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An Rx for Screen Time: Pediatricians and Kids' Media Use

When I heard that the AAP was starting to prepare a set of new recommendations for 2016, I was curious to know whether anything would change. I spoke with Dr. Ari Brown, chair of the AAP Children, Adolescents and Media Leadership Work Group to learn about the directions in which the AAP might go.
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When the American Academy of Pediatrics (AAP) makes a recommendation, a lot of people listen. That's why when the organization came out with its last set of recommendations about screen time for children, a lot of people were unhappy.

In 2013 the AAP recommended that parents limit screen time for children older than 2 to two hours or less per day and discouraged any screen time at all for children younger than 2. At the time I heard from many parents who felt that this was a suggestion that was very much out of step with the reality of their lives. I also talked with researchers who believed that while the AAP guidelines had been established based on some empirical work suggesting that very young children benefit greatly from direct interaction with other people, that there was little published research that would establish what role -- if any -- interactive media might play in the cognitive and social/emotional development of toddlers.

The 2013 recommendations were actually somewhat more liberal than the suggestions that came out in 2011. That set stated flatly that children under the age of 2 should have no screen time, at all.

So when I heard that the AAP was starting to prepare a set of new recommendations for 2016, I was curious to know whether anything would change. I spoke with Dr. Ari Brown, chair of the AAP Children, Adolescents and Media Leadership Work Group to learn about the directions in which the AAP might go.

Brown stated that she was aware of the fact that in this new era where iPads, tablets and mobile devices are increasingly found in small hands, a prescriptive "two hours or less" recommendation, "is just not the reality of what's happening. We really need to acknowledge the changing world, as these kids are growing up as digital natives."

I told her that I'd heard from many parents that the last set of recommendations just weren't realistic for families with more than one child. How do you prevent the child who is under 2 from looking at the screen -- any screen -- that the one who is older than 2 is looking at? "I'm not sure you can," Brown replied. "We simply wanted parents to realize what the priority is." She pointed out that we do know that there are real developmental differences in the ways in which children see, hear, interpret and recall media messages. "We wanted parents to be aware that a 4-year-old could have nightmares about something that's fine for an 8-year-old to see."

And what about the "discouraging" of any screen time at all for children younger than 2, even though other organizations, such as the National Association for the Education of Young Children (NAEYC) and the Fred Rogers Center had tempered a similar recommendation? These organizations suggested that children under 2 years old should not have any "passive screen time," but posited that "interactive" screen time, such as Skyping with a parent or grandparent not present in the home, might not be so bad. "Technology moves faster than science," Brown pointed out. "Our next set of recommendations will contain some practical suggestions for parents given what we now know about the effects of interactive technologies. What we're trying to accomplish is to craft a set of recommendations that are evergreen."

One new area that's likely to surface in the next set of AAP recommendations is the suggestion that media constitute another environment in which children live. "That was a real 'a ha' moment for us," said Brown. "Media aren't necessarily so different from other environments in which children hang out. They might present more opportunities but they also present some risk. You want to maximize the former and minimize the latter."

To illustrate this, Brown pointed to research suggesting that media can provide "amazing opportunities for identity formation, ways for older kids to find a peer group online, great opportunities for kids with gender identity issues or eating disorders to find others who can answer their questions and give them support." But she also said that digital hangouts can provide children with false information and ways to conceal problems from the adults in their lives who want to help them. "We're going to try to find ways of crafting recommendations that recognize the power of social media in kids' lives but offer solid advice on how to use it effectively and pro-socially."

Brown said that the next set of AAP recommendations will also likely take on the issue of how parents' own media use can affect children. "Distracted parenting really affects your child," she said. "Parents don't realize how significant their role is, like talking to your child while you're cooking dinner and how you don't do this if TV is on, or texting while you're at your child's sporting event instead of watching the game. I'm sure this will be emphasized."

Since Brown's own background is in both child development and pediatrics, she is familiar with both social science and medical research. She has both special interest and background in establishing AAP guidelines for children's media use that are nuanced as well as practical. In a recently released paper entitled, "Growing up Digital: Media Research Symposium," Brown and her co-authors review some of the most current research on children and media use and offer suggestions for parents, educators and pediatricians. Among other recommendations, they state that parents should set limits for children at every age's media use, avoid digital media displacing non-mediated play and conversation, keep in mind that kids need to learn digital etiquette, engage in digital media play with their children and model appropriate media behaviors.

The AAP is aware of its role in translating research into practical suggestions for healthy child living. "In 2006 we were shouting about how we all ask parents about car seats and bike helmets -- why weren't we asking about screen time?" said Brown.

Dr. Wendy Wornham agrees. As a community pediatrician and assistant professor of pediatrics at Harvard Medical School, she believes that children's media use is an area of interest and concern in child health. "Parents look to their children's pediatricians for information and for support," she said. "We listen to the guidelines that the AAP puts out but they're not completely practical." Wornham would like to see guidelines that offer more specific suggestions and that take into account the fast-changing realities of kids' media use.

For Wornham, the issue is crystallized when she's running a little late and walks into the waiting room at her practice. "There are parents using their phones, there are kids using mobile devices to watch videos and play games." She's concerned about the kinds of interaction that she does and doesn't see, and she'll be looking to the AAP to come out with information that will help guide pediatricians, educators and parents in these new realities of media use and communication.

The new AAP recommendations are due to come out in the fall of 2016. And so, as we used to say in the era when television programming dominated our consciousness, "stay tuned..."

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