Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Prospective, Multi-Centered, Pseudonymized Survey among Parents and their Children

Abstract

Introduction: There are many opinions about the use of digital screen media (dsm) in childhood, however, all experts agree on one thing: children spend on average too much time in front of screens. So far, there are few interventions to restrict the quantity and increase the quality of screen-time. The aim of this study was to investigate the impacts a media fasting intervention would have on screen use and overall wellbeing.

Method: A pilot study with an open, prospective, multi-centered design of a pseudonymized survey with pre and post assessment of a 44-day media fasting intervention. Participating families were approached at family practices, at schools, at one pediatric hospital and by including individuals. Here we report on the intentions of parents and their children at the start of the intervention.

Results: 365 parents (50% <40 years; 51% high school education) and 280 schoolchildren (aged 10.5 ± 3.1 years; 56% boys). Parents had 0.3 ± 0.9 media-free days/week. Children had 0.8 ± 1.5 media-free days/week. Parents found that using less dsm would be good for themselves (77%) and for their children (81%), felt annoyed/stressed by permanent availability of dsm (58%). They hoped that by using less dsm they would have for more time for their children (63%) and become more attentive and calmer as a family (79%). 58% hoped that media fasting would improve their child’s ability to concentrate. Some children accused their parents of using too much dsm (49%), felt that they themselves used to much dsm (39%), felt annoyed and stressed by the permanent availability of dsm (only 16%), and hoped for improved concentration (55%) and more attentiveness and calmness as a whole family (72%) by reducing dsm.

Conclusion: Parents and children, show a self-critical attitude towards media, even though children assign them a less negative status. All groups hope reduction of dsm will improve quantity and quality of family time.

Full text

Arch Pediatr, an open access journal
ISSN: 2575-825X
1 Volume 04; Issue 02
Archives of Pediatrics
Research Article
Schwarz S, et al. Arch Pediatr 4: JPED-171.
Self-Perceived Usage of Digital Screen Media and Intentions to
Reduce it: An Open, Prospective, Multi-Centered, Pseudonymized
Survey among Parents and their Children
Silke Schwarz1, Hanno Krafft1, Arndt Büssing1, Katja Boehm1, Till Reckert2, Uwe Büsching2, David Martin1,3*
1Witten/Herdecke University, Chair of Medical Theory, Integrative and Anthroposophic Medicine, Germany
2German Association of Pediatricians, Germany
3Tübingen University, Department of Pediatrics, Germany
*Corresponding author: David Martin, Witten/Herdecke University, Chair of Medical Theory, Integrative and Anthroposophic Med-
icine, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany. Email: david.martin@uni-wh.de
Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and In-
tentions to Reduce it: An Open, Prospective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr
4: 171. DOI: 10.29011/2575-825X.100171
Received Date: November 06, 2019; Accepted Date: November 13, 2019; Published Date: November 19, 2019
DOI: 10.29011/2575-825X.100171
Abstract
Introduction: There are many opinions about the use of digital screen media (dsm) in childhood, however, all experts agree on
one thing: children spend on average too much time in front of screens. So far, there are few interventions to restrict the quantity
and increase the quality of screen-time. The aim of this study was to investigate the impacts a media fasting intervention would
have on screen use and overall wellbeing.
Method: A pilot study with an open, prospective, multi-centered design of a pseudonymized survey with pre and post assessment
of a 44-day media fasting intervention. Participating families were approached at family practices, at schools, at one pediatric
hospital and by including individuals. Here we report on the intentions of parents and their children at the start of the interven-
tion.
Results: 365 parents (50% <40 years; 51% high school education) and 280 schoolchildren (aged 10.5 ± 3.1 years; 56% boys).
Parents had 0.3 ± 0.9 media-free days/week. Children had 0.8 ± 1.5 media-free days/week. Parents found that using less dsm
would be good for themselves (77%) and for their children (81%), felt annoyed/stressed by permanent availability of dsm (58%).
They hoped that by using less dsm they would have for more time for their children (63%) and become more attentive and calmer
as a family (79%). 58% hoped that media fasting would improve their child’s ability to concentrate. Some children accused their
parents of using too much dsm (49%), felt that they themselves used to much dsm (39%), felt annoyed and stressed by the per-
manent availability of dsm (only 16%), and hoped for improved concentration (55%) and more attentiveness and calmness as a
whole family (72%) by reducing dsm.
Conclusion: Parents and children, show a self-critical attitude towards media, even though children assign them a less negative
status. All groups hope reduction of dsm will improve quantity and quality of family time.
Keywords: Child; Digital screen media use; Family; Parents;
Screen time; Survey; Stress
Introduction
In July 2017, the rst author and senior author convened a
Think Tank Future of Childhood: key players in the areas of health
and education spent a weekend together to consider the question:
“What do we have to do now in order to secure a good future for
childhood?” Tackling the question as to the effect of screen media
on children was seen as the greatest and most urgent challenge.
Thus, in October 2018, a new Think Tank was convened on the
subject of digitalization and childhood, additionally inviting
specialists in the area of media pedagogy. The goal of this meeting
was to develop a plan for an intervention that would be most likely

Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Pro-
spective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr 4: 171. DOI: 10.29011/2575-825X.100171
2 Volume 04; Issue 02
Arch Pediatr, an open access journal
ISSN: 2575-825X
to have a lasting benecial effect on how digital screen media
(dsm) is used in childhood. The authors came up with the idea
of the Media Fasting Set with questionnaires and a calendar as
portrayed in this publication.
In addition to TV, children are spending increasing amounts
of time in front of interactive screens, such as computers, tablets,
smartphones and gaming consoles. Numerous studies have shown
that extensive screen exposure during very early childhood can
be harmful: for cognitive development [1,2], social competences
[3-5], mental health [5,6] and physical wellbeing [7] with negative
inuences on concentration, sleep, risk of obesity and diabetes,
mental development, psycho-motoric development, speech
development, and general family life [8]. According to a study by
the Media-pedagogical research group South West 97% of the 12-
19-year-old adolescents in Switzerland own a smartphone, and on
average use it for 3 hours 41 minutes per day, especially for social
media [9]. Another survey by Ernst & Young found that young
adults aged between 21-30 years spend an average of almost 7
hours per day online, of which 3 hours on their smartphones [10].
The German health insurance DAK reported that 2.6% of German
children and adolescents full the criteria for social media addiction
as measured by the Social Media Disorder Scale (girls 3.4%, boys
1.9%) [11]. Especially alarming is the nding that people addicted
to social media have at times a higher risk of depression. A study
carried out at the US San Diego State University showed that
teenagers who on average spent more than 5 hours of their free time
behind screens were twice as dissatised with their life compared to
adolescents who spent less time [12]. This does not necessarily mean
that screen time generates dissatisfaction with life or depression;
screen time can also be an escape from concrete life. According
to the German BLIKK study (BLIKK: accomplishment, learning
behavior, intelligence, competence, communication) babies whose
mothers regularly use their smartphone during breastfeeding often
experience feeding problems, problems going to sleep and even
attachment issues [13]. Nearly 70% of young people say that they
use their mobile phones in the last ten minutes before going to bed.
About half of them can even be woken up at night by messages.
Young people who use smartphones and tablets late in the evening
or even take them to bed have poorer quality of sleep, less sleep
in absolute terms and are signicantly more tired during the day
[14]. The effects of newer display screen devices have still been
poorly studied [15] and the above-mentioned sources are partly
of a preliminary nature, but new studies show that brain structure
changes measurably after only 6 weeks of gaming [16]. South
Korean researchers found that intense online gaming destabilizes
the chemical balance of the brain. Using Magnetic Resonance
Spectroscopy (MRS), they found that in intensive gamers the ratio
of important messengers in a particular region of the prefrontal
cortex was signicantly shifted, including an increased level of
GABA. This neurotransmitter slows down neurons and thus brain
activity, similar to patients with severe depression. Only after a
longer gaming break did the brain chemistry of the volunteers
normalize [17].
Although the technology is seen as the “big equalizer” [18,19]
which closes the development gap between wealthier and poorer
children, the facts speak a different language: families with lower
socio-economic status are more willing to allow screen devices in
the children’s room, and children from such families suffer more
damage from media devices in their bedrooms than children from
higher socio-economic backgrounds [20,21]. This suggests that
parents with higher socio-economic status are more able to choose
media content that is conducive to child development, or at least
less harmful [22]. Further, parents with lower socio-economic
status tend to use screen devices as a substitute for relationships to
keep their children busy, and without knowledge of media content
[23]. However, the same might be increasingly true for parents of
higher socio-economic status. It is now clear that non-educational
media content increases the risk of later attention decit disorder
[22]. The American Academy of Pediatrics recommends that
children of ages 2–5 years should spend ≤2 hours per day with
screen media, because excessive viewing has been linked to a
plethora of physical, academic, and behavioral problems [24].
Media education is a challenge for the majority of parents, and real
media use paths are far from this ideal, with dire consequences:
Longitudinal studies report excessive use of screen media at school
age to be connected to a number of negative outcomes: tobacco
use, obesity, poor educational performance, alcohol use and drug
use, decreased sleep quality, loss of empathy/aggression, and video
game dependency [25]. Children with lower socio- economic
status are more severely affected [26]: This is true for all three sub
dimensions of problematic media use (equipment/time, content and
functionality) [27]. In Germany, 10-year-olds with low parental
education levels owned TVs three times more often and gaming
consoles four times more often than in high parental education
families. Daily usage times as well as bedroom screen equipment
increase substantially during kindergarten and elementary school
years [25,28]. Higher bedroom screen equipment is associated with
longer screen time, which in turn goes along with the consumption
of a higher percentage of problematic content. Media use paths are
difcult to change once they are established [12,28].
Research into universal prevention of other addictions
suggests that early interventions strengthening children´s real
life resources provide effective prevention in various elds
including behavioral addictions [18], whereas cognitive deterrence
and information strategies have shown inconsistent or even
counterproductive effects in the past [19]. Information and technical
media use skills do not automatically provide protection against
addictive screen use. On the contrary, they have been shown to be
associated with a higher risk of exposure to problematic content
and internet addiction [20]. Critical media literacy skills, on the

Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Pro-
spective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr 4: 171. DOI: 10.29011/2575-825X.100171
3 Volume 04; Issue 02
Arch Pediatr, an open access journal
ISSN: 2575-825X
other hand, show a connection to lower addiction risk. However,
they are not connected to technical mastery, but to lower usage
times, and to a higher overall educational level [21]. Studies on
screen-time reduction programs proved to be effective in RCTs,
but most of them focused only on one of the problem dimensions,
namely screen time, and that, in turn, was often considered a
means to reduce obesity, not a goal in itself [22,26]. Schmidt, et
al. [29] conclude that “there are several research gaps, including
limited long-term (>6 month) follow-up data (n = 5), and few (n
= 4) targeting removing TVs from children’s bedrooms.” Despite
this, there are very few research interventions.
Materials and Methods
Specic Objectives
It is a long-term objective to generate an increase of behavioral
change and health competent awareness concerning the handling
of screen media in the world population, especially in families
and institutions with children, by providing medical information
and intrinsic incentives for observing one’s own experience of
the effects of media, and to act upon it. Media fasting times are
assumed to generate awareness by rst promoting assessment of
personal use of screen media for oneself and one’s family, and,
based on this assessment, to dene goals for media fasting. Based
on experiences during media fasting, participants are encouraged
to make long-term decisions, redesigning media habits with the
help of information about the opportunities and risks of dsm for
adult and child development. This can lead to a familial, social,
empathic sensitization in the use of media monitors. We therefore
planned a voluntary 6-week media fasting intervention study for
parents and their children as a family. Before and during these six
weeks of media fasting, the participants were encouraged to deal
with the topic of their habits with regard to the use of screen media
and the time spent with it. Various alternatives and offers were
suggested, including ideas for common family activities from the
areas nature, play, sport, culture and nutrition, in order to make
this media-restricted time a ‘celebration of the senses, culture and
relationships’. In this way, an increased, behavior-changing health
awareness of screen media is intended within the families. Since
media fasting is to take place annually from 2020, a supporting
media fasting community is intended. Thus, media fasting may
create a sense of community in the eld of prevention. The
pediatrician’s ambulatory clinics, schools, kindergartens, youth
welfare ofces and associations are to offer a further supporting
role through education, animation, participation and special offers
during this time. In this paper we intended to initially analyze and
present the media fasting intentions and expectations of parents
and children willing to participate at the start of the intervention.
We further asked how many hours per day they use these media
and how many hours per day they intend to reduce it.
The MediaFasting sets included the pre and post questionnaires
for adults, children and adolescents developed in co-operation with
the Professional Association of Pediatricians (BVKJ), Germany.
Each MediaFasting set consisted of an esthetically designed cover
that opened into three sections (Figure 1): Sections one and three
each contained questionnaires for two adults plus 3 children to be
given before and after media fasting. Section two contained a letter
to the family, the MediaFasting calendar with its 44 doors each
containing impulses for media-free activities covering the areas
movement, nourishment, play, nature and relationships (Figure 2),
and a brief guideline on media in childhood based on the BVKJ
guideline for families
Figure 1: MediaFasting Set containing calendar and
questionnaires.
Figure 2: Front cover of the MediaFasting calendar.
We distributed 1284 sets between February 1st until the
end of lent (March 6th) 2019 to six practices for pediatric and
adolescent medicine to be handed out to parents. Also, those
families who decided not to take part (non-participants) were
asked for their reasons not to take part in the study. Recruitment
was done in the German federal state of North Rhine-Westphalia
in six established pediatric medical practices. In each practice,

Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Pro-
spective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr 4: 171. DOI: 10.29011/2575-825X.100171
4 Volume 04; Issue 02
Arch Pediatr, an open access journal
ISSN: 2575-825X
250 families with children from all social backgrounds were to
be recruited to actively participate in the 6-week media fasting
period, parallel to the Christian fasting time, or lent. This began
6th of March 2019 and nished 16th of April 2019. Included were
families with children who agreed to participate. There were no
exclusion criteria except ability to read the questionnaires. For
data collection, consent forms had to be signed by an adult or legal
guardian of the children (approved by the ethics commission of
Witten/Herdecke University, application no.194/2018).
In order to collect socio-demographic data, data regarding
the private dealings with dsm and to assess one’s wellbeing,
emotions, experiences, current behavior and the limitation of dsm
at home, standardized questionnaires for children, adolescents and
adults were provided. These were lled out by each participant
within a family and were pseudonymized for the examiner.
Statistics
Analysis was open, descriptive and group comparison
(gender, age classes). If not otherwise indicated, results are given
as mean ± Standard Deviation (SD). Correlational analyses will be
carried out in regard to health behavior and use restriction.
Results
Pilot Study Data Collection
Distributions of the media-fasting sets to the patients took
place between January 21th and March 6th, 2019. A number of
unpredictable issues occurred in 5 out of the 6 original medical
practices – mainly involving the medical staff that were meant
to hand out the sets (death, diseases, water pipe burst). Thus,
those practices did not achieve distribution of 250 sets each.
After roughly two weeks in the distribution period the principle
investigators received the feedback that not all sets would be
successfully distributed. Thus, blank sets were returned from 5 out
6 medical practices, whereas the 6th practice actually ordered 100
further sets. Hence, the principal researchers distributed sets via
other institutions. In four schools, a parent-evening was organized
on which the investigators directly introduced the study to the
parents. Respective amendments were made to the protocol, which
received ethics approval. Therefore, altogether there were 15
medical practices involved in the study, one pediatric department
of a hospital and 4 small schools (3 Steiner/Waldorf schools and
one state primary school) who expressed interest to take part.
The sample-questioning of non-participants (n=249) showed
a broad range of reasons for not taking part. 64.5% of them stated no
interest to participate, while 35.5% stated interest but were unable
to participate. 17.1% of them had a migration background and
stated difculties with the German language. Among other reasons
for not participating were: “no need”, “no interest”, “child has no
interest”, “child is too young”, “participating would result in stress
with the children”, “as a family we use digital screen media only
rarely”, “already have a conscious usage of digital screen media”,
“too much stress” etc.
Socio-Demographic Data
Results of parent (Table 1a) and children (Table 1b)
investigations: In the parent group (n = 365), mothers (66%) were
more frequently represented than fathers (34%). Parents had an
average of 2 children (Table 1a). The parent group of < 40 years
was the strongest with 50%, followed by the 40-50-year-olds
(42%). The parent group was dominated by people with a higher
school education (51% with high school graduation and 21% with
vocational baccalaureate diploma). Media-free days in the week
were hardly present (0.3 ± 0.9 days): 88% did not have any media-
free days, 9% 1-2 days, 3% used no media for more than 2 days
per week. There were no signicant differences between men and
women. In the primary group of children (n = 407) 20% were 0-5
years old, 34% 6-9 years old, 29% 10-13 years old and 17% 14-
18 years old. The group of small/kindergarten children was not
considered for the following analyses, so that 280 school children
(56% boys and 44% girls) with an average age of 10.5 ± 3.1 were
examined (Table 1b). Media-free days in the week were hardly
present (0.8 ± 1.5 days): 72% did not have any media-free days,
16% had 1-2 days, 12% used no media for more than 2 days per
week. There were no signicant differences between boys and girls.
In the group of primary school children, the number of media-
free days was relatively highest (1.2 ± 1.8 days), and intermediate
(0.6 ± 1.3 days) among 10-13 year olds and hardly any among 14-
18 year olds (0.1 ± 0.4 days); these differences were statistically
signicant (F=13.4; p<0.0001).
Number % M ± SD
Gender
Female
Male
238
123
66
34
Age class
< 40 years
40-50 years
<50 years
178
148
30
50
42
8
Average age 41,2 ± 6,8
School education
Lower secondary education
Secondary school level
College
High school
18
81
74
182
5
23
21
51
Number of children 2,0 ± 0,8
Media-free days 0.3 ± 0,9
Table 1a: Characteristics of investigated parents (N = 365).

Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Pro-
spective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr 4: 171. DOI: 10.29011/2575-825X.100171
5 Volume 04; Issue 02
Arch Pediatr, an open access journal
ISSN: 2575-825X
Number % M ± SD
Gender
Girls
Boys
124
156
44
56
Age classes
6-9 Years
10-13 Years
14-18 Years
120
101
59
43
36
21
Average age 10,5 ± 3,1
Media-free days 0,8 ± 1,5
Table 1b: Characteristics of investigated children and adolescents
(N=280).
Agreement in The Child and Adolescent Group On Use of
dsm
77% of parents found that it would be good for them to use
less dsm and 81% found that using less dsm would be good for their
children. 58% felt annoyed / stressed by the permanent availability
of dsm. If they reduced their use of dsm, 63% hoped for more time
for their children and 79% hoped to become more attentive and
calmer as a whole family. 58% hoped that media fasting would
improve their child’s ability to concentrate. For these statements
there were some noticeable differences for the age cohorts, which
was strongest for the self-assessment that it would be good to use
less dsm. This was highest among <40 year olds and lowest among
>50 year olds. For gender, there was a relevant difference only
for the perception of being stressed by dsm, which was higher in
women (Table 2a).
N1: it would
do me some
good, to use
less dsm.
N2: it would
be good for
my child(ren)
to be using
less dsm.
N3 I feel
stressed because
of dsm.
N4 I hope
for more
time with my
children.
N10 I hope
that as a
family we will
become more
attentive and
calmer.
N13 I hope
that the ability
to concentrate
will improve
for my
child(ren).
Agreement (%) 77 81 58 63 79 58
Scale Agreement-Score 0-3 0-3 0-3 0-3 0-3 0-3
Age classes
All parents
(n=355)
Mean 2.05 2.15 1.71 1.68 1.95 1.60
SD 0.78 0.84 0.95 0.88 0.83 1.01
<40 years
(n=177)
Mean 2.15 2.01 1.72 1.73 1.95 1.45
SD 0.75 0.90 0.94 0.93 0.90 1.09
40-50 years
(n=146)
Mean 2.01 2.28 1.77 1.65 1.97 1.73
SD 0.78 0.74 0.94 0.80 0.78 0.96
> 50 years
(n=28)
Mean 1.68 2.25 1.41 1.61 1.75 1.86
SD 0.77 0.75 1.01 0.88 0.70 0.76
F-value 4.96 4.48 1.70 0.44 0.82 3.88
p-value 0.008 0.012 n.s. n.s. n.s. 0.022
Gender
Female
(n=236)
Mean 2.10 2.20 1.83 1.72 2.01 1.66
SD 0.75 0.83 0.91 0.85 0.81 1.04
Male (n=120)
Mean 1.95 2.04 1.47 1.62 1.83 1.50
SD 0.83 0.86 1.00 0.93 0.85 0.96
F-value 2.88 2.80 10.91 1.11 3.50 2.09
p-value 0.090 0.095 0.001 n.s. 0.062 n.s.
dsm = digital screen media
Table 2a: Agreement-scores in the adult group.

Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Pro-
spective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr 4: 171. DOI: 10.29011/2575-825X.100171
6 Volume 04; Issue 02
Arch Pediatr, an open access journal
ISSN: 2575-825X
57% of the children admitted that their parents felt that they (the children) would be too busy with dsm, while 49% of the children
accused their parents of using too much dsm themselves. As many as 39% of the children felt that they were too busy with dsm for too
long, but only 16% felt annoyed and stressed by the permanent availability of dsm. If they reduced their use of dsm in media fasting,
55% hoped that their concentration would improve and 72% hoped that they would become more attentive and calm as a whole family.
There were no signicant gender differences when agreeing with these statements, but there was for the age cohorts. When it came to
estimating too much dsm use, this was lowest among primary school children and highest among adolescents. Primary school children
felt more strongly than older children that their parents would use too much dsm. It was also the primary school children who hoped that
media fasting would make their families more attentive and calmer toward one another (Table 2b).
X2: My
parents say
that I am too
engaged with
dsm
X25: In my
opinion I am
currently too
engaged with
dsm
X26: my
parents are
using too
much dsm
X3: I feel
stressed
because of
dsm
X13: concentration
improves
X28: that
we are doing
much more
together as a
family
Agreement (%) 57 39 49 16 55 72
Range agreement score 0-3 0-3 0-3 0-3 0-3 0-3
All children
(n=274)
Mean 1.54 1.12 1.45 0.62 1.56 2.00
SD 1.04 0.98 1.01 0.85 1.08 1.04
Age classes
6-9 years
(n=116)
Mean 1.19 0.74 1.67 0.49 1.51 2.10
SD 1.05 0.86 1.00 0.78 1.05 1.00
10-13 years
(n=101)
Mean 1.71 1.30 1.35 0.66 1.58 2.09
SD 1.04 1.07 1.08 0.85 1.16 1.07
14-18 years
(n=58)
Mean 1.97 1.55 1.19 0.81 1.60 1.63
SD 0.77 0.78 0.79 0.96 1.01 0.96
F-Value 13.95 17.78 5.37 3.02 0.20 4.76
p-value <0.0001 <0.0001 0.005 0.050 n.s. 0.009
Gender
Female
(n=123)
Mean 1.45 1.24 1.45 0.60 1.63 1.94
SD 1.03 1.01 1.03 0.84 1.06 1.09
Male (n=151)
Mean 1.62 1.02 1.46 0.64 1.49 2.05
SD 1.05 0.96 1.00 0.87 1.09 0.99
F-value 1.93 3.29 0.00 0.15 1.10 0.68
p-value n.s. 0.071 n.s. n.s. n.s. n.s.
dsm = digital screen media
Table 2b: Agreement-scores in the child and adolescent group.

Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Pro-
spective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr 4: 171. DOI: 10.29011/2575-825X.100171
7 Volume 04; Issue 02
Arch Pediatr, an open access journal
ISSN: 2575-825X
Correlation in the child and adolescent group on use of dsm
The perception that it would do good to use less dsm was
moderately associated with the assessment that it would also do
children some good to use less dsm (r=.41) and to be annoyed and
stressed by the permanent availability of dsm (r=.34). Moderately
associated with this was also the expectation that through media
fasting more time would be available for the children (r=.37).
The perception that it would be good for their children to use less
dsm was moderately associated with the hope that their ability to
concentrate would improve (r=.48) and that they would become
more attentive and calmer as a family (r=.37). There was a
strong correlation between the hope of parents to become more
attentive and calmer as a family and the hope that media fasting
would improve the child’s ability to concentrate (r=.53). All these
statements showed no signicant correlation with the previous
media-free days of the parents (Table 3).
Children’s perception that they would be too busy with dsm
coincides strongly with their statement that their parents would
also perceive this (r=.51). The self-assessment of being too busy
with dsm showed a moderate correlative relationship with the
perception of being annoyed / stressed by dsm (r=.35) and with
the expectation that media fasting would improve concentration
(r=.45). The concrete stress sensation itself was also moderately
associated with the expectation of concentration improvement if
one were to limit the use of dsm (r=.32). This improvement in
concentration was also moderately associated with the expectation
of becoming more attentive and calmer as families (r=.42). The
perception that their parents themselves use too much dsm was
not signicantly associated with any of the other perceptions. The
frequency of media-free days to date was moderately negatively
associated with the statement that their parents felt that they (the
children) are too busy with dsm and weakly negatively with the
conrming self-perception (r=-.38) (Table 3, Figure 3).
N1: it
would do
me some
good to
use less
dsm.
N2: it would
be good for my
child(ren) to use
less dsm.
N3: I feel
stressed
because of
dsm.
N4: I hope
for more
time with
my children.
N10: I hope that
as a family we
will become more
attentive and
calmer.
N13: I hope that the
ability to concentrate
will improve for my
child(ren).
N1 it would do me
good to use less dsm. 1.000
N2 it would be good
for my child(ren) to use
less dsm.
.414** 1.000
N3 due to the
continued availability
of dsm I feel irritated/
stressed.
.336** .150** 1.000
N4 I hope for more
time with my children. .370** .371** .197** 1.000
N10 I hope that as a
family we will become
more attentive and
calmer.
.286** .372** .219** .399** 1.000
N13 I hope that the
ability to concentrate
will improve for my
child(ren).
.147** .478** .043 .431** .532** 1.000
So far I have already
had (...) media-free
days.
.076 -.001 .101 -.021 .024 .037
**p<0,01 (Spearman rho), dsm = digital screen media, moderate and strong correlations were highlighted (bold)

Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Pro-
spective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr 4: 171. DOI: 10.29011/2575-825X.100171
8 Volume 04; Issue 02
Arch Pediatr, an open access journal
ISSN: 2575-825X
X2 My
parents tell
me that
I am too
engaged
with dsm
X25 Currently,
I am very
engaged with
dsm
X26 My
parents are
using too
much dsm
X3 stressed
due to dsm
X13 concentration
improves
X28 that we are
going to do more
together as a family
X2 My parents tell me
that I am too engaged
with dsm
1.000
X25 Currently, I am
very engaged with dsm .514** 1.000
X26 My parents are
using too much dsm .029 -.035 1.000
X3 stressed due to dsm .129 .347** .088 1.000
X13 concentration
improves .162** .452** .045 .316** 1.000
X28 that we are going
to do more together as
a family
.045 .266** .096 .087 .424** 1.000
So far I have already
had (…) media-free
days
-.380** -.238** -.076 -.108 -.036 -.016
**p<0,01 (Spearman rho), dsm = digital screen media, moderate and strong correlations were highlighted (bold)
Table 3: Correlational analysis - children and adolescents (dsm = digital screen media).
Figure 3: Perceptions of parents and their children towards usage of digital screen media (dsm).

Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Pro-
spective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr 4: 171. DOI: 10.29011/2575-825X.100171
9 Volume 04; Issue 02
Arch Pediatr, an open access journal
ISSN: 2575-825X
Discussion
This study obviously has a bias in that the majority of the
responding parents had high-school education. By the same token
it reects that well-known problem that over-use of dsm is not
only a phenomenon of the less-advantaged [30]: 77% of these
parents found that it would be good for them to use less dsm and
58% stated, that they felt annoyed or stressed by the permanent
availability of dsm. While 88% of the parents did not have any
media-free days in the week, 12% of these parents do still have
media-free days. Our results raise the question as to whether dsm
steals time parents would normally spend with their children,
because 63% of the parents hoped for more time for their children
if they would reduce their use of dsm. Fitting with this hypothesis
is the fact, that half of the children (49%) also openly accused their
parents of using too much dsm while primary school children felt
more strongly than older children that their parents use too much
dsm. The fact that 79% of the parents and 72% of the children
hope to become more attentive and calmer as a family can be
interpreted as a sign that the whole family is challenged by dsm.
Again, primary school children hoped most, that media fasting
would make their families closer toward one another. That using
less dsm would be good for their children was stated by 81% of the
parents and that 58% hoped that media fasting would improve their
child’s ability to concentrate, shows that parents somehow know
about the negative inuences of dsm or at least associate dsm with
negative developments of their children. All these intentions point
in the right direction as it is being suggested that the parental home
has a dening effect on children’s early media socialization, as
parents are role models for duration and style of media use [31].
Pediatric recommendations for parents regarding mindful dsm
use have already been put forward: 1. Be aware: you are a role
model for your child; he or she will imitate you. 2. Use, and let
use, technical equipment purposefully and not out of boredom or
to occupy your child. 3. Eat without screen media and use screen
media without eating. 4. Enable healthy sleep: screen-free sleep
rituals and screen-free bedrooms are necessary. 5. Do not use
screen media as a reward, punishment or reassurance [32].
Not only parents, depending on their age also 72% of the
children did not have any media-free days in the week. The well-
known rise in use of dsm with age (13) is reected in our data.
However, in contrast to their parents, children seem to be less
critical of the situation: even if 57% of the children admitted that
their parents felt that they (the children) would say so, only 39% of
the children felt that they were too busy with dsm for too long, and
only 16% expressed feeling annoyed or stressed by the permanent
availability of dsm. Like their parents, children seemed to attribute
dsm a negative inuence and 55% hoped that their concentration
