Impact of COVID-19 Shelter-In-Place orders on pediatric device use, outdoor activity and eye symptoms

ABSTRACT

Purpose: The COVID-19 pandemic caused the implementation of public health measures globally, including a call to Shelter-In-Place (SIP). In most cases, traditional classroom teaching became remote, pediatric outdoor programs such as organized sports were halted and parks closed. This study primarily aimed to understand the impact of COVID-19 SIP orders on pediatric habitual device use, outdoor activity, and reported eye symptoms. Methods: Eligible participants included English and Spanish speaking UCSF pediatric ophthalmology patients aged 5-10 years with no history of ocular disease, surgery or trauma. A parental survey was administered electronically or over the phone by a trained examiner. The survey included questions regarding their child's average daily device use, outdoor activity and how often their child typically reported eye symptoms before and during SIP. Statistical analysis was performed using paired t-tests to examine changes in behaviors before and during SIP. Results: 42 participants (n=17 female, mean age 6.6 ± 1.3 years) were enrolled in the study. 98% (n = 41) of those surveyed reported that their child was in remote online learning during SIP, with the majority (56%) using a laptop as their main device for remote learning. On average, laptop and hand-held device (smartphone or tablet) use increased significantly during SIP for both weekdays and weekends (Laptops ~3 hour increase weekdays and 1 hour increase weekends, p <0.001;Hand-held devices ~1 hour increase weekdays and weekends p <0.002). Outdoor activity decreased on average by approximately 1 hour on both weekdays and weekends (p <0.008). Despite the increase in device use, there was only a slight increase in 'eyes feeling uncomfortable or tired' (from never to occasionally, on average). None of the other eye symptoms surveyed (seeing words moving, jumping, swimming, or floating;headache;dry eyes;blurry vision) were reported to change during SIP. Conclusions: This study provides insights into how COVID-19 SIP orders impact habitual pediatric device use and outdoor activity. Despite children spending significantly increased time on devices during SIP, there was a low prevalence of reported eye symptoms in our cohort. Further work is warranted to determine the potential longer term impacts of these behavior modifications on pediatric eye health.