Project iBabyECDA Early Childhood Conference 20th September 2014 The Incredible early years: Supporting Young Children’s DevelopmentSingapore Expo Convention & Exhibition Centre

A generation of childrenGlued to screen devices

12 THE STRAITS TIMES AUGUST 7 2014

Five-year-oldKristy gets towatch TV foran hour or soduringlunchtime

and for about twohours during dinner.

“After dinner, her ‘reward’ is at least11/2 hours of time on an Apple iPadbefore she washes up for bed. Then, wetake her through some educational appsor games before she sleeps,” said hermother, Mrs D Lee, 39, who holds anoffice job.

“It is effective as a babysitting tool aslong as we set the rules. We will warnher before we take back the iPad. Sheknows that if she doesn’t cooperate, itwill be confiscated for a couple of days.”

Mrs Lee said she first allowed Kristyto play with the tablet when she wasaround two, but the time spent on it wasa lot shorter.

“It’s really a case of bo pian (Hokkienfor no choice) now as I have athree-month-old baby. Otherwise, I will gomad. She’ll keep bugging me and I haveto express milk most of the time.”

Mrs Lee is aware of the possibledangers of too much “screen time” butis not overly worried.

Screen time is the time spent on anymedia device with a screen, such astelevision, computers, video gameconsoles and handheld screen devices,including mobile phones and tablets.

She is among the many parents todaywho whip out their smart devices toentertain their children.

Indeed, a recent study by studentsfrom the Yong Loo Lin School ofMedicine, National University ofSingapore (NUS) called Project iBabyfound that nine out of 10 children in the18 to 24 months age group are exposedto screen devices.

As part of a community health project,the fourth-year students interviewedparents of 800 children in February tofind out how often young children usescreen devices and the attitudes,practices and beliefs of their caregiverstowards such use.

SCREEN TIME OVERLOADWhat is of concern is the amount ofscreen exposure young children areexperiencing. The Project iBaby studydiscovered that almost half of thesechildren under the age of two spend anhour or more on screen devices a day.

The study also found that there was alack of parental knowledge when it cameto the subject matter of screen timeexposure. Eight in 10 parents wereunaware of any guidelines put forth byprofessionals regarding screen time foryoung children while four in 10 parentsfailed to supervise their child’s screenusage all the time.

“This is the first time in Singaporethat screen viewing behaviour of veryyoung children has been investigatedcomprehensively,” said Dr FalkMueller-Riemenschneider from the NUSSaw Swee Hock School of Public Health,who is the supervisor of Project iBaby.

“Our findings highlight that exposureto screen devices is highly prevalent andthat awareness about the detrimentalhealth effects is limited.”

The excessive use of screen devicescan be harmful.

It can cause speech delays andbehavioural issues in young children,and attention problems in school-goingchildren, apart from the possible weightgain that can accompany sedentarybehaviour.

Mr Readon Teh, 23, thestudent-in-charge of Project iBaby’sresults, said: “We also found out thatkids below the age of two, who areexposed to screen time, are more likelyto have less than the recommended 13hours of sleep a day.”

IMPACT CAN DEEPENEarly and heavy screen-time exposurecan result in a higher rate of attentiondeficit when a child is of school-goingage and result in language delays ifparent-child interactions arecompromised as a result of screen time,said Dr Jennifer Kiing, consultant,division of neurodevelopmental andbehavioural paediatrics at thedepartment of paediatrics, NationalUniversity Hospital.

“There is also a link between screenviolence and aggressive behaviour inchildren,” she said.

In older children and adults, thosewho show addiction-like behaviour ontheir smartphone use can exhibit socialeffects such as declined performance inwork or study and neglect of family orimportant relationships or socialengagements, said Dr Tan Hwee Sim, aspecialist in psychiatry and consultant atRaffles Counselling Centre.

They can also be affectedpsychologically. For instance, they mayfeel anxious when they are unable toaccess their devices, or depressed whenthey read negative remarks on socialnetwork sites.

