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