Nieman: Common sense prescribed for screen time following a concussion
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Imagine your child suffers a concussion and the ER doctor, after an appropriate checkup, tells you it is safe to go home. On the way out of the busy ER, a nurse reminds you and your son, “Make sure no cellphone use or TV is watching for the next few days.”
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Your son is?unlike most teenagers in North America; he engages only in four hours per day of screen time.?
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According to findings published in JAMA Pediatrics recently, screen time among adolescents during the COVID pandemic averaged around seven hours daily.
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Being a diligent parent, you do some online research. (Zero screen time, as advised by the ER staff, seems a bit harsh). You discover that Harvard researchers in 2021 recommended abstinence from screens. The lead author, Theodore Macnow, MD, and peers in the Boston area noted that when concussed patients, aged 12 to 25 were instructed to abstain from phones, computers and TVs for the first 48 hours, they recovered 4.5 days sooner than those who were permitted to use them.
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Perhaps the nurse was correct. But what about more screen time after the first few days following the first 48 hours, post-concussion? You discover a recent Canadian study, published in Pediatrics in November 2022, and it confuses you a bit.
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The Canadian study involved 633 children and adolescents recruited from five emergency departments within the Pediatric Emergency Research Canada network. The Canadian group agreed with the Harvard study, but they noted, “Although screen time within the first 48 hours post-injury could contribute to temporary symptom exacerbation, its longer-term impact has not been examined empirically.”
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The Canadian researchers studied the role of screen time over the first seven to 10 days, post-concussion and its impact on post-concussion symptoms over the following six months.
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The Canadian study identified a Goldilocks effect. Those whose screen time was between the 25th?to 75th?percentiles had less severe symptoms. Patients who reported the lowest screen time (<25th?quantile) and the highest (> 90th?quantile) during the first seven to 10 days post-injury reported more cognitive and somatic symptoms than those in the 25th?to 75th?quantile of screen time.
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Their conclusions? It is unwise to cocoon those who suffered concussions. There are risks of social isolation and psychological distress. Screen time is significant, but not one of the most influential factors in concussion recovery. Other risk factors and health behaviours had stronger associations with symptom severity than scrolling on a TV, cellphone or computer.
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Does this mean that parents need not worry as much to limit screen time – especially smartphone use, as opposed to TV watching or the use of iPads? We simply do not know for sure.
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The editors of Pediatrics invited Dr. Macnow and his peers to write an editorial, commenting on the Canadian study. Macnow stood by the original research which advocates for zero screen time in the first 48 hours, but they also point out that the Canadian study included younger concussed patients. The younger children were less likely to rely on their cellphones compared to older patients. The Harvard study?prescribed?screen time instead of?observing?self-regulated screen time.
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Other hard-to-control variables were the degrees of physical activity. Some children were given no chores while others were limited in their exertion, but still given chores.
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It is important to strike a balance between avoiding boredom, deconditioning, and overextending patients physically or cognitively.?
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Many researchers agree that different types of screen time may have variable effects; that we are clueless if consecutive duration matters more than total screen time; we do not know if blue light matters or not; we are unsure if the adverse impact of screen time is related to the screens or being sedentary; we are unsure about the timing of the day of use.
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We also have no data on the resilience of the brain after a concussion when children consume foods which favour optimal brain development. (For example, a vegan diet, as opposed to the more common standard American diet high in fats, sugars and salt and low in phytonutrients and ant-oxidants.)
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In the absence of definitive and often contradictory academic data, I favour common sense:
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? Have zero screen time in the first 48 hours after concussion and, after that, limit it to the bare minimum, at least for the first 10 days following a concussion.
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? Be adamant that there be no screen time at least one to two hours before bedtime. It seems that the hour preceding our bedtime, for both adults and children, has become more meaningful than ever; meaning it’s a time to wind down and?not?rev up.
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? Eat healthy to set the brain up to be more resilient; concussions unexpectedly may strike your child and derail him/her for a season. Be diligent and prepared by living holistically.
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Dr. Nieman is entering his 36th year of working as a community pediatrician. He runs marathons, provides health coaching and authored two books: Moving Forward and 101 Finish Lines.
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