Goldilocks effect: screen time in moderation after concussion may be “just right”

By Conor Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.

A study by Molly Cairncross et al. published in Pediatrics explored a potential link between adolescents’ screen time use in the first 7-10 days post-injury and their postconcussion symptom severity. The authors found that both very low and very high screen time predicted more severe postconcussion symptoms in the first 30 days post-injury. However, this association was no longer present once patients were more than 30 days out from their injury. In this study, “Other variables had stronger associations with symptom severity than screen time.” 

The authors argue that a moderation or “goldilocks” zone may exist for screen time after concussion–an amount that allows adolescents to still feel connected to their peers and community but not so much as to “disrupt sleep or interfere with engagement in other important activities, such as recreation… Undue restrictions from screen time after concussion could prevent access to social support or disrupt routines and increase emotional distress, worsening symptoms.” In the study, the moderate range of screen time was so equivalent to about 2 and 7 hours per day, according to lead author Molly Cairncross.

While a 2021 study by Macnow et al. found that higher screen time in the first 48 hours post-injury was associated with longer recovery times, that study only looked at screen time within that 48 hours and tracked patients for 10 days (See our blog post about this study.) In the 2022 study, Cairncross et al. explored how screen time use during the first 7-10 days post-injury predicted postconcussion symptom severity out to 6 months. They found that “children and adolescents with concussion who reported the lowest (<25th [percentile]) and highest screen time (>90th [percentile]) during the first 7 to 10 days postinjury reported more cognitive and somatic symptoms” in the following six months than those reporting moderate screen time. This U-shaped association was also true of parent-reported somatic (physical) symptoms. The mean screen time (50th percentile) in the first 7-10 days was between 8.5 and 9 hours total over that period. 

Cairncross et al. concluded that “Although the Macnow et al. clinical trial demonstrated that reducing screen time in the first 48 hours postinjury may offer short-term benefits, small group differences in our sample after 30-days postinjury suggest that early screen time is not detrimental for long-term recovery in children and adolescents with concussion.” The authors believe “Recommending moderation in screen time may be the best approach to clinical management.”