Thursday, November 29, 2018

Worried about classroom screen time?
Ask the right questions
  
The schools' demands for ever more digital device use has parents worried, and for good reason. Many moms ask me, "How much screen time is safe for my child?" But focusing exclusively on the amount of screen time may not get to the heart of the matter, because it's just too complicated a health issue for a cookie-cutter solution.

The best way to approach the problem is to have a complete examination of your own children's health and their specific requirements so you can protect them. That's a concrete determination from medical professionals that cannot be refuted by the schools.

This means a full physical and a dilated eye exam (be sure to ask about dry eye disease, too - it's critical) and a full understanding of the kids' overall habits as they impact sleep, healthy weight, mental health, academic performance and overall healthy development.

Are your children becoming nearsighted? Overweight? Having trouble sleeping? Depressed or anxious? Unable to stop using a device? These health issues are all directly associated with daily use of devices. Armed with data about your own children's health, you can ask for specific adjustments in the classroom, based on your doctors' perspective and your role as a parent. You can demand that your child's health is not negatively impacted and remind the teachers and school administration of their legal obligation to provide a safe learning environment (their "duty of care").

Next, ask for a full accounting of your own children's daily screen experiences at school and the schools' requirements for more screen use at home for studying. Determine if proper seating and lighting are employed in the classroom, per the manufacturers' safety warnings. This is where it gets very interesting.

Is your school heeding manufacturers' safety warnings?

Few - if any - central offices actually share the manufacturers' safety warnings with the schools, the teachers, the students or the parents. There are hundreds of pages documenting the safe use of this equipment to avoid what HP and Dell (makers of Chromebooks, by the way) describe as "serious bodily harm."

The makers of the equipment have already done all this homework; the school systems are just conveniently not sharing it - or heeding it. How many schools allow students to sit humped over screens, or balance the devices on their laps? Laptops were never intended to be used as full time workstations - they are ergonomically unsafe, and need to be mitigated with a monitor stand for proper height (adjustable, for growing children), an exterior keyboard and an exterior mouse.

Here are some links and details to share with your school.  Request that their digital devices are used in a safe manner - which means employing the manufacturers' guidelines for health and safety:

It becomes evident very quickly that "screen time" is only part of the problem. How the devices are configured, the lighting in the room and the glare on the screens, the lack of recess and sunlight (which profoundly increases myopia risks in growing kids who are already predisposed for nearsightedness) and homework on a device (ruining sleep, and adding to obesity, anxiety and related conditions like diabetes) play just important a role in negatively impacting our children's health as the amount of time they're on the devices.

Taking frequent breaks, stretching and blinking are key health components, for instance, that often get overlooked in screen health conversations. These simple healthy opportunities are all but impossible in a standardized testing environment, which can last as long as 110 minutes per unit for growing kids who are helpless to protect themselves from being literally hurt - blurry vision, dry eyes, headaches - from the tools the schools insist they use.

At the bottom of my last blog entry, I've offered specifics suggestions for schools to follow. It's long and detailed for those who want substantial research, but should help get some conversations started for those who just want the basics. Hopefully, it will help you fast track the conversation.

Q: How do you push back against the language from teachers and parents who say "but this is the society they live in.  Phones etc. Are all part of that."

I tell them that the future for which they are preparing their children should be the healthiest possible and that they are enabling their children's health to be destroyed - now, and in the future. When kids get damaged while they are still growing, the long-term impacts are significant.

Severe myopia will blind thousands of children who are staring into screens at school right now because, while it may just be a new pair of glasses every year while they're young (and if they're lucky), the long-term result may be glaucoma or retinal detachment.

Retinal cells are being destroyed by the screens' blue light. They're not coming back, and that will lead to macular degeneration, a blinding condition, that used to be reserved for very old eyes. Children's eyes lack the lens pigmentation adults have developed that mitigates some of this retinal cell death, making children the most vulnerable to long-term damage.

Little kids are obese, getting asthma, and suffering from hypertension. Little kids. These same kids will needlessly suffer heart disease later in life.  It's absolutely unconscionable, especially when some common sense measures like additional recess and no online homework could go so far to protect them from this avoidable misery. Avoidable misery caused by their schools.

Protecting children's health is not mutually exclusive from benefiting from the devices they're using. We must have both. That's what I tell parents - when I can get them to look up from their own phones. And teachers? I remind them that they are legally obligated to provide a safe learning environment, and that must include the safe use of the schools' hazardous digital devices. Just like OSHA provides office workers, and has since the 1990s.

Cindy Eckard

Wednesday, November 14, 2018

Business as usual: MD State Department of Education defends its digital curriculum, instead of our children's health 

Maryland's landmark classroom screen safety law went into effect July 1, 2018. Passed unanimously in the House and Senate, and swiftly signed by Governor Larry Hogan, the bill establishes a state mandate to the Maryland State Department of Education (MSDE): consult with the Maryland Department of Health and develop Health and Safety Best Practices for Digital Devices to protect both public and private school children from the well-documented health risks posed by daily classroom digital device use.