would improve if they reduced their use of dsm during media
fasting. This attitude is emphasized by the correlation of children’s
self-assessment of being too busy with dsm, the perception of
being annoyed or stressed and with the expectation that media
fasting would improve concentration. As expected, the frequency
of media-free days to date was moderately negatively associated
with the statement that their parents felt that they (the children)
are too busy with dsm and weakly negatively with the conrming
self-perception. The correlation of the perceptions to be annoyed
and stressed by the permanent availability of dsm and that it would
do good to use less dsm for both, parents and children, combined
with the expectation that through media fasting more time would
be available for the children indicates that there seems to be a need
among parents for less media use. Especially when it comes to a
child’s ability to concentrate, parents envisage a context with a
more attentive and calmer family as a result of less media. This
correlation was also suggested by Babic et al. who have looked
at changes in screen time and mental health in adolescents
investigating n = 322 kids throughout an entire school year. They
found that changes in total recreational screen time and computer
use were negatively associated with psychological well-being [6].
As this study has found, many parents feel irritated and
stressed due to dsm and would like to limit their use and instead
have more time with their child(ren) and more conscious quality
time as a family. Their children, on the other hand, feel signicantly
less irritated and stressed, nor do they have the feeling that they are
using too much dsm, but they hope nevertheless that there would be
more conscious quality time as a family if they all were to reduce
the use of dsm. This pilot study also showed that there seems to be
a discrepancy of judgement between parents and children: children
see the problem of ´too much´ to be centered on their parents.
Finally, media use in children is not being sufciently
researched; its premature pedagogization, instrumentalization
and misuse of childhood play through dsm require more political
attention. The importance of the strengthening of early media
competency can only be underlined and repeated. Research,
scientically accompanied model settings and online qualication
of dsm users should be one of the top priorities on the political
agenda [33]. There is a remarkable paucity of interventional
studies aiming at helping whole families become more conscious
of the use of dsm and motivating them to make positive changes.
The fact that all the invited pediatricians (who were asked to invite
parents to participate) came to the study launch meeting on January
18th, 2019, free of charge and even brought staff with them, is an
indication of the high degree of concern and motivation regarding
this theme. Collectively, the study showed that a sensitization of
user behavior towards dsm leading to intentions for change are
possible. In coming articles we will describe the results of the
media fasting. The lessons learned in this pilot study are also useful
for a large randomized trial, which is planned by the authors.
Conict of Interest
The authors declare that the research was conducted in the

Citation: Schwarz S, Krafft H, Büssing A, Boehm K, Reckert T, et al. (2019) Self-Perceived Usage of Digital Screen Media and Intentions to Reduce it: An Open, Pro-
spective, Multi-Centered, Pseudonymized Survey among Parents and their Children. Arch Pediatr 4: 171. DOI: 10.29011/2575-825X.100171
10 Volume 04; Issue 02
Arch Pediatr, an open access journal
ISSN: 2575-825X
absence of any commercial or nancial relationships that could be
construed as a potential conict of interest.
Funding
This study was supported by unrestricted grants from
the Software AG – Foundation, Concors Foundation, Chaja
Foundation and MAHLE Foundations, as well as the DAK state
health insurance company.
Acknowledgment
All cooperating pediatric practices and schools are warmly
thanked for their active support. Dr. Thomas Fischbach, President
of the BVKJ, and Tobias Maurer, Annette Weninger and students
of the Witten/Herdecke University and the Witten/Annen Institute
are thanked for their support. A heartfelt thanks goes to all
supporters of Future of Childhood, www.lebens-weise.organd
www.medienfasten.org.
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