I am grateful for the workgroup’s effort to make screen use in schools as healthful as possible, and the proposed document treats this thoroughly. My concern is that the guidelines’ promoting optimal use of screens will inevitably promote increased use of screens. Some of the resource materials, though endorsed by academic institutions, have a promotional tone and are sponsored by entertainment, social media, video gaming, and digital news media companies, e.g. the Boston Children’s Hospital guide (p. 5, resource 3) and the Cleveland Clinic video (p. 10, resource 4).

What is most missing from the guidelines is the setting of age-appropriate, total screen time limits per day to include both school-day limits and homework time limits, keeping in mind that most students will add additional leisure screen time.

In our fixed 24-hour day, the stated goal of “preserving offline experiences” (p. 6, #1) will necessarily require limiting screen time, and this should be explicitly addressed.

The guidelines’ worthy aim to diversify digital experiences (p. 4, #5) should be matched with equal effort toward overall diversity of media and experiences, including “human to human and hands-on interaction," to quote Dr. Azmaira Maker (cited on p.7, #6).

The guideline of minimum one hour per day spent outside is quite low (p. 6, # 8). I would present this as an absolute minimum with a much longer target for average time spent outside per weekday.

A common theme in the supporting materials is that screen use must be individualized for each child. That makes sense, but there should still be maximum time limits in the guidelines; teachers, parents, and students can then customize screen schedules within those limits. As we await longitudinal medical research on the still-increasing screen use by children, I urge erring on the side of caution, i.e. low maximum limits for total daily screen time.

James V. Rives, M.D.

Board-Certified in Psychiatry

Member, School Health Advisory Board, Arlington County, VA