My research topic question is "What affect does overexposure of Mobile phone have on Toddlers?" I have attached instruction on how to write this paper. I have also attached the example essay below to

The experts’ recommendations are: no screen time <18 months, for children 2-5 years limited to one hour/day, for children ≥6 years there should be limits on the time spent using media and the types of media. The authors aimed to evaluate how much screen time the children are exposed to during the day. We conducted a prospective study, February-May 2019 in the Pediatrics Department of “Grigore Alexandrescu” Hospital. Parents were asked to fill in a questionnaire containing screen time, type of screen, behavior related to screens. 200 patients were enrolled, mean age 8 years 9 months, sex ratio M/F=1.1/1, 82% from urban areas. Parents declared the children started using screens at an average age of 4 years 1 month (minimum 6 months). 3% were exposed to screens below the age of one.

The devices used were: smartphone, TV, tablet, laptop, computer and gameboard in 81%, 59.5%, 42.5%, 36.5%, 22.

% and 22.5% respectively. Children used screens alone on average 2.8 hours/day, 5.6 days/week and alongside their parents on average 2.2 hours/day, 4.5 days/week. Devices were used during meal time in 41%. 22% of parents used screen time as reward and 48% felt retrieving the device to be an effective punishment. 20% of children were falling asleep with the TV on. Conclusions: Screen time for children is progressively increasing as the age of exposure decreases. The most frequently used devices are smartphones, laptops. The screen related behavior is “educated” in the family.

Keywords: screen time, media device, child Introduction In the past decade, media has become an important factor that influences children’s physical and psychological development. Whether we are talking about traditional media (television) or “new” media (cell phones, iPads and social media) there is evidence on the negative impact that digital media and screen viewing has on general health and cognitive development of children.

The American Academy of Pediatrics (AAP) encourages health care providers, parents and teachers to take action on diminishing harmful media use. The latest statements recommend pediatrician to take “a media history” on a routine visit and ask at least 2 questions: “How much recreational screen time does your child or teenager consume daily?” and „Is there a television set or Internet- connected device in the child’s bedroom?” (1). Some authors are concluding that media usage is one of the leading activities in young people other than sleeping (2, 3). Prolonged screen viewing in infants and young children has been linked in several studies with neurodevelopmental problems such as delayed cognitive and language development (4,5), behavior issues such as violence and aggression (6-8) and low social interaction with peers and parents (9,10). A prospective study on a Canadian cohort of 2241 children evaluated using a developmental scale revealed that the higher the levels of screen time exposure, the poorer were the developmental test’s performance (11).

Moreover, high screen view exposure has been correlated with vision (12-14) and overweight problems in late childhood and adolescence (15, 16). Excessive screen media exposure has been associated to low quality of sleep by limiting sleep duration (17-20), increasing night awakenings and inducing an intermittent sleep pattern (21). The bright screens of electronic devices induce a state of hyper arousal by activating different automatic pathways of the nervous system (22). Also, recent research is suggesting that a good quality of sleep is mandatory for the processes of active learning and memory build up (23). On the other hand, media use can promote social interactions, especially in teenagers. Social media platforms enhance communication with peers, create opportunities for engaging in community programs and promotes creativity through blogging and podcast production (24). Another advantage of social media is that it can improve the quality of learning by using platforms in which students can collaborate outside the class and exchange ideas and knowledge (25). Moreover, studies have shown positive impact for interactive technologies, such as smartphones and tablets, in supporting active learning beyond the formal way of education. 1 “Grigore Alexandrescu” Emergency Hospital for Children, Bucharest, Romania 2 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 3 “Matei Balș” National Institute of Infectious Disease, Bucharest, Romania E-mail: [email protected], [email protected], [email protected], [email protected], [email protected], [email protected] JURNALUL PEDIATRULUI – Year XXII, Vol. XXII, Nr. 85‐86, January‐June 2019  79 Taken into account all of the facts exposed, a balance must be kept in children of all ages between the time of screen viewing, media usage and quality of contents.

Material and methods The authors aimed to evaluate how much screen time the children are exposed to during the day. We conducted a prospective study, February-May 2019. The patients were enrolled in the Pediatrics Department of “Grigore Alexandrescu” Emergency Children’s Hospital, Bucharest, where they were admitted for unrelated pathology. Parents were asked to fill in a questionnaire containing brief personal data (age, sex of the child, socio-economic status, education level of the family), screen time, type of screen and behavior related to screens.

Results 200 patients were enrolled in the study. The mean age was 8 years 9 months (ranging from 12 months to 17 years). The distribution of by age is depicted in fig.1. The patients were equally distributed among genders. Sex ratio was M/F=1.1/1. The majority of patients (82%) came from urban areas. 27.5% of children were in kindergarten, 51% in primary school and 13.5% in high school. The parents were in most cases (70%) university graduates. Socioeconomic level of the family as declared by the parents was above 1000 euro/month in half the cases. 11% of children came from monoparental families. The main caregivers of the child were the parents in 78.5%, followed by the grandparents in 18.5%. Fig.1. Age distribution JURNALUL PEDIATRULUI – Year XXII, Vol. XXII, Nr. 85‐86, January‐June 2019  80 Parents declared the children started using screens at an average age of 4 years 1 month (minimum 6 months).

