Anales de Pediatría has published a special article titled “Impact of digital media on development and physical health” by Salmerón-Ruiz et al.1 The article reviews the evidence on screen use in the Spanish pediatric population and its impact on health and development, and then offers a series of recommendations.
It addresses an issue of vital importance, given the widespread use of digital devices, particularly in children and adolescents. This health challenge has also been broached by the Board of Physicians of Barcelona (CoMB),2 among other institutions.
However, we believe that there are some crucial limitations to the article by Salmerón-Ruiz et al., which we have also observed in the document published by the CoMB (as described in a previous article).3 For instance, it cites the article published by Ponti in 20234 to support the association between a greater screen time and difficulties in focused attention during childhood (page 5, paragraph 2). However, Ponti cites a study according to which “tablet training with an educational game app can foster sustained attention in children 3–4 years old”, and later states that the evidence of an association between screen time and attentional difficulties remains mixed.
In fact, the absence of references to evidence on the potential benefits of screen use leads us to suspect that there is selection bias in the study. The statement of Salmerón-Ruiz et al. that “education systems in most countries have been introducing digital media into education in the absence of sufficient scientific evidence corroborating beneficial effects on learning” is unsubstantiated, and we believe it stems, to a large extent, from that bias.
Another point worth noting is the lack of distinction of screen use involving technologies as diverse as television, smartphones, video games, social media, or internet access. It seems to us that the evidence on these different subjects is neither comparable nor sufficiently homogeneous to obviate the need for separate analysis.
We unreservedly agree with the conclusion of Salmerón-Ruiz et al. that “it would be advisable for decisions in the education system to be based on scientific evidence, with studies demonstrating that the implementation of a given measure is beneficial.” However, the same article lists a series of recommendations whose benefits do not seem to be supported by evidence: some are generic recommendations unrelated to the digital world (e.g., a “healthy diet”), others are obvious (e.g., “pediatricians need to be aware of this problem”), others are not founded in a process that would support their feasibility (e.g., “encourage parents to proactively limit the use of electronic devices in the family”), and some even appear paradoxical (e.g., “avoid the use of screens for development of digital skills”).
In conclusion, we encourage future efforts to develop evidence-based guidelines or recommendations to use a systematic and transparent approach, thereby minimizing the risk of bias in the selection and interpretation of the evidence.
