increasing screen time in toddlers; new immun guidelines kids/adults

Children’s screen time has increased dramatically for those <2 years old  (see screen time in kids jamapeds2109 in dropbox, or doi:10.1001/jamapediatrics.2018.5546)

Details:
-- screen time usage based on diary data from the 1997 and 2014 Child Development Supplement of the Panel Study of Income Dynamics, a population-based representative sample of US children
-- 1327 children under 6 years old in 1997 were compared with 443 children in 2014, stratified into 2 cohorts: 0 to 2 years old and 3 to 5 years
-- in 1997 screen time was defined as time spent on any activity while watching TV or videotapes plus electronic video games and home computer related activities. In 2014 screen time was defined as television, videotapes, digital video disc, game devices, computer, cell phone, smart phone, tablet, electronic reader, and children’s learning devices
-- children were divided into those who were high-users vs low-users, based on median screen time within the age groups
-- the following demographics reflected statistically significant differences:
    -- 1997: high-users were more likely to be older (3.3 vs 2.5 years), lower income, primary caregiver was less likely employed, more children in the household
    -- in 2014: high-users were more likely to be male, household head or spouse had less education, were lower income, lived in a metro area

Results:
-- children 0 to 2 years old: daily screen time 1.32 hours in 1997, increased to 3.05 hours in 2014
    -- time on television increased from 0.56 hours 1997 to 2.62 hours in 2014, an increase from 43% to 86% of all screen time. In 2014, 0.37 hours were spent on mobile devices
-- children 3 to 5 years old: daily screen time 2.47 hours, with no significant change in 2014
    -- time on television 1.19 hours in 1997 (48% of total screen time), increasing to 2.14 hours (78% of all screen time) in 2014, and 0.42 hours were on mobile devices

Commentary:
-- actual diary data of screen use, as in the above study, is more accurate than parent surveys
-- the increase in television watching may reflect (my guess) that by 2014 there was much greater access to many television programs across the country (by streaming), and targeted TV programming was much more sophisticated
--there is a huge concern about the increased screen time with kids and brain development, though the results are still unclear. The New York Times reported on a study featured on “60 Minutes”, finding that in a preliminary report from the Adolescent Brain Cognitive Development study, a $300 million project financed by the NIH with 11,800 children, “heavy screen use was associated with lower scores on some aptitude tests, and to accelerated ‘cortical thinning’ in some children” (see  https://www.nytimes.com/2018/12/10/health/screen-time-kids-psychology.html?mc=contentSEdom&ad-keywords=auddevgate&gclid=CjwKCAiA767jBRBqEiwAGdAOr8tvkxbrWcISdpUqA3aDf237Uvix8LYkiTL4yxby-VehqRJWdkN0TBoChjIQAvD_BwE ). It was noted that this is preliminary; cortical thinning is a natural process; the adolescent brain is quite plastic (i.e. these changes may or may not be long-lasting); and if there is causality, does the screen time lead to cortical thinning or vice versa? And, perhaps some screen time may be worse than other, depending on its actual content.

so, interesting shift in screen time to TV for both age groups, as opposed to the oft-cited concern about mobile devices (phones, electronic games, etc).  there certainly is justified concern about the documented effects of screen time on social interactions with peers/family, sleep deprivation, lack of exercise, obesity, decreased social skills overall, and perhaps aggression (esp if violent video games). The really hard question is how to limit screen time when it has overtaken so much of all of our lives, and it is so easy…. 

But, the possible silver lining: these pretty striking increases were noted in young kids (esp toddlers), and there may be ways to prevent later addiction to screens: more parental education about the potential harms of screen time, and some restructuring of our societal direction, including the usual suspects: increasing available and affordable high-quality daycare, improving the level of education in general, increasing social mobility/decreasing income inequality/providing more hope and more fulfilling lives for the vast majority of the population….

See http://gmodestmedblogs.blogspot.com/2018/08/screen-time-increasing-in-kids-and-new.html for the Am Heart Assn perspective on screen time/prevention and management of childhood obesity and  literature review

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2019 Childhood immunization guidelines (see https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html )

Details (not a lot of changes, just the following):

--Influenza: live attenuated influenza vaccine (LAIV) is an option for those at least 2 years old, except if immunocompromising conditions (incl HIV), anatomical or functional asplenia, pregnancy, contact with immunocompromised people, those 2-4 yo with asthma in prior 12 months, those on aspirin/salicylates. also, precaution in those >5 yo with asthma, chronic pulmonary/cardiovasc/renal/hepatic/neuro/hematol/metabolic disorders including diabetes

--Hep A vaccine: homelessness is an added indication, and travelers 6-11 months old doing international travel

--Meningococcal vaccine: now with "precaution" for pregnancy

see the website for the color pictures of the immunization schedule by age, the catch-up schedule and immunization recommendations by medical conditions

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2019 Adult immunization guidelines (see https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html ), also, not a lot of changes:

--Influenza: live attenuated influenza vaccine (LAIV) is an option until age 49, except if immunocompromising conditions (incl HIV), anatomical or functional asplenia, pregnancy, contact with immunocompromised people [I remain a bit skeptical here: former LAIV vaccines were much more effective in younger adults (eg <30yo), with  waning effectiveness with increasing age]

--Hep B: Heplisav-B can be given in 2 doses at least 4 weeks apart (see http://gmodestmedblogs.blogspot.com/2018/05/more-effective-new-hepatitis-b-vaccine.html for assessment of this vaccine)

--Hep A: homelessness added as indication [given the high level of international travel, the vaccine should be pretty widely given; and, i would further argue, that we should be giving this more generally anyway, since there were 10,582 cases of hepatitis A in the US in 2018]

see the website for the color pictures of the immunization schedule by age and by medical conditions

geoff

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