The Preventable Complications of Remote Learning (that no one is talking about)

We’ve all heard discussion around the potential negative consequences of remote learning, including:

  • Social disconnection
  • Academic loss
  • Socio-emotional & developmental regressions

But what about the complications that no one is talking about? 

The ones that may be preventable? 

The ones that we as parents can actually do something about?

Since we went into lockdown and remote learning began in March 2020, I’ve seen some surprising trends in my patients’ physical & mental health – some predictable, some not. These are based solely on my observations in my practice and may not be indicative of larger trends. But I would guess others are noting these, too. At least for my kids, and many of the kids in my practice – there are no plans to go back to school in person any time soon. There are many things out of our control as parents during this time, so let’s take back control over the things we can.

Remember, knowledge is power. And the first step in recognizing a problem is knowing to actually look for it.

Some of your kids are back in school, and some are not yet. Even for those kids back in school in-person, many are in a hybrid model with a continuing significant amount of online asynchronous learning. The following are the top PREVENTABLE complications of online learning that I’m seeing, their potential causes, and the solutions that you can implement now no matter what your child’s school looks like now and in the future..

Problem: Functional/Postural Scoliosis

Functional or postural scoliosis results from a temporary cause and is different from structural scoliosis in children, which is often genetic of undetermined etiology. The type of scoliosis I am encountering more during the pandemic is functional scoliosis. Addressing this now can prevent long term posture problems, back pain and headaches.

  • Sitting in front of a screen for prolonged periods with back hunched, belly pooched out, shoulders slouched, neck and head strained forward
  • Or WORSE, on screens while leaning sideways on one arm over your desk, slumped on the couch, or laying on your stomach on your bed or the floor
  • Sit with feet on the floor, tummy muscles engaged, back straight, shoulders up but relaxed, head level with screen at eye level

Problem: Weak Core

I’m seeing kids who can barely sit upright for a few seconds before they have to slouch because their abdominal muscles have become so weak. Weak core muscles can lead to back pain, balance problems, and difficulty doing pretty much any activity that kids enjoy (like riding a bicycle or playing sports). Weak abdominal muscles also make it harder to sit still, which may cause your kids to fidget even more in their seats than they already are.

  • Pretty much the same cause as functional scoliosis
  • Sit with tummy muscles engaged, back straight, shoulders back, head level
  • Consider a “wobble cushion” to engage core muscles while sitting
  • Keep back straight and tummy tucked in even when standing
  • Get up and MOVE during breaks. High-knees marching in place will get blood pumping and core working

Problem: Weight Gain

Between pandemic baking, pandemic boredom, and pandemic snacking coupled with a lack of movement, unhealthy weight gain is a real problem for many kids and adults. Obesity and diabetes are among the leading risk factors for serious COVID-19 illness. We do NOT want to come out of quarantine less healthy than when we started!

  • Not enough movement
  • Easy access to snacking all day long
  • Get up and MOVE! Make exercise a family priority!
  • Cut the sugar and the snacking
  • Make every bite count – focus on nutrient-dense, healthy snacks filled with protein and healthy fats (not sugar!)
  • Stay hydrated – hunger can sometimes be confused with thirst
  • Teach kids to recognize their hunger and satiety signals, so that they don’t snack out of boredom or stress

Problem: Myopia (nearsightedness)

Cool glasses may be fun to wear, but rapidly progressive nearsightedness is nothing to laugh at. Eye strain is a significant problem for your child’s long-term vision and eye health.

  • Staring at a screen for prolonged periods (for school and for fun), causing strain to vision muscles.
  • Give your eyes a break! Use the 20-20-20 rule: Every 20 minutes while on screens for school or fun, STOP and look at something at least 20 feet away for at least 20 seconds.
  • DO NOT immediately use school Zoom breaks to text, FaceTime, game, or go on social media.

Problem: Flat Feet

While there is controversy as to whether barefoot walking is better for your feet than wearing shoes, one thing that I, and some of my podiatrist colleagues, are noticing is an increase in children with flat feet, ankle pronation and bunion formation which may lead to long-term foot pain that may require orthotics or surgical correction.

  • Walking around barefoot all day long
  • Wear household slippers or sandals with arch support (like FitFlop or Vionic for older kids and adults, and OluKai for all ages)
  • Exercise those arches with a tennis/golf ball roll. While sitting with a straight spine, roll a tennis or golf ball back and forth under one foot, focusing on where your arch is. Do this for a few minutes and then switch to the opposite foot.

Problem: Cavities

Many routines have fallen by the wayside – including regular brushing (at least for some kids, and ahem – adults). Some parents are shocked to find that their kids have multiple cavities at their first visit back to the dentist since quarantine.

