The first years of a child’s life are crucial for development. It’s when they learn how to communicate and connect with other people and to interact with the world around them. “Much of early learning is hands-on, through touch, and through real-life interaction with people,” says David Rosenberg, MD, a pediatrician at Grand Strand Medical Center in Myrtle Beach, South Carolina. “When infants don't have that exposure to other people, when they just have a screen, they don't learn as well.”

Yet according to a study by Common Sense Media, 38 percent of American children have used a mobile device before they’ve even celebrated their second birthday.

The American Academy of Pediatrics (AAP) advises that it’s best to keep technology away from infants 18 months and younger, not including video chatting. And once they’re 18 to 24 months, the Academy suggests monitoring kids’ tablet usage to ensure they’re only viewing programming that’s high quality and educational.

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Here are some of the downsides of tablet use for children under 2—and what parents can do to set healthy limits on tech use.

Drawbacks of too much tech

Potential delays in speech and social development: The first two years of a child’s life are pivotal for intellectual growth. And there is some evidence that tablet usage during these years can stunt speech development. “One of the concerns is that if the only stimulation kids are getting is from this two dimensional screen, there can be delays in the development of expressive speech,” says Dr. Rosenberg.

In a study presented at the 2017 Pediatric Academic Societies meeting, researchers investigated how much screen time can lead to delays in speech, examining 894 children between the ages of 6 months and 2 years, from 2011 to 2015.

By the time the children in the study were 18 months old, 20 percent were already using a device for 28 minutes a day, despite the AAP’s recommendation against media usage for children under that age. The researchers found that when the toddlers spent 30 minutes on a screen, they had a 49 percent increased risk of delayed speech development.

That said, technology deployed in certain settings may offer benefits for speech. Some evidence suggests that live video chatting can help toddlers learn words and connect with family members. But, according to an October 2016 policy statement in Pediatrics by the Council on Communications and Media, it’s no substitute for the real thing.

Rosenberg concurs: “With increasing screen time, there may be decreased maternal and paternal time. And we know how important that time is for bonding, growth and development.”

Sedentary lifestyle: Spending extended periods of time on devices can make children less physically active. “If they’re sitting watching television or playing video games, the only exercise they’re getting is with their thumbs,” says Rosenberg. According to the AAP, children 1 to 2 years old should have at least 30 minutes of structured play and 60 minutes or more of unstructured play per day. Structured play, which is directed by an adult, helps children develop motor skills; unstructured play, while monitored by an adult, is driven by the child. “Not only is this type of play important for physical fitness, it's also important for mental health,” says Rosenberg.

Sleep interruptions: Sleep is essential for cognitive development at any age, but especially for young children. In an April 2017 study in Scientific Reports, researchers examined the relationship between tablet usage and sleep. Researchers sent an online survey to 715 parents with questions about their toddlers’ screen habits. According to the survey results, for each hour spent on a device, a child lost about 15 minutes of sleep. The researchers suspect that the bright light of devices can affect toddlers’ circadian rhythms. “The devices get kids excited,” says Rosenberg, “which translates into poorer quality sleep.”

What you can do as a parent

It’s not easy juggling multiple responsibilities, and sometimes setting your child in front of the iPad for a few minutes is just what you need to get the laundry done or dinner on the table. But it's important to maintain limits, and to remember that you have the power to positively influence how your child interacts with media. If tech use has become a habit in your household, here are some ways cut back:

Develop a plan: The AAP recommends creating a “family media use plan” to help you set clear boundaries about household media usage. Sites such as Healthychildren.org allow you to devise a plan online to help you limit screen time to certain areas of your home (which can help reduce the overall amount of viewing that takes place) and to choose how you would like your child to view media (such as by watching only with an adult present).

Co-view media together: “If your kids are going to be using media, take responsibility for what they're looking at,” says Rosenberg. The AAP recommends that you monitor what your child is viewing and, as much as possible, watch with your child. Bear in mind that the AAP notes that most programs advertised as educational aren’t actually of benefit to children under 2 years old.

Replace screen time with something else: Structured and unstructured play time is essential for toddlers because it encourages problem solving and motor skill development. As much as possible, substitute iPad time with engaging, interactive activities, such as playing outside, reading books together or playdates with other children.

According to Rosenberg, as long as they’re in an environment where they have things and people to play with, toddlers won’t be missing out if a parent decides to cut out screen time altogether. “The most important thing,” he says, “is stimulation.”

This content originally appeared on Sharecare.com