Parents’ Interpretations of Screen Time Recommendations for Children Younger Than 2 Years

Abstract

Move and Play Every Day: National Physical Activity Recommendations for Children 0-5 Years was part of a suite of physical activity guidelines issued by the Australian Government Department of Health and Ageing in 2010. Guidelines included the recommendation that “children younger than 2 years should not spend any time watching television or using other electronic media.” In-depth semistructured interviews investigated parents’ interpretations and factors affecting decision making regarding screen time behaviors of their young children (from birth to 2 years). Results reveal great diversity in understandings of recommendations and confirm that unique contextual factors, many of which emerge from the micro-environment of the family home, affect decision making. Variations in interpretation may account for disparities in the awareness and effectiveness of recommendations. Results may help inform future guidelines and interventions by pointing to the need to consider the idiosyncratic nature of young families in order to have the desired impact.

Keywords

screen time physical activity recommendations parents infants and toddlers

Introduction

There is no disputing that in most homes, the use of television and other electronic media is on the incline for people of all ages, including infants and toddlers (American Academy of Pediatrics [AAP], 2011b; Campbell et al., 2013; Christakis & Zimmerman, 2009). Younger children also appear to be exposed to more “background and foreground television” than older children (Lapierre, Piotrowski, & Linebarger, 2012), with televisions frequently on all days (Australian Research Alliance for Children and Youth, 2012; Campbell et al., 2013; The Royal Australasian College of Physicians, 2004), and exposure to newer forms of screen technology also increasingly prevalent (Rideout, 2011, 2013).

At this point, there is limited research on the positive outcomes associated with early childhood screen experiences (see Danby [2015]—Early Start Conference; Brown et al., 2013; Dayanim & Namy, 2015). However, experts do note that early screen time behaviors and practices can potentially make changes in later childhood and adolescence more difficult as television and sedentary lifestyle habits become entrenched in family living and broader social norms (AAP, 2011a; Certain & Kahn, 2002; Christakis, 2009; Evans, Jordan, & Horner, 2011; Francis et al., 2011; Jones & Okely, 2011).

Based on this evidence, as well as research that identifies the role that significant adults and parents of young children play in influencing health behaviors, beliefs, and attitudes during the formative stages of child development (Campbell et al., 2013; Carson & Janssen, 2012; Pearson, Salmon, Crawford, Campbell, & Timperio, 2011), government bodies and health organizations choose to target parents of young children with recommendations, safety precautions, and interventions (De Bock, Fischer, Hoffmann, & Renz-Polster, 2010; Koplan, Liverman, Vivica, & Wisham, 2007; Pearson et al., 2011; Spurrier, Magarey, Golley, Curnow, & Sawyer, 2008; Queensland Government, 2013; Queensland Health, 2010; Sigman, 2012; Trost & Loprinzi, 2010). An example of this are the Australian Government’s Move and Play Every Day: National Physical Activity Recommendations for Children 0-5 Years (2010, 2014). These guidelines include the recommendation that children younger than 2 years should not spend any time watching television or using other electronic media (DVDs, computer, and other electronic games).

At this point, little is understood regarding the effectiveness and uptake of these types of recommendations on families with young children. This article starts by outlining the background motivation and research behind recommendations such as Move and Play Every Day. Findings from in-depth semistructured interviews with nine families with children from birth to 2 years are then shared that illuminate parents’ interpretations of screen time recommendations and the contextual factors that affect their decision making in providing access to screen time for their young children. In order for recommendations such as these to more effectively resonate with parents of young families, it makes sense to better understand not only this phenomenon (Christakis & Zimmerman, 2009) but also the unique nature of the contexts in which these behaviors take place.

Background to Screen Time Recommendations

Screen time recommendations are underpinned by evidence that points to sedentary behavior, such as television viewing, being strongly associated with excessive adiposity, and that children would be better off engaged in active games, outdoor play, and other more social pursuits (Australian Government Department of Health and Ageing, 2010; Okely, Salmon, Trost, & Hinkley, 2008; Trost, 2005). Sedentary practices, such as screen time are identified as being an independent risk factor in child obesity and a range of other chronic disease, along with diet and physical activity levels, due to fewer calories being expended during screen time compared with other sedentary pursuits (Cooper, Klesges, Debon, Klesges, & Shelton, 2006; Mota, Ribeiro, Carvalho, Santos, & Martins, 2010). Experts recommend reductions to screen time as a promising population-based approach to addressing one piece in the puzzle of the worldwide obesity epidemic, as screen time affects two contributing factors: energy intake and energy expenditure (Birch, Parker, & Burns, 2011; National Health and Medical Research Council, 2013).