However, MSDE has instead continued its established pattern of ignoring the serious health impacts of digital device use and assigned its classroom technology proponents, not MSDE student health experts, to draft these critical digital device best practices.

The following letter was written to the Maryland Board of Education President, Dr. Justin Hartings, and the other Board members, asking that they intercede to correct the situation, and make sure that MSDE student health experts are included in drafting protections for our children.

The letter includes the response from MSDE's staff when asked why student health experts are not involved in this landmark effort to protect students from epidemic myopia, obesity, addiction, sleeplessness, anxiety and depression - all of which are associated with the schools' demand for ever more digital device use.

Suffice it to say, it's business as usual in Maryland right now. Advocates for children's health and safety should contact their elected officials, the Maryland State Board of Education and Governor Hogan's office.  A review of this process is desperately needed.

A practical guide to classroom screen safety best practices follows below; it has been provided to Maryland Department of Health, to MSDE and to the State Board of Education. Let's hope that this landmark effort does not get whitewashed and a meaningless set of best practices is offered instead.

As it stands now, MSDE is promising a computer safety video, produced by Maryland Public Television (MPT) - the same people who promote ever more screen use at school and at home. Interestingly, MPT is responsible for professional development training for Maryland teachers; MPT and PBS are among the biggest proponents for the schools' digital agenda.

Hardly the health advocacy that the Maryland General Assembly had in mind when the lawmakers unanimously passed this critical effort to protect our children.

Ongoing research is shared routinely on the Twitter account, @screensandkids. Please follow that account for the latest developments on Maryland's screen safety law as well.

Cindy Eckard
www.screensandkids.us
@screensandkids

 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

October 30, 2018

Dear Dr. Hartings and Members of the Board,

I am writing to request that a recent Maryland State Department of Education (MSDE) staff assignment is reviewed and corrected, to ensure that MSDE is appropriately fulfilling its legal obligations to implement HB1110: "Health and Safety Best Practices for Digital Devices," and to address the current appearance of impropriety as well.

The irrefutable public health threats associated with digital device use by children convinced the General Assembly to pass HB1110 during the last legislative session. The law requires MSDE to consult with the Maryland Department of Health (MDH) and draft health and safety best practices by June 1, 2019, to be presented to the local school districts by July 1, 2019.

The lawmakers recognized that as a consequence of using the schools' digital devices every day (and night, for studying), Maryland students are at risk for serious health problems. For example, the negative impacts of daily digital device use increase students' risk for myopia, obesity, sleeplessness, anxiety and addiction.

The bill was supported by the Maryland State Medical Association (MedChi), the Maryland Chapter of the American Academy of Pediatrics, Prevent Blindness, the Mental Health Association of Maryland and the Maryland Occupational Therapy Association, in addition to several pediatric specialists and child health advocacy groups nationwide.

"Educational" applications equally hazardous

The fundamental understanding expressed by the medical community in its support of the legislation centers on the use of the equipment itself, not on the content - in short, "educational" applications pose the same degree of physical health risks to children as any other use of digital equipment. Practitioners describe this situation as a public health issue facing our children, at the hands of the schools.

With unanimous support in both the House of Delegates and the Senate, and a swift signature from Governor Hogan, this new law establishes a clear state mandate: MSDE must protect Maryland students from the known health hazards associated with the schools' digital devices by drafting health and safety best practices.

However, MSDE has recently assigned its leading digital learning proponents - rather than student health experts - to draft the health and safety best practices for digital devices. This choice casts serious doubt on the Department's commitment to protecting the health of students or faithfully implementing the law. Rather, the Department now appears more interested in protecting its own digital curriculum than it is, the health and safety of Maryland students.

Last month, I met with MSDE administrators who were originally identified as project staff members for the creation of best practices. I was assured that the health concerns which instigated the law would be adequately addressed by school health experts. Now I'm told that the administrators and staff with whom I met have been replaced by leaders of the digital learning initiatives.

In a conversation last Wednesday (October 24th) with the Department spokesperson, no explanation was offered for the transfer of responsibility from the MSDE division that routinely handles school health matters, to the digital curriculum division.

When I questioned the change in oversight for these critical student health concerns, the spokesperson responded, "MSDE teaches; that's what we do." He continued, "The Department of Health is responsible for the health of children." He saw "no issue" with the state's leading technology curriculum proponents drafting MSDE's student health and safety best practices for digital devices.

This situation is intolerable and indefensible.

The Governor and the General Assembly have given MSDE a mandate to correct serious public health threats posed to our growing children through the schools' demand for digital device use every day. In response, the Department has shown a complete disregard for student health, and assigned unqualified staff - who also happen to be the most influential MSDE digital device advocates - to carry out this critical effort.

The spokesperson confirmed this dynamic on the phone with me, verbalizing that classroom health issues are not among MSDE's priorities; indeed, he suggested that MDH alone was responsible for addressing student health risks, while the focus of his Department was singularly curricular. "I don't see an issue here at all," he said.


The notion that MDH has become responsible for implementing this law has been voiced by other MSDE staff as well, which implies an abdication of responsibility.