  • Getting out of your daily flossing/brushing routine – because who cares about your breath when you’re at home?
  • Floss & Brush – EVERY DAY! Pay attention especially to your nighttime dental routine

Problem: Sleep Issues

Quality, restorative sleep is important any time – but especially now to help mitigate the stress of the pandemic and support memory and attention/focus while our kids are remote learning. Bedtimes have creeped later and later for many kids, especially for our teens who may be up until the wee hours of the night on Discord or FaceTime with friends. I totally get that our kids are on screens more during the pandemic, as a necessity to stay in touch with their friends and maintain social connection. And I am more forgiving in screen time limits now for my own kids and the kids in my practice than pre-pandemic. As long as:

  • Screen time does NOT take the place of the daily essentials – like quality sleep, schoolwork, exercise, outdoor time, and family time
  • Screen time ends at least 1 hour before bedtime; and
  • Phones/devices are kept OUT of the bedroom.

A study of 234 children between 8-17 years of age found that devices used at bedtime reduced the quality AND the quantity of sleep. Kids who watched TV or played video games before bedtime slept an average of 30 minutes less than kids who did not. And if kids used their phones or computers before bed, they slept a WHOLE HOUR LESS. Not only that, the use of any technology at bedtime was associated with a higher body mass index (BMI) in kids with a higher risk for obesity and pre-diabetes. And what was startling (at least to me!) was that the use of any type of technology (TV, video game, cell phone, computer) before bedtime, resulted in a much higher likelihood that kids would WAKE UP in the middle of the night to use their cell phone (like waking up to text someone!).

  • Erratic sleep/wake times
  • Screen time too close to bedtime
  • Blue light from screens that:
    • Blocks melatonin production
    • Changes our sleep patterns with
      • 1) less deep restorative sleep
      • 2) less REM sleep for memory & processing the day’s events
  • Consistent sleep/wake times
  • Turn off screens 1-2 hours before bedtime
  • No phones/devices in bedroom
  • Blue-light blocking glasses day and night
  • Nightlight mode on all screens

Problem: Brain Imbalance

Digital devices are changing our children’s brains – and not necessarily for the better. Several studies have identified the link between excessive screen time and changes in brain function. Our children’s brains are actively creating new connections (synapses), and just as actively pruning (getting rid of) connections that are less frequently used. During these critical periods of brain development in our children and teens, we want to ensure a rich diversity of offline and online experiences to create new, useful connections while getting rid of connections that aren’t needed or useful. We don’t want our children’s future brain architecture to be molded solely by screen use. We want our kids’ brains to make and keep the connections they need to be successful and thriving adults.

  • The Adolescent Brain Cognitive Development (ABCD) Study has found that screen time can cause parts of the brain to shrink (cortical thinning), and also lower scores on thinking and language tests
  • Screen time can change the neurotransmitters that affect mood/anxiety/sleep (serotonin) & focus/attention/motivation (dopamine) – leading to screen addiction and the physiological, psychological and socio-emotional harm that any addiction can cause
  • Screen time can increase anxiety/depression & suicidal thoughts in kids/teens. Not surprisingly, the single most protective factor for our teens was IN-PERSON social interaction – something we’re all sorely lacking these days
  • Screen time can lower connectivity in the regions of the brain related to language and cognitive control. On the flip side, reading was correlated with higher connectivity in these same regions
  • Educate your kids about the potential consequences of excessive screen time – without judgment
  • Help your kids plan screen-free activities
  • Read an actual book
  • Play online games WITH your children. While playing, help them think about what they’re seeing and doing on screen
  • Plan safe in-person social time with friends
  • Have screen-free family time (meals, car rides, exercise, games, etc.)
  • No devices in bedroom overnight
  • Model the behavior you want in your kids

While this is not an exhaustive list of the negative consequences of remote learning, it’s a start. And I’ll be here with you to the end.

We’re all in this together.
xo Holistic mama doc – Elisa Song, MD

  1. How about reducing online school hours as an easy solution for all these issues? My second grader’s online schedule was increased from 3.5 to 5.5 hours this week, but I explained to the teacher that wasn’t going to work for us. I’m having her sign-out as soon as she knows what her assignments are in math and language arts. It would be even better if I could get all the assignments in advance because even the remaining screen time is excessive!

    • Yes I absolutely agree – whatever schools can do to reduce screen time while kids are remote learning is so important!

  2. I love your posts, they are always so well-researched and informative, thank you! As an occupational therapist I feel obliged to mention that wobble cushions can be great for kids with regular tone for approximately 30 minutes at a time – a good indicator to stop using it and give the child’s back more support is when they start to slouch or move to positions that provide more stability, like on to their knees or leaning through their forearms. Basically, regularly changing positions and moving is the best thing, regardless of the type of seating! 🙂

    • absolutely! I love my wobble cushion for myself and definitely changing positions and moving is so key!

  3. I’ve just stumbled onto your blogs and enjoyed reading them. My 9 yo has been on the computer a lot since the pandemic. I’ve done osteopathic mainipulative treatments on her on a regular basis, but she seems to be requesting treatments more regularly (twice/wk is not enough for her, but this mama is tired at night and want to go to bed early as well). Her thoracic, ribs, and cervical (especially CT junction) always tighten up by the time I treat her again. I blame it on frequent bending at the desk and slouching. When she’s tired of sitting on her chair at the desk, she moves to her bed.

    • She’s so lucky to have you as a mama!

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