Research also highlights concerns over increased media and screen use (see AAP, 2011b; Australian Communication and Media Authority, 2007; Christakis & Zimmerman, 2009) and its relationship to a number of associated health and developmental outcomes (see Australian Bureau of Statistics, 2009; Okely et al., 2012; L. Ritchie, Welk, Styne, Gerstein, & Crawford, 2005; Sigman, 2012). For example, screen-based sedentary behavior for more than 2 hours appears to unfavorably affect other aspects of social–emotional development including social skills, self-esteem, and mood, as well as other health and cognitive behaviors, including sleep patterns, and academic achievement, which may in turn affect indirectly on bodyweight and composition (Christakis, Zimmerman, DiGiuseppe, & McCarty, 2010; Salmon, Tremblay, Marshall, & Hume, 2011; Tremblay, Colley, Saunders, Healy, & Owen, 2010; Tremblay et al., 2011). There are also correlations between high levels of screen usage during infancy and toddlerhood and the impact of these behaviors on future life-course trajectory of sedentary lifestyle choices and habits, including higher levels of electronic media use in later childhood (Certain & Kahn, 2002; Evans et al., 2011).

Targeting Young Families and a Framework for Understanding Behavior

Young children are a unique population group to target in supporting the development of lifelong health and well-being behaviors (World Health Organization, 2013). Although a diverse range of factors are associated with childhood screen-based activities (such as computer games, television, and mobile phone use), parents and the home environment are noted as being significant to screen time behaviors, particularly those habits of infants and toddlers (Campbell et al., 2013; Carson & Janssen, 2012; Pearson et al., 2011). Parents and older siblings also play an indirect role in influencing very young children’s behaviors through socialization processes and modeling (Brown, 2012; Cardon, van Cauwenberghe, & de Bourdeaudhuij, 2011; DeJong et al., 2013; Spurrier et al., 2008; Veitch, Bagley, Ball, & Salmon, 2006).

An effective lens to understand screen time habits in families is through a social ecological framework. This lens recognizes that parents and children are anchored in the norms of the domestic space of the family home (the micro-environment), yet also enmeshed with factors located within macro- and meso-systems, and temporally through time and prior experiences (Brown, 2012; Jamner & Stokols, 2000). For example, parent decision making for exposing children to screens includes using screens as a babysitter, to educate children, to encourage physical activity, to maintain peace within the household, as a means for improving communication between parents and children, and as a strategy to help regulate child behavior (AAP, 2011b; Garvis & Pendergast, 2011; Rideout & Hammel, 2006). In addition, a range of broad environmental factors located outside the family home have a direct and indirect impact on family screen use (Carson & Janssen, 2012; L. Ritchie et al., 2005). These factors include the increasing availability of media-related equipment and pressure from society to purchase screen devices, as well as poor weather, and perceived safety issues affecting limiting opportunities for children to play outdoors (instead reverting to television and other screens).

The Impact of Recommendations on Families With Young Children

Although some systematic evidence exists in relation to the impact of physical activity guidelines for children and young people (Okely et al., 2012), at this point, research has not explored children younger than 5 years or decisions made by adults in supporting this age group. However, despite recommendations to avoid screens, children’s screen use of these devices continues to increase (AAP, 2011b; Campbell et al., 2013; Christakis & Zimmerman, 2009; The Royal Australasian College of Physicians, 2004). This leads to questions regarding realistic targets set by government and health authorities, whether recommendations are having the desired impact, and the types of barriers experienced by parents of young children in terms of efforts to adhere to such recommendations.

There are also concerns that interventions and recommendations to monitor practices within the home could be interpreted as a “big brother authority” encroaching on the domain of parents (Garvis & Pendergast, 2011), with a number of parental responses, particularly in blogs, social media, and online forums indicating parents finding this type of advice intrusive, overbearing, and even quixotic (see comments from blog attached to the Sydney Morning Herald newspaper article written by Edgar, 2009: “Childhood Policy Straight Out of Fantasyland”; see also parent responses to Bita’s, 2009, article: “Guidelines Call for Television Ban for Children Until Age Two”).

