Is tech injuring children?

Mitali Perkins worries about her sons' hands. Her 13-year-old twins, James and Timothy, are avid gamers who own three computers, two Sony PlayStations, a Nintendo GameCube and a Microsoft Xbox. Physically, they're fit, with one oddity: The boys can bend their thumbs all the way back to their forearms, and they constantly stretch and crack their knuckles with ease. For tasks like ringing a doorbell, dialing a phone number and changing the remote, they use their thumbs.

"The word 'arthritis' comes to mind," Perkins wrote in an e-mail to CNET News.com.

The Perkins boys' flexi-thumbs could be genetic--or they could be the physical adaptation of two game fanatics, just like big thighs are to bicyclists and strong shoulders are to swimmers. Whatever the case, the prolonged exposure to technology by a generation of kids has doctors, researchers and physical therapists expecting a rash of new repetitive stress injuries in the coming years.

A study from 2000 in Australia on the effects of laptop computers in schools showed that 60 percent of students aged 10 to 17 complained of neck and back discomfort while using the PC.

"Not since the development of a written language has the task performed by children and adults changed so dramatically," according to the report from the International Ergonomics Association.

Unfortunately, conclusive research on the subject of computer ergonomics for kids has been lacking. But researchers are concerned nonetheless.

"The exposure to ergonomic risk hazards for children is expected to be higher than it would be for adults because of the sheer amount of time that they're on computers at home and at school," said Ken Harwood, director of the practice department at the American Physical Therapist Association.

"So we expect to be seeing more diagnoses of repetitive stress injuries (RSI) in kids in the upcoming years as these kids start to develop, but we lack the evidence that supports it," said Harwood, who's also a physical therapist and certified industrial ergonomic specialist.

Some physical therapists and pediatricians are already citing cases of RSI in children as young as 8 years old. Kids complain of headaches, neck problems and backaches. And when pediatricians can't identify the source, they'll send the child to a physical therapist.

"We see so many more middle school children with neck (pain) and backaches," said Doreen Frank, a physical therapist based near Albany, N.Y. "When we evaluate them and find there's been no trauma or no new activity, it narrows down to the fact that they sit for way too long and then they're on the computer way too long," Frank said.

Many adults who have witnessed kids trading hobbies like soccer or dance for instant messaging and computer games aren't surprised by these concerns. But even athletic children can suffer as a result of prolonged states of sedentary computer slump without break that strain developing muscles and joints. In the last five years, Frank said, at least 5 percent of her patients have been middle school children with neck and back pain, some in just the sixth grade.

Alan Hedge, a professor of ergonomics at Cornell University, said it takes an average of five to 10 years for people with poor computer habits to develop RSI problems. At that rate, kids in high school or college today might be primed for stress injuries while in the workplace--and it would likely be recorded as a work-related injury. Because there's no national database tracking child ergonomics issues in schools, there would be no way for researchers to understand the scope of the effects, he said.

Still, there's hope that digital kids could adapt to their heavy computer use.

A theory called the "Healthy Worker Effect" supposes that when someone performs a repetitive task for a long time, like lifting heavy boxes or surfing the Web, the person can develop a resistance to problems associated with the activity. The effect may be developmental, according to Harwood, in that children could develop a body structure to handle more ergonomic stress than they would have if they started the task as an adult.

Harwood said that it's not easy to measure RSI symptoms and then link them to a particular activity. Most research is conducted through surveys, he said, and kids don't fair well filling out such questionnaires. However, he said, there have been many studies in adults that show a relationship between computer use and RSI, and that could correlate to children. There's a need to track children's use of technology over time so as to measure future effect, he said.

"There's a lot of work that still needs to be done in this area," he said.

The potential dangers are associated with several trends. One, of course, is the ubiquity of computers, cell phones, text messaging, instant messaging, social networking, and whatever the next technological fad might be. More than 80 percent of American kids age 12 to 17 use the Internet, and more than half of those kids log on daily, according to a Pew Internet and American Life study.

Kids nowadays can spend hours cradling a cell phone with a crooked neck, slumping over a computer game, slouching in front of a PC while text messaging friends and listening to music. And that's on top of time they might spend in school on a PC surfing the Web to research topics and do homework.

Experts are particularly concerned about the ergonomics of PC setups in schools because many computer labs are designed with a one-size-fits-all approach. Children might not have chairs suited to them or computer screens at eye-level that help avoid common repetitive strain.

College and high-school kids could once be found on a bed or couch reading a book for school. Now, studies are happening more on the computer, adding hours to sitting at the PC.

The state of Maine, for example, has mandated that all school kids be equipped with a computer. Microsoft, too, has donated computers to schools. Yet many such initiatives don't include programs to teach children how to use those computers properly to avoid injury, experts say.

"We'll have trouble; then we'll accommodate to it," said Dr. Stephen Nicholas, director of the Nicholas Institute of Sports Medicine and Athletic Trauma.

Karen Lunda, a physical therapist in Tuscon, Ariz., said when it comes to children, people consider the developmental vulnerabilities they're prone to in many activities. For example, the pitcher in Little League baseball is restricted in how many innings he or she can pitch to avoid arm injury. The same might be warranted for computer use, she said. Perhaps, she added, kids should be forced to take a break every 1,000 keystrokes.

"It's something to examine because if we don't, boy, we're going to have a huge problem as they get older," she said.

Except for a few initiatives, very little has been done in the United States to protect children from computer injury and teach them good habits like regular breaks, posture and stretches, experts say. The state of New Jersey has passed legislation to set standards for school furniture that would support computer use, but the measure has yet to be enacted. At least one company, Magnitude, has developed software for schools called Ergo Fun. Cornell has also developed downloadable software that teaches kids the principles of PC ergonomics.

"If you teach children the principles of good ergonomics for using computers when they're young, then those will become habits to protect them throughout their life," said Cornell's Hedge.

For now, the Perkins boys show no signs of repetitive stress from mouse or joystick use, according to their mother, who said that's likely because she and her husband do their best to limit game play.

"I'm not sure about the long-term effects," Perkins said.

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