From TV to smartphones and tablets to social media, the lives of
children and adolescents are dominated by 24/7 media exposure. The key
to a healthy balance between digital life and real life, for kids, is to
make healthy media choices by managing the time spent with various
media. The American Academy of Pediatrics have released a new set of
guidelines to help parents and families do just that.
The AAP states that media can be used as a tool to support the family connection when used together.
The focus of the updated recommendations lies with parents not only
paying attention to the amount of time their children spend on digital
media but also how, when, and where they use the media.
To support the guidelines, the American Academy of Pediatrics (AAP) have
released an interactive, online tool for families to create their own
personalized
Family Media Plan.
"Families should proactively think about their children's media use and
talk with children about it, because too much media use can mean that
children don't have enough time during the day to play, study, talk, or
sleep," says Dr. Jenny Radesky, a developmental behavioral expert and
pediatrician at University of Michigan C.S. Mott Children's Hospital in
Ann Arbor, MI, and lead author of the first policy statement, "
Media and Young Minds," which focuses on infants, toddlers and preschool children.
"What's most important is that parents be their child's 'media mentor.'
That means teaching them how to use it as a tool to create, connect and
learn," she adds.
Parents should not feel pressurized to introduce devices to infants
While media use alone has not been identified as the leading cause of
any health problems in the United States, experts say that excessive
media use can contribute to many health risks, including
obesity, lack of sleep, school problems, aggression, and behavioral issues.
The statement advises that with the exception of video chatting - that has been shown to help toddlers learn new skills and social interactions - all digital media should be avoided before the age of 18 months old.
The guidelines note that parents should not feel pressurized to
introduce technology to their child early, and reassure that interfaces
are so intuitive that their child will figure them out quickly once they
do start using them. For children aged 2-5 years, the statement
recommends that media should be limited to 1 hour a day and should
involve a high-quality program or activity that parents and kids can
view and engage with together.
"Digital media has become an inevitable part of childhood for many
infants, toddlers, and preschoolers, but research is limited on how this
affects their development," says Dr. Radesky.
Dr. Radesky points out that research is solid in children over age 3 and shows that high-quality programs like
Sesame Street
can help children learn new ideas and improve literacy and social
outcomes. "However, under 3, toddlers' immature brains have a hard time
transferring what they see on a screen to real-life knowledge. We don't
yet know if interactivity helps or hinders that process."
What researchers do know, she adds, is that early childhood is a time of
rapid brain development where children need time allocated to play,
sleep, learn to handle emotions, and build relationships. While research
suggests that excessive media use can distract children from these
activities that play an essential part in their development, the AAP
highlight that families can maintain a healthy balance.
Using devices to soothe children limits their ability to regulate emotions
The AAP caution that while many apps that parents find are located under
the "educational" category in stores on smartphones and tablets, a
majority are not evidence-based and include little to no input from
developmental educators.
Highlights from the recommendations include banning digital media an
hour before bed, turning off devices not in use, and ensuring that
bedrooms, mealtimes, and a majority of parent and child playtime remain
screen free.
The authors advise that while digital media may be a useful tool
to soothe children while on a plane or during a medical procedure,
media should not be used as the primary method of calming down a child.
According to Dr. Redesky, using devices as a regular soothing strategy
limits a child's ability to regulate their emotions.
Despite the best intentions of limiting time using media, it has become
ingrained in the culture of daily life. Families, therefore, have to be
realistic about healthy ways to use media from an early age while
setting time constraints.
"Video chatting with grandparents, watching science videos together,
putting on streaming music and dancing together, looking up new recipes
or craft ideas, taking pictures and videos to show each other, having a
family movie night. These are just a few ways media can be used as a
tool to support family connection," Dr. Radesky says.
For children aged 18-36 months, it is crucial that adults interact with
their child during media use and help their child understand what they
see on screen and how it relates to the world around them.
Parents can set boundaries to ensure positive media experience
The second policy statement, "
Media Use in School-Aged Children and Adolescents," provides recommendations for children and teens aged 5-18 years. This policy - along with a technical report, "
Children, Adolescents and Digital Media," that provides a review of the scientific literature to support both policies - was published in the journal
Pediatrics.
