In a room filled with toys, three-year-old Malik is having a blast playing with his dad, Adrian.

Do you see these numbers here?

What are these numbers? You recognize this one?

One, two, three, four, five.

Oh, very good. Now, let’s see, what colors?

Um, blue, green, yellow, blue.

And as Malik tells my producer Grace, this is his favorite way to spend his time.

What are your favorite things to do, Malik?

But make no mistake, today is not just about fun and games.

I can’t tell you what happened for sure with Malik, but what we have seen on average is that children find it much more difficult to disengage from these highly stimulating apps.

That’s Dr. Dimitri Christakis. He’s invited us to his Seattle lab to get a close up look at something special – his research into how very young kids actually respond to screen time.

We think of compulsive or digital addiction happening in older children and adults. But the truth is, I think its roots are actually in early childhood.

Now, as a neurosurgeon, I couldn’t help but wonder, what is it exactly about the iPad or the tablet that just makes it so hard for kids to put down. The lights, the sound, the constant stimulation? And what impact is all of that having on their very young and impressionable brains? The fact that kids as young as Malik, even younger, might prefer screens over real life, that raises a lot of big questions for me. And this type of research is exactly what made me want to talk to Dr. Christakis. You know, so far this season, we’ve heard from a lot of different experts, fellow parents, content creators. I’ve even interviewed all three of my own kids. But, you know, after all of these conversations, I still wanted to know, what are those raw ingredients that make these screens so darn irresistible? And what exactly is happening in the brain when my kids are using these screens? Even if you’re not a doctor like me or Dr. Christakis, I bet you want to know the answers to these questions as well. Because it might help us. It might help us make the best choices for future generations of kids – kids like my daughters, kids like Malik. So on today’s episode, we’re going to dive into some of the latest, most cutting edge research in this field. I’m Dr. Sanjay Gupta, CNN’s Chief Medical Correspondent, and this is Chasing Life.

All right. Well, we’re going to get started here in a few minutes. Really appreciate your time.

Over at the lab. Dr. Christakis and his assistant, Shaye, are getting ready to give us a behind the scenes look at how he studies his youngest, tiniest research participants. Now, as you can imagine, studying children this young can be pretty cute, but it also isn’t very easy.

It’s fun. It’s fun. It’s fun, but it’s challenging. They have their own schedules, their own needs, and no day is typical for them. So, you know, I don’t know where Malik is in his nap cycle. I don’t know if he’s had a snack and I don’t know if this is a good or bad day, but it’s it’ll be fun regardless.

Now, to be clear, today, Dr. Christakis and his team, they’re not gathering actual data during this recording. They’re giving us a demonstration to show us how this all works. We wanted to get close, but we did not want to disrupt the results of his studies.

What we’re trying to do in the lab here today is to to test the hypothesis that children find different types of digital interactive experiences more difficult to disengage with than traditional toys and even traditional electronic toys.

Dr. Christakis is a pediatrician. He’s also the director of the Center for Child Health Behavior and Development at Seattle Children’s Research Institute. What he’s most known for is studying young kids development. And what we’re about to hear is the results of some of his latest research. It’s called the Daisy Study. He started gathering the data during the early days of the pandemic and he’s now in the final stretch. The main goal: pretty simple. Figure out how kids Malik’s age interact with screens, such as iPads or tablets, and compare that to traditional children’s toys. It’s the digital world versus the real world. Which is more attractive to a young child? And why?

So part of what we’re doing with this is not just looking at how typical toddlers respond to these different types of toys, but can we identify subsets of children who are, if you will, predisposed to find apps more difficult to put away? And by doing that, we can help identify risk factors and alert parents the fact that, you know, your child is at higher risk for finding these kinds of toys so alluring.

To kick off the experiment. Dr. Christakis asks his lab assistant, Shaye, to hand Malik a plastic toy. It’s a toy that’s covered in bright blue, green and yellow buttons.

Okay, so for these first few minutes, we’re going to play with some toys so that Malik can get more comfortable with the room. So please play with Malik as you normally would at home.

Now, much to Malik’s surprise and delight when he presses these buttons, some of his favorite TV characters pop up.

Big Bird. Okay. All right.

Now, while Malik is playing with the toy, Shaye tries to distract him by pointing to different corners of the room. And

It works. After a few minutes, Shaye asks Malik to hand over the toy.

Now she hands Malik an iPad.

Okay, so for this next part, we’re interested to see how Malik naturally responds to the tablet activities. So I say you just observe unless Malik asks for you.

The assistant tries her best once again to distract Malik as he plays.

This time, however, Malik’s eyes are glued to the screen. He looks up from the iPad, but more slowly than he did before. After a while, she asks him to hand over the iPad, and Malik slowly agrees.

All right, we are all done.

All right buddy, high five! Good job, good job.

As they wrap up, Shaye asks Malik which game was his favorite. Playing with the toys, with all the bright buttons. Or playing a game where he slashes fruit on the iPad.

Do you like playing with the toys?

Do you like slashing the fruit?

Yeah. Which one was your favorite?

The fruit. Oh, okay. Mine, too.

And probably yours, too, if you’re being honest. But the thing that is striking, just how young this split happens, this digital desire surpassing real life experiences. In this case, a three-year-old chose the screen.

Our big findings so far is that young children in this 18-to-24 month age group find it very difficult to take their attention away from an app; more difficult than they do with other traditional toys, even electronic toys.

The thing is, if you’re like most people, especially parents, we now fully recognize we are surrounded by these digital objects, which as a general rule, are going to be the most alluring, fascinating objects in our orbit. And as hard as it is to admit, kids, even really young kids, are going to prefer those digital objects over tangible real life things. Heck, sometimes they prefer them over tangible, real life people. You see, the real world seemingly starts to pale, become dull and flat when constantly compared to a digital world. It’s the exact reason that I have devoted an entire season talking about this.

It wasn’t until I became a parent, which was now 25 years ago, with the birth of my son Alexi, that I became very interested like you, for very personal reasons in, in, in, in child development. I spent the third month of his life on paternity leave and spent hours with him snuggled against me, watching more CNN than I’d ever watched. And I noticed that he was very interested in the screen, and I couldn’t understand why as a pediatrician, since as much as I’d like to believe that my three-month-old was understanding the content, I knew he wasn’t.

As most of you know by now. This season of the podcast has been a really personal journey for me as well. The whole reason I’m doing this is for my three teenage daughters. So I got to tell you, I can really relate to what Dr. Christakis did next. He took his questions about his son’s exposure to television and he turned it into a decades long research project.

So I began really a journey of trying to understand how early experiences affect child cognitive, social and emotional development. And over time, that’s where I switched my entire research portfolio.

I’m really curious. When you were caring for at that time, your three-month-old, and he’s fascinated by this screen and the colors and all the stimulation, just as a doctor, as a as someone who takes care of kids, at that point, did it worry you? Did you think, okay, what is that doing to their brain?

So it’s funny you say that because that was the start, the genesis, if you will, of what I came to call the overstimulation hypothesis. What was keeping him engaged in the screen was the rapid changes in images and the the sudden sounds that were unpredictable to him and sometimes even unpredictable to adults. The newborn brain triples in size in the first two years of life, and it does that in direct response to external stimulation. So our our minds fine tuned themselves to the world we inhabit. It’s an evolutionary advantage historically. The question I had, the concern I had was that that overstimulation would kind of preconditioned the brain to expect high levels of input, and then reality by comparison would be under stimulating, would be boring. And so that was my first foray into this, that the idea that early exposure to rapid image change might precondition the mind to be inattentive to reality later in life.

That’s interesting.

And what we found was just that that the more television children watched and again, television was the medium of the day early in life, the shorter their attention spans were at age seven.

I want to make sure you understand this. What Dr. Christakis is saying here is that toddlers were overstimulated by the lights and colors and the sound from the television. They came to expect rapid changes in sounds and sights in their entire life, and that could lead to attention problems in young kids a few years down the road. Now, these findings about TV and kids brains were pretty groundbreaking, but that was back in the early 2000s. But then when iPads and smartphones became popular, everything became turbocharged.

The touch screens are a game changer. And I think it’s really important to emphasize that because a lot of the science that we have around screens is based on 80 years of research with television, but it’s very limited because the interactive nature of touch screens fundamentally changed the experience. It activates different parts of the brain. To put it in concrete terms. What is the one thing a child never says or never thinks if they’re pre-verbal when they’re watching television? The answer is: I did it. Because they didn’t do anything. It’s entirely a passive experience. In fact, the purveyors of early television for children knew this, and they knew that interaction with the screen would enhance engagement. So in their own crude way, they would often ask questions, right. Sesame Street would do this. Blue’s Clues would do this, and they would pause. And then whatever the child said, they would say, “that’s right, you got it,” without knowing, of course, whether or not the child responded at all or whether they’d responded correctly.

You know, I think I’m really going to need your help today trying to figure out why Blue is sad. I don’t like it when Blue is sad. Will you help me? You will.

