by Nancy Humphrey
Ryley, a Clarksville teenager treated at Monroe Carell Jr. Children’s Hospital at Vanderbilt for her often-uncontrolled type 1 diabetes, is facing another serious health hurdle — the result of spending too much time gaming on screen devices.
Her dependency on electronic gaming on her cellphone and other smart devices, and sitting for prolonged periods of time, resulted in a deep, infected, painful, 6-inch pilonidal cyst in the crease of her buttocks that had to be removed surgically. Healing, because she has diabetes, will be slow.
Although Ryley’s is an extreme case, a Children’s Hospital pediatric endocrinologist says that over the past five years she has seen an increasing trend of health conditions in patients with chronic diseases like diabetes, directly or indirectly related to excessive screen time.
Nidhi Gupta, MD, assistant professor of Pediatrics and Ryley’s pediatric endocrinologist, said that she is also seeing increasing incidences of obesity leading to type 2 diabetes in children between the ages of 6 and 12. “At one point, type 2 diabetes in that age group was uncommon. A lot of it, including the children we see in the endocrine clinic for fatigue, is related to diet and lifestyle, including excessive screen time activity,” she said.
“When I ask children about their sleep habits and how much time they spend on screens before going to bed, that’s where we often find the cause of their fatigue — not necessarily in the thyroid or the adrenal glands,” Gupta said, adding that it’s best to turn off your device off at least a half hour, but preferably one hour, before going to bed.
And although technology has its benefits for the pediatric patient population diagnosed with diabetes, it also has its challenges. “While children with type 1 diabetes can use technology to their benefit to a great extent, they’re also finding it hard to balance taking care of themselves vs. not wasting time on technology,” she said.
Gupta recently participated in a podcast on the subject hosted by the British Medical Journal.
Although cellphones and other screens are not listed as an addiction in the “Diagnostic and Statistical Manual of Mental Disorders,” the handbook recognized in the medical community to diagnose mental disorders, there are similarities between cellphone overuse and behavioral addictions like compulsive gambling.
In both, dopamine, a chemical in the brain, is triggered to reinforce compulsive behaviors. For many people social interaction stimulates the release of dopamine, and people use their cellphones for social interaction. They become accustomed to constantly checking their cellphones for that hit of dopamine that’s released when they connect with others on social media or, in Ryley’s case, gaming apps, Gupta said.
“Ryley has had a hard time making friends,” said her mother, who asked that their last name not be used. “Her outlet is making friends on these games. She used to love to be outside and playing in the neighborhood, but that all stopped when electronics came into the picture,” she said.
Gupta said she has only a limited amount of time during a patient’s clinic visit to discuss screen time and its implications on health.
“I can only give them the very basic blurb about screen time,” she said. “But I felt this is not enough and not much has been done about this, definitely in the general pediatrics realm, and absolutely not within the subspecialties. So, I decided to look into it a little more because my patients and their families are so affected by this issue.”
In the clinic visit, Gupta helps the patient and any family members present to identify that a problem may exist in their excessive interaction with their smart devices.
She asks both the child and parents to go to the settings feature on their cellphones, and to make sure the screen time setting is turned on. If it is, she asks them to look at how much time is spent on the phone. The feature will also show what apps the child is spending time on. The feature allows parents to set time limits for apps and also to block inappropriate content.
“When asked how much time they would guess they spend on their screens daily, the child will tell me not much, maybe one to two hours,” Gupta said. “But when they look at their screen time, they are often shocked to see that it can be three, four, five, six hours. It shows them they are spending way too much time on their screens and that not all of it is accounted for by school work or reading.”
Gupta said she also asks the parents to check screen time on their own devices “so it’s not just the child being thrown under the bus in the doctor’s office during an evaluation for obesity or for a visit for their diabetes. It’s the whole family. They need to have a media plan so they can hold each other accountable.”
Most guidelines suggest that children shouldn’t spend more than 2 hours on their screens outside of school work, Gupta said.
“The issue isn’t so much about how much time is being spent on devices, but what else should be happening during this time that the devices are allowing us to escape from,” she said.
Gupta said she tells her patients to “replace screen time with green time,” meaning to put your phone away and enjoy some exercise or outdoor time or non-media hobbies.
“With only 24 hours in a day, we need to make time for 8-12 hours of sleep, depending on your age, school or office, family time, mealtime, personal care, outdoor time, leisure activities. After you’ve achieved this most days, then a little bit of online browsing or mindless gaming might be OK.”