While MSDE's digital platform may be the Department's sole priority, Dr. Hartings, it is hardly its sole responsibility, especially within the specific implementation of this law.

Long-standing Responsibility for Student Health

The schools' obligation to student health issues is long-standing and far-reaching, from vaccinations, mental health, nutrition, dental health, vision and hearing screenings and safe playgrounds, to sexually transmitted diseases and limiting screen time for child care centers, to name just a few. And while the MSDE spokesperson claimed only one staff member was medically proficient and "couldn't be everywhere at once," the fact is, significant numbers of school health staff are employed by MSDE.

By failing to include its own medical professionals in this critical effort to mitigate serious classroom health threats to Maryland students, the Department has failed to embrace the gravity of the physical and emotional risks its digital equipment is imposing, while it ignores its responsibilities as defined by statute.

It is more than disheartening to hear the Department spokesperson disavow responsibility for student health; it speaks to negligence. The Department has both a social contract and a legal obligation to provide a safe and healthy learning environment for all Maryland students. The sole responsibility for implementation of HB1110 is legally that of MSDE, not MDH, which is required to serve in a consulting capacity only.

Department has known about digital device health risks

The Department has been well aware of the risks to students for years, and has taken no initiative to protect our children.  The negative health impacts were brought to the attention of the Department in 2015; the legislation was originally introduced to the General Assembly in 2016. The Department was made aware that OSHA has regulated the daily use of computers for decades to protect adult users from avoidable harm. State testimony that MSDE knew about also revealed that the equipment manufacturers themselves provide extensive safety warnings which explicitly inform consumers that "serious bodily harm" can ensue if safety warnings go unheeded.

The very MSDE staff now assigned to lead the health and safety best practices effort are the same who neglected to perform any due diligence for safety risks associated with classroom devices in the first place, and ignored the well-documented health warnings that have been published and broadcast in medical journals, radio, television, newspapers, and online media and shared in state testimony. They instead continued to encourage increased use of hazardous equipment, without any regard to our children's health, which is what prompted the introduction of the original legislation.

Now it is law. The Department should finally roll up its sleeves, get all of its health experts together, and work with MDH to get our kids the protections they need and are legally owed - at last. The serious nature of the ailments related to the schools' equipment dictate that qualified MSDE student health staff are part of the solution. Our children's health needs defending, not MSDE's curriculum.  It is essential that the health and safety best practices for digital devices provide meaningful protections to ensure our children are not physically or emotionally damaged by their schools' demands.

Mandate from Maryland General Assembly

MSDE must carry out the will of the people as unanimously voiced by every member of the General Assembly and the Governor. The prolonged appearance of impropriety will only add to the public's significant distrust for MSDE, a distrust which is guaranteed to expand if this situation isn't corrected. And while the legislation does not require it, the creation of any sound public policy, of course, requires input from stakeholders. Interim updates on the progress of this landmark student health initiative would also serve the public interest.

I am attaching substantial documentation to help you better understand the serious health risks now threatening Maryland students. I've shared this research with leadership in both MDH and MSDE and included specific suggestions for mitigations as well.  Ongoing research is also posted on my Twitter account. It has well over 500 followers, that include JAMA Pediatrics, the Pediatric Academic Society, the USC Roski Eye Institute, AAP leadership as well as national education leaders and national parent groups - many of whom are watching this Maryland policy-making, with a hope of replicating it in their states.

I hope I can look forward to a response from the Board, as little meaningful communication from MSDE appears to be forthcoming, despite several attempts to discuss this with members of its administration.

Sincerely,



A GUIDE TO CLASSROOM SCREEN SAFETY
provided to the Maryland Department of Health, the Maryland State Department of Education, and the Maryland Board of Education, Fall, 2018

Background Notes:

Assumptions regarding educational versus recreational device use must be addressed and dispelled to ensure that teachers, administrators and parents recognize the fundamental medical hazards posed by the devices themselves, independent of the content. "Educational" applications are just as damaging to a child's vision, for instance, as any other content.

Growing children are not just small adults; they are developing in specific stages and at different rates, without a full set of adult physical or psychological capabilities. As such, children are more vulnerable to the hazards posed by devices. Students will suffer more serious damage due to those vulnerabilities, because the related health risks are cumulative and the schools are demanding use of devices at ever earlier ages.

Students using devices in an unsafe way will likely suffer a greater variety of long-term co-morbidities as well. For instance, online homework is associated with melatonin suppression, leading to sleeplessness, which contributes to obesity, diabetes and heart disease. Severe myopia is associated with a higher risk of glaucoma, retinal detachment and cataracts later in life.

Because the schools are requiring daily device use from students, starting at a very young age, and continuing throughout these developmentally critical stages, extreme caution should be applied when demanding the use of school equipment - equipment that has been regulated for adults by OSHA since the 1990s.

New technologies poised for classroom use -  including virtual reality tools and applications - will bring even higher levels of risk to Maryland students. It is within this context of increased digital exposures that policy makers must make responsible, well-informed, regulatory and purchase decisions to protect students from known - and future - classroom hazards.

