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."


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).


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

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

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

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

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

Wednesday, March 28, 2018

YES! 139 times - yes.
Maryland House of Delegates votes unanimously in favor of classroom screen safety bill

Sending cheers across the country, the Maryland House of Delegates today voted unanimously to approve a measure that requires the Maryland State Department of Education to create "Health and Safety Best Practices" for the use of digital devices in Maryland classrooms.

The bill now moves into the Senate Rules Committee, which will refer the legislation to the Senate Education Health and Environmental Affairs (EHE) Committee. Please call the members of the Rules Committee, and ask them to move this bill forward as soon as possible.

While there is no opportunity to testify in person in any of these deliberations, please contact your Senator and ask him/her to take action and support this critical effort to protect Maryland children from avoidable harm in their classrooms.

Your Senator's contact information is here.

The Maryland House of Delegates is to be commended for their unanimous vote today; it is a display of unparalleled leadership in protecting the health and safety of all Maryland students, and preventing avoidable harm in their classrooms.

Deepest thanks to everyone who is voting, calling, writing, tweeting, sharing, liking, emailing and working so hard to get this done this year. 

Cindy Eckard

Tuesday, March 27, 2018

One Step Closer

The Maryland House of Delegates adopted amendments to HB1110 today, moving the nation's first classroom screen safety legislation one step closer to passage.  A final vote of approval from the House is expected tomorrow when the delegates reconvene.

The bill's next step will be in the Senate Rules Committee, and then on to the Senate Education, Health and Environmental Affairs Committee. 

Discussion and updates regarding amendments to the bill will be posted here in coming days. Today, however, it's time to just say thank you to all who are working so hard to protect our kids, and a special thank you to all who voted to move HB1110 forward today.

Cindy Eckard