Mobile devices, musculoskeletal risk exposure in children, and a great opportunity for Corporate Social Responsibility

Youth of today - patients of tomorrow?

In any café or on any train across the country, you don't have to look far to see children peering and swiping at mobile device screens. It is hard to imagine what it must be like growing up with smartphones and tablets. They offer levels of immediate, controllable visual stimulation and which my own generation could barely even dream about (Donkey Kong anyone!?).

5 minutes peace!
Tablets and smartphones are also sometimes used as modern day soothers. Parents who need a few moments to themselves – which we all do at some point - or who are trying to calm down an upset child, can hand over the mobile device and it gives them a virtually indefinite breathing space. I can say this by way of a personal confession – it's reality and not a criticism or judgement.

It's no surprise then that many children are growing up spending considerable amounts of time each day, using mobile devices. A lot of that time may be quite constructive – devices are not just great entertainers, there are some great educational apps as well. The problem is that even if a child is using the most educational app they can possibly find, their postures are still likely to be poor and they are still likely to be making repetitive movements.

The same poor posture risks as adults
Children like the rest of us will drift fairly quickly towards poor posture when using mobile devices. Neck severely bent forward, often leaning forward without back support. Children also tend to use their thumbs a lot to scroll and swipe, especially if a device is hand-held and they are using both hands to hold it. We should also remember that relative to muscle strength, mobile devices are substantially heavier for children – particularly younger children.

Starting work with 18+ years of mobile device use - there is no precedent
Today's children are the employees of tomorrow. But unlike the current employees, they will arrive in the workplace with a full 18 years of device use behind them. There is no precedent for knowing how they will be affected by this from a musculoskeletal point of view. There is growing evidence though that device use is starting to have a real impact on many young people, leading to pain and a need for professional treatment at ages which where it would previously have been almost unheard of.

Musculoskeletal problems in the young

A study by the Hong Kong Polytechnic University found that out of a group of children aged 10 to 15 (27.6%, n=582) reported musculoskeletal discomforts related to the use of electronic devices. Close to 80% of that group (127 persons) reported neck pain, 30% (55 persons) had shoulder pain, and 51% (85 persons) had wrist and finger pain symptoms.

Two much cited research surveys carried out in the UK came to similar concerning findings. Research by Abertawe Bro Morgannwg University Health Board found up to 72% of primary school aged children had experienced back pain. A British Chiropractic Association survey found that by 11 years old, 45% of children had experience of back pain.

More recently, on top of the musculoskeletal risks, there have been indications of increased myopia (short sightedness) associated with mobile device use at young age.

For most people that's probably enough to go on; mobile devices and children are not a particularly healthy combination. Most of us with childcare responsibilities are aware of that to some extent, but it is hard to do much about it. As anyone who has ever tried prizing a 5 year old away from an iPad will know all too well!

What has this got to do with employers?

Employers have a legal duty to manage the work-related risks that their employees are exposed to, including provision of training and detailed guidance. This applies to any musculoskeletal or other health risks presented by working with mobile devices. By providing training and increased increasing employee awareness of the issues, employers' are probably in a stronger position than anyone to get safe device use messages out into general circulation, which – we hope – will filter down to children.

A shared exposure to risks
Mobile devices are used – often intensively – from the cot all the way through adulthood. Children are being exposed to the same musculoskeletal risks from mobile device use, that adults are – in many cases they are even more heavily exposed to the risks, if their use of devices is not carefully managed. This shared exposure to musculoskeletal risk is unique and as far as we can see there is no precedent. There is no other such intensive 'artificial' physical activity in our lives which is experienced so equally by children and adults.

Corporate Social Responsibility - the nub of the matter

This means employees now have a unique opportunity for enhancing and promoting their corporate social responsibility, something which forward looking companies are keen to do. By giving employees valuable musculoskeletal risk management training for mobile device use, and promoting good-practice when using mobile devices, it is reasonable to hope that employees will pass those good practices on to the next generations. This is probably one of the most viable routes for getting this important public health message out there.

The effects of employers doing this would be felt not just in the short term in current employees, but over the longer term we could look forward to the children of today arriving as employees of tomorrow not already suffering from musculoskeletal problems brought on by poor posture and techniques using mobile devices. The alternative in the long-term is possibly more costly for businesses; more adjustments to work practices, wider ranges of equipment needed and higher absenteeism due to musculoskeletal problems – not to mention having to deal with the more immediate potential costs of civil claims if employees are able to demonstrate inadequate training and risk controls.

Employers can go a long way to providing employees with skills in musculoskeletal risk recognition which they can pass down to children. But there are inevitably details which are useful when managing the risks to children, but which go beyond the kinds of things which employers could reasonably be expected to cover in training for their staff. In the section below we cover a few of these and provide some tips.

Tips to help manage the risks which children are exposed to from mobile devices

A key considerations for managing risk in children is that children are less likely than adults to be self-restrained and manage their own use of devices. They are possibly also more vulnerable to the addictive nature of mobile devices. This is why in our view, exposure to mobile devices needs to be actively managed and not left to develop unchecked.

Time management apps
Consider using time management apps to limit the amount of time children spend on devices. Two good examples are Screen Time Parental Control and OurPact Parental control (both available on iOS and Android). Monitor device use on different days – maybe think about why there is more screen time on certain days compared with others.

Use stands
Always get children to prop tablets and smartphones up on stands wherever possible. especially when they are just watching rather than interacting. Try to avoid them laying devices down flat on a table or on their lap when using them.

Keep devices in sight
Keep mobile devices out of childrens' rooms – don't allow them to take them to bed etc. This is an ergonomics issue as much as it is an internet safety one.

Keep to <2hrs per day
Limit device time to no more than 2 hrs per day.

Avoid or highly restrict use for under 2s
Avoid screen time for children under 2 years old.

(The previous 3 points were initially proposed by The American Academy of Pediatrics).

Get them a stylus
Encourage use of a stylus to vary wrist posture, and to help build up the fine motor controls needed for writing (this is something with direct finger interaction does not help with).

Exciting alternatives
Make sure there are interesting and engaging alternatives to mobile devices. This is seldom an easy one when you are out and about, but at home this shouldn't be easier to manage.

Flatten your batteries!
Experience frequent mysterious battery or wifi trouble! This is a bit of a cheeky one, but children learn pretty quickly that a flat battery or no wifi = no device time. Of course if your phone rings 5 minutes after you have said this – you might have some explaining to do!!

Warn in advance about new rules coming into force
Give fair warning on any new 'rules' about limiting device use. Nothing aggravates and confuses a small person like a sudden imposition of a random new rule.

Be good yourself
Set a good example! There's no point trying to get children to give up devices if you sit for hours using one yourself.

Engage with schools
Encourage schools to engage with the issue. Ergonomics4kids is an initiative set up to provide advice on healthy device use by children. It provides useful learning modules for children from primary school age (key stage 2) through teens into higher education.

Everything in moderation!

Some device use is valuable. Children are growing up in a world where mobile technology is the reality of day-to-day life. It is important that they learn the skills needed to use it easily and benefit from it, and as already mentioned there are some brilliant fun educational apps. But it's also important to balance those learning benefits against the musculoskeletal risks, and do as much as we can to encourage the former without also increasing the latter.


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