The burden of safe hardware configurations appropriately rests with state vendors who are aware that laptops are not designed to be used as full-time workstations. Therefore, according to the manufacturers, the devices must be retrofit with peripherals to establish a safe work environment for students. Those peripherals are necessary to ensure the ergonomic safety of all students, regardless of age or height.

They may include a mechanism for raising the monitor to the appropriate eye level, an external keyboard, and an external mouse. Peripherals that ensure student safety should be part of any future purchases, but do not represent a significant cost to the state. Simple, low-cost, adjustable kickstands, for instance are readily available.

MEEC can certainly require appropriate configurations when writing its RFPs. Demanding safety from all vendors will go a long way in making the bids more competitive.

Finally, a theme runs through most of the documented medical hazards posed to students by these devices, and is echoed in the suggestions for mitigating many of those risks: keep the school's digital devices at school, and stop requiring students to take them home and use them at night. 

The cost savings that the state will realize in reduced maintenance, repair, and replacement costs will be astronomical (the cost for a carrying case alone is between $35-$50 per student). Keeping the devices at school will also increase classroom productivity because the devices will be intact, operable, charged and ready for use in class when needed.

Many of the documented health risks to Maryland students posed by daily use of the schools' digital devices are listed below, with suggestions to mitigate those risks. I have omitted references to radiation and wi-fi routers, since ample documentation is already compiled by MDH. I have also omitted any reference to cell phone use as those devices are not school-issued.

Extensive additional medical references, studies and reports are available on my website www.screensandkids.us. The links contained herein are provided for your quick access to some of the more definitive or recent scientific evidence, underscoring the need for the best practices you are tasked to develop.

RISKS TO STUDENTS' EYE HEALTH AND VISION


- epidemic, nationally and world-wide; use of screens recognized internationally as major cause
- exacerbated by fixed, near work and lack of exposure to the sun
- genetic predisposition among Asian, African-American and Hispanic populations
- developmental predisposition among 11-15 year olds
- often undetected due to lack of proper eye exams
- blurs vision; interfering with academic, athletic abilities
- progressive; can lead to blinding conditions such as glaucoma, retinal detachment and cataracts

SUGGESTED MITIGATION:

- Schedule device use within grade levels to ensure routine breaks from screens on a daily basis. For instance, when device use is required in the first period, it must take place in the first 20 minutes of class. The next 20 minutes would be used without screens. Then in 2nd period, device use would also take place during the first 20 minutes, followed by a break. Third period, the same first 20 minutes. Each grade level team could determine what part of the class they would prefer, as long as the use and breaks were consistent throughout the school day.

- Increase recess and outdoor classes. Sunshine has proven to be a key factor in the mitigation of myopia. It stimulates dopamine in the brain, which helps to curb the elongation of the eye that is taking place when the child grows. That elongation helps to create the refractive error.

- Work toward increased eye exams - not just vision screening - for all students. The schools may be unwittingly exacerbating pre-existing conditions; one third of all students needs a comprehensive eye exam.

- Begin public health information campaign to alert families to risks at school and at home from excessive screen time; strongly encourage more breaks and more outdoor play.

- Develop classroom posters that remind teachers and students to take breaks; duplicate posters as flyers to be used at home.

- Develop classroom contracts similar to those needed for science class that outlines for the teacher, student and parent what the risks and mitigating practices are regarding the safe use of the school's digital devices (emulate the approach used for lab equipment).


- Hazardous blue light is absorbed more by children because their lenses have yet to develop the protective pigmentation that provides adult eyes a bit of protection from retinal cell destruction caused by blue light, emitted by digital device screens.

- The light travels to the back of the eye - the macula - and the process permanently destroys the cells needed to see. This process has been recognized as part of aging. It has been called age-related macular degeneration or AMD. Today, signs of macular degeneration are being seen in much younger patients as a result of screen use.

- Blue light suppresses the production of melatonin, the hormone that regulates sleep. Sleeplessness is directly associated with anxiety, depression, poor academic performance, and obesity. Obesity is epidemic among children today and leads to heart disease, kidney disease and diabetes.  That's why the American Heart Association published a statement this summer calling for screen time limits for children.


SUGGESTED MITIGATION:

- Blue light filters should be installed on every school-issued digital device and made a basic requirement for all future RFPs.
- No homework should be assigned on devices. Schools cannot control the time which students use the schools' equipment, and therefore, could be contributing to the interruption of critically important healthy sleep patterns, since many students are doing homework late in the evening.
- To protect students from the serious risks posed by blue light exposure, the use of screens in the classroom should be limited to actual school work; "free play" or "quiet time" should not be spent using devices.


- Children (and adults) blink 67% less often when using digital devices, which has caused a significant rise in dry eye disease symptoms in younger patients. Severe dry eye can permanently damage the cornea.
- Dry eye disease and computer vision syndrome are closely related since the symptoms can overlap: red, scratchy eyes, blurred vision, headaches and tearing.
- The student's discomfort can interfere with academic performance since the child finds it difficult to concentrate. Moreover, if children are accustomed to experiencing this discomfort, many will find it "normal," and not report it to an adult.
- Sore necks, back pain and shoulder discomfort are also related to computer vision syndrome, as those muscles can also affect a student's vision. 
- Undetected, unreported chronic eye discomfort can be a sign of more serious conditions and permanently damage children's eyes and vision.

