The Pediatric Insider
© 2016 Roy Benaroch, MD
Today, the American Academy of Pediatrics released two new policy statements outlining their official recommendations for media use in children and adolescents. Media, here, means television, video games, tablets, apps – pretty much anything with a screen. We know this kind of entertainment has become a huge part of our lives. How much is too much, and how do we ensure that media is being used wisely and safely? The policy and accompanying technical report rely on hundreds of solid references, providing the best answers based on the best science we know about how children learn and interact with the world of media.
Younger children, less than 2, need exploration and social interactions to learn best. They cannot learn from traditional “media”, at least not on their own. Some learning via electronics can begin by age 15 months, but only via caretakers participating with their children and reteaching the content in an interactive way. By 2 years, we know children can learn word skills by live video-chatting with a responsive adult, or by using apps that reward the child for choosing the right answers.
Preschoolers, aged 3 to 5, can boost their literacy and cognitive skills by watching well-designed TV programs (like Sesame Street.) However, higher-order thinking skills like task persistence, impulse control, and flexible thinking are still best learned during truly social, interactive play – and that’s just not something media can provide.
There are some specific medical concerns raised by media use in young children. Heavy media use increases the risk of obesity, by filling time with sedentary activity and exposing children to unhealthful food advertising. And increased media use directly corresponds to less sleep for children (this is especially true for evening exposures, before bedtime, which interfere with sleep onset, sleep quality, and sleep duration.)
Excessive media use in early childhood is also associated with cognitive, language, and social delays. Some of these associations depend on exactly what’s being watched — switching from violent to pro-social content has been shown to improve preschool behavior, especially in boys. There’s also concern that excessive media use by parents can interfere with other family activities, and may model and reinforce media excess in their children.
With all of this in mind, the AAP has made these specific recommendations for young children and media use:
Under 18 months, discourage all media use (other than video chatting with family. Facetime and Skype are OK.)
From 2-5 years, limit all media, combined, to a total of less than 1 hour per day of high quality shows. These should be shared together between parents and children.
No screens at all during meals and for 1 hour before bedtime.
Parents should keep bedrooms, mealtimes, and parent-child playtime screen free.
The AAP had a second policy statement about media use in school aged children and adolescents. There’s good evidence for some benefits of media use at this age, including exposures to new ideas and information, and opportunities for community engagement and collaboration. Social media can help children access support networks, which may be especially valuable for kids with ongoing illnesses or disabilities. Media can provide good opportunities to learn about healthy behaviors, like smoking cessation and balanced nutrition.
But: there’s a down side, too. There are risks for obesity and sleep problems with excessive or untimely media use. Children who overuse online media are at risk problematic, addiction-like media usage, sometimes characterized by a decreased interest in real-life relationships, unsuccessful attempts to cut back, and withdrawal symptoms.
Many teens use media at the same time they’re engaged in other tasks, like homework. They may think they’re learning, but good objective data shows that no one can truly multitask like that. And, of course, though media can deliver positive, healthful information, parents need to be wary of some of the misinformation that’s out there. Information about nutrition, vaccines, and exercise is often misleading or flat-out wrong. Kids can easily find material actually promoting risky health behaviors like eating disorders, sexual promiscuity, and self-mutilation.
There are also significant risks from cyberbullying, sexting, and online solicitation – issues that are especially problematic because the perpetrators may be anonymous. The internet has created some horrifying opportunities for the exploitation of children.
Bottom line, here’s what the AAP recommends for these school aged children and adolescents:
Families are encouraged to create their own Media Use Plan. This addresses how media is accessed, both how much and what kind. Consistent limits and a clear and explicit understanding of expectations is crucial. Families should work on these plans together.
Children should not sleep with their devices in their bedrooms (parents shouldn’t either.)
Media shouldn’t be used during schoolwork, family meals, or other family-designated “media free times.”
Parents should engage in selecting and co-viewing media with their kids.
There needs to be ongoing discussions of online citizenship and safety.
The AAP’s new policy doesn’t include a specific amount or number of hours of media time is recommended for children and teens. But media use should be limited, so there’s time for exercise, adequate sleep, and other activities. How much media is too much? For teens, when it prevents them from participating in other activities they ought to be doing. Media has become a huge part of all of our lives, but there needs to be time for other things, too.
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