Not many victims of the opioid crisis in America make national headlines. Tyler Skaggs was different.

The 27-year-old was a professional athlete, a pitcher for the Angels, wealthy and famous. On a road trip with the team, he was found in his hotel room. He had choked on his own vomit after consuming a mix of alcohol, oxycodone and fentanyl.

His death on July 1, 2019, sent shock waves through the sports world. A highly publicized criminal investigation not only revealed that Skaggs had secretly used painkillers for years, but also led to the arrest of a team employee accused of providing him with tainted, black market pills.

Five years later, The Times has pored over hundreds of pages of court documents and cellphone records to reconstruct Skaggs’ final hours. Playing cards with teammates on a three-hour flight. Teasing rookies on the bus. Trading affectionate texts with his wife until late at night.

Even the most ordinary details tell an important story, offering an intimate look at an epidemic that has ravaged the country.

Tyler Skaggs pitches against the Oakland Athletics on June 29, 2019, two days before his death.

(Marcio Jose Sanchez / Associated Press)

Skaggs pitches at Angel Stadium against the Oakland A’s and is pulled after surrendering two runs in four-plus innings. CAA agent Nez Balelo texts to commiserate about “the quick hook … after cruising basically through 3 and 4.”

Skaggs is nothing if not dogged. At 6 feet 4 and 225 pounds, he has fought back from a string of serious injuries, refusing to quit, which might help explain his painkiller use. After the game, his mother, Debbie Hetman, a longtime softball coach at Santa Monica High, calls him and his wife.

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“I didn’t FaceTime him because I was – we were super busy, so we just talked really quickly,” Hetman later testifies during the team employee’s trial. “I think he was in line at In-N-Out with Carli.”

Mike Trout, wearing Tyler Skaggs’ number in his honor, speaks to Eric Kay in the dugout before a July, 12, 2019, home game against the Seattle Mariners.

( John McCoy / Getty Images)

(Animation by Kelvin Kuo/Los Angeles Times)

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Shortly before a 1:07 p.m. game against the A’s, Skaggs receives a text from Eric Kay, the team communications director who for years has allegedly supplied him with “blue boys” — blue, 30-milligram oxycodone pills.

Kay: “Hoe [sic] many?”

Skaggs: “Just a few like 5”

Kay: “Word”

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Skaggs: “Don’t need many”

4:25 p.m. Pacific Time

The Angels conclude their four-game home series with a 12-3 loss. It is a get-away day, meaning the team will head directly from the stadium to Long Beach Airport, where a charter plane waits for the start of the road trip.

Skaggs has previously asked his manager’s permission for the players to dress like cowboys for the flight to Texas. Before leaving the stadium, he meets his wife, Carli, so she can snap pictures of him in his black hat, bolo tie and boots.

“When did he buy that outfit?” a prosecutor later asks her during Kay’s trial.

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“The day before.”

“Did you help him pick it out?”

“Yes.”

6:11 p.m. PT

Skaggs gathers with teammates on the tarmac beside a United Airlines charter plane for another photo to show off their Western wear. He hitches his thumbs in his belt like a cowboy. Seeing the picture on Instagram, Carli comments: “So cute”

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8:07 p.m. PT

(Animation by Kelvin Kuo/Los Angeles Times)

With the Texas Rangers next on the schedule, the flight to Dallas Fort Worth International Airport lasts about three hours. Along the way, Carli texts to ask how things are going.

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Skaggs: “Good gambling … losing”

Carli: “Damn babe … How much cool … Lol*”

Skaggs: “200 bucks … I’m winning now”

Carli: “Sweet”

11:06 p.m. Central Time

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On the 15-minute ride from the airport to a Dallas-area hotel, Skaggs grabs a microphone at the front of the bus.

“So, he would have been kind of like emceeing, doing the music,” teammate Andrew Heaney later testifies. “You know, we would call younger guys up, ask them, you know, embarrassing questions or make them tell a funny story or whatever it may be, make them sing a song, something like that.”

