“Sit up straight!” It’s the go-to refrain of parents everywhere, and it’s an increasingly common one you may start hearing more and more thanks to phones and tablets. Increased use of digital media (and less time active playtime) is affecting children’s posture, causing neck and back pain, and may permanently impact how their bodies’ grow and develop, according to a pediatric orthopedist.

Cordelia Carter, M.D., pediatric orthopedic surgeon and director of the Pediatric Sports Medicine Center at Hassenfeld Children’s Hospital, has noticed a change in the patients that come through her office. Children frequently come in with neck, shoulder, or low-back problems — a.k.a. “text neck” — and it’s all related to how they sit.

“What it really is a trapezius muscle spasm from literally having your head bent and looking down the whole time,” she says. “Every single child, when I walk into the room, they have to put their phone down because they’re using it while they’re waiting.”

The result: “I just look at their posture and it’s terrible,” she adds. “Kids come in and they sit completely slouched, and that’s been a thing ad infinitum but it is definitely worse.”

So far, “text neck” is phenomenon only really studied in adults. When you’re looking straight ahead with your arms at your side, about 10 to 12 pounds of pressure is exerted on the neck, a 2014 study published in Surgical Technology International found. Look down 15 degrees and that number jumps to 27 pounds. At 30 degrees, it’s 40 pounds; at 45 degrees, it’s 49 pounds; and 60 degrees, it’s a whopping 60 pounds. Considering most us bend our necks between 20 and 45 degrees when we’re using our phones, that’s a lot of undue stress on the spine.


And it’s no secret the youngest generation is using these devices more and more. Kids under 8 look at mobile ones for an average of 48 minutes per day, according to a 2017 report from Common Sense Media. That’s more than triple the average recorded four years earlier. When you factor in TV, total screen time tops out at about 2 hours and 9 minutes every day. The American Academy of Pediatrics recommends no more than one hour per day of high-quality programs for children ages 2 to 5, and consistent limits for kids 6 and older.

And while text neck is essentially an overuse injury, missing out physical playtime is what she calls an underuse injury. “The entire spinal column is lined on either side with very strong erector muscles that support the core. If those muscles are not actively engaged while you’re sitting, then they just weaken over time,” Dr. Carter says. “If you’re not supporting your spine, the forces are being distributed across abnormally and it ends up causing pain.”

Cutting down on screen time is the first step preventing future discomfort and inflammation, but teaching your kids (and yourself) a few ergonomic techniques can go a long way. Holding your phone up higher at eye level puts less strain on your neck. Resting a tablet on a thigh or table — as opposed to giving it to your kids to hold — can also ease the weight exerted on hands and wrists. And hopefully your older kids are already using two hands to text — it puts less strain on any one thumb and helps support the phone.

Set reminders (like your phone timer) to shift positions, too. “It’s so easy to look up from your phone and realize that your neck hurts because you’ve been so absorbed in what you were doing for 30 minutes,” Dr. Carter says.

For minor texting-related aches, she recommends taking ibuprofen and applying arnica cream, which doubles as a massage when you apply it, but more severe pain may require a doctor’s help. A case of “text thumb” is really tendonitis and could require a splint.

But does this screen time-induced pain physically hurt your kids in the long run even after the inflammation’s gone down? “That is the million-dollar question,” Dr. Carter says. “I don’t think we fully understand the ramifications and how reversible they are.”

She compares it to how repeatedly hurling baseballs can hurt the elbows of Little League pitchers, and how gymnasts can shut down the growth plates in their wrists by repeatedly walking on their hands, a potential problem as the adjacent bones grow. With texting-associated pain, it could be just a strain on muscle and tendon — or it could affect how the body grows and develops like these other injuries.

“Prevention is probably the best thing to do,” Dr. Carter says, “which is not to take screens away. It’s to be smart in how you deploy them and introduce variety into kids’ lives.”

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