Furthermore, their health may beaffected as they could suffer from sleepdisturbances, eye strain and neck pain,said Dr Tan.

Problematic use can even causelong-standing issues such as familybreak-ups and poor academic results,she added.

One reason why the parents ofAngeline (not her real name), 16, tookher to see Dr Tan recently was becauseher academic results had deteriorated.She was also highly irritable and herrelationship with her parents was

strained. “It turned out that she hadbeen spending increasing amounts oftime on her smartphone: watchingvideos, following updates on varioussocial media sites and playing games,”said Dr Tan.

Her anxiety about her poor results hadled her to use her smartphone evenmore to escape from her problems.

Dr Tan assessed Angeline and ruledout any underlying mood or anxietydisorders. She then counselled her androped in her parents when she devised a

plan to help the student gradually reduceher smartphone use.

Problematic smartphone use oftenoccurs in the context of other underlyingconditions, such as anxiety anddepression, said Dr Tan.

That is why it is still not clear whether“smartphone addiction” is truly aseparate disease entity or amanifestation of other issues, she said.

She added that there is currently noconsensus among psychiatrists,although some want it to be formally

recognised as a disorder here.Those who are vulnerable to

addiction-like behaviour are people withpoor social skills, low self-esteem, or aresuffering from negative emotions, suchas anxiety, depression and anger, andwho have limited coping skills, she said.

MONITOR USAGEThe students who took part in ProjectiBaby have developed educationalmaterials, such as brochures andposters, as well as held baby fairs at

KK Women’s and Children’s Hospitaland National University Hospital to raiseawareness of harmful effects of toomuch screen time.

But more needs to be done.Dr Mueller-Riemenschneider said morewidespread and comprehensiveapproaches, involving childcare centresand teachers, the health-care sector andother institutions, will be needed to raiseawareness on a larger population level,as well as to overcome misperceptionsabout the beneficial effects of screenviewing in the very young.

Some parents believe that certain TVprogrammes or apps will benefit theirchildren cognitively but, in fact, there isno evidence to show that these arebeneficial for very young children belowtwo, he said.

“There also remains a need to betterunderstand why so many children engagein excessive amounts of screen viewingbehaviour and what the barriers toreducing such behaviour in children are,”said Dr Mueller-Riemenschneider, whosearea of speciality is in public health.

There are currently no officialguidelines on the length of screen timechildren should be exposed to inSingapore, but several health-careorganisations in the United States havediscouraged media use by children up tothe age of two.

For years, the American Academy OfPaediatricians (AAP) has beenrecommending that TV and otherentertainment media be avoided forinfants and children under the age oftwo, and that older children and teensshould engage with entertainment mediafor no more than one or two hours perday.

Experts say children under the age oftwo learn best through real-lifeinteractions and not through videos.

In general, children under the age oftwo are more likely to have speechdelays and behavioural issues if they areexposed to excessive media screenexposure before they turn two, saidDr Tan Kuanyang from ThomsonPaediatric Centre.

That is why the general stand ofpaediatricians is to discourage the useof media devices below the age of two,he said.

The recommendation also applies toeducational apps. “An app speaks to youand does not require you to interact,resulting in speech and behaviouralissues,” said Dr Tan.

Mrs Lee said she will monitor Kristy’sbehaviour. If there are any issues, shewill “moderate Kristy’s time with theiPad”.

joyceteo@sph.com.sg

For more info on Project iBaby, goto http://doctorsoftomorrow.me/

projectibaby

It is not only young children who are at risk ofbecoming too attached to smart devices. Olderchildren and adults can become hooked on suchdevices too.

The main difference between a heavy smartphoneuser and a problematic smartphone user is that forthe former, the use does not interfere with his work,relationships or life, said Dr Tan Hwee Sim, aspecialist in psychiatry and consultant at RafflesCounselling Centre, who has clinical interests inaddictions.