A common sentiment expressed within these platforms is that although parents agree that limiting children’s television viewing is a positive recommendation, they perceive these expectations as unrealistic, and not without complications, as families experience a number of obstacles in regulating children’s viewing habits (Evans et al., 2011). With little known about the screen time behaviors of children from birth to 2-years, and the decision-making processes of parents, there is a need for further investigation into the contextual nuances of the values, behaviors, and modern circumstances of families, in order to contribute to more realistic benchmarks pertaining to screen use. This study attempts to contribute to the paucity of research around this phenomenon with the intent of gaining insight into how parents receive, interpret, and understand recommendations for their very young children’s screen time (from birth to 2 years).

Method and Data

An intrinsic case study approach (Stake, 2003) was adopted for this research. This approach enabled rich and context-dependent data to be collected in order to gain an understanding of experiences and motivations unique to each site, rather than gain the perspectives of a representative sample (Denzin & Lincoln, 2005; Flyvbjerg, 2006; Hurlburt & Knapp, 2006). The case was defined as parents with at least one child 2 years of age or younger with access to at least one “screen.” These parameters were relevant to the phenomenon being investigated, as the lived experiences of parents would help inform understandings of interpretations and practices around screen time recommendations for very young children (Cohen & Omery, 1994; Grbich, 2007; Van Manen, 1990).

Nine families (nine sites) were investigated consisting of nine mothers and two fathers aged 25 to 43 years. Parents with very young children were the focus of this research based on the understanding of the behaviors of very young children being significantly influenced by the values and practices of primary carers (Baranowski, Cullen, Nicklas, Thompson, & Baranowski, 2003; Műller, Danielzi, & Pust, 2005). Ethical approval to conduct the study was granted by the University of Southern Queensland Human Ethics Committee (ID number H13REA097). Purposive sampling was used to target two early learning centers located in a regional coastal town north of Brisbane, Queensland, Australia. Both centers supported the researcher sending out a letter of invitation to parents with young children to participate in the study. Parents were recruited through these services, as well as through parent networks and several referrals. Interested parents responded via e-mail where a follow-up e-mail was then sent to organize an agreed time to meet. As government screen time recommendations was a central topic guiding the study, each parent was provided a copy of the National Physical Activity Recommendations for Children 0-5 Years (Australian Government Department of Health and Ageing, 2010) prior to the interview. Note that no definition of the word “screen” was provided to participants by the researcher as it was deemed important to gain insight into parents’ interpretations of this recommendation in its entirety.

Face-to-face recorded semistructured interviews, approximately 45 minutes in length, were conducted in the home of each family during September to November, 2013. This setting was identified as a key location to conduct the interview as it enabled the researcher to gain a contextual appreciation of each home environment where values, behaviors, and health practices are influenced, including the habits, behaviors, and screen time practices of very young children (Campbell et al., 2008; McNeil, 2010). Early in the interview process, information was gathered on the number of people living in the home, the ages of family members, and hours worked by adults in paid employment. Parents were also asked to list the number and type of screens in their house and provide a quantitative estimate of the amount of screen time that their young child engaged in.

Semistructured interviews were then initiated with the question, What are your thoughts on this recommendation? An interview guide was used sparingly, with care taken to allow parents time to reflect and add to their thoughts, without interruptions, or the researcher’s interests being imposed on their experiences (Morgan, 2011). Rapport- and trust-building techniques, such as starting the interviews with casual banter, creating an informal environment by using first names, the researcher choosing to dress in casual but professional clothing, and using body language that reflected openness and acceptance by engaging in eye contact, were a few of the strategies employed underpinned by the “CHE principles” of Connectedness, Humanness, and Empathy (Brown, 2012; Brown & Danaher, 2012). These strategies afforded opportunities to break down barriers between the researcher and participants, maximizing the authentic interactional encounters afforded by the interviews (De Fina & Perrino, 2011). A strength of face-to-face interviews was the ability to receive immediate clarification of responses and to observe body language, facial expressions, and gestures that deepened understanding of parents’ experiences (Morgan, 2011). This data collection technique allowed for the researcher to seek further clarification of responses, where expansion on a point offered greater insight into parent behaviors and values.

