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Our children are returning to school. The idea is surreal, and beautiful. What used to be an accepted annual routine is now a much bigger deal. Virtual learning, hybrid learning, and masked learning have become part of our lives. As we prepare our children for “Back to In-Person School,” we may be excited, we may be apprehensive, we are likely both. The question is – How do we best prepare them for the start of the school year? How do we best prepare their brains to learn?

The best first step to prepare for school is to reset routines. Schedules and habits that may have been functional, or behavioral Band-Aids, during the pandemic, may need to be scrapped for healthier routines. Sleep hygiene and screen time limits are particularly critical routines that affect learning, and thus demand a parental review, and likely a behavioral reset.

Consequences of Sleep Deprivation

Sleep deprivation has profound consequences on our health. Acute sleep deprivation is bad, chronic sleep deprivation is much worse. In toddlers, poor sleep is associated with language delay. In school age children, sleep deprivation leads to cognitive impairment. Tasks requiring sustained attention can be impaired by even a few hours of sleep loss. In adults, chronic sleep deprivation was recently associated with dementia. Regardless of our age, the brain needs sleep.

Consequences of Excess Screen Time

Excess screen time appears to stress the brain in a manner similar to sleep deprivation. Animated videos and fast-paced video games that demand intense sustained concentration appear to have the greatest harmful effect. Excess screen time has been associated with both language delay and ADHD. A 2019 study showed that children with more than 2 hours screen time per day had a 7-fold increased risk of ADHD. Again, tired brains don’t learn well. It should be noted that face-timing grandparents and e-books are not of concern. 

Recommendations for Parents

Resetting routines is easy to say, but hard to do. I tell parents in my practice, “Being a pediatrician is much easier than being a parent.” If your child had a healthy routine two years ago, resetting it will be easier. If your child has never learned to fall asleep on their own, or if they’ve been addicted to screen time for years, then the changes will be more difficult, but much more critical. As parents, we are supposed to pick our battles. Taking a stand on behaviors that affect the health of our children’s brain, and therefore their cognitive and emotional health, couldn’t be more important. Below are 5 steps to behavior change that will be successful, if we commit to their daily execution:

  1. Nurture Relationship:  Find time every day to play or participate in an activity that your child chooses and enjoys. As a young mother taught me, “Relationship before rules leads to respect; Rules before relationship leads to rebellion.”
  2. Communicate Intentions:  Our job as parents is to educate our children, not boss them around.  Be straightforward and concise in communicating the intentions of the behavior change. For example, “My job as your mother/father is to keep you healthy. Too much screen time hurts your brain; I can’t say yes to things that hurt your brain.” Or, “Falling asleep on your own teaches you to be calm, rather than scared. I love to fall asleep with you, it feels good, but that doesn’t mean it’s healthy. Let me teach you how repetitive routines, like humming the same song, help to replace fear with calm.” 
  3. Set Clear, Enforceable Limits:  Black and white limits are easier to enforce than ‘fuzzy’ limits. In my experience, 30 minutes of screen time per day usually evolves into 1 – 2 – 4 hours/day. My preference is to limit screens (like video games) to just the weekend (2 hours max). If your child has daily screen time currently, try first setting a goal of reducing it to every-other day. For example, Monday – Wednesday – Friday are screen free. Create momentum in a healthy direction.
  4. Provide Alternative Healthy Behaviors:  Partner with your child as you replace screen time with exercise/reading/Legos/art/music. Enjoy the time together. Remind them that they are resting their brain and exercising their body or feelings. You’re coaching balance. For sleep, replace a parent’s presence with a stuffed animal and song/prayer.
  5. Be Compassionately Firm in Enforcing Limits:  Video games are designed to be addictive. Screen time is addictive. Our young children need our loving limits to help them reset to a new normal. They may not like us for a couple weeks, but they will respect and appreciate us. 


Overuse injuries to the brain can have profound intellectual and emotional consequences. When we reset or create behaviors that keep our child’s brain healthy with adequate sleep and thoughtful screen limits, the investment will pay off with a healthy child who returns from school with an educated smile. 

Dr. David Reuter is a pediatrician in the Allegro Pediatrics Bothell location.    

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