“There is no universal agreement as to the specificcriteria for ‘smartphone addiction’, whether it is amental disorder or, indeed, whether it is a disorder atall,” she said.

As smartphone addiction is not an establishedmental disorder, the criteria for substance usedisorder can usually be applied to problematicsmartphone use, she said.

These include:● The person using the device more than he intendedto. For instance, he would tell himself that he wouldspend only an hour on the device but ends upspending the whole night on it.● Showing a desire to cut down on or control howmuch he uses the device but is unable to.● Craving the use of the device.● Continuing to use the device despite negativeconsequences, such as deteriorating academicresults.● Neglecting important activities, such as schoolworkor housework, because of time spent using thedevice.● Using the device in situations in which it isphysically hazardous, for example, when driving orcrossing the road.● Experiencing withdrawal symptoms, such as anxietyor irritability, when withdrawing from the use of thedevice.

NIP IT IN THE BUDDr Tan suggested the following ways to help parentsstem problematic use of smartphones.1. Recognise that the usage is out of control“Some people are able to modify their behaviour oncethey have an insight into the negative consequencesthat their behaviour causes,” said Dr Tan.

“If there is any underlying issue that may cause orsupport the problematic usage, it needs to beaddressed. Examples include depression, anxiety,stress or self-esteem and social skills issues.”

A formal consultation may be needed to assesswhat issues are involved, she said.2. Modify usageBy keeping a log on how much time is spent using adevice for non-essential activities, a person can setgoals to reduce such usage.3. Set rulesLay down some guidelines for not using thesmartphone in certain situations. For example, whendriving, eating, spending time with the family or whenin the bedroom.4. Eliminate data planIf a person is still unable to control his usage despitethese efforts, he should consider using a device withno data plan, so he cannot surf the Internet on it, inorder to break the habit.

Warningsigns

Screen time may be unavoidable today but parents have the powerto manage their children’s exposure to tablets, TVs and computers

Screen time should not compromiseparent-child interactions, saydoctors.

Here is some advice frompaediatricians and Project iBabyresearchers on how parents canmanage their children’s screen time.1. Discourage children below the ageof two from using screen devices.2. For children above two years old,limit the time spent on screendevices to no more than one or twohours a day.3. Review the content that your childis watching and watch it with him.4. Make and enforce rules to limitscreen time.5. Encourage other interactiveactivities which promote proper braindevelopment, such as playing andreading.6. Watch TV or use other devices inthe living room only and not in thechildren’s bedroom.

JOYCE TEO

Turn off that tech toy

PHOTO: ISTOCKPHOTO

How tomanagescreen time

Cover Story

Source: Mind Your Body © Singapore Press Holdings Limited 7th August 2014. Reproduced with permission.

“Our findings highlight that exposure to screen devices is highly prevalent and that awareness about the detrimental health effects is limited.”

“Early and heavy screen-time exposure can result in a higher rate of attention deficit when a child is of school-going age and result in language delays if parent-child interactions are compromised as a result of screen-time.”

Dr Falk Mueller-Riemenschneider NUS Saw Swee Hock School of Public Health

Dr Jennifer Kiing Paediatrics, National University Hospital

What is screen time?

Screen timeTelevision programs!Prerecorded videos!

Web-based programming!DVDs

viewed on either traditional or new screen technologies!

Brown A. Media use by children younger than 2 years. Pediatrics. 2011 Nov;128(5):1040-5. PubMed PMID: 22007002. Epub 2011/10/19. eng.!

Screen

Questions for today

6

What is so bad about screen time?1

Early childhood media exposure is associated with multiple detrimental effects spanning the

various developmental domains

iBaby

1. Zimmerman FJ, Christakis DA. Children’s Television Viewing and Cognitive Outcomes: A Longitudinal Analysis of National Data.Arch Pediatr Adolesc Med. 2005;159(7):619-625. doi:10.1001/archpedi.159.7.619. 2. Chonchaiya W, Pruksananonda C. Television viewing associates with delayed language development. Acta Paediatr 2008; 97:977-82 3. Zimmerman FJ, Christakis DA, Meltzoff AN. Associations between media viewing and language development in children under age 2 years. The Journal of pediatrics. 2007;151(4):364-8.