Recognizing that quantitative and qualitative inquiry can support, compliment, and inform each other (Feilzer, 2010; Huberman & Miles, 2002), the employment of a small but strategic component of quantitative research was included with the goal of getting inside the research problem. More specifically, this type of data would help bring to light the differences in parents’ translation of the quantifiable recommendation to their postmodern realities and also enable the gathering of parents’ numeric estimates of the amount of screen time their children were exposed to, based on the prescriptive approach adopted by the government recommendation (Australian Government Department of Health and Ageing, 2010; Jones & Okely, 2011). Examples of questions included the following:

Before being asked to participate in this study, were you aware of, or familiar with, any recommendations from government or health organizations regarding screen time for children?

After reading this brochure, could you tell me how much screen time your child has in a typical week (if any)?

Do you think this recommendation is including background media when they say “Children younger than 2 years of age should not spend any time watching television or using other electronic media”?

Do you consider it as screen time for your children if others are using screens/watching television when your child from birth to 2 years is in the room?

Later, these estimates were analyzed alongside data collected through qualitative methods to give greater insight into the contextual variation of parents’ interpretations that affected their understandings of the recommendations.

Data Analysis

Recordings of interviews were listened to multiple times by Author 2, followed by transcripts completed for each interview. During and after the transcription process, preliminary notes were made of points of interest and provocations, using Microsoft Word’s reviewing toolbar (Chenail, 2012). Transcripts were then read again to identify a thematic coding framework through which the material could be sifted and sorted. This thematic method of analysis has been successfully adopted by a number of researchers conducting research on and with families (see Dey, 1993). The process of coding consideration also included sharing and discussion of observations, interpretations, and reasoning for themes with critical friends.

Themes were informed by referring to the original research questions and patterns of particular views, experiences, and concepts as raised by parents (J. Ritchie & Spencer, 2002). Themes were also informed by drawing on a social ecological lens (Carson & Janssen, 2012; Stokols et al., 2003) to help make sense of the complex set of factors that affect the parent–child/children dyad in including factors that influence their habits, experiences, and behaviors, particularly within the domestic space of the family home (Brown, 2012; Dockett et al., 2009).

Two evaluative criteria were important for thematic findings: “plausibility” and “illumination”; that is, interpretations needed to be well supported by textual evidence and promote a new understanding of parents’ experiences (Morgan, 2011, p. 36). Four key themes emerged from interviews: that there was only a low level of awareness of the recommendations among parents interviewed, that the recommendation of no screen time from birth to 2 years was perceived as unrealistic, that variation and confusion existed in how to measure screen time, and that a number of factors existed which affected the level of screen time children from birth to 2 years were exposed to. These factors that have an impact fell under five further social ecological themes related to both the family micro-environment and the broader meso-environment: parental level of social connectivity, pervasiveness and multifunctional nature of screens in domestic spaces, using screens as a support tool, older siblings, and parenting values.

Themes comprised consistent rather than identical meanings with the intent of highlighting important commonalities of parents’ lived experience with screen time from different angles (Seidman, 2006). These themes were developed from parents’ experiences as represented in interviews, rather than forcing their words into theories derived from other sources, especially as most prior research on the topic was derived from families with older children or unspecified ages (e.g., DeJong et al., 2013; Evans et al., 2011; Garvis & Pendergast, 2011). Where possible, parents’ own words were used for labels and descriptions to give a sense of first-person engagement and to reduce the risk of forcing their ideas into preexisting theories (Morgan, 2011).

Labels were created and excerpts indexed into files for each theme, with some responses placed into more than one relevant file (J. Ritchie & Spencer, 2002). Each parent’s transcript was coded in a different color throughout analysis to mark each excerpts’ original source, with a key kept to link colors to parents’ pseudonyms and interview number. After filing excerpts into themes, transcriptions were reread file by file, marking those that stood out because they connected to each other, connected to the literature, were contradictory, or unique (Seidman, 2006). Research notes were reviewed and discussed critically between the research team, to compare and contrast perceptions, accounts, and experiences of parents, searching for patterns and connections and seeking explanations for these from within the data.

Results

Awareness of Recommendations

Only one third of parents interviewed were aware that a recommendation existed around the use of screen time for their young child, and these parents believed the recommendation was based on concerns regarding viewing content, without recognizing the physical activity considerations underpinning the recommendation. Parents who were aware of recommendations obtained this information from a community health center, hospital, or from accessing online parenting articles through Facebook and other sites. Despite not all parents interviewed having heard of these recommendations, their responses indicated that the message of keeping children active and limiting screen time, as promoted by the range of government health campaigns over the past decades (Life Be in It, n.d.; Get moving, n.d.; Unplug and play, n.d.), had filtered through, and summed up in the following comment: “It’s pretty obvious you shouldn’t be sitting your kids in front of the TV, especially with childhood obesity and everything” (Shelley).