Throughout the league, Skaggs is known as friendly, funny, eminently likable. Teammate Mike Trout later says: “The energy he brought to a clubhouse … every time you saw him, he’s just picking you up.”

11:25 p.m. CT

The Angels arrive at the Hilton Dallas/Southlake Town Square, where players receive key cards to their rooms and peruse a table of snacks, protein bars and Gatorade. A friend invites Skaggs to go out, but the pitcher remains in his room.

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11:47 p.m. CT

(Animation by Kelvin Kuo/Los Angeles Times)

Skaggs texts his room number to Kay.

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“469,” he writes, adding: “Come by”

“K,” the communications director responds.

Kay had used opioids enough to know black market oxycodone pills might be laced with dangerous drugs such as fentanyl, a synthetic opioid 50 to 100 times more powerful than morphine. In a jailhouse call recorded after his trial, he denies giving drugs to Skaggs that night, saying he visited the pitcher to talk about something else.

“I guess he hated the rookies or something — and he was one flight up so I flipped my door and went up,” he says.

The hotel does not have security cameras in the hallway, so it is unclear how long Kay spends in room 469.

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12:02 a.m. CT

(Animation by Kelvin Kuo/Los Angeles Times)

Skaggs texts with teammate Ty Buttrey. He then trades messages with his wife.

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Skaggs: “Miss you babe”

Carli: “Miss u too”

When the two met in 2013, Skaggs reportedly fell hard. Now, they have a house and are thinking about kids. They text continually when the Angels are traveling.

12:42 a.m. CT

“What u Doin,” Carli asks.

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No answer. She tries again: “Helllooooo.”

1:09 a.m. CT

It is late in Dallas — two hours later than Los Angeles — and Carli is still waiting for a “goodnight” from her husband. She writes: “U know better than to get drunk and fall asleep without texting me”

Approx. 12:53 p.m. CT

Angels’ Mike Trout, left, embraces Andrew Heaney, who fights back tears as he answers questions about their late friend and teammate Tyler Skaggs.

(Tony Gutierrez / Associated Press)

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The night passes, followed by morning, and still no word from Skaggs. Heaney texts him: “Lunch?”

After a few minutes, Heaney stops by room 469. Light shines from under the door; the curtains must be open in there. Nearby, hotel workers are noisily cleaning a carpet. Heaney wonders how anyone could sleep through all this.

When his knock gets no response, he goes back to his room and tries calling Skaggs on the hotel phone.

1:49 p.m. CT

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Tom Taylor, the Angels traveling secretary, is having lunch with Kay at a nearby barbecue joint and recalls Carli texting him. Heaney also reaches out to Taylor.

“He hadn’t heard from him either,” Taylor later testifies.

More than 12 hours after Carli’s last exchange with her husband, she messages again: “You have a drinking problem. I’m about to text tom Taylor.”

Carli later insists these words were sent “purely out of anger” with “no truth to it.”

Irritation gives way to another emotion. Carli contacts Skaggs’ mother, Hetman.

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“She was really nervous,” Hetman later testifies. “I was really nervous because it was very unusual not to hear back from Tyler. Tyler was very good about returning text messages.” Hetman dials his number, and it sounds as if the call goes directly to voicemail. Her husband, Dan Ramos, sends a text:

“Hi kid. How r u doing. How is life treating u. How is your arm feeling”

A photo of Tyler Skaggs and his wife, Carli, is displayed outside a memorial service for the Angels pitcher in 2019.

(Christina House / Los Angeles Times)

2:04 p.m. CT

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Now Hetman tries texting: “Hey Ty Are you okay today?”

Around the same time, Taylor returns to the hotel and knocks on Skaggs’ door. He then summons Chuck Knight, one of the team’s security men, and they ask hotel management to let them into room 469.

