Confident Mr 3yo walked over to my computer screen in the clinic and automatically try to swipe and tap. Finding no response after a few tries, this little one shared his wisdom with me, “This is broken! Get a new one?” He was rather shocked when I explained my computer was not “touchscreen smart”.
Children of today are “digital natives”.(1) Many are tech savvy and computer literate way before they are able to read or write.(1) I am constantly surprised by how comfortable and competent young children are with using screen media – televisions, mobiles, iPads, tablets, Nintendo DS, etc. A recent study from Birkbeck, University of London found that 51% of infants aged 6-11mths and 92% of toddlers aged 26-36mths use a touchscreen device daily.(2)
Digital technology has become “the norm” in everyday living. There are, of course, many advantages to digital technology. For example, internet access has changed the way we access information and communicate. There are numerous number of programs or apps available to entertain, educate, self-help and for carrying out various tasks (e.g. encourage toothbrushing).(3-5)
On the flip side, digital technology has taken over many children’s world, changing how children use their time and impacting on children’s play, socialization, development and learning. Screen viewing is habit-forming and daily screen time tends to increase with regular use.(6,7) Excessive screen time has been shown to: delay development of gross motor skills, fine motor skills, cognitive and language skills, negatively affect the development of emotional and social skills, reduce movement and physical activities and outdoor time, overstimulate, disturb night-time sleep, and promote weight gain and childhood obesity.(6-12) Particularly for children under the age of 5yrs, research studies have shown translation of learning from screen is limited and children learn best from “live, direct and dynamic interactions with caring adults”.(6,8)
Let’s imagine a child who spends more time swiping and taping on digital devices than “hands-on” playing such as painting , sculpting with play dough, creating with blocks and exploring in the park. If the child’s muscle movements are limited to constant swiping and taping, do the other muscles develop? How will muscles strengthen? How will coordination and perception be finessed?
Well-developed fine motor skills and coordination are needed for numerous self-help skills and dexterity-related tasks such as shoe lacing, getting dressed, buttoning up, toothbrushing and flossing. Effectiveness of toothbrushing is key to good oral health and is influenced by many factors including oral sensory perceptions, skill of brushing movements, muscle activities, coordination and strength.(13)
Motor skills development is dependent on motor experience. Habitual use of screen devices decreases time for other activities and tasks that practise a variety of motor skills and coordination.(14,15) Lin and co-authors (2015) demonstrated a significant association between motor delays and prolonged screen time in children less than 3yrs.(16) Declined motor skills proficiency has been shown to cause disengagement and difficulties with advanced motor activities such as playing a musical instrument.(17)
Moreover, fine motor skills have been shown to play a significant role in child development and school readiness.(18-21) Fine motor skills are linked to cognitive, language, numeracy and literacy development.(18-21) There are many hypotheses as to why this is. One school of thought suggests that fine motor skills and cognitive skills having same neural mechanisms and shared neural capacity, and another suggests that fine motor skills is a basal ability and cognitive development occurs from sensorimotor dimensions to the abstract.(14,20)
So how is this relevant to children’s oral health?
- Young children learn best through activity engagement and interaction with others therefore, toothbrushing and flossing skills are best taught through parental and professional guidance and interactions. Toothbrushing and flossing apps are effective adjuncts for supporting parents’ instructions but by themselves, are “poor teachers”.
- Children who can manipulate their digital devices skilfully may not necessarily have the coordination and motor competence needed for effective toothbrushing and flossing.
- Excessive screen time may limit motor experiences that are important for motor skills development, including toothbrushing and flossing skills, resulting in the need for parent-assisted toothbrushing and flossing to continue until child is much older.
- Fine motor skills are linked to cognitive, language, numeracy and literacy development. Developing fine motor skills by teaching children toothbrushing and flossing from an early age may have a positive impact on child development.
The American Academy of Pediatrics(AAP) discourages screen time for children 18mths and under and recommends “no more than 1hr per day digital media use” for children 2 to 5 years and “no screens during meals and for 1 hour before bedtime”.(9) To assist parents in the mindful use of digital media, AAP encourages having a customised “family media use plan” (create one via https://www.healthychildren.org/English/media/Pages/default.aspx). Dental and non-dental professionals working with children and as a member of the community, we can assist with promoting this important health and well-being message.
- Nelissen, S. & Van den Bulck, J. (2017). When digital natives instruct digital immigrants: Active guidance of parental media use by children and conflict in the family. Information, Communication & Society 21(3): 375-387. DOI:10.1080/1369118X.2017.1281993.