Those little interactive moments in children’s television were made to keep kids engaged. And it worked. So fast forward years down the road and interactive screens capitalized on that knowledge. Think about it this way. When you touch the screen of an iPhone or a tablet, it responds to you. Something pops up. When you send or receive a message, your phone dings or makes a noise. It’s a near-constant level of interaction that we’ve never had before. And Christakis believes these types of interactions have a fundamentally different effect on all of our brains. But there’s one age group in particular, Dr. Christakis says, is likely impacted the most.

The typical preschool child spends about four and a half hours on a screen in the United States, and they’re awake for 12. So if you just think of it that way, does it make sense to us that a third of a child’s waking time would be spent in front of a screen? Even if we think those screens are good for them? I think for early children, the risks are greater for sure because of the fact that the brain is is conditioning itself for a lifetime, right. There’s this critical window early in brain development. So there’s something special about early childhood. And I do worry that there are lingering effects there.

Safe to say that there is a difference then in terms of these these screens and the interactive nature of touch screens are, by their very nature, going to be able to keep you around longer for all the reasons you mention, which is fascinating. If I heard you correctly, you said that the younger, you know, the 0 to 5 sort of age toddlers, young kids, they are the most likely to become I don’t want to use the word addicted here necessarily.

Yeah.

But overuse overuse.

Yep.

Issue with the screens more likely to happen if young brains are exposed to them. Is that a fair statement?

It’s a very fair statement. So we did a study, gosh, almost 20 years ago now here at Seattle Children’s, where we had parents of 18-to 24-month-olds keep diaries of what their children do on a typical day. And the typical 18- to 24-month-old at any given day will spend on average 20 minutes with their favorite activity, whether that’s blocks or books or dolls. That’s how much time they’ll spend. They will spend way more time happily with that with the screen, a touch screen or not. That alone tells you something is fundamentally different from this experience. They are engaging the brain, keeping the child interested in a way unlike anything else they might otherwise play with. Now, why is that? Children are born without any knowledge right of the world they live in, and they spend an enormous amount, really all of their mental energy, trying to figure out the rules of the world. And if you look at little babies and they’re staring at you or looking around. That’s what they’re trying to do. They’re trying to figure out what makes something happen or what makes something good happen. The example I often use that most parents can relate to is if you if you take a six month old or an eight month old and you put them on a highchair, I’m sure you had this experience with your daughters and you put a toy or two toys on their highchair, almost invariably the child will take the toy and throw it down and almost invariably the new parent will pick the toy up and bring it back. That’s an incredibly delightful experience for a child. They’ve made two things happen. They threw the toy down. They made their parent come and bring it back to them. It’s only about the third or fourth time that the parent realizes they’re in an infinite loop and this game will never end. The child finds this so satisfying that they can predictably make something happen, that they’ll keep doing it.

It’s making the world do something for them. In this case, a parent running over and over again for the toy. But remember this point. It’s the critical ingredient we’ve been talking about. The interaction. The interaction is what Christakis says makes smartphones so tempting for toddlers and young children. Think back to what we saw from Malik in Dr. Christakis’ lab. He loved all of his toys, but it was the iPad, the thing that was interacting with him that definitely grabbed his attention the most.

Now, the iPad, unlike the parent, never tires. It never says, we’re done here. This is an infinite loop. They will happily keep pushing it. It’s not addictive use per se, but it becomes compulsive that they find it more difficult to disengage from a screen than they do from a typical toy, even from an electronic toy. It’s commanding their attention so much more.

And yes, all of a sudden, a child is spending a ridiculous amount of time getting sucked down a technology rabbit hole.

When I think of the effects of screens on children. There are two pathways. The first is sort of the direct pathway. How does what I’m watching affect the way I think the way my brain works? But there’s another equally important pathway, which is what I call the indirect pathway, and that’s mediated by displacement, right. There are only so many hours in a day, every day for every hour spent on a screen comes at the expense or force of some other activity. In young children, that activity could be interacting with the caregiver. It could be physical play. It could be imaginative play. It could be being held and loved by by a parent or a grandparent. Think of it as a media diet. If you asked me, “are carrots a healthy food?” I would say yes. But if you told me that you eat a bushel of carrots every day, I would say that’s not a healthy diet. You’re not eating other things that you need to balance that out. So in the case of young children, it’s so important that they have these real world interactions because of the lifetime consequences of their brain development.

But make no mistake, none of this is easy to figure out. I mean, even though Dr. Christakis knows the risks of overdoing it on screen time, he’s quick to remind us there’s still a lot we don’t know, that we are all living in a brave new world.