A former Anaheim Police Department officer, Knight enters the room alone, staying less than a minute. Taylor later recalls him emerging with “a shocked-looking face, almost like, it’s not good, what he saw.”

2:16 p.m. CT

Knight calls 911. Asked later about what he encountered in the room, he testifies: “I saw two legs hanging off the end of the bed in a position that I thought was unusual for someone that might be sleeping … I walked closer in an attempt to obtain a pulse. I reached down to grab his wrist and noticed that his skin was very cool to the touch. I did not obtain a pulse.”

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Heaney, who is getting messages from Carli, returns to the hallway outside room 469. Taylor tells him: “It’s not good.”

“I knew what was going on, but his wife didn’t,” Heaney later testifies. “And she was texting me, so it was — I just felt like I wanted her to know what was going on.”

He decides not to answer.

A call crackles over the scanner: “Medic 4-1, truck 4-1 respond. Medical emergency, Hilton Southlake Town Square.” The dispatcher adds: “It’s gonna be … a possible death investigation. PD is arriving on scene now.”

A Southlake police officer finds Skaggs’ room looking mostly undisturbed — the bed still made, a backpack and another bag on the couch, unopened beers on the coffee table. There is a white, “almost chalky” substance on the desk. Skaggs’ cellphone lies near his head.

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A memorial for Tyler Skaggs on the outfield wall at Angel Stadium.

(Los Angeles Times)

2:23 p.m. CT

Cory Teague, a Southlake Fire Department paramedic, arrives at room 469. His medical supplies include Naloxone, which can be administered to reverse the effects of opioid overdose.

“Did you use it?” a prosecutor later asks at trial.

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“No.”

“Why not?”

“The patient had signs incompatible with life, unable to be revived.”

3:05 p.m. CT

Carli’s phone rings as she pulls up to her parents’ house in Santa Monica. It’s Billy Eppler, the Angels’ general manager. “I’ll never, ever forget that call,” she later says. She dials Hetman, who is at her Los Angeles home, and breaks the news. Hetman later recalls “crying and yelling and screaming.”

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Buses are scheduled to take the Angels to their evening game. Instead, players and staff are told of Skaggs’ death and shepherded into a hotel banquet room where police take statements.

“The questions that we asked were generic for each player and employee,” Cpl. Delaney Green of the Southlake Police Department later testifies. “And it was along the lines of: When was the last time that you had seen or spoken to Tyler Skaggs? Had you seen him consume any alcohol on the plane? And did you know of any drug use that you were aware of?”

Kay is among those interviewed. He tells police that Skaggs was drinking on the flight to Texas but adds, “I didn’t think he had a lot.” He says he last saw the pitcher when they collected their room keys in the lobby.

3:52 p.m. CT

The Times and other news agencies report Skaggs’ death on social media. Family members call his mother at home. She later testifies that “before I could even talk to anybody, that whole — everything was like blowing up and it was super-crazy.”

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4:11 p.m. CT

Angels manager Brad Ausmus speaks at a 2019 news conference about Tyler Skaggs’ death.

(Tony Gutierrez / Associated Press)

The Rangers announce the postponement of that night’s game as the Angels switch to another hotel. The team gathers for an emotional meeting. “We were able to talk about Tyler and laugh at some of the stories and some of the goofy things he did, listen to some of his music,” manager Brad Ausmus later says before breaking down.

On social media, players from around the league post messages.

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“RIP to my longtime friend and Little League teammate,” then-St. Louis Cardinals pitcher Ryan Sherriff writes. “i love you brotha.”

About 8 p.m. CT

Carli and the Skaggs family board a flight to Texas.

About 10 a.m. CT

Carli and the Skaggs family visit the medical examiner’s office in Fort Worth. She later recalls kissing her husband’s cold lips as he lay on a gurney.

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11:10 a.m. CT

The medical examiner begins an autopsy. He will eventually determine that “alcohol, fentanyl and oxycodone intoxication” caused Skaggs to choke on his own vomit.