- Beford R, Saez de Urabain IR, Cheung CH, Karmiloff-Smith A, Smith TJ. (2017). Toddlers’ fine motor milestone achievement is associated with early touchscreen scrolling. Frontiers in Psychology 7:1108. DOI: 10.3389/fpsyg.2016.01108.
- Neumann MM, Finger G, Neumann DL. (2017). A conceptual framework for emergent digital literacy. Early Childhood Education Journal 45(4): 471-479. DOI: 10.1007/s10643-016-0792-z.
- Bates CC, Klein A, Schubert B, McGee L, Anderson N, Dorn L, McClure E, Huber Ross R. (2017). E-Books and e-book apps: Considerations for beginning readers. Reading Teacher 70(4): 401-411.
- Bry LJ, Chou T, Miguel E, Comer JS. (2018). Consumer Smartphone apps marketed for child and adolescent anxiety: A systematic review and content analysis. Behavior Therapy 49(2): 249-261. DOI: 10.1016/j.beth.2017.07.008.
- Canadian Paediatric Society. (2017). Screen time and young children: Promoting health and development in a digital world. Paediatric Child Health 22(8): 461-477. DOI: 10.1093/pch/pxx123.
- Duch H, Fisher EM, Ensari I, Harrington A. (2013). Screen time use in children under 3 years old: A systematic review of correlates. International Journal of Behavioral Nutrition and Physical Activity 10:102. DOI: 10.1186/1479-5868-10-102.
- Radesky JS, Christakis DA. (2016). Increased screen time: Implications for early childhood development and behaviour. Pediatric Clinic of North America 63: 827-839. https://dx.doi.org/10.1016/j.pcl.2016.06.006.
- American Academy of Pediatrics (AAP). (2016). Media and Young Minds. Policy Statement. Pediatrics 138(5): pii: e20162591. DOI: 10.1542/peds.2016-2591.
- Domingues-Montanari, S. (2017). Clinical and psychological effects of excessive screen time on children. Journal of Paediatric Child Health 53(4): 333-338. DOI: 10.1111/jpc.13462.
- Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS. (2016). Association between portable screen-based media device access or use and sleep outcomes: A systematic review and meta-analysis. JAMA Pediatrics 170(12): 1202-1208. DOI: 10.1001/jamapediatrics.2016.2341.
- Moody AK, Justice LM, Cabell SQ. (2010). Electronic versus traditional storybooks: Relative influence on preschool children’s engagement and communication. Journal of Early Childhood Literacy 10(3): 294-313.
- Uenoyama A, Inada J. (1990). Muscle activities in the hand and arm during tooth brushing and the regulation of brushing movements by oral sensory perception. Journal of Osaka Dental University 24(2): 87-120.
- Glenberg AM, Gallese V. (2011). Action-based language: a theory of language acquisition, comprehension and production. Cortex 48(7): 905-922. DOI: 10.1016/j.cortex.2011.04.010.
- Ross ST, Dowda M, Saunders R, Pate RR. (2013). Double dose: The cumulative effect of TV viewing at home and in preschool on children’s activity patterns and weight status. Pediatric Exercise Sciences 25: 262-272.
- Lin L, Cherng R, Chen Y, Chen Y, Yang H. (2015). Effects of television exposure on developmental skills among young children. Infant Behavior and Development 38: 20-26.
- Lopes L, Santos R, Pereira B, Lopes VP. (2012). Associations between sedentary behaviour and motor coordination in children. American Journal of Human Biology 24: 746-752.
- Suggate S, Stoeger H, Fischer U. (2017). Finger-based numerical skills link fine motor skills to numerical development in pre-schoolers. Percetual and Motor Skills 124(6): 1085-1106. DOI: 10.1177/0031512517727405.
- Suggate S, Pufke E, Stoeger H. (2018). Do fine motor skills contribute to early reading development? Journal of Research in Reading 41(1): 1-19. DOI: 10.1111/1467-9817.12801.
- James KH, Gauthier I. (2006) Letter processing automatically recruits a sensory-motor brain network. Neuropsychologia 44: 2937-2949.
- Robinson LE, Stodden DF, Barnett LM, Lopes VP, Logan SW, Rodrigues LP, D’Hondt E. (2015). Motor competence and its effect on positive developmental trajectories. Sports Medicine 45: 1273-1284. DOI: 10.1007/s40279-015-0351-6.