Proceedings of Workshop on Children in a Digital World

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Proceedings of Workshop on
Children in a Digital World

By Dr. Nazish Imran

Today’s children are ‘digital natives’, who have grown up surrounded by digital information and various screens (TV, Computers, mobiles, tablets to name a few). However, there have been growing concerns of impact of screen time on the health and development of young people. Recognizing the importance of addressing this issue and to increase awareness among Professionals and parents alike, a workshop on “Children in a Digital World” was organized recently during an International Psychiatric Conference in Lahore, Pakistan. The conference was organized by Department of Psychiatry and Behavioral Sciences, Fatima Memorial Hospital in collaboration with Child & Adolescent Mental health special interest group with the main theme of the “Prescription for Wellness: Working across Boundaries”.

The aim of the workshop was to provide an overview of the effects of screens on children health and development. Coordinators of the workshop were Dr Nazish Imran, Head/ Associate Professor of Child & Family Psychiatry Department in King Edward Medical University, Lahore Pakistan and Professor Dr Waqar Azeem, Inaugural Chair of Psychiatry / Child Psychiatry for Sidra Medicine in Doha, Qatar. Dr Waqar Azeem is also Professor of Psychiatry at Weill Cornell Medical College / Cornell University, USA.


Photographed during the workshop on “Children in a Digital World” held during the Int.
Psychiatry Conference on Prescription for Wellness from (L to R) are Dr. Wamiq Ali, Prof.
Tipu Sultan, Prof. Waqar Azeem, Prof. Iftikhar, Prof. Agha Shabbir, Dr. Nazish Imran, Dr.
Durre Shahwar, Mrs. Khawar, Dr. Mohsina Najeeb, Dr. Ayesha Minhas, Dr. Shahryar Jovindah

After introduction of topic, the participants were divided into groups with one facilitator each, where they could discuss one aspect of screen time impact on children health and development and gain insight into most current understanding relevant to it. After group work and presentations from group representative, facilitators summarized the evidence base for specific areas of interest.

Dr. Aisha Sanober Chachar from Agha Khan University, Karachi discussed adverse effects of screens on Physical Health of the children. Highlighting that hheavy media use during preschool years is associated with small but significant increases in BMI, she stated results of a recent study of 2-year-old children, which found that BMI increased for every hour per week of media consumed. Dr Vaughan Bell and colleagues noted that “low levels of physical activity associated with the passive use of digital technology have been linked to obesity and diabetes”. There is some emerging evidence that the devices used to access social media and the Internet may have an effect on the body and its physical development. Anna Clark from Cardinus Risk Management highlighted that there was “research looking at backs, spines and posture” and that while the “biological make-up” of children can mean that they “tend not to get repetitive strain as often” as adults, there were ongoing studies examining “children texting with one thumb and texting with two thumbs and how it is impacting on the c-spine”.

Dr. Ayesha Minhas highlighted the impact of screen time on child development. Population-based studies continue to show associations between excessive screen time in early childhood and cognitive, language, and social/emotional delays, likely secondary to decreases in parent– child interaction and poorer family functioning in households with high media use. Children who started watching television before 12 months and watched more than two hours a day were six times more likely to have language delays. Attention problems are also associated with early screen viewing, with each additional hour of viewing/day at ages one and three years associated with a 9% increase in risk of ADHD diagnosis by age 7. A positive correlation between screen media viewing and Autism based on country data was noted by Waldman et al in 2006.

Dr. Nazish Imran (KEMU) and Dr Wamiq ((AKUH) focused on complex associations between screen time and mental health. It was observed that ddifferent types of screen time may have different effects, both in terms of wellbeing and in terms of poor mental health. Furthermore, association between screen time and low well-being was found to be larger for adolescents than in young children. Numerous plausible potential intervening pathways relate young people's mental health to the amount of time they spend on social networking sites, and the ways in which they engage and interact online. A systematic review of reviews published in BMJ in 2019 found moderately strong evidence for associations between screen time and higher depressive symptoms and poorer quality of life and weak evidence for associations of screen time with anxiety, poorer self-esteem. No or insufficient evidence for an association of screen time with eating disorders or suicidal ideation was observed. Another area that has received attention is the relationship between social media, screen-time and sleep. The young people in studies highlighted how the need to be on social media, and contactable at any time, could disrupt sleep. Furthermore, potential effects of the ‘blue light’ emitted from smartphone and tablet screens on having an effect on a chemical in the brain called melatonin is studied. Melatonin facilitates the onset of sleep.

Dr. Durre Shahwar, from CAMHS, Sidra Medicine, Weill Cornell Medical College, Doha, Qatar discussed Psychological aspects of Cyberbullying. Describing the difference between traditional and cyberbullying she noted that traditional bullying end when school ends but with cyberbullying there is no escape. Cyberbullying has a wider audience, affect children in public and private spaces from school to their bedrooms, and escalate in scale quickly due to people sharing or commenting on bullying content. The key elements of cyberbullying involve ‘boundless space, an infinite audience, unknown bully and low parental presence’. Highlighting the associational evidence between children’s experiences of cyberbullying and mental health, she gave example of a pan European study which found that 12.2% of victims of cyberbullying had viewed websites associated with suicide compared to 3.7% of people who were not involved in cyberbullying. Focusing on solutions to the issue, she discussed roles and responsibilities of social media companies, to prioritize the promotion of children and young people’s mental health and well-being across their platforms, timely, effective and consistent responses to online bullying alongside parents role as well.

Dr. Shehryar Jovindah, Child & Adolescent Psychiatrist at Shaukat Khanum Memorial Hospital, Lahore focused on psychosocial conflicts arising in adolescents in Pakistani society context due to excessive exposure to inappropriate content on social media. These psychosocial conflicts in turn leads to various negative outcomes including Agitation, frustration, Anger, Anxiety, Depression and Substance misuse.


Group photograph shows Faculty members, members of the Experts Panel and participants in
the workshop on Children in the Digital World held during the Int. Psychiatry Conference
on Prescription for Wellness, held at Lahore recently.

Towards the end Prof. Waqar Azeem and Dr. Nazish Imran mentioned the salient points and recommendations of WHO and AACAP and APA regarding appropriate use of screens by young children. They highlighted that the time limits recommendations for screen time include 0-2 Years: No screen time; 2-5 years: Limit to under one hour/ day; Upto 11 years: 2-2 1/2 hrs/ day; and avoiding screens for at least one hour before bedtime. They also emphasized that because parent media use is a strong predictor of child media habits, reducing parental media use and enhancing parent–child interactions may be an important area of behavior change.

The conference was attended by Pediatricians, Psychiatrists, Psychologists, speech therapists, school teachers, nurses & medical students. Panel of experts led by a renowned Pediatrician Professor Agha Shabbir, Professor Tipu Sultan (Paediatric Neurologist). Pediatricians Professor Haroon Hamid & Professor Iftikhar, Dr. Mohsina (Child Psychologist) and Mrs Khawar (School principal and Educator) participated in the interactive discussion and question answer session.

It was concluded that as digital technologies become more ubiquitous, pediatric providers must guide parents not only on the duration and content of media their child uses, but also on creating unplugged spaces and times in their homes to ensure that we create the good digitalized society where we take advantage of the digitalization and at the same time protect the normal development of our children.

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