Theme 2: Screen time and digital media use among children and youth

Screen time and digital media were the second theme of the conference. The challenge is to find a balance between the risks and benefits of digital media consumption. National guidelines for screen time for young people have been established or are being drawn up in many Nordic countries.

The Nordic ministers for health and social affairs have agreed that more work should be done at the Nordic level to address how screen time affects the health and well-being of children and young people.

The conference highlighted the work currently being done in this field in Denmark, Norway, and Sweden, before delving deeper in a panel conversation.

Jens Kristoffersen, Senior Advisor at the Prevention and Inequality Unit at the Danish Health Authority: Recommendations on screen use – The Danish model

– We commenced this work in 2019, focusing on the increasing use of screens and social media among children and young adults. Our efforts have two objectives: firstly, to generate knowledge to inform recommendations, and secondly, to disseminate this knowledge through reports and campaigns.

Jens Kristoffersen says that healthy digital use is still a very new subject and that the Danish Health Authority has focused on five factors that increased screen time might affect. These are sleep, physical activity, relationships and friendships, stress, and neurological effects.

The current Danish recommendations, established in 2023, are divided between general guidelines for the whole population and additional recommendations for parents with children living at home.

– Everyone in Denmark, both children and adults, is advised to avoid using screens before bedtime, to keep phones or tablets out of the bedroom, spend time away from screens and remain physically active, and be mindful of their social media use and how screen time affects their well-being.

In additional recommendations, parents are reminded that children under the age of two should not use a screen without active interaction with an adult. Limit screen use when you are with your child. Take an interest in your child’s digital life. Make agreements about screen use in the family, which apply to both children and adults. 

Olov Belander, Senior Advisor at the Norwegian Directorate of Health: Recommendations on screen use – The Norwegian model

 
Norway leads in social media usage per day among children and youth in the Nordic countries: approximately 50 % of 9-year-olds and nearly 100 % of 13-year-olds use social media.

– It’s important to find the balance. We live in a digital world and need to be digital, but too much screen time might lead to problems with sleep and concentration. Screen use and children is a very complex matter. Age, what they are watching, how active the child is when not on screen, and how well they do in school and with friends are all factors that play a role, Olov Belander says. 

The Norwegian government has appointed a committee, Skjermbrukutvalget, which is currently working on evaluating the effects of screen use on children’s health. The committee is expected to complete their work by the end of 2024. The current Norwegian recommendations on screen use for children and young adults are based on the WHO guidelines, with some adjustments. 

No screen time is recommended for children under 1 year old; no TV, computer games, tablets, or mobile phones are recommended for children aged 1–2. For children aged 2–5, screen time should be limited to one hour a day, with less being better. Children and adolescents from 6 years up should limit the amount of time spent being sedentary, particularly passive screen time during leisure time. 

Olov Belander says that some schools in Norway are taking steps to reintroduce physical books and limit screen use following a public debate. He also emphasises that more work needs to be done to help children become more physically active in the future. Belander also highlights the need for a discussion about the role of the industry behind the increased screen time, from software to hardware developers, in the same way that the sugar industry has been debated.

– Sometimes I wonder if we are conducting a live experiment with our children today, given how much they are exposed to screens. It’s a challenging and complex field with more research being conducted all the time. I think it’s good that we collaborate on a Nordic level as well.

– Olov Belander, Senior Advisor at the Norwegian Directorate of Health

Sara Fritzell and Helena Frielingsdorf, Senior Analysts at the Public Health Agency in Sweden: Is there a need for recommendations for healthy digital media use among children in Sweden?

 

A commission is working in Sweden on recommendations for healthy digital media use among children. The aim is to present the recommendations for ages 0–18 in September 2024, and subsequently develop guidelines for their implementation. The knowledge is gathered both through dialogue with experts and reference groups, and through a literature review.

– We also have a collaboration with Norway and Denmark, which we are very pleased with. This will be ongoing throughout the entire commission, Sara Fritzell says.

Sara Fritzell and Helena Frielingsdorf presented the results from one of their focus groups, which consisted of children. The positive aspects the children associated with digital media include its benefits for learning and entertainment, easy access to information, and the ability to socialise with friends and people from around the world, providing a sense of connectedness and support. Negative aspects involve the ease of becoming stuck and sedentary, exposure to threats and hate, encountering unrealistic ideals that diminish self-worth, and impacts on sleep. 

Sara Fritzell says many children want to talk with their parents about their screen time. While some parents may opt to confiscate their children’s phones, this isn’t always the most effective solution as it removes a significant aspect of the children’s lives.