Later that morning, Carli and the Skaggs family arrive at the Southlake police station to retrieve his luggage, iPad and other belongings.

In words that underscore the anguish of losing a loved one to opioids, Hetman later testifies: “I was angry because I knew that my son loved life and he did not want to die. He did not know that there was poison in that pill that cost him his life.”

About 5:30 p.m. CT

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Team officials hold a news conference with Kay standing quietly to the side, hands clasped at his waist. At one point, he appears to take a deep breath, look toward the ceiling and exhale.

7:05 p.m. CT

Teammates place jerseys with Tyler Skaggs’ number 45 on the mound at Angel Stadium at their first home game after his death.

(Kent Nishimura / Los Angeles Times)

The game against the Rangers proceeds as scheduled. The ballpark is eerily quiet, with the home team forgoing the usual walk-up music.

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The Angels, wearing black No. 45 patches on their jerseys, score early and cruise to a surprising 9-4 victory, but Trout says: “All I was thinking about was Tyler. It was just a different feeling, you know. Just shock.”

Angels pitcher Tyler Skaggs died of an overdose in a hotel room on July 1, 2019.

(K.C. Alfred/San Diego Union-Tribune)

Federal prosecutors charged Kay with distribution of a controlled substance resulting in death and conspiracy to possess with intent to distribute controlled substances. A trial began in February 2022.

“This was a case of one, one person who went up to that room on June 30,” a prosecutor said in court. “One person who went into that room and gave Tyler Skaggs fentanyl.”

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The jury deliberated less than 90 minutes before returning a guilty verdict on both counts.

At a hearing where the judge sentenced him to 22 years in federal prison, Kay — who didn’t testify during trial — apologized to his family for the “disgrace and embarrassment” he had caused them.

Privately, however, he continued to profess innocence. In a recorded jailhouse call, he told a friend: “The worst thing, though, is that text that he sent me … because I didn’t know what he wanted. I had no idea. In my head, I think he thought I already got more [pills] for him but I told him they were going to be s—.”

By then, the Skaggs family had filed a wrongful-death suit against the Angels. The team has denied wrongdoing, and the case continues.

In the five years since Skaggs died, opioid overdoses — fueled by illicitly manufactured pills — have claimed hundreds of thousands of American lives.

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The Substance Abuse and Mental Health Services Administration has a 24-hour helpline for individuals and families facing mental and substance abuse disorders. The number is (800) 662-HELP (4357).

Attention sunscreen skeptics: The sun’s UV rays are coming for you, and you’re just making their job easier.

Summer is now upon us, which means more time in the sun — and more exposure to the ultraviolet radiation it emits. Longer-wavelength ultraviolet A rays can reach beneath the skin’s surface, causing it to age prematurely. Shorter-wavelength ultraviolet B rays affect the outermost layers of skin, causing sunburns and tans. (A third type of rays, ultraviolet C, is intercepted by Earth’s protective ozone layer.)

Both UVA and UVB damage the DNA in skin cells, causing mutations. These mutations can accumulate over time and cause tumors to grow. The more UV exposure you have, the greater the risk, according to the Skin Cancer Foundation.

Basal cell carcinoma is the most common type of skin cancer in the United States, followed by squamous cell carcinoma. About 5.4 million of these cancers combined are diagnosed each year, and they cause between 2,000 and 8,000 deaths, the American Cancer Society says.

Melanoma of the skin is both more rare and more deadly, affecting an estimated 100,640 Americans this year and resulting in 8,290 deaths, according to the National Cancer Institute.

Sunscreens can protect you from these malignancies in one of two ways. Chemical sunscreens contain ingredients such as avobenzone that absorb UV rays. Mineral sunscreens rely on zinc oxide or titanium dioxide to block or reflect the rays. Either way, the solar radiation is unable to penetrate the skin and corrupt your DNA.