SUGGESTED MITIGATION:

- Adhere to manufacturers' safety guidelines for safe workstation settings to include monitor height, monitor angle, and proper settings for glare and contrast (and audio settings - which are often ignored, and necessary to protect students' hearing).
- Review classroom seating and overhead lighting to minimize glare and reflection from windows or other light sources.
- Ensure proper ergonomic posture among students; require proper posture to avoid muscular discomfort.
- Train teachers and school nurses to recognize the signs of discomfort when children are using devices, and develop policies to offer paper alternatives whenever possible.
- Teach children to recognize and report their own symptoms of dry eye or digital eye strain.
- Make these issues part of the overall public education component (classroom posters and letters to the home) for digital device screen safety.
- In all cases, encourage parents to provide a full eye exam for their children and establish a policy of uniform, scheduled breaks from the screens throughout each school day.

ADDITIONAL CONSIDERATIONS

There are many additional health and safety concerns that must be addressed in your deliberations, chief among them:

- fundamental cultural biases within the school climate that encourage ever-increasing screen use
- little awareness of screen addiction; it is exacerbated by the constant demand that students use devices regardless of healthier alternatives that would serve the same purpose, and also made worse with the increase of educational "gamification"
- little understanding of the associations between screen use and mental health issues: anxiety and depression are sharply rising and suicides have tripled among teenage girls in recent years

A clear understanding of the educational benefits and health risks posed by these devices must emerge so that they are used to their best advantage, without harming students in the process, visually, physically, or psychologically.

Wednesday, June 13, 2018

Moving forward: 
Next steps for MD classroom screen safety

Maryland Governor Larry Hogan was quick to protect students across the state when he signed the nation's first classroom screen safety legislation into law on April 24th, just weeks after the state's General Assembly voted unanimously in favor of the bill.

HB1110 goes into effect on July 1, requiring the Maryland State Department of Education (MSDE) and the Maryland Department of Health (MDH) to draft health and safety best practices for the state's classroom technology tools.

Their work will be presented to both private and public Maryland schools within a year. Though not required by the legislation, it is expected that most school districts will adopt the MSDE best practices in their classrooms.

This landmark legislation and its passage reflect the significant, indisputable and mounting research that illustrates the multitude of serious, negative impacts posed by daily digital device use on children, affecting their physical and visual health and their emotional well-being, now and in the future.

The real work is just beginning, but the science is already available

The real work of identifying safe thresholds, along with the appropriate hardware configurations and settings, that might enable children at varying stages of growth to use the schools' digital devices without being harmed must be based on solid information, not on band-aid attempts to cover up serious health risks. Or attempting to dismiss valid concerns.

It is the use of semantics alone that contributes to any "debate" about classroom tech tools and health risks since much of the necessary background information is already documented. Research has been available about the ill effects of using computers unsafely since the 1990s when OSHA first regulated their use for office workers. The health impacts on students now required to use electronics every day at school are worse, because they're growing children who are even more vulnerable.

Device manufacturers have also drafted safety warnings and published user guides that identify and define the safe use of their equipment. Their recommendations, combined with the data from government agencies that already regulate technology equipment, should help form the initial knowledge base for Maryland policy makers.

Substantial Medical Documentation

The following medical studies and reports were all shared online just last month; it is only a small sample of the new and growing data that underscore the health risks students face.

From epidemic myopia and obesity to retinal damage, sleeplessness and soaring suicide rates among our children, the alarms being sounded by the medical community should be a wake-up call to schools, parents and pediatricians. Daily digital device use in any setting - including a classroom, where kids spend the majority of their childhood - poses a public health risk to growing children if not used safely. 

Catchy suggestions such as the "20-20-20 rule," are no substitute for addressing the serious risks to children's eye health and vision. In this Optometry Times article, Dr. Brian Chou concludes that "the 20-20-20 rule became famous for being famous... No peer-reviewed studies to date have validated, let alone evaluated this technique."

It's important to note that most of the following reports also contain additional citations to even more scientific evidence, illustrating the myriad health impacts our children now face.

Health risks associated with (HEV) blue light emissions 

Review of Optometry
Seeing Blue: the Impact of excessive blue light exposure

An optometrist who was also a middle school teacher, Dr. Heather Flint Ford cites exhaustive research in her overview of blue light hazards from ubiquitous digital device use, concluding: "It is vital to consider the potential hazards of such exposure and to educate our patients about its risks, including the loss of antioxidant and anticancer functioning, disruption to the circadian rhythm and sleep cycle, and potential vision loss from age-releated macular degeneration (AMD)."

USC Roski Eye Institute, May 2018
Ocular tolerance of Contemporary Display Devices

Over 60 studies cited. "These findings raise concern that a threshold for acute damage may exist, or, more concerning, long-term, chronic changes that may potentially be already occcurring under current usage patterns [of electronic screens]."