For school-aged children and adolescents, the AAP recommend that digital
media use be balanced with other healthy behaviors. The guidelines
state that problems begin to arise when media use displaces physical
activity, hands-on exploration, and face-to-face social interaction in
the real world, which are all critical to learning.
Dr. Megan Moreno, lead author of the policy statement on media use in
school-aged children and teens, emphasizes the importance of careful
use of media in the family unit.
"Parents play an important role in helping children and teens navigate
media, which can have both positive and negative effects. Parents can
set expectations and boundaries to make sure their children's media
experience is a positive one. The key is mindful use of media within a
family."
Dr. Megan Moreno
In addition to covering parents' role in their children's use of media,
pediatricians are also encouraged to help parents be "media mentors" or
role models for choosing high-quality digital content.
"Pediatricians have the opportunity to start conversations with parents
early about family media use and habits," says Dr. Radesky. "We can help
parents develop media use plans for their homes, set limits and
encourage them to use devices with their children in a way that promotes
enhanced learning and greater interaction."
Read about whether Pokémon Go use is positive or negative for health
.
This policy
statement focuses on children and adolescents 5 through 18 years of age.
Research suggests both benefits and risks of media use for the health
of children and teenagers. Benefits include exposure to new ideas and
knowledge acquisition, increased opportunities for social contact and
support, and new opportunities to access health-promotion messages and
information. Risks include negative health effects on weight and sleep;
exposure to inaccurate, inappropriate, or unsafe content and contacts;
and compromised privacy and confidentiality. Parents face challenges in
monitoring their children’s and their own media use and in serving as
positive role models. In this new era, evidence regarding healthy media
use does not support a one-size-fits-all approach. Parents and
pediatricians can work together to develop a Family Media Use Plan (www.healthychildren.org/MediaUsePlan)
that considers their children’s developmental stages to individualize
an appropriate balance for media time and consistent rules about media
use, to mentor their children, to set boundaries for accessing content
and displaying personal information, and to implement open family
communication about media.
Introduction
Today’s
generation of children and adolescents are growing up immersed in
media, including broadcast and social media. Broadcast media include
television and movies. Interactive media include social media and video
games in which users can both consume and create content. Interactive
media allow information sharing and provide an engaging digital
environment that becomes highly personalized.
Media Use Patterns
The
most common broadcast medium continues to be TV. A recent study found
that TV hours among school-aged children have decreased in the past
decade for children younger than 8 years.
1 However, among children aged 8 years and older, average daily TV time remains over 2 hours per day.
2
TV viewing also has changed over the past decade, with content
available via streaming or social media sites, such as YouTube and
Netflix.
Overall media use among adolescents has
continued to grow over the past decade, aided by the recent increase in
mobile phone use among teenagers. Approximately three-quarters of
teenagers today own a smartphone,
3
which allows access to the Internet, streaming TV/videos, and
interactive “apps.” Approximately one-quarter of teenagers describe
themselves as “constantly connected” to the Internet.
3
Social
media sites and mobile apps provide platforms for users to create an
online identity, communicate with others, and build social networks. At
present, 76% of teenagers use at least 1 social media site.
3 Although Facebook remains the most popular social media site,
3
teenagers do not typically commit to just 1 social media platform; more
than 70% maintain a “social media portfolio” of several selected sites,
including Facebook, Twitter, and Instagram.
3 Mobile apps provide a breadth of functions, such as photo sharing, games, and video-chatting.
Video games remain very popular among families; 4 of 5 households own a device used to play video games.
4
Boys are the most avid video game players, with 91% of boys reporting
having access to a game console and 84% reporting playing video games
online or on a cell phone.
3
Benefits of Media
Both
traditional and social media can provide exposure to new ideas and
information, raising awareness of current events and issues. Interactive
media also can provide opportunities for the promotion of community
participation and civic engagement. Students can collaborate with others
on assignments and projects on many online media platforms. The use of
social media helps families and friends who are separated geographically
communicate across the miles.
Social media can enhance
access to valuable support networks, which may be particularly helpful
for patients with ongoing illnesses, conditions, or disabilities.
5
In 1 study, young adults described the benefits of seeking health
information online and through social media, and recognized these
channels as useful supplementary sources of information to health care
visits.