We have to remind ourselves that the iPad that we all think about has been around forever is 12-years-old. This touch screen technology has not been around very long, and therefore we’re very limited in fully appreciating the effects it’s going to have. And speaking about the negative by the way. We could do a 12-hour show on all the amazing things technology does. It they those things sell themselves. They sell themselves too well, frankly. But we do have to be mindful of the risks, which is why I focus on those, not because I’m such a doom and gloomer.

Knowing the risks is a good first step. But I do know many parents out there who may be wondering, how do I handle this with my own kids? What’s it all mean?

Unfortunately, I think and practically, I think for a lot of us parents, we’re really busy. And sometimes you inevitably end up putting the TV show on so you can get ready or you can finish work or do these things.

After the break, we’re going to hear how one mom’s finding balance with her young toddler, as well as Dr. Christakis’ tips for what he calls a healthy media diet.

As I’m listening to Dr. Christakis, I understand what he’s saying as a doctor and as a journalist. But if there’s one thing I know as a dad, it’s that telling a child to do anything, especially something they don’t necessarily want to do. Well, that’s easier said than done.

Sometimes when we try to get the kids off of screens, it’s it’s a battle. Sometimes they will get really whiny, sometimes they get really frustrated.

That’s Rose. And you may also hear her five-year-old son, Harry. He’s the one playing in the background there. My producer Grace, met Rose and Harry while visiting Dr. Christakis at his lab. And while they were there, Harry played with the same games that Malik had, but when it was his turn to give up the iPad, he hesitated.

How do you like that game?

Mommy and Daddy usually give us a long hour of tablet time.

Oh they do? How long again? An hour?

That was much shorter than an hour just now, huh?

Safe to say Harry was not happy about his screentime being cut short. But Rose says she sets these limits because she knows about the dangers of too much technology. In fact, Rose works at the Research Institute with Dr. Christakis. But the thing is, even with this knowledge, Rose struggles to put screen time limits into practice, especially in today’s digital first world.

Unfortunately, I think and practically, I think for a lot of us parents, we’re really busy and sometimes you inevitably end up putting the TV show on so you can get ready or you can finish work or do these things. You know, in a perfect world, we would be able to engage both of our kids all the time, but that’s just not realistic.

I think most of us can relate to what Rose is saying, and I know that it resonates with me as a parent. Sometimes life just gets in the way. To be honest, up until the season, I kind of thought of the device as more of a toy that could help occupy my kids when they were young. I didn’t think of it like the high powered tool that it is. I didn’t really consider all the impacts it might have. Maybe I worried about things like the brightness of the screen on the eyes or the volume of the speakers on their ears, but not as much about the entire device’s impact on their brains. Overall, it was just so easy and it was so effective. But now that I know about some of the risks, I wanted to ask Dr. Christakis about the latest guidance for parents and his most practical tips for setting limits on screen time. But I did want to acknowledge something important that we’re all learning together and that even the experts might change their minds. So I find it interesting Dr. Christakis – 1999, so now I’m doing the math here. This is your child is a year old?

Yes.

1999. And the American Academy of Pediatrics that sets forth these guidelines, which I think a lot of people paid attention to, and basically, it says people under the age of two.

I was one of of the authors of those guidelines so.

So you were one of the authors that said under two should not be exposed to screen time and you got a one year old at home, so you’re thinking, hey, I’m going to say at least another year before my before my son should be exposed. But but why was two, why was two years of age the right age limit at that time?

It wasn’t the right age limit at that time. It was an arbitrarily selected age based on our best knowledge of or best guess at what would be an appropriate age. Since then, and we’ve revised the guidelines and I was one of the lead authors of the revision, we lowered it to 18 months. But I also want to put some parameters on this. I think it’s important. When the guidelines were written at eight in 1999, it was just television and there was no content for kids under the age of two.

Yeah.

Now, what we’ve learned since is that before the age of 18 months, even though children will watch television or play with touch screens, they don’t transfer that knowledge to the real world. What do I mean by that? If you give a child, a 16-month-old, an app that has a Lego building program so they can drag blocks and assemble something, and then you put them in front of the same blocks, but now in 3D form, they start all over. They they don’t build what they’ve built before.

Really?

And again, we’re talking about on average. Starting at 18 months, they can, but they need parental co-teaching. They need someone in the room to sort of help scaffold the online experience to the real world one. And the reason we revise the guidelines to say up to a half an hour for children that young was based on the study I alluded to earlier about how much time children would spend with any other toy. So if they’ll only spend 30 minutes with blocks, they should only spend 30 minutes with an iPad.