CBS New Health Watch
Eye Doctors Concerned About Blue Light From Electronic Devices
"They give out iPads for the kids to do their homework on. I never thought it could be damaging."

Blue light may be factor in the development of myopia as well

Ophthalmic and Physiological Optics
 "Circadian rhythms, refractive development, and myopia"
First published: 24 April 2018

"Retinal signaling is now believed to influence refractive development; dopamine, an important neurotransmitter found in the retina, not only entrains intrinsic retinal rhythms to the light:dark cycle, but it also modulates refractive development."

Myopia is a growing epidemic

Many people don't realize that myopia - nearsightedness - is not necessarily a simple matter of putting on glasses. It can be a progressive condition that usually begins in childhood. Uncorrected, it can lead to serious complications later in life. Severe myopia is associated with glaucoma, retinal detachment and cataracts, all of which can be blinding if not properly treated in time.

USC's Roski Eye Institute reports that myopia among American children has doubled in the last 50 years, and near-work such as the daily use of digital devices is a known factor. Scientists are also finding that outdoor play may mitigate the condition, due in part to chemical reactions caused in the brain and in the eye by "good" blue light from the sun.

Increased recess at school may hold the key for improving students' eyesight, while also addressing obesity. Both are associated with daily use of digital devices.

Healthline: Outdoor play to mitigate myopia
"Studies have shown that more time spent outdoors can reduce the risk of myopia, but fewer children are playing outdoors as they spend increasing amounts of time on electronic devices."

Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial. New Taiwan study shows that outdoor classroom reduced myopia.

Dry Eye Disease

Children do not blink often enough when using digital devices; they literally stare into the screens. As a result, pediatric ophthalmologists are now observing dry eye disease in children. If the surface of the eye becomes too dry, it can cause serious, sometimes irreparable, damage.

Dr. Preeya Gupta, pediatric ophthalmologist
"Dry Eye Disease and Kids"

"A problem for which we don't routinely screen is affecting children, with permanent effects. What's more, knowing this may alter the way we currently look at baseline gland architecture in adults. Only by examining pediatric patients for MGD and atrophy can we treat the problem before dry eye symptoms or permanent damage develops."

Sleeplessness

The American Academy of Sleep Medicine now links screen time to insomnia symptoms and depressive symptoms in adolescents. This is critical information, given the alarming rise in teen suicides (noted below).

Suicide

New York Times
Childhood Suicide rates have nearly tripled
New York Times, May 16, 2018

"From 2008 to 2015, the proportion of emergency room and hospital encounters for suicide-related diagnoses almost tripled... In the new study, the researchers noted a strong temporal relationship between the school year and the frequency of the encounters for suicidal thoughts or actions; the rate dropped sharply in the summer."

Still in denial?


This, and more highly accessible, voluminous research are just tiny drops in the vast sea of scientific documentation that continues to grow regarding the impact of tech tools on children's health.

Those professionals who deny that there is relevant and applicable evidence regarding this public health threat are beginning to appear not just misinformed, but increasingly, self-serving.

"Educational" apps offer no special power to protect growing children from the physical and psychological impacts posed by these devices. That convenient mythology has been upended by the passage of Maryland's classroom screen safety bill, which recognizes the need to protect children from avoidable classroom health risks.

What can a parent do?

Until classroom best practices are developed, parents can ask their school for the User Manual associated with any school-issued digital device that their child is required to use, especially if that device enters the home.

The device manufacturers spell out serious risks to children and to the home itself if the device is not used in the specified manner. Improper use of laptops by kids, for instance, can cause fires, especially if the device is left running on a bed or a couch. Batteries can be swallowed by younger siblings, which is often lethal.

The manufacturers also explicitly define the safe use of their equipment, including the proper monitor height and settings to avoid what they call "serious bodily harm." Be sure you have that documentation, and discuss how the school is employing the manufacturers' safety warnings in the classroom.

Hope on the horizon

Ultimately, it's up to families to safeguard their own children - and parents are definitely stepping up to the plate these days. This was admirably demonstrated in April with the inaugural Children's Screen Time Action Network Conference, held by Campaign for Commercial-free Childhood.

One glance at the impressive schedule, the professional speakers, and the informative hand-out materials gives us all great hope for children's improved health and well-being in the future, led by groups like CCFC and involved parents.

Thank you, Josh Golin, and your excellent CCFC team for your leadership and commitment to protecting the nation's children. Your work is pivotal in defending childhood, ending commercial manipulation of kids and halting large scale privacy intrusion. We are all in your debt.

Moving forward, there is much to celebrate in Maryland too, as MSDE and MDH begin the challenge of defining the safe use of classroom technology. Child health advocates have rolled up their sleeves across the country, sharing research. Policy makers can be assured that ongoing information will be made available over the coming months to aid this crucial effort.

Cindy Eckard
@screensandkids
www.screensandkids.us

Sunday, April 8, 2018

Waiting for Governor Larry Hogan to Sign
the Classroom Screen Safety bill
Update 4/24: Governor Hogan has just signed the bill

Children's health advocates have much to celebrate in the wake of the Maryland General Assembly's vote on HB1110: "Public Schools – Health and Safety Best Practices – Digital Devices." The bill passed unanimously in both the House of Delegates and the Senate.