1) Lower reading, recognition and comprehension scores with daily TV viewing before 3 years

!

2) 6-fold increased likelihood of language delay with exposure before age 12 months

!

3) Reduced Communicative Development Inventory (CDI) scores with increased duration of exposure regardless of media platform

1. Kirkorian HL, Pempek TA, Murphy LA, Schmidt ME, Anderson DR. The impact of background television on parent-child interaction. Child development. 2009;80(5):1350-9. 2. Vandewater, E. A., Bickham, D. S., & Lee, J. H. (2006). Time well spent? Relating television use to children's free-time activities. Pediatrics,117, 181-91.

1) Background television reduces parent-child interaction and promotes rapid attention shifts in the child

!

2) Inverse relationship between TV time and time spent with parents/sibilings in other activities

1) Increased incidence of attention deficits

2) Association with aggressive behaviour!

1. Christakis, D. A.., Zimmerman, F. J., DiGiuseppe, D. L., & McCarty, C. A. (2004 April). Early television exposure and subsequent attentional problems in children. Pediatrics, 113(4), 708-713. 2. Singer MI, Slovak K, Frierson T, York P. Viewing preferences, symptoms of psychological trauma, and violent behaviors among children who watch television. J Am Acad Child Adolesc Psychiatry. 1998;37(10):

1041–8.

• Obesity !!

• Myopia – rising myopia rates!!

• Sleep – Irregular sleep schedules with negative impact on growth, behavior and cognitive development

!1. Mendoza JA, Zimmerman FJ, Christakis DA: Television viewing, computer use, obesity, and adiposity in US preschool children. Int J Behav Nutr Phys Act 2007, 4:44. 2. Czepita D, Mojsa A, Ustianowska M, Czepita M, Lachowicz E. Reading, writing, working on a computer or watching television, and myopia. Klinika oczna. 2010;112(10-12):293-5. 3. Thompson DA, Christakis DA. The association between television viewing and irregular sleep schedules among children less than 3 years of age. Pediatrics. 2005;116(4):851-6.

!

“American Academy of Pediatrics discourages screen time in children

younger than 2 years"! – AAP 2011 guidelines

1. Brown, A. (2011). Media use by children younger than 2 years. Pediatrics, 128(5), 1040–5. oi:10.1542/peds.2011-1753

DOI: 10.1542/peds.2011-1753; originally published online October 17, 2011; 2011;128;1040Pediatrics

Council on Communications and MediaMedia Use by Children Younger Than 2 Years

http://pediatrics.aappublications.org/content/128/5/1040.full.html

located on the World Wide Web at: The online version of this article, along with updated information and services, is

of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2011 by the American Academy published, and trademarked by the American Academy of Pediatrics, 141 Northwest Pointpublication, it has been published continuously since 1948. PEDIATRICS is owned, PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

by guest on March 2, 2014pediatrics.aappublications.orgDownloaded from by guest on March 2, 2014pediatrics.aappublications.orgDownloaded from

• Understanding screen time behavior among Singaporean children up to 2 years old!!

• Characteristics of screen time behavior!!