Here are 10 sunscreen myths you can’t afford to fall for:

Myth 1: As long as you don’t get a sunburn, you’re safe.

The reality: You don’t need to get a sunburn to put your skin at risk. UV exposure will compromise the DNA of unprotected skin — even if your skin looks normal to the naked eye — and the effects are cumulative, said Dr. Henry Lim, a photodermatologist at Henry Ford Health in Detroit who studies the effect of sunlight on skin.

“Each time the skin is damaged by the sun, with or without sunburn reaction, there is some damage that the skin would have to repair,” Lim said. “If that subclinical damage goes on often enough for a long enough period of time, the skin’s ability to be able to completely repair all that DNA damage will be compromised.”

Myth 2: Your body needs vitamin D, and sunscreen will keep you from getting it.

The reality: It only takes a small amount of sun exposure to produce all the vitamin D your body needs. One study of white people in the Boston area determined that 5 to 10 minutes of sun on the face, arms and legs two or three times a week during the summer months was enough to produce sufficient amounts of vitamin D.

Even if you apply sunscreen, you’ll still get that minimum amount of sun exposure, Lim said. “When we use sunscreen, we don’t apply enough,” he said. “It’s just human nature.”

Dr. Anne Chapas, a dermatologist in Manhattan and clinical instructor at Mt. Sinai Medical Center, advises patients who are concerned about their vitamin D levels to protect their skin and seek out the nutrient in foods or take supplements.

“You do need vitamin D to be healthy, but there are multiple ways to get it,” she said.

Myth 3: The chemicals in sunscreen can cause cancer.

The reality: The active ingredients in sunscreens sold in the U.S. are regulated by the Food and Drug Administration, which has determined that they are safe and effective. The National Academies add that “sunscreen use is not linked to higher rates of any type of cancer.”

In fact, it’s the reverse that’s true, Chapas said: “If you’re trying not to get cancer, then wear sunscreen.”

Myth 4: You don’t need to wear sunscreen when the UV index is low.

The reality: The UV index primarily measures UVB, which Lim calls “the sunburn spectrum.” Even if UVB is low, you still need to protect yourself from UVA.

“As long as there is light out there, there’s enough UVA” to induce tanning, cause wrinkles, and contribute to skin cancer risk, Lim said.

Chapas concurred. “Even on cloudy days, about 80% of the sun’s rays come through and you can can still get sun damage,” she said.

Myth 5: You don’t need sunscreen if you have dark skin.

The reality: People of every complexion can get sun damage and skin cancer. In fact, “skin cancer in patients with darker skin tones is often diagnosed in later stages, when it’s more difficult to treat,” said Dr. Seemal Desai, president of the American Academy of Dermatology.

Chapas added that since darker skin is apt to produce melanin in response to sun exposure, it may become discolored more readily than lighter skin.

Myth 6: Mineral-based sunscreens are safer than chemical sunscreens.

The reality: Both types are safe to use, but there are fewer unknowns with mineral sunscreens since they are not absorbed into the skin, Lim said.

Chapas said that’s one reason why she prefers mineral sunscreens. She also appreciates their versatility, since they can be applied on top of makeup or moisturizer. “The challenge is that some of these formulations have a whitish cast to them, so you have to find one that works with your complexion,” she said.

Myth 7: You can protect yourself from the sun by building up a “base tan.”

The reality: A tan can provide a small bit of protection, but it’s less than the equivalent of SPF 5, Lim said. That’s not nearly enough to make sunscreen unnecessary.

Besides, a tan itself is a sign of sun damage. “When our skin is exposed to UV light, it stimulates the production of melanin to prevent more UV from entering the skin and damaging the underlying skin cells,” Chapas said. “A tan isn’t healthy. A tan is actually your body trying to protect itself.”

Myth 8: The antioxidant astaxanthin will protect you from UV and act as an “internal sunscreen.”

