- The Washington Times - Tuesday, August 6, 2002

Children of today are sedentary. They watch TV and use computers and other media an average of six and a half hours a day. No wonder childhood obesity is on the rise.

"I see obesity as the biggest problem when it comes to sedentary kids," says Dr. Esther Pinder, a Washington Hospital Center pediatrician with a private practice in Northeast. "But there are other problems too," she says.

They include weaker bones, joints and muscles, mental health problems, dry eyes and a lack of cardiovascular fitness, such as elevated levels of total cholesterol and high blood pressure.

Dr. Pinder says she's even started seeing teenagers with wrist problems reminiscent of carpal tunnel syndrome (a hand pain and weakness that adults get due to compression of the median nerve at the wrist) because of computer overuse. In the children's case, the wrist pain is usually tendinitis.

"The older children who are [Internet] chatting a lot, are coming in with wrist problems," Dr. Pinder says. "They don't use the keyboard right."

It's important that the keyboard is neither too high nor too low, she says. When typing, the hands and wrists should be "neutral," meaning the hands should extend straight without bending at the wrist.

Dr. Pinder tells parents to monitor not only what Internet sites their children are logging on to, but also how they are using their computers. Sometimes, she recommends that parents buy a soft pad to lay in front of the keypad. The pad gives the hands and wrists support and may help prevent tendinitis.

Also, she recommends limiting TV and computer use to one hour a day, unless the use is for a school assignment.

"I think parents need to just turn off the TV and limit computer use, except for homework," Dr. Pinder says.

And she doesn't think children should be allowed to have TVs or computers in their rooms.

•••

It's not just joints as in tendinitis that are affected by computer and TV use. Bones and muscles are too. Exercise builds bones and muscles, and a sedentary lifestyle weakens both.

"We know that exercise is extremely important to build bone," says Dr. Michael Ring, a pediatric orthopedic surgeon at Inova Fairfax Hospital for Children.

"If you sit in front of the TV for hours your bones aren't going to be as strong [as if you exercise]," Dr. Ring says, who is also a consultant to the National Institutes of Health on osteogenesis imperfecta, an uncommon condition in which the bones of the body are abnormally fragile.

Dr. Ring says even very young people with normal bones can suffer fractures easily if they live a sedentary life and eat food that contains only minimal amounts of calcium, as does most junk food.

"I see it as a big problem. We're heading down a spiral that may not be so steep right now," Dr. Ring says. "But with more and more interactive computer games and so on, it can become very troubling."

The good news is that even after years of inactivity a person can build healthy bones, increasing bone density, through exercise and a calcium-rich diet, Dr. Ring says.

Another piece of good health news is that computer and TV use does not damage the eyes, contrary to what many believe.

"There is not a whole lot of scientific evidence against TV or computer use," says Dr. Maxwell Helfgott, chairman of the ophthalmology department at the Washington Hospital Center.

The radiation that television sets of the 1940s and 50s emitted could be problematic, but radiation from today's monitors is negligible, Dr. Helfgott says.

But while TV and computer use doesn't cause any serious vision problems, one vision "nuisance," as Dr. Helfgott refers to it, is common: dry eyes.

"Whenever you are staring at something and blinking less, your eyes get dry," Dr. Helfgott says.

Also, because the monitor is often placed up high, the eyes are open wider more exposed to the dry air than when one reads a book. The book, as opposed to the computer, is often placed in the lap, allowing the eyelids to cover the eyes more, which moisturizes them.

So, there is no documented damage to the eye by computer and TV use. But it's impossible to say what future research might hold in this area, Dr. Helfgott says.

The effects of TV and computer use on children's health are not just physical. Children are affected mentally too.

At a young age, TV watching has a damaging effect on socialization skills, Dr. Pinder says. Young children learn how to interact with each other through play. But when they are watching television and everything is being played out on the screen, there is little reason for them to interact, she says.

Watching television is a very passive pastime. Computer games can be more interactive, but since people can play them on their own, they don't necessarily require any socialization skills.

"It takes imagination to play, but not to watch TV," Dr. Pinder says.

Other impacts on mental health include depression, fear and sleep disturbances, caused primarily by media violence, according to the American Academy of Pediatrics.

The data are still scarce on the mental health benefits of exercise, but some doctors say that it may help young people as well as adults to cope with stress.

While 30 minutes of exercise several times a week is recommended for adults, there is no general exercise guideline for children, Dr. Pinder says.

"In the past we haven't had a reason to issue a recommendation," Dr. Pinder says. Children exercised naturally, walking to school, playing at the playground or bicycling in the neighborhood. But that happens less frequently now.

She suggests that children should exercise for an hour or two each day. Aside from healthier bones, joint and muscles, children gain cardiovascular fitness through exercise. Overweight, inactive children often have higher blood pressure and lower levels of "good" cholesterol than active children.

Cardiovascular fitness, gained through aerobic exercise, can help prevent cardiovascular disease, from which 2,600 adult Americans die every day, according to the Centers for Disease Control and Prevention.

Not only will children who start exercising see immediate health effects, such as feeling stronger or losing weight (if they need to), but they will start a healthy habit that may last for a lifetime.

"Active children often become active adults," Dr. Pinder says. While "inactive children generally become inactive adults."

Many local pediatricians are trying to convince parents of the importance of cutting down on media exposure, while increasing physical exercise. But it's a hard sell, Dr. Pinder says.

"It's hard to convince the general public to limit TV and computer use," Dr. Pinder says. "It's not sensational, no one is dying from watching TV."

No, not yet. So far, children who use computers and watch TV excessively are just becoming more unfit, mentally and physically.

Dr. Ring says there should be room for both sedentary indoor and active outdoor activities in children's lives.

"It's about creating a happy medium," Dr. Ring says. "It comes back to 'a sound mind in a sound body.'"

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