• Determine factors influencing screen time behavior

Study Objectives

• Cross sectional study!• Interviewer administered

questionnaire!• Two polyclinics

• February 2014

Study Design

Study Population• Inclusion:

- Parents of children up to the age of two

- Developmental assessment or vaccination clinics

• Exclusion: - Non parental caregivers - Visits for other reasons - Non Singaporean or non permanent residents

Study FlowchartTotal Visits (n=1061)

Excluded (n=250)

Eligible (n=811)

Rejected (n=71)

Agreeable (n=740)

• Age >2 years (n=113) • Non Singaporean/PR (n=46) • Attempted before (n=37) • Reasons other than DA (n=54)

• Time constraints (n=24) • Not keen (n=47) Response rate >90%

Sociodemographics of study participants Study Cohort Sociodemographic Data

Number %

Child Gender (n=738)

Male 403 54.6Female 335 45.4

Child race (n=739)

Chinese 431 58.3Malay 201 27.2Indian 83 11.2Eurasian 3 0.4Others 21 2.8

Parents Marital Status (n=740)

Married 725 98.0Single 12 1.6Divorced 2 0.3Widowed 1 0.1

• Children!

• About half were male!

• Majority were Chinese!

• Parents!

• Majority were Married

• Most parents had education level of diploma and above!

• Father - 68.1%!

• Mother - 66.3%

• Dichotomized into high vs low education for subsequent analyses

: Study Cohort Sociodemographic DataNumber %

Paternal Education (n=734)

Primary 26 3.5Secondary 125 17.0Post-secondary 83 11.3Diploma 237 32.3University 188 25.6Post-graduate 75 10.2

Maternal Education (n=737)

Primary 25 3.4Secondary 154 20.9Post-secondary 69 9.4Diploma 216 29.3University 213 28.9Post-graduate 60 8.1

Sociodemographics of study participants

Study Cohort Sociodemographic DataNumber %

Income (SGD) (n=740)

<3000 141 19.13001 – 6000 300 40.56001 – 9000 171 23.19001 – 12000 67 9.1>12 000 45 6.1Don’t Know 16 2.2

Housing (n=733)

HDB (1 and 2 room) 35 4.8HDB (3 room) 105 14.3HDB (4 room) 337 46.0HDB (5 room/exec) 223 30.4Condominium 24 3.3Landed 9 1.2

• Median Income was between SGD 3001 - 6000!

• Median Housing type is a 4 room HDB flat

Sociodemographics of study participants

What is the local prevalence of screen time for children aged 2 and under?

2

Prevalence of screen time?

Almost 1 in 2 children are exposed to screen devices !52.8% have screen time exposure!

Prevalence of screen time?

Prevalence of exposure roughly doubles every 6 months Reaching 87.6% between 18-24 months

Stratified by age group

0

25

50

75

100

0-6 months 6-12 months 12-18 months 18-24 months

88.2 76.4 62.2 29.0

11.8 23.6 37.8 71.0

No Screen Time Have Screen Time

Significant difference between age groups, P<0.001

Which devices are most implicated?3

Devices

Television Computers Video Game Consoles

Personal Portable Devices

Device ownershipTable 5: Device Ownership (%)

0 1 2 3 4 5 >5

Television! 1.0 41.3 32.9 16.7 6.4 0.7 0.9

Computer! 5.6 37.5 33.5 15.0 4.0 2.4 2.0

Video Games! 69.1 25.0 4.4 1.3 - - 0.1

Personal Portable Devices! 0.1 1.3 20.2 27.2 18.0 13.3 19.9

• 4 in 10 households own one television and one computer!

• 8 in 10 households own three or more personal portable devices!

• Mobile phones, tablets, handheld video game device

Majority of time spent on television and personal portable devices

!

Parallels the trend we observe in Singapore’s public places!

Type of device used

Duration of screen viewing by device

• Majority of time is spent on !

• Television !