So you have been known for when you talk about screens challenging this prevailing wisdom that all screens are created equal.

Right.

They’re different. And I totally agree with you on this. I think sometimes it’s it’s the challenge is sometimes parsing out exactly what the differences are. But educational content versus, you know, playing some shoot em up game. You know, I think people can generally agree that those are different contents. Let me ask you about something that you said specifically in terms of interacting with others. So my kids will video chat with their grandparents. Okay. So they’re looking at my my parents on a screen and they’re having a video chat with them. Now, it’s not in-person.

Yep.

Where do you place that?

I’ll tell you where I place that. I wouldn’t count that as screen time at all. In fact, I would. I would count that if I would, if it’s with grandparents, I would give bonus points for it. You know, here’s the thing, Sanjay. You and I are I think you’re younger than me, but you’re certainly better looking. But, but when…

Magic of the screen.

When we, when we were kids, we spend hours on the telephone. No one thought about that as being harmful. And I don’t think it was. Again, hours on the phone comes at the expense of some other activity. It might just be your homework. But I don’t think video chatting should be thought of as a negative. It’s not exactly the same thing as being in the same room, but being in the same room with your grandparents, even pre pandemic was not always an option.

Look, Doctor, you know, as much as we talk about this stuff, you know, being totally candid, you don’t always practice what we preach. One of my daughters told me my oldest, who’s 17, said she told me the other day, and this is like a vulnerable thing as a parent, right. It’s a bit of a gut punch. But she said, you know, when I have kids, meaning her, she would probably wait longer.

Yeah.

Than we did to give her kids access to a phone in social media. And here I thought I was being the very, you know, very liberal parent, you know, trying to do the right thing, be a good dad. And she’s like, yeah, you kind of got it a little off there. I probably would have waited longer. But I think the point is that we’re we’re all figuring it out. Every kid is different. So all these other parents must be coming to you and asking you, help me figure this out. What do you what do you tell them at a at a backyard barbecue about this sort of stuff?

You know, it’s funny because I get questions from from two groups of parents, one from people who who feel guilty because they’ve done it wrong.

Yes.

And come and asked me like, you know, for for to show them grace or to give them the advice for how to undo the damage they’ve done. And the other I think from very earnest parents who have a chance to prospectively help their children build a healthier relationship with screens. So I’m not one who by any means delights in having parents feel guilty. I think it’s the hardest, most important job there is. God knows I made tons of mistakes, but my general advice is: be mindful, take it slow and and be aware. Know what your children are doing. I often am asked what apps are educational? What programs are educational? Every program is educational. The question is what is it teaching? And that’s what you need to figure out from your children. Facebook, Instagram, Snapchat, they’re all teaching them. YouTube, they’re all teaching them. Your job is to figure out what are they teaching them and how to make sure that that the messages are what you want them to take away.

I fully agree with Dr. Christakis there. Look, parenting is one of the toughest, most meaningful jobs I’ve ever had. And the fact of the matter is, we all make mistakes. There’s one thing I try not to do this season. It’s parents shame. You’ve never heard me parent shame. So I’m really glad Dr. Christakis mentioned the stress that can come along with having to make some of these decisions. There is so much that is still unknown. There is so much that is simply out of our control when it comes to raising our kids in a digital world. We’re really all just doing the best we can, in pretty unprecedented circumstances. It’s something I’ve heard from everyone along this journey, from experts to fellow parents like Rose, to you, the listener.

I try to veg out on my phone and I have heard so many times from my kids and from my partner that my focus is so much on my phone rather than my family. So just having to think about and reevaluate what that actually means to have a connection to my phone versus the connection to my family. I think that’s been just really poignant from listening to your show.

I’ve definitely reevaluated my own habits during the season, and it’s meant so much to me to hear from so many of you while making these episodes. In our final episode of the season. I’m going to sit down with another very special parent, a very special guest, my wife, Rebecca. We’re going to talk about what she thinks about this crazy, wonderful journey we’ve been on, what we’ve learned about our girls and ourselves along the way. Our season finale is coming up next Tuesday. Thanks for listening.

Chasing Life is a production of CNN Audio. Our podcast is produced by Grace Walker, Xavier Lopez, Eryn Mathewson, and David Rind. Our senior producer is Haley Thomas. Andrea Kane is our medical writer and Tommy Bazarian is our engineer. Dan Dzula is our technical director. The executive producer of CNN Audio is Steve Lickteig. And a special thanks to Ben Tinker, Amanda Sealey and Nadia Kounang of CNN Health and Katie Hinman.