3% were exposed to screens below the age of one. This age did not differ according to parents’ level of education, primary caregiver, nor type of family (mono/biparental).

The devices available in the home were: smartphone, laptop, TV, tablet, computer, gameboard, eBook reader in 88%, 71%, 67.5%, 56%, 35%, 26% and 4.5% of cases.

More than 3 devices were present in 81% of homes. The most frequently used devices by children were: smartphone, TV, tablet and laptop in 162, 119, 85, 73 patients (fig.2).

80% of children used at least two devices and one third more than four.

The most frequently used devise by children aged 1-3 years was by far the smartphone (78.9%), followed by the TV (42.1%) and tablet (15.7%). The percentages of children watching TV or using a laptop progressively increased with age. Boys played with game boards more than girls (31.1% vs. 12.7%). Children in rural areas used smartphones, tablets and TV less than city children: 67.5 vs. 84%, 32.4 vs. 44.7% and 48.6 vs. 61.9% respectively; nevertheless for all the other devices percentages were similar. Children used screens alone on average 2.8 hours/day, 5.6 days/week and alongside their parents on average 2.2 hours/day, 4.5 days/week. Screen time did not differ according to age groups, gender, nor living area.

The declared main purposes for media device usage were: you tube (49%), game playing (46%), watching movies (45%) and listening to music (44%). Only 11% of children were using devices to read books online.

In 80% of cases at least one device was available in the child’s room; 15% had more than 3 devices. The time period during the day the child was most likely to accumulate screen time is between 6 and 8 p.m. Only a little more than half of the parents (58%) declared they control the type of media content the child watches. The decision to get the media device was in most cases made by the parents (61%).

Devices were used during meal time in 41%. 22% of parents used screen time as reward and 48% felt retrieving the device to be an effective punishment. The device the child was most reluctant to be apart from was by far the smartphone (56.5%), distantly followed by the tablet (12%). Almost a quarter of children (20%) were falling asleep with the TV on.

Discussion According to the American Academy of Pediatrics, the experts’ recommendations are: no screen time <18 months, for children 2-5 years limited to one hour/day and as for children ≥6 years, there should be limits on the time spent using media and the types of media allowed (1). In our study parents declared the children started using screens at a relatively low average age (4 years 1 month). We consider the fact that 3% of children were exposed to screens below the age of one to be at least concerning, not to mention that the lowest age of exposure was 6 months.

Regardless of AAP recommendations, the majority of children are still spending most of their spare time in front of screens. Studies in the United States have shown that 98% of the aged 0-8 year-olds are spending an average time of 2 hours a day using screens (26), the average 8-10 year- old spends approximately 8 hours a day using different media sources, while teenagers spend more than 11 hours per day (2). The children in our group used screens alone on average 2.8 hours/day, 5.6 days/week and alongside their parents on average 2.2 hours/day, 4.5 days/week.

Unlike literature data, in the present study, screen time did not differ according to age groups, nor according to gender or living area. The statistics on media usage and screen viewing are similar in other countries as well. In Japan, 86% of children by 18 months old spend > 1 hour watching TV daily (27). In Australia, children under 4 years of age watch TV more than 2 hours per day (28).

TV is still the leading type of used media (>4 hours daily), but with the development of new technology, about one third of TV programs are watched on alternative screens (computers, cell phones, iPads) (1). Our data placed the TV on the second place (59.5%), outranked by the smartphone (81%) and followed by the tablet (42.5%).

Published data show that 71% of children and teenagers have a TV set in their bedrooms (2). This research revealed that in 80% of cases at least one device was available in the child’s room; furthermore 15% had more than 3 devices. As regarding the use of internet, 98% of the children aged 0-8 years in the United States are living in houses with access to high speed internet (26), and about one third of all aged children have internet access in their bedrooms (1). Time spent using computers accounts for nearly 1.5 hours/day, half of it being used for videogames and social networking (1). Although in most cases the decision to get the media device was made by the parents, a very concerning fact resulting from our study was that only a little more than half of the parents had control over the type of media content the child watches. The authors also identified other potentially harmful screen related behavior in parents:

usage of media device to reward or punish the child, screen viewing during meal time or to induce sleep.

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Correspondence to: Raluca Maria Vlad „Grigore Alexandrescu” Emergency Children’s Hospital, 30-32 Iancu de Hunedoara Blv, sector 1, Bucharest E-mail: [email protected] Tel: 0722451462 Copyright ofJurnalul Pediatrului isthe property ofRomanian SocietyofPediatric Surgery and itscontent maynotbecopied oremailed tomultiple sitesorposted toalistserv without the copyright holder'sexpresswrittenpermission. However,usersmayprint, download, or email articles forindividual use.