• Personal portable devices

Table 6: Median Duration of Screen Viewing by deviceMedian (hh:mm)

Percentiles25% 50% 75%

TV!(n=389) 00:30 00:14 00:30 01:27

Computer!(n=388) 00:00! 00:00 00:00 00:00

Video Game consoles!(n=388)

00:00 00:00 00:00 00:00

Personal Portable Devices!(n=388)

00:10 00:00 00:10 00:30

How is sociodemographic data associated with screen time?4

Parental education and screen time Parental education and Screen Time

PRR 95% CI

Low Paternal Education 1.22 0.98 - 1.51

High Paternal Education

1.00 (reference) -

Low Maternal Education 1.49 1.20 - 1.85

High Maternal Education

1.00 (reference) -

Low Maternal Education associated with screen viewing behavior

Income, Housing and screen time

Table 12: Income, Housing and Screen Time

PRR 95% CI

High Income 0.87 0.73 - 1.05

Low Income 1.00 (reference)

Larger House 0.84 0.72 - 0.97

Smaller House 1.00 (reference)

• Stratified Income!

• $SGD6001 and above!

• Stratified Housing!

• 4 room HDB flat and above!

• Families in larger houses are associated with less screen viewing behavior!

• Borderline evidence for income

Race and screen time

Race and Screen Time

PRR 95% CI

Chinese 1.000 (reference) -

Malay 1.70 1.33 - 2.18

Indian 1.50 1.00 - 2.24

• Malay and Indian families seem to be associated with screen time behavior

Child’s gender and screen time

Child’s Gender and Screen Time

PRR 95% CI

Female 1.00 (reference) -

Male 1.07 0.94 - 1.22

• No differences between gender

What are the attitudes and practices of local parents?5

Positive Association +

Perception that screen time is beneficial to!!

- Cognition PRR 1.62 (1.38-1.89) - Language PRR 1.13 (1.04-1.22) - Social PRR 1.36 (1.14-1.61)

Negative Association -

Perception that child would mimic aggressive behavior!PRR 0.91 (0.84-0.98)

Attitudes and screen viewing

4 in 10 parents fail to supervise child’s usage all the time

AAP: Understands that exposure is a reality, therefore

recommends supervision of screen time !!

Parental Supervision

Awareness of Guidelines

8 in 10 parents are unaware of any professional guidelines

Parental Knowledge of professional guidelines

• Majority of parents were unaware of professional guidelines (85.2%)!!

• Weak evidence for an association between awareness of guidelines and reduced screen time behavior!!

• Parents who claimed to be aware were misinformed of the guidelines

Parental awareness and Screen Time

PRR 95% CI

Not Aware 1.00 (reference) -

Aware 0.75 0.53 - 1.07

Reported duration by parentsCorrect Answer

(minimum screen time)

Wrong Answer

Aware 12.7% 87.3%

Not Aware 25.5% 74.5%

Parental Practices - Coping tool

• Parents who felt a screen device is a good coping tool is associated with increased child screen viewing behaviour!

• Association not seen for parents who felt children enjoyed screen devices

Table 19: Parental attitudes - Other factors

OR 95% CI P-value

Coping tool 1.66 1.23-2.25 0.001

Child enjoys screen device 1.28 0.897-1.84 0.172

BMC Public Health. 2012 Jul 23;12:539. doi: 10.1186/1471-2458-12-539.!

Parental Practices - Parental Rule Setting

• Parents who set rules are associated with reduced child screen viewing behaviour!

• Especially where rules are set regarding duration of use

Table 20: Rule setting

OR 95% CI P-value

Rule Setting 1.80 1.12-2.88 0.014

Rules on Time duration

1.12 1.04 - 1.19 0.002

Rules on Program use

1.30 0.885-1.91 0.190

Does screen viewing affect the child’s other activities?6

Screen viewing and child’s sleep time

• National Sleep Foundation Recommendation : 13 hours of sleep for children aged under two years!

• Screen viewing associated with sleep duration of <13 hours

Sleep times for Children

Outcome PRR 95% CI

No screen time

Sleep time >13 hours

1.00 (reference) -

Have screen time 0.60 0.52 - 0.68

Comparison with international studies• USA: 90% of children up to the age of two years!• Japan : 86% of children by 18 months of age!!

Singapore !- Overall prevalence of cohort (with median age 6 months) :

52.8%!

