Smartwatches in childhood: a mixed blessing?-a scoping review

Smartwatches are commonly used within the community, especially amongst its younger population. These devices have a wide range of capabilities, including measuring the heart rate, generating electrocardiographic traces, and issuing alerts when 'abnormal' activity is detected. This information has potential benefits but also potential risks if the health-related measurements lead to inappropriate clinical interventions. This study aimed to evaluate the current literature on the prevalence, perception and interpretation of smartwatches that document and record cardiac information as it impacts on children, adolescents and their parents.

We conducted a scoping review based on the principles of Arksey and O'Malley, which followed the scoping review checklist of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

The selection criteria yielded 29 papers. They reported that smartwatch usage in children ranged from 15% to 40%, depending on the country of residence. The number of children presenting with smartwatch-based heart concerns had increased, with many false positives and few true arrhythmia diagnoses. Although there was good accuracy of heart rate measurements, there were poor automated algorithms for heart rhythm classification for the paediatric population. In addition, a few studies reported paediatric smartwatch user anxiety arising from the information generated by the devices.

The wearing of smartwatches has increased in children and adolescents. While they are able to record heart rates and provide corresponding electrocardiographic tracings virtually continuously and non-invasively, misinterpretation of the data arising from poor algorithms have led to increased healthcare presentations, as well as child and/or parental concern. There remains a need for ongoing education to understand the variability of the heart rate, especially in children. Furthermore, better algorithms for the interpretation of the information gleaned are required for this relatively well young population, so as to allay the anxiety that may be experienced. The issues related to medicolegal liability, privacy and cybersecurity remain to be resolved.