By Tara Bannow • The Bulletin

One of the first questions Dr. Nathan Osborn, a child and adolescent psychiatrist in Bend, asks his patients is whether they have access to technology. From there, he finds out where they charge their smartphones, tablets and computers.

“If the answer is, ‘I charge them in my room,’ immediately I’m highly, highly suspicious of a problem,” he said.

Osborn, who owns Cascade Child & Family Psychiatry, said he sees a number of patients experiencing attention, anxiety and mood problems, many of which are exacerbated or even caused by their technological devices disrupting their sleep. Some of his most severe cases are kids who stay up all night playing video games.

“I tell them, ‘You might have all kinds of other problems going on, nothing will get fixed, zero, until this is fixed,’” Osborn said. “Until this is no longer an issue, I can’t help you. What’s an antidepressant going to do for a child whose sleep is completely disregulated? … It’s a disaster.”

Likewise, local pediatricians say these days, they routinely ask patients about their technology use, and have become increasingly concerned about the effect such devices are having on their sleep and, in turn, their mental and physical health.

A study last week in the journal Pediatrics linked sleeping near small screens such as smartphones or iPads and having TVs in bedrooms with shorter durations of sleep among fourth- and seventh-graders. It also found kids who slept near small screens were more likely to report insufficient rest.

The University of California, Berkeley researchers cautioned parents against permitting unrestricted access to small screens in kids’ bedrooms.

Jennifer Falbe, the study’s lead author, said while research has piled up on the effects of TV on kids’ sleep and health, there haven’t been many studies looking specifically at small screens.

“Small screens are concerning because they’re a portal to video games, social media and other distractions, and they emit alerts and incoming texts and calls that can interrupt sleep,” she said. “They’re potentially even more concerning.”

Most organizations recommend school-age kids get between 8.5 and 9.5 hours of sleep per night. Falling short has been linked to a number of physical and mental health issues, including obesity, attention problems, poor performance in school and reduced immunity to protect against illnesses.

Dr. Rupert Vallarta, a pediatrician with St. Charles Family Care in Redmond, said technology-related sleep issues often present in the form of behavioral issues.

“Usually what happens is that they’re more prone to tantrums, they’re more irritable — that’s because of that decreased sleep time,” he said.

School-age kids often complain of headaches, too, but that’s mostly when they’re on their computers or wearing headphones, he said.

Keeping kids awake

The American Academy of Pediatrics has a number of tips for parents for bringing their kids’ technology use to a healthy level, including that they only use devices recreationally between one and two hours per day.

A 2010 Kaiser Family Foundation report, however, found kids ages 8 to 18 used media between 7 and 8 hours per day. And since Kaiser surveyed the kids in 2008 and 2009 — before the iPad was released, for example — the amount of time kids spend with technology could conceivably be higher today.

Dr. Kyle Johnson, a pediatric sleep medicine physician and associate professor of psychiatry and pediatrics at Oregon Health & Science University, said the AAP’s recommendations probably don’t reflect the reality of today’s kids.

“I don’t disagree with their recommendation,” he said. “I don’t think it’s happening.”

Vallarta estimates between 80 to 90 percent of his 10- to 14-year-old patients use their smartphones before bed, and he said there are a number of reasons why that hurts their sleep.

First off, they’re using the devices instead of sleeping, so they’ll set them down at, say, 11 p.m. instead of 9 p.m., he said.

But even after they do, notifications can disrupt sleep.

“Once you turn off your TV, that TV will not bother you any more,” Vallarta said. “With smartphones, you will get texts, you will get alerts, you will get audible notifications, and that will really affect a child’s sleep.”

There’s a more hidden, biological component to that, too. Humans naturally operate on 24-hour circadian rhythms, a series of mental and physical changes in the body that regulate sleepiness and alertness. The hormone melatonin is an important part of that. Its levels typically increase at night to help someone fall asleep. But if that someone is holding a bright light in front of his or her face, the melatonin release may not happen to the same degree.

A team of Harvard Medical School researchers found that using such devices at bedtime prolongs the time it takes to fall asleep, delays the circadian clock, suppresses melatonin release, reduces the amount of deep sleep and reduces alertness in the morning, according to a November 2014 study in the Proceedings of the National Academy of Sciences.

A TV across the room wouldn’t have the same effect, Vallarta said.

“You’re watching it at a distance,” he said. “That might not affect you as much as holding a cellphone or tablet in front of your face. That will really affect your melatonin levels, and that will really affect your sleep.”

A handful of pediatricians interviewed say they agree with the AAP’s other recommendations: No using devices within an hour of bedtime, and they all must be charged overnight in a common area of the house, such as the living room or kitchen. That means no phones in bedrooms.

‘An area of discovery’

In addition to restricting their kids’ use of technology, Vallarta said parents should maintain ongoing, open communication with their kids about their use.

“You have to have that family pledge,” he said. “You have to have that contract between your kids. It could be a written contract or a verbal contract, but that conversation should always happen.”

With that, several pediatricians said parents need to serve as good role models for their kids, and should demonstrate healthy technology use.

Osborn, the psychiatrist, said he’s concerned about the psychological impact of parents’ constant, random withdrawals of attention from their kids, but said no research thus far has explored the issue.

“What you’re teaching your kid is, ‘My attention is capricious and vulnerable at any moment to be dominated by this little thing, and that’s normal,’” he said. “What does that do a kid’s mind? I have no idea, but I’m worried.”

A smaller study in Pediatrics early last year observed caregivers eating with children in fast food restaurants. Forty out of the 55 caregivers used devices during the meal, and 16 of them used the devices almost continuously throughout the meal. The kids in those cases tried to get their caregivers’ attention by singing loudly, reaching for their phones and breaking plastic forks.

And with kids across the country being required to use iPads in schools — many of them with the capability of downloading games and other apps — Osborn said he worries whether kids are neurologically equipped for such a transition.

Bend-La Pine Schools is currently undergoing a “digital conversion,” under which eventually every student in grades three through 12 will receive an iPad they’ll use in classes and take home to study and complete assignments. High school students can download certain apps, but elementary and middle-schoolers cannot. And regardless of where the students are, the iPad will filter their Internet use through the district’s settings.

“What we believe is that we’re not preparing kids for today’s jobs, we’re preparing them for tomorrow’s jobs, and we believe this enables and enhances our students’ ability to work collaboratively, be creative and engage,” said Skip Offenhauser, the district’s executive director of curriculum and instructional technology.

The district’s website has tips for parents on establishing ground rules for using the devices at home and keeping kids on task while they’re using them.

Offenhauser said he’s never heard about such devices being linked to less sleep.

Dr. John Peoples, a pediatrician with Central Oregon Pediatric Associates, said although experts understand the negative effects device use can have on kids’ sleep and health, no one truly knows yet what the long-term impact will be.

“It’s going to be an area of discovery going forward in the next 10 to 20 years,” he said.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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