6 Research also supports the use of social media to foster social inclusion among users who may feel excluded
7
or who are seeking a welcoming community: for example, those
identifying as lesbian, gay, bisexual, transgender, questioning, or
intersex. Finally, social media may be used to enhance wellness and
promote healthy behaviors, such as smoking cessation and balanced
nutrition.
8
Risks of Media
A
first area of health concern is media use and obesity, and most studies
have focused on TV. One study found that the odds of being overweight
were almost 5 times greater for adolescents who watch more than 5 hours
of TV per day compared with those who watch 0 to 2 hours.
9
This study’s findings contributed to recommendations by the American
Academy of Pediatrics that children have 2 hours or less of sedentary
screen time daily. More recent studies have provided new evidence that
watching TV for more than 1.5 hours daily was a risk factor for obesity,
but only for children 4 through 9 years of age.
10
Increased caloric intake via snacking while watching TV has been shown
to be a risk factor for obesity, as is exposure to advertising for
high-calorie foods and snacks.
11,12 Having a TV in the bedroom continues to be associated with the risk of obesity.
13
Evidence suggests that media use can negatively affect sleep.
14 Studies show that those with higher social media use
15 or who sleep with mobile devices in their rooms
16
were at greater risk of sleep disturbances. Exposure to light
(particularly blue light) and activity from screens before bed affects
melatonin levels and can delay or disrupt sleep.
17 Media use around or after bedtime can disrupt sleep and negatively affect school performance.
13
Children who overuse online media are at risk of problematic Internet use,
18 and heavy users of video games are at risk of Internet gaming disorder.
19 The
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,
20
lists both as conditions in need of further research. Symptoms can
include a preoccupation with the activity, decreased interest in offline
or “real life” relationships, unsuccessful attempts to decrease use,
and withdrawal symptoms. The prevalence of problematic Internet use
among children and adolescents is between 4% and 8%,
21,22 and up to 8.5% of US youth 8 to 18 years of age meet criteria for Internet gaming disorder.
23
At
home, many children and teenagers use entertainment media at the same
time that they are engaged in other tasks, such as homework.
24
A growing body of evidence suggests that the use of media while engaged
in academic tasks has negative consequences on learning.
25,26
Media Influence
Evidence gathered over decades supports links between media exposure and health behaviors among teenagers.
27 The exposure of adolescents through media to alcohol,
28,29 tobacco use,
30,31 or sexual behaviors
32 is associated with earlier initiation of these behaviors.
Adolescents’
displays on social media frequently include portrayal of health risk
behaviors, such as substance use, sexual behaviors, self-injury, or
disordered eating.
33–36 Peer viewers of such content may see these behaviors as normative and desirable.
37,38
Research from both the United States and the United Kingdom indicates
that the major alcohol brands maintain a strong presence on Facebook,
Twitter, and YouTube.
29,39
Cyberbullying, Sexting, and Online Solicitation
Cyberbullying and traditional bullying overlap,
40
although online bullying presents unique challenges. These challenges
include that perpetrators can be anonymous and bully at any time of day,
that information can spread online rapidly,
41
and that perpetrator and target roles can be quite fluid in the online
world. Cyberbullying can lead to short- and long-term negative social,
academic, and health consequences for both the perpetrator and the
target.
42 Fortunately, newer studies suggest that interventions that target bullying may reduce cyberbullying.
43
“Sexting”
is commonly defined as the electronic transmission of nude or seminude
images as well as sexually explicit text messages. It is estimated that
∼12% of youth aged 10 to 19 years have ever sent a sexual photo to
someone else.
44
The Internet also has created opportunities for the exploitation of
children by sex offenders through social networking, chat rooms, e-mail,
and online games.
45
Social Media and Mental Health
Research
studies have identified both benefits and concerns regarding mental
health and social media use. Benefits from the use of social media in
moderation include the opportunity for enhanced social support and
connection. Research has suggested a U-shaped relationship between
Internet use and depression, with increased risks of depression at both
the high and low ends of Internet use.
46,47
One study found that older adolescents who used social media passively
(eg, viewing others’ photos) reported declines in life satisfaction,
whereas those who interacted with others and posted content did not
experience these declines.
48 Thus, in addition to the number of hours an individual spends on social media, a key factor is how social media is used.