Perceptions of Recommendations

Consistent with a study on older children (Evans et al., 2011), parents agreed that limiting television was a positive recommendation. However, the majority commented on the impracticality and unrealistic nature of the recommendation of no television or other media for children younger than 2 years using words such as “difficult” (Betty), “a bit harsh” (Shannyn), “tricky” (Angelica), “ridiculous” (Hayley), and “overboard” (Shelley). Parents indicated they accepted the existence of the recommendation as an “ideal” (Shannyn), or a “good guide” (Shelley), but would use their own commonsense to decide how much screen time they would allow their child. Although parents were unanimous in the opinion that screen time should be limited, it emerged through interviews that the interpretation of an “appropriate limit” was subjective and varied from family to family. For example, one parent indicated that she limited her daughter’s television viewing to 2 hours per day, while another indicated that she felt half an hour was an acceptable amount of screen time.

Parental Variation in Measuring and Defining Screen Time

Although the recommendation adopted a quantitative, prescriptive approach based on the rationalization that it would better facilitate ongoing monitoring and surveillance of children’s physical activity levels (Jones & Okely, 2011), the majority of parents highlighted that children’s screen time practices were difficult to define and quantify, as viewing often occurred at irregular intervals, across numerous screens, and throughout multiple environments. “What counted” as screen time also emerged as a significant theme with varying interpretations. This included debate and uncertainty over whether background TV and newer forms of media such as iPads, smartphones, and tablets “counted” as screen time in the eyes of those administering the recommendation. Underpinning this confusion was parents’ differing opinions on whether background TV had any impact on their child, usually based on how much attention they believed their child to be paying to background TV. Furthermore, there was a common understanding among parents that touch screen apps were developmentally beneficial because of their “interactive” or “educational” nature. These understandings may stem from the marketing and categorization of many apps as educational, for example, on the iTunes App Store, and possibly from research conducted with older children that supports screens as beneficial to children’s learning (AAP, 2010; Zimmerman, Christakis, & Meltzoff, 2007). In addition to background television, there was also evidence of a number of parents regularly using smartphones with their child in close proximity, and though some parents acknowledged the negative social impact of this use, most did not count this background media as “screen time” for their child.

Factors Influencing Parent Decision Making Regarding Use of Screen Time

Consistent with current literature on older children, parents’ decision making with their young children (from birth to 2 years) was influenced by a wide range of factors, including parents using screens as a coping tool or to occupy their child while doing household chores, the ease and availability of screen time, and the fact that their child enjoyed screen time (AAP, 2011a; Carson & Janssen, 2012; Evans et al., 2011; Garvis & Pendergast, 2011; Rideout et al., 2013; L. Ritchie et al., 2005).

There were also a number of factors that affected parent decision making that were unique to parents of very young children, with a significant point of difference between age groups being that physical activity guidelines for older children recommended limiting screen time, whereas with children from birth to 2 years recommendations are to avoid screens all together. This highlights a unique set of challenges that have not previously been tracked to a family level. In this study, all parents reported having screens on either for, or in the presence of, their babies at some point throughout the day. While parents spoke positively about attempting to implement small changes to reduce screen use, they admitted that recommendations to completely avoid screens came with unique challenges due to the anticipated disruptions this would cause to existing family members’ screen habits, particularly if background screen time was considered. Although a number of these factors were common among parents, there were also nuances within families that affected the variation and degree to which these factors affected their decision making.

A large proportion of children’s television viewing can be understood by social ecological factors located in the family micro-environment (Brown, 2012; Carson & Janssen, 2012; DeJong et al., 2013; Evans et al., 2011). Some of these themes included the multifunctional nature of screens in contemporary society; parents’ need for a support tool, for example, using television and tablets to distract infants while feeding them or changing nappies; the difficulty of not exposing infants to any screens while allowing older siblings access; and the perception of educational and developmental benefits of screens. In addition, screen time practices were found to be affected by factors at the meso-level including the degree or types of parents’ social connectivity.