The reality: There are two ways that antioxidants reduce the biological damage that comes with sun exposure, Lim said. When UVA rays harm DNA, they do so by causing oxidative damage to DNA, and antioxidants can help minimize it. In addition, when visible light interacts with the skin, it can cause cells to produce a type of destructive molecule called reactive oxygen species. Antioxidants can help counteract this process as well.

Including antioxidants in a sun protection regime makes sense, but they can’t do the job by themselves. “There are no pills that act as effectively as a sunscreen,” Chapas said.

If you do want to take an antioxidant to reduce sun damage, astaxanthin isn’t necessarily the best choice, Lim and Chapas agreed. The product Chapas recommends is from Heliocare.

Myth 9: The chemicals in sunscreen get into your bloodstream and build up over time.

The reality: There are no long-term studies of the blood of people who use sunscreen regularly, so there is no data to say whether this is true or false. However, the chemicals are excreted in urine, which is a sign that they don’t linger in the body, Lim said.

People who are wary of chemical sunscreens can opt for mineral sunscreens instead, he said.

Myth 10: You can keep sun damage at bay by wearing a good hat.

The reality: A wide-brimmed hat will definitely help protect you from the sun. This is particularly true for people who are bald or have thinning hair, since “we don’t have great sunscreens for hair-bearing areas,” Chapas said.

However, a hat will only block UV rays coming from above. Without sunscreen, you’ll still be vulnerable to rays that reflect off the water, sand, or urban surfaces like a sidewalk and come at your skin from below. (This is also why you need sunscreen even if you’re in the shade.)

“There are multiple actions we need to take,” Lim said. “Each one of them is helpful, but it’s not as good as when you put everything together.”

Parents are bombarded with a dizzying list of orders when it comes to screen time and young children: No screens for babies under 18 months. Limit screens to one hour for children under 5. Only “high-quality” programming. No fast-paced apps. Don’t use screens to calm a fussy child. “Co-view” with your kid to interact while watching.

The stakes are high. Every few months it seems, a distressing study comes out linking screen time with a growing list of concerns for young children: Obesity. Behavioral problems. Sleep issues. Speech and developmental delays.

Maya Valree, the mother of a 3-year-old girl in Los Angeles, understands the risks and constantly worries about them. But limiting her daughter’s screen time to one hour feels impossible as she juggles life as a working parent, she said.

Over the past few years, her child’s screen time has ranged up to 2-3 hours a day, more than double the limit recommended by pediatricians. Valree puts on educational programming whenever possible, but it doesn’t capture her child’s attention as well as her favorites, Meekah and “The Powerpuff Girls.”

“Screen time is in the top three or five things to feel guilty about as a mom,” she said. “I’ve used it to pacify my daughter while cooking or working or catching up on anything personal or professional.”

Valree is among the legions of parents who by choice or necessity allow their babies and preschoolers to watch several times more than the limit recommended by experts, creating a vast disconnect between the troubling predictions of harm and the reality of digital life for American families.

But her feelings of guilt may put Valree in the minority. Directives to limit the time young children spend on digital devices may not be taking root because many parents simply don’t believe their child’s screen time is a problem in the first place.

Parents need to have some type of distraction for their kids, and “screens tend to be the easiest option, the lowest hanging fruit,” said Dr. Whitney Casares, a Portland pediatrician and author of the book “Doing It All.” “I hear more people saying, ‘I know screen time is bad, I wish we had less of it in our family, but I feel helpless to change it.’”

Screen time use among older children made news last week, when the Los Angeles school board approved a cellphone ban all day on campus, and the U.S. surgeon general called for a warning on social media platforms advising parents that they can damage teenagers’ mental health.

Many families, however, support their children’s phone use for safety and education. For a generation of parents of who grew up with cellphones and computers, such sentiments appear to start with much younger children. A national survey of families with children 8 and younger found that the majority of parents believe screen time is a net positive — helping their children learn to read, boosting creativity and even improving their social skills.

Should children under 5 have screen time?

