Give no screens at ages 0 to 3, avoid them as far as possible at 3 to 6, and keep non-study use to no more than 1 hour a day for school-age children

Cost

Free. The hard part is taking the screen out of the child's hands, and also cutting down on your own screen time in front of the child.

What you get

Article 4 of the Ten Core Messages on Preventing and Controlling Myopia in Children and Adolescents (《防控儿童青少年近视核心知识十条》) reads: “Infants and toddlers aged 0 to 3 should not use video screen products such as phones, tablets and computers; children aged 3 to 6 should avoid contact with and use of phones, tablets and computers as far as possible; for primary and secondary students, screen use not for study should not exceed 15 minutes at a time and 1 hour in total per day.” The same article states: “Using electronic screen products at close range for long periods easily uses up a child's hyperopic reserve and is an important reason for early onset and high rates of myopia in children and adolescents.” The 2018 implementation plan from eight departments including the Ministry of Education (教育部) gives parents the same requirements and adds: “The younger the age, the shorter the continuous use of electronic products should be.” The research evidence is much weaker. One systematic review included 33 studies, of which 11 went into the pooled calculation, with subjects from 3 months to 33 years old. For phones and tablets alone, the odds ratio for myopia was 1.26 (95% CI 1.00 to 1.60, I²=77%). Combined with computers it was 1.77 (1.28 to 2.45, I²=87%). The authors went no further than saying the two “may be related,” and noted that none of the 33 studies had a reliable measure of screen time.

Notes

This is graded B because the official guidance is a set of rules by age group, not numbers measured in a trial. The lower bound of the odds ratio in the research just touches 1.00, and the authors would only say “may be related.” So treat it as a house rule that is easy to follow, and don't treat it as “no screens means no myopia.” What really has a randomized trial behind it is §30.4 (2 hours outdoors). Check preschoolers' eyes too: the same document says refraction screening should be done regularly at ages 1 to 3, 4 to 6 and after 7, to see how much hyperopic reserve is left; for how to check, see §30.12 (dilated eye exam). The link between screens and children's language has also been meta-analyzed: 42 studies with 18905 people found that the more screen time, the weaker the language ability (r=−0.14, 95% CI −0.18 to −0.10). But watching together with a parent, and watching educational programs, were instead positively related (r=0.16 and 0.13). This is correlation, not cause. It only shows that using a screen in place of talking with the child is a poor trade.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. 国家卫生健康委办公厅 (2023). 防控儿童青少年近视核心知识十条（国卫办妇幼函〔2023〕278 号）. https://www.gov.cn/zhengce/zhengceku/202307/content_6894284.htm
2. 教育部等八部门 (2018). 综合防控儿童青少年近视实施方案（教体艺〔2018〕3 号）. http://www.moe.gov.cn/srcsite/A17/moe_943/s3285/201808/t20180830_346672.html
3. Foreman J, Salim AT, Praveen A, et al. (2021). Association between digital smart device use and myopia: a systematic review and meta-analysis. The Lancet Digital Health, 3(12), e806-e818. https://doi.org/10.1016/S2589-7500(21)00135-7
4. Madigan S, McArthur BA, Anhorn C, Eirich R, Christakis DA (2020). Associations between screen use and child language skills: a systematic review and meta-analysis. JAMA Pediatrics, 174(7), 665-675. https://doi.org/10.1001/jamapediatrics.2020.0327

Translated from the Chinese original. Original book, section 30, tip 5. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer