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Screen Time & Pediatrics

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Michelle Smith

on 31 July 2013

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Transcript of Screen Time & Pediatrics

Screen Time & Pediatrics

AAP Policy: Remove television, internet connections, and video games from children’s rooms and limit nighttime screen use.

American Academy of Pediatrics. (2012). Media Kit: Children and
Media. American Academy of Pediatrics: Dedicated to the health of all children. Retrieved from http://www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Media-Kit-Children-and-Media.aspx
Carter, C. (2009). Positive Parenting: Screentime. Greater Good:
The Science of a Meaningful Life. Retrieved from http://
Center on Media and Child Health (2008). What You Need to
Know About Media and Kids’ Health. CMCH. Retrieved from http://www.cmch.tv/mentors_parents/messaging.asp
Healthychildren.org (2013). Media. Retrieved from http://
Hockenberry, M. J. & Wilson, D. (2011). Wong’s Nursing Care of
Infants and Children (9th ed). St. Louis, MO: Elselvier
Mayo Clinic Staff (2011). Children and TV: Limiting your child’s
screen time. Mayo Clinic. Retrieved From http://www.mayoclinic.com/health/children-and-tv/MY00522
Only 15% of parents report that pediatricians discuss media use in kids.
Ask how much screen time is being spent/day & if there is a TV set or internet connection in child’s bedroom (every well-child visit).
Use the AAP Media History form as a tool for collecting data.
Give parents ideas for supervised independent play when they aren’t able to engage with their child (e.g. nesting cups on kitchen floor while preparing dinner).
Stress to parents that “unstructured, unplugged play” helps their child’s mind expand, think innovatively, develop reasoning skills, and problem solve.
“The importance of parents sitting down to play with their children cannot be overstated" (AAP, 2011).
Encourage alternative entertainment for children, including reading, athletics, hobbies, and creative play.
Guidelines for
Healthcare Professionals
Five Cs for Families (Center on Media and Child Health, 2008)
Control time.
Content matters. Every form of media is educational. Some provide healthful, accurate information, while others are harmful and misleading.
Context is important. The setting and audience in which children use media can either help or hinder them.
Critical thinking. Teach your kids how to actively and critically use media to further their development.
Create and model media mastery. “What we feed children’s minds is as important as what we feed their bodies. Teach children to develop a healthy media diet, and engage them in the process of thinking about the media they use, rather than passively consuming it.”
"Every day children are inundated by endless messages intended to educate, entertain, or influence their behavior. It takes commitment and effort on the part of parents to monitor and help interpret these external influences on children" (healthychildren.org, 2013).
Be a good media role model!
AAP Policy: Parents should watch or use media with their children.
Some parents say that they avoid co-viewing things with their kids because it lets them do other things around the house.
Make thoughtful media choices and coview them with children.
Talk about the content of the shows and commercials.
Promote critical thinking about the content.
Coviewing should include discussing the inappropriateness of the violent solutions offered in the specific television show, movie, or video game and helping the child to generate nonviolent alternatives.
Avoid using the TV as a babysitter!
“The average child in the United States over the age of 8 spends more time watching television or using a computer and video games (>6hours/day) than in any other activity except sleeping.” Media is allowed more time to influence children’s perceptions and attitudes than parents and teachers (Hockenberry & Wilson, 2011).
90% of children less than 2 years watch some form of electronic media each day.
14% of 6 to 23-month-olds watch more than 2 hours per day.
1/3 of 3-year-olds have a TV in their bedroom.
Many families have a TV on at least 6 hours per day or on always on as background noise.
“By the time the average person reaches age 70, he or she will have spent the equivalent of 7 to 10 years watching TV” (AAP, 2013).
The Prevalence of Screen Time in the Lives of American Children

By: Melissa Dey & Michelle Smith

Parents' media use can have a negative effect on their own children. Television intended for adults that is on with a young child in the room distracts both the child and parent.
Use the V-chip to control the content your child is exposed to and avoid violent video games (defined as games that include intentional harm to other game characters, including cartoonish or unrealistic violence as well as realistic or gory violence).
It is important for kids to spend time on outdoor play, reading, hobbies, and using their imaginations in free play.
Parents should guide their child’s media experience by offering educational media and non-electronic items (board games, books, newspapers).
"In a recent study of 709 7- to 12-year-olds, children who did not adhere to the American Academy of Pediatrics guidelines of less than 2 hours/day of screen time and 11 000 to 13 000 pedometer steps per day were 3 to 4 times more likely to be overweight. Conversely, preschool-aged children who ate dinner with their parents, got adequate sleep, and had limited screen-time hours had a 40% lower prevalence of obesity than those exposed to none of these routines" (AAP, 2011).
AAP Policy: Limit screen time to less than
1-2 hours per day of educational, nonviolent programs for children 2 and older.

AAP Policy: Avoid Screen time for children younger than 2.
Encourage Interactive Play.
The 1st 2 years of a child’s life are vitally important for brain growth & development. They need positive adult and child interaction, especially as they are learning to talk and play with others.
“Young children learn best by interacting with people, not screens” (AAP, 2011). Talking, playing, singing, and reading can help promote brain development.
"Infant vocabulary growth is directly related to the amount of “talk time” or the amount of time parents spend speaking to them. Heavy television use in a household can interfere with a child's language development simply because parents likely spend less time talking to the child."
“There have been no studies to indicate that screen time contributes positively to infant development." 7 studies have shown that children less than 1 year who watch TV can have delays in language development. Children less than 2 years who watch TV tend to have more expressive language delays (AAP, 2011).
“Sesame Street” has been shown to have a negative effect on language development in kids less than 2 years old.
"To be beneficial, children need to understand the content of programs and pay attention to it.”
American Academy of Pediatrics Health Care Policies on Screen Time
Illicit & Risky behaviors
Research has shown that bedroom TVs are associated with greater substance use and sexual activity by teenagers
Sexual risk behaviors (early sexual activity, sexting)
Substance abuse: smoking, alcohol, illicit drugs
¼ of all MTV videos contain alcohol or tobacco use
Privacy concerns
Attention Problems
Reduced persistence at problem solving (Hockenberry & Wilson, 2011).
Poor Academic performance
School-age children with TVs in their bedrooms more commonly perform worse on tests than those who don’t (Mayo, 2011).
Civil Participation Positive Social Behavior Tolerance School Readiness Knowledge Acquisition
Positive Self-image Sharing Manners Cooperation
‘”The media that children use & create are integral to their growing sense of themselves, of the world, and of how they should interact with it…For any given child, which effects occur depends largely on the media’s content, the child’s age, the context in which the child uses media, the amount of media the child uses, and whether that use is active and critical” (Center on Media and Child’s Health, 2008).

Effects of Screen Time on Children
What Does Screen Time Entail?
Video Games
Computers & Internet
Electronic Devices