The American Academy of Pediatrics recommends families avoid screens for babies under 18 months, with the exception of video chatting. Parents who want to introduce digital media to toddlers ages 18-24 months should keep it very limited, choose high-quality educational programming, always watch alongside their children, and interact with their children both during and after watching.

For children ages 2-5, pediatricians recommend limiting screen time to one hour a day of high-quality programming that is educational, interactive and pro-social with few or no advertisements. Parents should avoid fast-paced programs, apps with distracting content and anything with violence. Whenever possible, they should co-view with their children to help them understand what they are seeing.

Maya Valree’s 3-year old daughter watches screen time on an iPhone while her mother works on Saturday, June 22, 2024 in Los Angeles, CA.

(Zoe Cranfill/Los Angeles Times)

Pediatricians also recommend that children avoid screens during mealtimes and at least one hour before bedtime. When no one is watching the TV, it should be turned off. And parents should avoid regularly using screens to calm their child, because it can make it difficult to set limits and teach children to regulate their own emotions.

“We don’t want to be the scolds. It’s our job to provide information to parents but to also say we understand the reality of everyone’s current lifestyle. It’s just a different world now,” said Dr. Nusheen Ameenuddin, one of the authors of the academy’s policy statement. “[Parents] aren’t going to be perfect 100% of the time.”

Jacqueline Nesi, an assistant professor of psychiatry at Brown University and author of Techno Sapiens, said screen time limits need to be a balance. While there is evidence that endless screen time — especially more than four hours a day — can be harmful, Nesi said there aren’t data to support a strict one-hour cutoff.

“As parents we know life isn’t always aligned with the recommendations. We don’t want to throw them away, but we also don’t want to be in a place where we’re demonizing all screen time.”

What percentage of parents limit their kids’ screen time?

The most recent data available come from a national survey of nearly 1,500 families with children ages 8 and younger conducted by Common Sense Media in 2020, just weeks before the pandemic closures began. The survey found that few families were coming anywhere close to pediatricians’ recommended limits.

• Children under 2 watch an average of 49 minutes of digital media a day, while the guidelines recommend avoiding screens for children under 2.
• Children ages 2-4 watch an average of 2.5 hours a day, more than twice the limit recommended.
• Children 5-8 watch just over three hours a day. The American Academy of Pediatricians does not provide strict time limits for school-aged children but advises parents to make sure screen time does not displace other activities.

The majority of parents surveyed reported that they’re not concerned about the amount of time their kids spend with screens, the impact screen media have on their child or the quality of the content available to them. The survey also asked about the reasons for children’s screen use: More than three-quarters of parents said “learning” was very or somewhat important, and more than half said parents need “time at home to get things done.”

For a generation of parents who grew up with cell phones and computers, letting kids indulge in a bit of phone or TV time doesn’t feel like a big deal.

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Henja Flores, a mother of three in Fresno, said videos from YouTube sensation Ms. Rachel taught her toddler sign language and the ABC’s. “I use it as an educational thing, but also if I have to make lunch or dinner,” she said. She’s seen the headlines, but she lets her children watch two to three hours a day, as long as the shows don’t seem too overstimulating.

“I just don’t think it’s something parents need to stress about. Moms need breaks. Moms needs to get things done. As long as it’s helping, I don’t think there’s anything wrong with it at all,” said Flores.

The Common Sense survey found screen habits varied by income level, race and ethnicity. In lower-income families, for example, children were watching an average of two more hours each day than those in higher-income families.

“For lower-income families there are going to be bigger barriers to limiting screen time. It takes a lot of time and work. Higher-income families are more likely to have high quality child care, which is very expensive in our country,” said Nesi. “Sometimes screen time is serving as that thing that’s going to keep your kid occupied and safe.”

Black parents and those in lower-income households were also much more likely than their higher-income or white counterparts to perceive educational benefits to their children from screen media. Latino parents, meanwhile, had the highest level of concern about the possible negative effects of media in their children’s futures.

Why do pediatricians want to limit children’s screen time?

The strongest evidence for avoiding excessive screen times involves the “opportunity cost” — the valuable learning opportunities children miss out on during the hours they spend on digital devices.

In order to develop cognitive, language, motor and social-emotional skills, young children need to experience the world hands-on — playing with toys, exploring outside, experimenting with different materials, and having back-and-forth interactions with nurturing caregivers, said Ameenuddin. When they are watching digital media, they lose that time to grow and learn.

Maya Valree’s 3-year old daughter plays with a toy laptop and watches a video while her mother works on Saturday, June 22, 2024 in Los Angeles, CA.

(Zoe Cranfill/Los Angeles Times)

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This is particularly true for babies and toddlers, because there isn’t much evidence that they can learn through screens.

For preschoolers, there’s more evidence that educational shows like “Sesame Street” can help improve literacy and social development, but only in limited amounts. Heavy media use in the early years has been linked to a greater risk of obesity because these children often miss out on physical activity and outdoor time. They’re also more like to see advertisements for sugary foods and drinks.

Children who are watching screens also have fewer valuable interactions with caregivers and hear fewer words during the course of their days, which is linked to cognitive, language and social delays. Some studies have found evidence linking excessive screen time with behavioral issues such as ADHD, though the research did not show that one was actually caused by the other.

A bigger question is whether the screen time is changing the wiring of babies’ and young children’s brains. A small MRI study of preschoolers found that children who watched more than the recommended one hour a day had lower development in the brain’s white matter that supports language and early literacy skills. But Ameenuddin says the evidence isn’t clear yet that screens themselves are affecting brain development.

Is screen time harmful for babies?

Babies should be playing and exploring the world, not watching screens, experts advise.

In the first three years of life, more than 1 million neural connections are formed every second, and key to this development are the “serve and return” interactions between children and their caregivers, according to Harvard’s Center for the Developing Child. Babies babble and make faces and gestures, and the people who love them respond in kind. Without these important interactions, the brain’s architecture can’t form the way it should.

These sorts of interactions don’t happen through screens.

A recent Japanese study found that the more time a baby spent watching screens at age 1, the more likely they were to have developmental delays in communication and problem-solving at ages 2-4 — particularly when they watched more than four hours a day.

But Nesi, the psychiatry professor, said there’s no need to shield a baby’s eyes when in a room with a television on. “There’s a lot of fear messaging around this, and there’s no evidence to suggest that your baby catching a glance of a screen every once in a while could do harm.”

How can I make the most of screen time?

“There is a lot of incredible, cool stuff for kids to watch and do on screens,” said Jill Murphy, chief content officer at Common Sense Media, which offers quality ratings and media reviewsfor children. In general, Murphy says it’s safer to stick with branded content from a production company that’s intended for young children, which often have child development staff or advisors.

YouTube Kids requires more parental guidance, she said, and parents need to evaluate videos in advance. If they can’t, they should create a profile with a child’s selected interests and a set number of videos coming into the feed.

“Anything violent is a hard no for young kids, even if it’s play slapping or hitting each other with a stick,” said Murphy. “They’re very quick to mimic that behavior.”

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Researchers recommend age-appropriate programming that actively involves children by asking them questions, helps them make meaningful connections to their everyday lives, and includes “socially meaningful” characters they can get to know rather than a disembodied voice.

Murphy says parents should designate screen-free zones and times, and set clear limits around when screen time will end. And whenever possible, stick with high-quality educational content without commercials, like the kind found on PBS Kids, which has been found to lead to better behavioral outcomes and language skills.

Set boundaries, avoid screens around bedtime, and whenever possible, watch alongside your child.

This article is part of The Times’ early childhood education initiative, focusing on the learning and development of California children from birth to age 5. For more information about the initiative and its philanthropic funders, go to latimes.com/earlyed.