Many thanks to all of our elected officials for protecting our children. And special thanks to Delegate Steve Arentz for his sponsorship and leadership of this bi-partisan effort.

The governor's signature this week will help parents, teachers, principals, advocacy groups and policy makers begin the important conversations with local school boards regarding their own student protections before the school year ends. The deadline for action by the Governor is May 28.

This bill recognizes the public health threat facing our children at school and speaks directly to preventing harm to students.  It acknowledges that the physical and psychological threats related to daily use of digital devices are posed regardless of the subject matter.

It mandates that the department of education develops "health and safety best practices," in other words, preventative measures to protect our children from documented associated health risks such as myopia, dry eye disease, retinal damage, sleeplessness, obesity and anxiety.

The safety and health best practices will be developed by the Maryland State Board of Education (MSDE) in consultation with the Maryland Department of Health (MDH) by June 1, 2019, and presented to local districts by July 1, 2019.

This is a key point: the agencies who are responsible will alone be accountable for the creation of best practices. The state's medical experts will help the department of education develop a uniform set of recommendations to share with local districts, many of which lack the resources to do this themselves, to protect their own students.

The best practices that will be developed are not required to be adopted by the local districts. This recognizes a long-standing tenet that the state does not dictate policy to the local school boards. Nonetheless, it is expected that many local districts will opt to employ the state's best practices.

Local districts might also choose to incorporate some of, or modify, the best practices offered by MSDE. As such, the state's documentation will serve as an important medical resource for districts, offering the best research available. Adopted in part or in whole, they will establish a critical guide to protect our children, one which schools, teachers, parents and parent groups can share and distribute.

While the original text called for a significant group of stakeholders to be convened, the amendments from the Education Subcommittee - which removed the stakeholders' participation altogether - do not in any way diminish the import of this legislation. Nothing in the original text required MSDE or MDH to heed the stakeholders' input or include it in their best practices; it merely required MSDE to convene a work group, a requirement that could have been satisfied by a single meeting.

The bill's import is that it officially acknowledges the health threat posed to students by the digital device use required by the schools, and - absent the stakeholders' group - now appropriately places the responsibility for remedies precisely and exclusively where it belongs: with the state agencies whose job it is to provide a safe, healthy learning environment for our kids.

The Education Subcommittee's change from "guidelines" to "best practices" is actually an improvement on the language. "Best practices" is more concise and offers citizens a more clearly defined set of expectations and specific performance measures.

Given the unanimous support for this bill in both the House and the Senate, it's difficult to imagine that the creation of this documentation will take place in a vacuum; our elected officials are well aware of the extreme interest parents and advocates have in this ongoing process.

As the spokesperson for the American Academy of Pediatrics' Maryland Chapter mentioned in the Senate hearing - which was echoed by the Maryland Occupational Therapy Association representative - those who have research and experience to offer MSDE and MDH will of course pursue a dialogue in the coming months to provide critical input.

Wild horses couldn't keep some of us away. Many medical experts and child development professionals have been researching these issues for years. We certainly don't need a work group to be heard.

Cindy Eckard
@screensandkids
www.screensandkids.us

Friday, April 6, 2018

Maryland passes classroom screen safety bill 

Leading the nation in its protection of students, the Maryland Senate today unanimously voted in favor of HB1110: "Public Schools - Health and Safety Best Practices - Digital Devices,"
acknowledging classroom digital device health risks, mandating the creation of health and safety best practices and establishing a model for other states.

The House of Delegates voted unanimously in favor of the bill last week which means that every single elected official in the state of Maryland supports this critical legislation.

Maryland Governor Larry Hogan is expected to sign the bill into law.

We did it.

Cindy Eckard
@screensandkids
www.screensandkids.us

Thursday, April 5, 2018

Senate EHEA Committee favorably reviews classroom screen safety bill

UPDATE: Senate passed HB1110 on second reader 4/5

Heartfelt gratitude to Chairwoman Joan Carter Conway and all the members of the Senate EHEA Committee for holding a public hearing on HB1110 and voting favorably to move it forward in the Senate.

We are one step closer to gaining the critical protections our children need in school, thanks to their leadership.

It was a unanimous vote.



The bill will be read on the floor today; a vote from the full body of the Senate is expected today or tomorrow. Updates will be posted on Twitter, and on this page.

Impossible? For a plain yellow pumpkin to become a golden carriage? 

Impossible things are happening every day.

Cindy Eckard
@screensandkids
www.screensandkids.us

Monday, April 2, 2018


House unanimously votes for screen safety -
Now it's up to the Senate

LATEST: Senate EHEA Committee will hear HB1110 Wednesday, April 4 at 1pm.  Deepest thanks to the Chairwoman.

UPDATE: Senate Rules Committee has referred HB1110 to the Education Health And Environmental Affairs Committee.

Thank you to all of the state's Delegates for your leadership. With your unanimous vote for HB1110 - requiring the creation of safety and health best practices for the schools' digital devices - you have taken a vital stand in the protection of our children's health.