- Prevalence from 18-24 months : 87.6%!

Arch Pediatr Adolesc Med. 2007;161(5):473-479. doi:10.1001/archpedi.161.5.473.

Cheng S, Maeda T, Yoichi S, Yamagata Z, Tomiwa K. Early television exposure and children's behavioral and social outcomes at age 30 months. Journal of epidemiology. Japan EpidemiologicalAssociation. 2010;20 Suppl 2:S482-9.

Local Findings!

• Lack of parental awareness and misinformation!!

• Coping tool phenomenon!!

• Lack of parental supervision!!

• Health effects of early screen time exposure!!

Limitations of Study

• Non truly representative sample !- More data needed from other regions of Singapore,

private patients!!

•No validated instrument locally!- Carefully crafted questionnaire based on literature review !!

• Inability to determine causality!!

!

The pace of research has not kept up

?

?

Need for timely intervention

Public Outreach• Partnerships!

!

• Media coverage!!

In a nutshell

iBaby?

Screen Media Use& Child Development

Media exposure is virtually unavoidable in today’s society;

however, many steps can still be taken to reduce screen time for our

young children. Here are some ideas on taking active steps to minimise

screen time:

Ŷ� �Review the content that your child is watching and watch the

programs with your child.

Ŷ Make and enforce rules, limiting screen media usage.

Ŷ Encourage other interactive activities that promote proper brain

development, such as playing and reading together.

Ŷ Watch in the living room only and remove TV sets from child’s room.

Ŷ� �Screen time has a primarily negative impact on children below the

@FD�NE����@ƤDBSHMF�LTKSHOKD�@RODBSR�NE�SGDHQ�CDUDKNOLDMS �3GDQDENQD��

screen time should be kept to a minimum for children below the

age of 2.

Ŷ� �While the eventual use of screen devices is unavoidable, plan ahead:

create concrete strategies to manage screen time.

Ŷ� �Whenever possible, review the content that your child is watching and

watch the programs with your child.

How should I manage screen time?

Is my baby an

References:

1. Brown A. Media use by children younger than 2 years. Pediatrics. 2011 Nov;128(5):1040-5. PubMed PMID: 22007002. Epub 2011/10/19. eng.

2. Carson V, Tremblay MS, Spence JC, Timmons BW, Janssen I. The Canadian Sedentary Behaviour Guidelines for the Early Years (zero to four years of age) and screen time among children from Kingston, Ontario. Paediatrics & child health. 2013 Jan;18(1):25-8. PubMed PMID: 24381488. Pubmed Central PMCID: Pmc3680268. Epub 2014/01/02. eng.

� ������"GQHRS@JHR�# �3GD�DƤDBSR�NE�HME@MS�LDCH@�TR@FD��VG@S�CN�VD�JMNV�@MC�VG@S�RGNTKC�VD�KD@QM�� BS@�paediatrica (Oslo, Norway : 1992). 2009 Jan;98(1):8-16. PubMed PMID: 18793294. Epub 2008/09/17. eng.

Website:http://doctorsoftomorrow.me/projectibaby

Facebook:https://www.facebook.com/projectibaby

Organised by: Supported by:

Yong Loo LinSchool of Medicine

Saw Swee HockSchool of Public Health

Baby Fairs to raise awareness at NUH and KKH!Preliminary analysis of utility is promising

GROWing upTowards a healthier Singapore

Guidance over viewing!Restriction of duration!Other activities!Watch with child

GROW

Conclusion

• Detrimental effect of early childhood screen time exposure!!

• Significant prevalence in children of Singapore!!

• Intervention needed!!

!

Thank you for your attention!

• Ass/Prof. Prof Falk Mueller Riemenschneider!

• Dr Tan Chuen Seng!• A/Prof Prof Rob Martinus Van Dam!

!

• CHP group 3 members in YLLSoM!!

• NHG polyclinics – Dr Angelia Chua, Dr Franco Wong!

!