Almost all parents of young children have witnessed their toddlers throwing tantrums and getting frustrated, whether it’s time to get up, time to go to bed, or time to eat a sandwich without the crust cut off.

According to a new study, there is another possible reason for the frequency of their outbreaks: the use of tablets.

The new study, published in the journal JAMA Pediatrics, shows that children’s tablet use at age 3.5 was associated with a higher number of anger and frustration expressions a year later. In addition, children who were more likely to express anger and frustration at age 4.5 were more likely to use tablets more frequently a year later (at age 5.5). Tablet use in early childhood “may contribute to a cycle” of problems with emotional regulation, the authors wrote.

I wanted to get more context by speaking with CNN health expert Dr. Leana Wen, an emergency physician and associate professor at George Washington University who previously served as Baltimore’s health commissioner. And more importantly, she is a mother of two young children.

CNN: Most parents have seen their toddler have a nervous breakdown after we took away the pills. What did this study find?

Leana Wen: This study was a survey of 315 parents of preschool-aged children from Nova Scotia. The same parents participated in the study when their children were 3.5 years old (in 2020), 4.5 years old (in 2021) and 5.5 years old (in 2022). They self-reported their children’s tablet use and then rated their children’s expression of anger using a standard questionnaire called the Children’s Behavior Questionnaire.

The researchers found that there was a link between tablet use at age 3.5 and an increase in anger and frustration at age 4.5. They found that the link between tablet use and anger went both ways, as children whose parents identified higher levels of anger and frustration at age 4.5 also used tablets more frequently at age 5.5. This means that the effects could work in both directions.

It is important to consider that this study was conducted during the peak years of the COVID-19 pandemic. The researchers noted this context and the fact that the pandemic led to more stress and disruptions to routine. Nevertheless, the reciprocal relationship between tablet use and the expression of anger and frustration was significant and should serve as a warning to parents to pay attention to screen time.

CNN: Are you surprised by the results of this study?

Who: Not at all. There have been other studies that have come to similar conclusions.

A paper published just this year sheds light on why tablet use may be linked to anger outbursts. Researchers found that children ages two to five whose parents frequently used technology to manage their negative emotions were more likely to exhibit poor anger and frustration management a year later. These children were also less able to choose a conscious response rather than an automatic one.

One reason for this is that children need to learn to manage their negative emotions on their own. They need to go through this process as part of their childhood development, with support from their parents, carers and teachers. If you give them a tablet, computer or smartphone to calm them down instead, they won’t learn to manage these emotions on their own. This can lead to problems later in childhood and adulthood, including when dealing with anger.

CNN: Does this study mean that parents should avoid giving their children tablets altogether?

Who: Not necessarily. There are some apps that can help with learning, and many schools are using tablets in their curriculum. I think the new study from JAMA Pediatrics, as well as other research, shows that tablets, smartphones, and other electronic devices should not be used as pacifiers. They should not be given to children when they are crying and upset to calm them down.

A recent study found that tablet use by children aged 3.5 years was associated with a higher number of outbursts of anger and frustration a year later. (martin-dm/E+/Getty Images via CNN Newsource)

They also shouldn’t be used as babysitters, replacing an adult’s interaction with the child. Children learn through active social interaction with others, and a big problem with screens – whether playing with apps or watching movies or TV shows – is that they replace face-to-face interaction with other children and adults.

CNN: You have two young children. What is your attitude towards tablet use?

Who: I try very hard to limit screen time. My children, ages 4 and almost 7, can watch a movie for a total of one hour on the weekend. During the week, their screen time is limited to when one of them has an asthma attack and needs to use the nebulizer. I allow them to watch a program for a maximum of 10 minutes to complete respiratory therapy.

We have tablets that I let them use on special occasions. For example, we just had a long transatlantic flight to visit my husband’s family in South Africa. The children were allowed to use their tablets during the flight. And when they are at a friend’s house and other children are playing with a tablet, we don’t forbid them from playing with it too. And of course they are allowed to use tablets at school when it is required.

Still, I understand the temptation to give tablets to kids. My little one went through a phase of terrible tantrums and I knew that if I played a show or let her use her tablet, she would calm down. It’s also really hard sometimes when childcare is canceled and my husband or I need a babysitter.

On several occasions when I have had virtual meetings and didn’t have a babysitter, I have had to give in and let the kids watch a movie while I lead the meeting. I try to make such situations the exception rather than the rule, as I want to limit the potential impact of tablet use on my children.

CNN: The new study is about young children. What does the research say about older children, how they use screens and, in particular, how much time they spend on social media?

Who: There has been a lot of research on the subject, and US Surgeon General Vivek Murthy released an alert warning parents about the dangers of social media. Earlier this year, Murthy said he wanted to add a warning label to social media apps, similar to the warnings on cigarettes and alcohol.

According to one study, girls who spent two hours or more on social media were more likely to report depression and self-harm than those who used it less. Another large study with three data sets found that teens who used social media five or more hours a day were 171 percent more likely to be unhappy than those who used it less than an hour a day. This is in the context of the near-universal use of social media: Up to 95 percent of children between the ages of 13 and 17 report using social media. American teens report spending a shocking amount of time—nearly five hours a day—on YouTube, TikTok, Instagram and other social media apps.

There are a number of problems with this type of social media use, one of which is what it replaces. Children who spend so much time glued to their phones and tablets aren’t exercising or getting enough exercise. They’re not interacting with each other in real life. And they’re not getting enough sleep. All of this has a negative impact on physical and mental well-being.

CNN: What advice do you have for parents regarding screen use?

Who: I would recommend the following four things. First, when children are young, delay smartphone and social media use for as long as possible. This works best if you coordinate with other parents, because peer pressure is a big reason why children start using them.

Second, as mentioned above, parents should avoid using screens and tablets to prevent tantrums. In young children, tantrums are a normal part of development. Parents who are concerned about the frequency or duration of tantrums should consult their pediatrician.

Third, if your children already have smartphones and use social media apps, talk to them about the impact of social media on them. Some of them may recognize the addictive nature of their devices and want to use them less themselves. Others may be persuaded to reduce their screen time in favor of other activities, such as spending time with friends.

Fourth, set boundaries. This includes keeping cell phones out of the bedroom at night and keeping devices out of places where devices aren’t likely – like the classroom and the dinner table. Parents should also follow these boundaries and set a good example. It’s no surprise that studies have shown that parents who spend a lot of time on their devices are more likely to have children who do the same.