– When we asked parents about the support and recommendations they seek, the responses showed a desire to learn more about the hazards and where to seek support especially if they felt their children were becoming addicted. The parents also emphasised that recommendations must be based on facts and clearly explain the consequences of problematic media use.

In developing the future guidelines, the Swedish commission has conducted extensive literature reviews, focusing primarily on how digital media affects physical and mental health.

– Sleep is an area where we have found robust results. Extensive screen time is associated with sleep problems, affecting both duration and quality. Sleep is, of course, very important for mental and physical health, school achievement, and well-being in general. We have also observed that digital media is associated with an increased risk of a negative body image and increased risks for eating disorders, Helena Frielingsdorf says.

Frielingsdorf points out that digital media also has positive effects, and highlights the necessity for recommendations to find the optimal balance.

– The challenge is to find ways to maintain the beneficial aspects while minimising the harmful effects.

Andreas Salomonsson, member of the presidium of the Nordic Youth Council: Screen time recommendations and the impact of digital media use from a youth perspective
 

– I use screens a lot for my studies, social contacts, and my hobby, which is gaming. For me, it’s more about what I do when I’m not using a screen. I make sure to bicycle every day or take a longer route to the convenience store. This is how I try to compensate, because I know I can’t reduce my screen time. 

Andreas Salomonsson acknowledges the challenges, especially the difficulty some young people face in taking a break from screens, as social media algorithms are designed to keep users on the platform. Salomon is also aware that not all screen time is bad.

– More emphasis should be placed on the diverse ways screens are used, as not all are harmful. Some people who are socially isolated in the real world might find their entire social community online. Screens are used for learning and reading, and many people employ screens for much more than just doomscrolling and social media. I think this aspect is partly overlooked.

Salomonsson recognises the need for regulations on screen time but warns against what he calls a kind of binary thinking by the authorities. He maintains that recommendations should come with explanations.

– Many young people don’t like being told what to do. It’s important to include an explanation in the recommendations so that people can understand why they need to reduce their screen time.

Panel conversation on the Nordic models for screen-time and digital media use among children and youth

 
To conclude the second theme of the conference – screen time and digital media – some of the experts gathered for a panel conversation. Their main focus was to deal with Minister Jakob Forssmed’s question on how society can create a constructive dialogue to support children and young people in developing a healthy relationship with digital media.

– We need to ensure that children and young people have the best options for consuming social media in a healthier way. This includes regulating the tech giants on how they can make social media addictive, as well as on what content is shown, Andreas Salomonsson from the Nordic Youth Council says.

Olov Belander at the Norwegian Directorate of Health agrees.

– I think a dialogue with the tech industry is important, as well as a dialogue across government sectors. And a dialogue with the children themselves!

More coordination between different authorities is also something Jens Kristoffersen at the Danish Health Authority advocates. He stresses that many actors’ interests converge, and we need to find a way to cater to them all. One group that has not received enough support is parents, but the question is how to reach them, and young people, effectively. 

– It’s not easy. Campaigns will not change behaviour, but they are a way of keeping the debate alive. We need to create a better structure around young people so they are not as exposed as they are today. This could include age restrictions, as a lot of content is not appropriate for all ages. It could also involve reducing screen time at school and during leisure time, and hopefully, parents can help by limiting access at certain times of the day, Kristoffersen says.

The need for broad cooperation is also endorsed by Olov Belander at the Norwegian Directorate of Health. He suggests implementing guidelines similar to traffic rules, which everyone follows.

– Maybe we need to implement something comparable to traffic rules, such as digital parenting rules.

Andreas Salomonsson from the Nordic Youth Council agrees that age restrictions should not be the only measure of reducing harm caused by social media.

– A 16-year-old might be consuming social media in a healthier way than a 55-year-old. We can’t focus on blocking social media altogether for certain ages, but we should concentrate on identifying and reducing its negative aspects. 

Screen time comes with a social gradient, and research indicates that parents with higher levels of education are better at managing their children’s screen time.

– From a public health perspective, the best approach is to reduce socioeconomic disparities, thereby addressing health disparities in general. The second-best approach is to provide compensation and increase access to guidelines on healthy screen use. Reaching those that need it the most is our priority, says Helena Frielingsdorf at the Public Health Agency in Sweden. 

Frielingsdorf stresses that responsibility lies at various levels within society. 

– If we aim to lead in digitalisation, as the Nordic countries do, we must also take the lead in understanding when digitalisation benefits public health and when it does not.