Pervasiveness and Multifunctional Nature of Screens in Domestic Spaces

In contemporary homes, families experience multiple forms of screens, aside from television, where these devices are often multifunctional and pervasive in nature. Jason and Fries (2004) reinforce this pointing to the increased accessibility of screen time becoming “an overwhelming presence in children’s lives” (p. 125). Each family in this study owned not only a TV and computer but also at least one smartphone or tablet. These touch screen devices were used extensively, for multiple purposes, and described as easily accessible items to use with children around. Six out of nine parents in this study reported their infants’ use of mobile devices for watching television shows, movies, cartoons, or video clips from the Internet.

Several additional examples of the changing nature of contemporary living spaces and lifestyles emerged from the data. The first factor was in relation to the physical layout and degree of open and shared spaces in many homes that could significantly affect accessibility to screens and screen time behaviors. Parents also commented on screen use being dependent on how freely children moved about the house, whether they had a separate playroom, the arrangement of living areas, and location of screens. A second point aligns with Australian statics and trends (Australian Bureau of Statistics, 2011a, 2011b) that highlights a shift in our society, where adults’ time is being increasingly spent with online, electronic, and audio/visual media. Parents shared a number of ways they used audio/visual media beyond watching television including using their computers, tablets, and smartphones for reading recipes, social networking, e-mail, “googling,” downloading movies, running online home businesses, and reading books.

Using Screens as a Support Tool

Viewing the data collected from a strength-based perspective (that looked at the contributions and positive aspects of parenting practices), parents demonstrated having good intentions when it came to raising their family, yet often required support in juggling this important duty alongside the many other tasks they faced in their daily lives. Common themes that emerged were parents using screens as a support, as a “babysitter,” to entertain, and or to distract their babies. They often expressed that they felt some screen time was okay if they used this time to complete chores, as opposed to “doing it just so that you could get them out of your hair” (Shelley). Data highlighted the idiosyncratic nature of screen time used for support, particularly in relation daily routines and experiences. For example, one parent used an iPad to distract her baby and quickly feed her when she was getting an older son ready for kindergarten. Another parent played music clips on TV to dance and engage with her daughter in the living room, while another carefully timed her daily routine so that dinner preparation aligned with the scheduling of “educational children’s shows.” Though parents often planned not to use TV, being “originally quite against it” (Naomi), after their child’s birth, this decision was often modified to one of using TV in moderation.

Older Siblings

Parents often directed the focus of the interview to their older child’s screen time, with comments on the lack of interest their baby showed in television and other media indicating that they perceived the issue of reducing screen time to be more relevant for their older child than their children from birth to 2 years. In some cases, parent perception that their infant was not interested in screens resulted in less screen time being offered to infants, because “there would be no point turning it on.” However, in regard to infants with older siblings, the perception that infants were not paying any attention to the television often resulted in them having more exposure to background screens because their parents did not view it as affecting them, therefore, seeing little need to limit this exposure. Parents with multiple children often shared an opinion that while they would not like to force their child to watch TV, such as in a high chair or playpen, they were comfortable with having TV on in the background.

Some parents with multiple children reported that as a result of having a second child, the older child watched more television, as they were now busier caring for the infant. This in turn resulted in more background TV for the infant. This pattern sees infants as embedded within an environment of reciprocity where they are not only both “active agents” that influence a phenomenon but are also affected (Bronfenbrenner, 1979).

Parenting Values

The personal preferences and micro-environment of parents and families influenced their decision making in offering screen time. For example, some parents appreciated a quiet environment, while others preferred noise, with a number of parents suggesting their children held the same preferences. Parents also talked about values for their child’s development as contributing to their decisions regarding screen time. Parents felt less screen time was offered when both parents held similar values for limiting it, rather than settling on “a happy medium.” For example, one mother commented on differences in parental values, where there was a priority for her family to eat dinner together at the table, while her husband regularly watched the news from the table at this time.

There was great variation in the types of experiences parents valued and, therefore, offered to their children (including physical activity opportunities, language and cognitive development, social and emotional development, and music and creativity). The prioritizing of these experiences affected the amount of screen time offered and were dependent on whether parents perceived screen time enhanced, or hindered particular areas identified as being of value. Some parents who placed a high value on language development offered their child time with “educational” TV programs or touch screen apps, while others who held the same values limited these with the view that “more screen time means less language” (June).

