E-games for kids: review of dangers and benefits + guidelines for professionals, children and parents

In developed countries kids spend a 4-8 hours per day using screen based electronic media. What are the risks attached to such high usage? What are the benefits? What should parents, health and education professionals and the industry be doing about it? This article in Ergonomics explores the worrying and more positive impacts of e-games on child development.

From the press release:

Up to 50% of all children have e-games in their bedroom, for most it is a socially acceptable part of daily life. Links have been found between high e-game usage and increased BMI, depression, vision problems, sleep deprivation, poor academic achievement, musculoskeletal health issues and markers for cardio-metabolic disorders. Kids have become more sedentary and are reporting in with new afflictions such as ‘Nintendo-thumb’ and ‘wii-itis’ and they are being exposed to often violent, sexualised games inappropriate for age and stage. This paints a depressing picture for our kids. It is however not all bad news. More active e-games have been proven to enhance motor competence and positively influence learning, confidence and social integration. Used correctly they could be a tool for health education, family cohesion, fun and learning.

In the absence of government health guidelines on use of e-games, the authors recommend a series of sensible guidelines for stakeholders affected by e-games. The hope is that they will become a basis for formal public health standards for practice and use. In the US kids are recommended to have no more than 2 hours daily exposure to electronic media. In Canada they have gone a step further and banned electronic media from kid’s bedrooms. This aside there is a global swathe of ignorance. This research provides a seemingly overdue set of simple, pragmatic suggestions tailored for children, parents, professionals and the industry.

But what are these suggestions? (Note: Hierarchy of evidence (Straker 1999): *minimal evidence, possibly from related research & expert opinion; **some evidence; ***moderate evidence.)

For the children:

Evidence-based guidelines for wise e-game use: children.
  • Keep the e-game equipment, surrounding furniture and yourself safe when you play**
  • Use an avatar for all online e-games and never give your personal details to anyone online*
  • Choose e-games that you enjoy and help make you feel happy when you finish playing, help you develop useful skills and respect yourself and other people**
  • Be social when you play – play with friends and family**
  • Talk with your family about your e-game playing*
  • Swap sedentary with active e-games – you will enjoy the feeling of your body moving***
  • Minimise the time spent on e-games that require repetitive button clicking or wrist actions**
  • Be aware of being in awkward postures (being uncomfortable) when playing – try and be comfortable**
  • Break up your e-games every 30 minutes to give both your body and eyes a rest***
  • Be aware of how long you play for, and try to minimise the time when you are sitting still – making time for active play both inside and outside***
  • For any new active e-game, or after a break, start with short turns to allow your muscles to get used to the activity**

For the parents:

Table 2 Evidence-based guidelines for wise e-game use: parents.
  • Be aware of what e-game playing your child does*
  • Ensure e-game technology is protected*
  • Create an e-game playing zone that is safe from electrical, trip and bump hazards**
  • Ensure online interaction safety*
  • Be involved with your child’s e-game playing*
  • Model appropriate use of e-games and participation in real-world activities**
  • Set, and enforce, rules around e-game use**
  • Be aware of windows of opportunity – after-school and weekend time – and provide and support environments that encourage non-sedentary activity**
  • Create screen-free bedrooms***
  • Use child interest in e-games as platform for broader interest/learning*
  • Encourage e-game playing to be social**
  • Avoid violence, racism or otherwise antisocial games**
  • Limit total and prolonged bouts of sedentary leisure including e-games**
  • Encourage breaking up SEG bouts every 30 minutes to provide an active break for body and eyes***
  • Replace SEGs with active e-games***
  • Encourage real-world physical activity and ensure it does not get displaced by e-games**
  • Encourage good ‘technique’ and safe playing space to avoid muscle and bone discomfort and injury***

For professionals:

Table 3 Evidence-based guidelines for wise e-game use: health/development/education professionals.
  • Be aware of what children are doing with e-games*
  • Use their interest in e-games as a platform for health intervention and learning*
  • Raise importance of e-games exposure with parents and children*
  • Educate parents about the negative effects of screens in bedrooms***
  • Encourage socially positive games*
  • Encourage limiting sedentary leisure and enhancing active leisure – virtual and preferably real world***
  • Discourage poor and sustained postures, repetitive actions, high accelerations, high forces during e-game play**
  • Encourage breaking up SEG bouts every 30 minutes to provide an active break for body and eyes***
  • Encourage games with demonstrated learning benefits, skill benefits or educational content**
  • Encourage enjoyment in all play!*
  • Use e-games as a supplement to aid intervention for special populations and rehabilitation**
  • Use e-games as a vehicle for learning, for example serious games for health education**

And for the game industry:

Table 4 Evidence-based guidelines for wise e-game use: game industry.
  • Develop/promote games with appropriate postures and movement (e.g. not high acceleration or high repetition)**
  • Develop/promote games with positive social content**
  • Develop/promote games with beneficial education/learning*
  • Develop/promote games where children have fun*
  • Create game play to support break taking/moderate exposures (for example, accelerated fatigue in role play and strategy games and the ability to pause game and save points so that a break can be taken easily)**
  • Provide clear information on the nature and content of game play (for example, the level of violence and the overall game aims)*
  • Provide clear information on the nature and intensity (light, moderate, vigorous) of physical activity involved in playing active input e-games

Abstract of the study (free access):

Electronic games (e-games) are widely used by children, often for substantial durations, yet to date there are no evidence-based guidelines regarding their use. The aim of this paper is to present guidelines for the wise use of e-games by children based on a narrative review of the research. This paper proposes a model of factors that influence child–e-games interaction. It summarises the evidence on positive and negative effects of use of e-games on physical activity and sedentary behaviour, cardio-metabolic health, musculoskeletal health, motor coordination, vision, cognitive development and psychosocial health. Available guidelines and the role of guidelines are discussed. Finally, this information is compiled into a clear set of evidence-based guidelines, about wise use of e-games by children, targeting children, parents, professionals and the e-game industry. These guidelines provide an accessible synthesis of available knowledge and pragmatic guidelines based on e-game specific evidence and related research.

Practitioner Summary: E-games are an important part of life for many children. Evidence suggests they impact on many aspects of children’s behaviour, health and development, though many issues lack convincing evidence. These evidence-based guidelines provide an accessible synthesis of available knowledge and pragmatic guidelines based on e-game specific evidence and related research.

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