Obesity, Nutrition, Dieting, Eating Disorders
Kids who watch >2h of TV/day are more likely to be overweight (Mayo, 2011).
Screen time can replace more active activities.
Junk food ads increase a child’s requests for that food.
Snacking increases while kids watch TV or movies.
Late night TV hinder kids from getting adequate sleep, which puts them at risk for obesity.
Poor body concept & self-image
Less time for creative, active play.
Displaces more meaningful & active ways to spend their time: reading, playing with friends, exercising
Sleeping Disturbances
The common theme of mutilation in movies negatively impacts children who are unable to differentiate reality with fantasy. They tend to have more nightmares, bedtime fears, and a fearful view of the world. (Hockenberry & Wilson, 2011).
Delays onset of sleep, anxiety about falling asleep, shortens sleep duration
Children <3 who watch TV before bed tend to have irregular sleep patterns which have a negative effect on mood, learning, and behavior.
Too much exposure to violence in the media can desensitize children to violence. They may start to see violence as a normal and acceptable outlet of solving problems (Mayo, 2011). They may try to emulate those characters who they admire who commit violent acts.
Research shows that a realistic portrayal of violence increases aggression & restrictive age levels labeling(e.g. M for mature, 17+) on video games increases a child’s interest in that game as if it were a “forbidden fruit (Bijvank, Konijn, Bushman, & Roelofsma, 2008).
Children are more likely to be bullies if they watch excessive amounts of TV than those who don’t (Mayo, 2011).
Cyberbullying & online harassment
Seeing violence on the news causes more fear and worry than viewing that same content in a fictional setting (Hockenberry & Wilson, 2011).
Tips for Parents
Limiting Screen time (AAP, 2011; Mayo Clinic Staff, 2011)
Start monitoring it.
Eliminate Background TV (Turn off the TV during family meals)
Keep TVs & Computers out of the bedroom and in public places in the house.
Don’t eat in front of the TV.
Set School Day rules (avoid using video games or TV as a reward for finishing chores or homework).
Talk to your child’s caregivers about your child’s screen time limits.
Suggest other activities (reading, playing a sport or board games, interactive play).
Set a good example (limit your own screen time).
Unplug it. (designate 1 day a week as a screen-free day…you can even put a lock on your TV’s electrical plug).
Become an active participant (make screen time engaging when it does happen. Watch programs with your child and talk about them. Discuss questionable content and put it in context within your family values. Supervise internet use and teach your kids about the dangers of the internet.)
Make viewing an event (treat it as though you were going to the movie theater).
Plan what your child watches. (Pay attention to TV Parental Guidelines or movie and video game rating systems. Avoid exposing young children and preteens to PG-13 or rated-R movies. Make a list of shows they can watch. Use parental controls on your home computer and monitor your child’s internet use. Preview video games before your child plays them. Make a contract about media and technology use.)
Record programs and watch them later(skip commercials, pause to discuss concepts with your child).
Choose video games that encourage physical activity.
Remain knowledgeable about the effects of screen time on children and education parents and patients about those effects.
Be aware that children with high screen time have higher levels of childhood stress, which puts them at risk for obesity, mood disorders, DM, CVD, asthma, and substance abuse. Displace screen time with more resilience-building, pro-social activities.
Advocate for child-positive media. Work within the community to develop media-education programs and make the public more aware of the issue.
Be a good role model by providing non-electronic activities for children in the hospital.
"Health providers have an emerging role in youth violence prevention & should be proactive in addressing violence prevention in child & adolescent health supervision. Children may be more likely to listen to their pediatrician than to their parents“(Bijvank, Konijn, Bushman, & Roelofsma, 2008).
"Counseling about limiting screen time has been shown to be effective in office settings. For example, just a minute or two of office counseling about media violence and guns could lead to less violence exposure for more than 800,000 children per year. Parents also need to be reminded that they are important role models in terms of their own media use" (AAP, 2011).
This will promote less screen-time and better sleep habits.
Background TV noise distracts parents and the child, takes the parent’s attention off of the child, and decreases parent-child interaction
“Unstructured playtime is critical to learning problem-solving skills and fostering creativity” (AAP, 2011).
Screen time takes away from time spent in creative play and with family.
"Unstructured playtime is more valuable for the developing brain than any electronic media exposure. If a parent is not able to actively play with a child, that child should have solo playtime with an adult nearby. Even for infants as young as 4 months of age, solo play allows a child to think creatively, problem-solve, and accomplish tasks with minimal parent interaction. The parent can also learn something in the process of giving the child an opportunity to entertain himself or herself while remaining nearby" (AAP, 2011).
Video deficit: Young children have a hard time discerning between occurrences on a video and the same information presented live. From 12 to 18 months children are more likely to learn and remember live presentations than televised ones.
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