A key objective of the recommendation that children avoid screen time was to increase opportunities for physical activity (DoHA, 2010; Jones & Okely, 2011). In this study, this aligned with the values of a number of parents who valued physical activity and outdoor play and, therefore, chose to minimize screen time. Of interest to note was a number of parents who chose the use of screens to facilitate and encourage physical activity with their young children through activities such as dancing to music clips on the TV. The screen time recommendation includes the statement, “Regardless of how active children are at other times, it’s still important to limit screen time.” This is consistent with previous studies conducted with older children that uncovered conflicting findings, with some researchers stating that each hour spent viewing media reduces children’s time for active play (Jason & Fries, 2004), and others that found no association between screen time and outdoor play (Spurrier et al., 2008; Vandewater et al., 2007). Some parents offered quiet activities, such as coloring and painting for their child to relax, while others felt that if their child was going to do something inactive, it made no difference if this activity was associated with screen time or an alternative restful activity such as reading a book.

Parental Level of Social Connectivity

Parents actively sought out ideas on screen time through connecting with the people around them, such as their community, social groups, and extended family. Parents’ level of social capacity, and the degree to which they engaged with and gained information from others, significantly influenced their decision on the amount of screen time for their child, as this socialization offered opportunities to hear about and consider ideas on screen time. Occasionally, this led to ideas about the benefits of screen time; but more often, it generated ideas about limiting screen time from a young age by getting into the habit of turning televisions off after use, and offering more concrete items for babies and toddlers to engage with. This theme aligns with Campbell et al.’s (2013) findings that parents’ preexisting social networks offer an effective opportunity to promote knowledge, skills, and strategies for healthy child behaviors. However, data from this study indicated that the witnessing or hearing about the negative effects of excessive screen time on other children was also an influential factor on parents’ developing their own views and parenting practices, with many looking at people familiar to them as “case studies on what not to do” (Angelica). These sentiments are captured in a comment by Sarah:

I think just, seeing what other people have done and what their kids turned out like, I think that’s just more of a scare than any recommendation is.

Consistent with Pearson et al.’s (2011) findings, parents’ concern for their child’s excessive viewing did not translate into limiting screen time. Many expressed that the recommendation had affected their level of consciousness regarding this issue, but not on their decisions and actions, indicating that other factors within their micro-environments may have been more influential on decision making. An interesting point to note was that in several cases, despite parents initially conveying that they were unlikely to modify their practices as a result of reading the recommendation, the interview process was in itself a “social process” that acted as an “eye opener” (Naomi) causing parents to reflect on the changes they felt they could make. This process was evident on a number of occasions where, after the formal interview process and after further reflections on their parenting practices, parents would approach the researcher and share news of reducing screen time in their homes as a result of personal reflection stimulated by the interview, and having later considered a number of the ideas shared in the newsletter provided to parents after their interview.

Data analysis indicated that despite the pervasiveness of screens, the need for screens to be used as a parenting “support tool,” and the challenges associated with older sibling television viewing, parents were innovative, and quite often proactive, in implementing strategies that limited the amount of screen time offered to infants and toddlers. These strategies included putting music on instead of TV, waiting until baby was asleep to use screens, proactively seeking out opportunities for active experiences outdoors, involving children in housework, sharing responsibilities between parents (e.g., one cooking dinner, while another plays with baby), limiting access to screens (e.g., keeping the car screen free), and trying other approaches to entertain and distract their baby such as playing games, cooking, and reading.

Discussion

The purpose of this study was to examine and describe the interpretations and practices around screen time recommendations of parents with very young children (from birth to 2 years). The authors acknowledge the methodological limitations of this study, particularly the specific focus on the richness of the lives of the small number of participants, and so care should be taken in drawing conclusions due to its exploratory nature. Nevertheless, although the participant group was specific to certain points of time, data advance the understandings of the minutia of individual families in relation to this phenomenon. The study also highlights that parents interpret government health messages in multiple ways and are influenced by a range of contextual factors. Although a much larger sample is required to verify that there are distinguishable patterns of impact, one tentative conclusion that may be drawn is that the screen time recommendation for very young children may not have had the desired impact. A number of recommendations for a number of strategies for better connecting with this sector of the population and ensuring recommendations better resonate with them are discussed below.

Considering the bombardment of messages to families, and the prevalence of public scrutiny and judgment of modern parenting practices, the authors suggest that greater sensitivity needs to be given to the language used in conveying health messages and recommendations to parents of young families so that parents are open to these types of messages. Adopting a language that is strength-based (that acknowledges the contributions and positive aspects of parenting practices), respectful, and enabling would go a long way in connecting and better conveying health messages, and other recommendations, to parents. Empowering parents to create their own solutions to these sorts of issues could start with a statement that acknowledges that parents of young children have their best intentions at heart. A series of reflective questions could then be posed as part of online recommendations or brochures.

