure to try to control for other factors that might affect these outcomes. Examples of some of these factors include BMI at 17 months, caregiver report of difficult temperament or physical aggression at 17 months, family characteristics (single parent home or dual parent home) at age 5 months, depressive symptoms in the mother and maternal education level at age 5 months, and maternal BMI at 17 months.

It was important to try to control for these factors because they might independently be associated with some of the outcomes the team wanted to know about. For example, in a child who already had a high BMI at age 17 months, a high BMI at age 13 years might not be related to television viewing in an important way. There may be other factors going on that might explain this high BMI other than the amount of screen time.

After controlling for as many factors as possible, Dr. Pagani and her team were able to draw some important conclusions from their data. They found that for every 1 hour and 13 minutes of television viewing in toddlerhood:

• At age 13, the rate of unhealthy eating habits increased by 8.2%
• At age 13, the rate of eating breakfast in the morning decreased by 10.1%
• At age 13, the rate of an increased BMI increased by 13.3%
• At age 13, the rate of self-reported student engagement decreased by 4.7%
• At age 13, the rate of present screen time increased by 5.8%

Taken together, these results show the profound influence that early childhood lifestyle habits can have on lifestyle habits developed later in life. “Our results underscore the importance of developing healthy lifestyle habits even in very young toddlers,” explains Dr. Pagani. “This includes healthy eating habits, regular exercise, and screen time.”

The Future of Screen Time

In addition to the outcomes explained above, Dr. Pagani and her team also looked at risk for social impairment, including both children who experienced bullying and those who perpetrate bullying. They found that increased television viewing time at age 2 led to an increased risk of such social impairment.

How does this happen? Dr. Pagani believes that television time is taking away from other activities, most importantly social interaction with other people. This includes the ability to read other people’s facial expressions and social cues, and the ability to interact comfortably with other people. “When you spend so much time in front of the TV, you’re just not learning the social skills you need to survive and thrive in our social world,” explains Dr. Pagani.

Dr. Pagani continues, “My goal is to make sure that every child that is born into this world grows up to become a contributing member of society. To achieve our full potential, we need to get as many social experiences as possible, as early as possible.” Dr. Pagani’s research shows that excessive television viewing can get in the way of these social experiences. For this reason, the American Academy of Pediatrics recommends no more than two hours of screen time per day in toddlers.

In future work, Dr. Pagani plans to conduct further analysis on this same dataset as the children continue to age. Right now, the children who enrolled in this study are turning 20 years of age. Dr. Pagani wants to continue to analyze the data for trends at age 15, age 17, and age 20 years.

It is important to remember that Dr. Pagani is looking broadly at a large group of children and their developmental trends over time. The specifics in any one case might be different. Just because you spent hours in front of the television each day as a child, doesn’t mean you must continue to do that for the rest of your life. You can start to develop healthy lifestyle habits at any moment—why not start now?

Dr. Pagani is Professor at the University of Montreal in Montreal, Canada where she studies child development and the effects of early childhood home life and lifestyle habits on the development of children. In addition to excelling professionally, Dr. Pagani also has a black belt in karate. When not working in the laboratory, Dr. Pagani enjoys karate, learning how to ride a motorcycle, and spending time with her family.

The people who have contributed to this research are: Professor Tracie A. Barnett (Institut Armand-Frappier), Caroline Fitzpatrick (Université Ste-Anne), Professor Eric Dubow (Bowling Green University), Professor Jeff Derevensky (McGill University), Emmalyne Watt M.Ed., François Lévesque-Seck M.Sc. (Jewish General Hospital), Marie-Josée Harbec M.Sc. (Sainte-Justine's Pediatric Hospital of the University of Montreal) Isabelle Simonato M.Sc. and Genevieve Fortin, M.Sc. Candidate.

For More Information:

1. Simonato, I. et al. 2018. “Prospective associations between toddler televiewing and subsequent lifestyle habits in adolescence.” Preventive Medicine, 110: 24-30.
2. Pagani, LS. et al. 2016. “Prospective associations between televiewing at toddlerhood and later self-reported social impairment at middle school in a Canadian longitudinal cohort born in 1997/1998.” Psychological Medicine, 46: 3329-3337.
3. Watt, E. et al. 2015. “Too Much Television? Prospective Associations Between Early Childhood Televiewing and Later Self-reports of Victimization by Sixth Grade Classmates.” Journal of Developmental and Behavioral Pediatrics, 36: 426-33.
4. Piché, G. et al. 2015. “Associations Between Extracurricular Activity and Self-Regulation: A Longitudinal Study From 5 to 10 Years of Age.” American Journal of Health Promotion, 30: e32-40.
5. Pagani, LS and Fitzpatrick, C. 2014. “Children's school readiness: implications for eliminating future disparities in health and education.” Health Education & Behavior, 41: 25-33.
6. Pagani, LS. et al. 2013. “Early childhood television viewing and kindergarten entry readiness.” Pediatric Research, 74 :350-355.
7. Fitzpatrick, C and Pagani, LS. 2013. “Task-oriented kindergarten behavior pays off in later childhood.” Journal of Developmental and Behavioral Pediatrics, 34: 94-101.
8. Fitzpatrick, C. et al. 2012. “Early childhood television viewing predicts explosive leg strength and waist circumference by middle childhood.” International Journal of Behavioral Nutrition and Physical Activity, 9:87.
9. Fitzpatrick, C. et al. 2012. “Early exposure to media violence and later child adjustment.” Journal of Developmental and Behavioral Pediatrics, 33: 291-297.
10. Pagani, LS. et al. 2012. “Relating kindergarten attention to subsequent developmental pathways of classroom engagement in elementary school.” ournal of Abnormal Child Psychology, 40: 715-725.
11. Romano, E. et al. 2010. “School readiness and later achievement: replication and extension using a nationwide Canadian survey.” Developmental Psychology, 46: 995-1007.
12. Pagani, LS. et al. 2010. “School readiness and later achievement: a French Canadian replication and extension.” Developmental Psychology, 46: 984-994.
13. Pagani, LS. et al. 2010. “Prospective associations between early childhood television exposure and academic, psychosocial, and physical well-being by middle childhood.” Archives in Pediatric and Adolescent Medicine, 164: 425-31.

To Learn More:

1. American Academy of Pediatrics.https://www.healthychildren.org/English/news/Pages/AAP-Announces-New-Recommendations-for-Childrens-Media-Use.aspx
2. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/toddlers2.html
3. Zero to Three.https://www.zerotothree.org/early-learning/screen-time

Written by Rebecca Kranz with Andrea Gwosdow, PhD at www.gwosdow.com

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