According to David Anderson, Ph.D., a clinical psychologist and senior director of National Programs and Outreach at the Child Mind Institute, it’s especially important “to be very cautious when using screens with young kids, as this study highlights, as young kids are in a critical developmental period.”

At this stage, children “require face-to-face interaction,” said Anderson to reach developmental milestones including building language and social skills. During this time they also develop empathy, the ability to understand emotion, and “build stamina to navigate personal situations,” he said.

This study brings up the important question: What is screen time replacing? It is unclear if the findings are related to the screen time itself, or from the lack of other activities that screen time replaces, such as reading with parents, socializing and outdoor play.

Is all screen time bad? Some forms may be worse than others. According to another recent study in JAMA Pediatrics that analyzed prior research on screen time in kids from ages 4 to 18, TV and video games in particular, were associated with worse academic performance, especially in teens.

On the other hand, Anderson pointed out that “there can be positive effects” of screen time including “increasing social connection, particularly in kids in marginalized groups, where finding online communities where they can be accepted and supported can be immensely positive.”

And in teenagers and adults, “small doses of screen time can be a mental health-positive way of relaxing, reducing stress, and connecting socially to friends and family members.”

What can parents do? In addition to the recommendations by the AAP to restrict screen time in young children, as children get older it is important to place limits not just on how much screen time, but when to allow screen time. Screen time later at night can interfere with sleep, so the AAP recommends parents pay special attention to limiting nighttime device usage.

It’s important to make an effort to spend time and socialize together, and promote activities like playing outdoors or participating in athletics.

“If your teenager is generally actively participating, getting homework done, having face-to-face interaction with family members and friends, and has extracurricular and physical activity … parents can relax a little [about screen time] … and reduce the guilt,” Anderson advised.