Results of this study highlight the importance of ensuring health messages are effectively received and interpreted by the target audience. Some parents did not receive the screen time recommendation or did not consider that it was directed at them, as they perceived their practices and level of allowances for their child as acceptable. Considering that evaluation is an important component in establishing if a health intervention has had the desired effect (DHS, 2003; World Health Organization, 2008), it is recommended that the intervention be further evaluated to determine the percentage of the target population that have received the guidelines, and explore ways in which these have has been interpreted and understood by a larger sample.

A critical aspect of this recommendation is understanding the parameters “what counts” as screen time; therefore, future recommendations would value from more clearly defining and providing examples to illustrate key terms such as these to parents. This could include providing obvious examples such as images of infants in bouncers sitting passively in front of televisions and highlighting concerns in relation to these practices, as well as more subtle examples of “background television” being counted as part of the recommendation and what this would look like. Additionally, the inclusion of examples that highlight the pervasiveness and accessibility of infants and toddlers’ experiences with other types of screens including iPads, smartphones, and tablets, and these being “counted” as screen time in the eyes of those administering the recommendation would also be important inclusions for future recommendations.

Findings from this study are consistent with research with parents of older children, in that both groups face a number of difficulties in meeting government recommendations to limit children’s screen time (Evans et al., 2011). However, recommendation that this age group completely avoids screens raised a number of unique challenges. The authors suggest that understanding the contextual factors and unique challenges, behaviors, and values that influence parent decision making about screen time may have important implications for future health intervention. Future recommendations could also include the addition of some “problem and solution” scenarios that provide examples of strategies to overcome difficulties in limiting screen time experienced by young families. This could include ways addressing background screens by considering the location of screens and the physical layout of leisure/play spaces by creating play spaces away from those in the immediate lounge room, such as play spaces in bedrooms, so children are not playing around screens. Another example could be providing examples of screens being used as a parenting “support tool” and contrasting this with innovative strategies devised by parents that did not require screens including putting music on instead of TV, waiting until baby was asleep to use screens, proactively seeking out opportunities for active experiences outdoors, involving children in housework, and sharing responsibilities between parents.

Consistent with other research conducted on health interventions (Australian National Preventive Health Agency, 2012; National Cancer Institute, 2008; Public Health Association Australia, 2010; Shanahan, 2000), this study recommends that clearer messages need to be delivered to parents by adopting an integrated, multipronged, and sustained approach to effectively increase parents’ awareness of this recommendation and the rationale behind it. Suggestions in adopting such an approach could include examples and definitions of screen time provided with online recommendations. A range of online strategies could showcase ways of overcoming difficulties in limiting screen time for infants and toddlers including limiting background screen time by turning the television off and turning music on, providing active play materials to children, or encouraging family outdoor play time.

Another approach could include parents sharing proactive strategies with their peers through case study examples online, or as part of ad campaigns. In the case of screen time recommendations, this could include building on the findings of this study in terms of the value parents placed in learning from and with other parents. Scenarios or case studies could include parents sharing with other parents (social connectivity) strategies for limiting screen time and choosing not to use screens as support, as a “babysitter,” to entertain, and or to distract their babies (e.g., using an iPad to distract their baby and quickly feed them). These types of strategies may support parents in devising context-specific and more relevant goals that can better account for the diversity of individual families and environments. These types of message may also be received better by parents are they may be seen as not being “talked down to.” Case studies or scenarios could also be included to compliment online information and recommendations.

Conclusion

The findings from the current study build on research conducted on screen time practices of older children by raising the importance of, and contributing to, the exploration of parents’ understandings of screen time recommendations and practices for very young children fron birth to 2 years. The study found that parents hold a number of positive ideas about limiting their child’s time with television and other electronic media, yet also face a number challenges in implementing recommended practices and strategies. The moderating role of context emerged as a significant determinant in the environments of young families, with factors often unique to parents with young families. These ecological factors challenge researchers and practitioners in population health to further consider the nuanced nature of contemporary families and the domestic space of the family home.

Footnotes

Acknowledgements

The authors would like to thank the nine participating families for their contributions to this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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