And thank you to all the medical experts, advocates and parent groups who are voicing overwhelming support for HB1110. The legislation soared unanimously through four separate House of Delegates votes in just two weeks.

As of this writing, the bill is in the Senate Rules Committee. If Rules assigns HB1110 for consideration, that referral will first be read on the floor of the Senate, which convenes this evening at 8:00 pm.

So it will be a long day - perhaps several days - of waiting for classroom screen safety advocates. Let's hope that the Maryland Senate acts quickly and follows the lead of the House of Delegates to vote unanimously in favor of establishing safety and health best practices for digital devices in Maryland classrooms. 

Background information, medical research and overwhelming support

This legislation will protect Maryland students from serious, avoidable health risks posed by their schools' requirement to use digital devices. Myopia, obesity and anxiety -- all of which are associated with daily use of digital devices - are now epidemic among children. 


These issues are contributing to additional health risks such as diabetes and heart disease, according to medical researchers. Unbelievably, addiction and suicide are now soaring among our children; both are associated with the use of digital devices. The CDC now reports that suicides have doubled among teenage girls. 

Students are also put at risk for dry eye disease when they are required to use devices every day without any health and safety oversight.  Children are not blinking when they use the schools' devices, which can cause discomfort, redness and fatigue. Dry eye disease can also impair and blur students' vision and affect their corneas.

One pediatric ophthalmologist reports that she knows when her school district is using devices heavily again, because of the increased number of appointment calls she gets: there is a correlation. Another physician reports that she stopped asking families how much screen time the children have because "they've already told me they're online all day at school."

Underprivileged children and minorities at greater risk

But these health risks do not impact our children equally: some will be put at greater risk than others, especially poor children and minorities. African-American, Latino and children of Asian descent share a genetic predisposition for myopia, according to the University of Southern California's (USC) Eye Institute, whose Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) is the largest ever conducted.


That study concludes that myopia has doubled among our children in the last 50 years.  Doubled. Clinicians report that unchecked myopia can lead to much more serious eye impairments, including glaucoma, cataracts and retinal detachment. In other words, severe myopia can lead to blindness.
 
The lead USC researcher says that the "likely culprit" is the daily use of digital devices and an increasing lack of sunshine. Several major newspapers have featured articles on the helpful role of sunshine in the prevention of myopia, as noted by Treehouse Eyes, a Bethesda-based pediatric myopia specialty practice that fully supports this legislation.

But what about the children who do not have a safe place to play outside in the sunshine?  Or those who live in a food desert, without access to the fresh fruits and vegetables that contribute to their eye health? They are the same children who also lack access to eye specialists for full eye exams, or glasses. 

Many of the same factors that contribute to myopia - no safe place to play outside in the sun, less access to fresh fruits and vegetables, and reduced access to expensive medical specialists for both diagnosis and treatment options -- are also contributing to obesity in poorer communities. The unregulated requirement of increased sedentary behavior, as introduced by increasing use of digital devices at school and at home for homework, will exacerbate existing threats to kids who already face disproportionate risks to their health. 

Uniform safety and health best practices will protect all students equally

Having a statewide framework for the safe use of technology is imperative, especially since many individual districts simply don't have the resources to adequately research this, and protect their own students. 


All of our kids should have equal access to every learning opportunity that Maryland offers AND have equal protections from the documented health risks known to be associated with the digital device usage that accompanies some of those learning opportunities.

That's why the state's entire medical community enthusiastically endorses HB1110: to ensure that as the proliferation of digital devices continues, so do the health protections for all of Maryland students.

Prevent Blindness has provided written testimony on this bill; so has the American Academy of Pediatrics' Maryland Chapter; the Maryland State Medical Society (MedChi); the Mental Health Association of Maryland and the Maryland Occupational Therapy Association. 

National support has poured in as well: Parents Across America, Campaign for a Commercial-free Childhood, and Common Sense Media have all provided testimony in favor of HB1110.

Queen Anne's County supports this measure as well, and provided written testimony in favor of the bill.

Baltimore County and Montgomery County parent groups, it should be noted, have been particularly vocal on this issue.  Advocates for Baltimore County Schools as well as the PTA Council of Baltimore County provided written and oral testimony in favor HB1110. Indeed, representatives of these groups waited over four hours on the day of the hearing just to testify in favor of this initiative.

And Montgomery County parents have recently helped to convince the Montgomery County Board of Education to reconsider its position on HB1110.  The Montgomery County BOE now fully supports this bill and will be writing a letter of testimony endorsing it, according to an article entitled "State Bill on Safe Use of Digital Devices in Classrooms Makes Progress in Legislature" published last week in Bethesda Beat.
 
Excellent media coverage from Maryland Matters and Maryland Reporter have also helped spread the word: Maryland wants this bill.
 

Of course our children need to master technology tools, but they must not be put in harm's way in the process, and suffer from known health risks that should have been avoided by their schools.

Let's hope the legislation will be voted on in its current form without delay. There's still plenty of time in this session for our Senators to protect our children with the swift passage of HB1110.

Cindy Eckard
www.screensandkids.us