Social Media and Privacy
Content
that an adolescent chooses to post is shared with others, and the
removal of such content once posted may be difficult or impossible.
Adolescents vary in their understanding of privacy practices
49; even those who know how to set privacy settings often don’t believe they will work.
50
Despite efforts by some social media sites to protect privacy or to
delete content after it is viewed, privacy violations and unwelcome
distribution are always risks.
51,52
Parent Media Use and Child Health
Social
media can provide positive social experiences, such as opportunities
for parents to connect with children via video-chat services.
Unfortunately, some parents can be distracted by media and miss
important opportunities for emotional connections that are known to
improve child health.
53,54
One research study found that when a parent turned his or her attention
to a mobile device while with a young child, the parent was less likely
to talk with the child.
55
Parental engagement is critical in the development of children’s
emotional and social development, and these distractions may have short-
and long-term negative effects.
Conclusions
The
effects of media use are multifactorial and depend on the type of
media, the type of use, the amount and extent of use, and the
characteristics of the individual child. Children today are growing up
in an era of highly personalized media use experiences, so parents must
develop personalized media use plans for their children that attend to
each child’s age, health, temperament, and developmental stage. Research
evidence shows that children and teenagers need adequate sleep,
physical activity, and time away from media. Pediatricians can help
families develop a Family Media Use Plan (www.HealthyChildren.org/MediaUsePlan) that prioritizes these and other health goals.
Recommendations
Pediatricians
Work with families and schools to promote understanding of the benefits and risks of media.
Promote adherence to guidelines for adequate physical activity and sleep via a Family Media Use Plan (www.HealthyChildren.org/MediaUsePlan).
Advocate for and promote information and training in media literacy.
Be aware of tools to screen for sexting, cyberbullying, problematic Internet use, and Internet gaming disorder.
Families
Develop,
consistently follow, and routinely revisit a Family Media Use plan (see
the plan from the American Academy of Pediatrics at www.HealthyChildren.org/MediaUsePlan).
Address
what type of and how much media are used and what media behaviors are
appropriate for each child or teenager, and for parents. Place
consistent limits on hours per day of media use as well as types of
media used.
Promote that
children and adolescents get the recommended amount of daily physical
activity (1 hour) and adequate sleep (8–12 hours, depending on age).
Recommend
that children not sleep with devices in their bedrooms, including TVs,
computers, and smartphones. Avoid exposure to devices or screens for 1
hour before bedtime.
Discourage entertainment media while doing homework.
Designate
media-free times together (eg, family dinner) and media-free locations
(eg, bedrooms) in homes. Promote activities that are likely to
facilitate development and health, including positive parenting
activities, such as reading, teaching, talking, and playing together.
Communicate guidelines to other caregivers, such as babysitters or grandparents, so that media rules are followed consistently.
Engage
in selecting and co-viewing media with your child, through which your
child can use media to learn and be creative, and share these
experiences with your family and your community.
Have
ongoing communication with children about online citizenship and
safety, including treating others with respect online and offline,
avoiding cyberbullying and sexting, being wary of online solicitation,
and avoiding communications that can compromise personal privacy and
safety.
Actively develop a
network of trusted adults (eg, aunts, uncles, coaches, etc) who can
engage with children through social media and to whom children can turn
when they encounter challenges.
Researchers, Governmental Organizations, and Industry
Lead Authors
Megan Moreno, MD, MEd, MP, FAAP
Yolanda (Linda) Reid Chassiakos, MD, FAAP
Corinn Cross, MD, FAAP
Council on Communications and Media Executive Committee, 2016–2017
David Hill, MD, FAAP, Chairperson
Nusheen Ameenuddin, MD, MPH, FAAP
Yolanda (Linda) Reid Chassiakos, MD, FAAP
Corinn Cross, MD, FAAP
Jenny Radesky, MD, FAAP
Jeffrey Hutchinson, MD, FAAP
Rhea Boyd, MD, FAAP
Robert Mendelson, MD, FAAP
Megan Moreno, MD, MSEd, MPH, FAAP
Justin Smith, MD, FAAP
Wendy Sue Swanson, MD, MBE, FAAP
Liaisons
Kristopher Kaliebe, MD – American Academy of Child and Adolescent Psychiatry
Jennifer Pomeranz, JD, MPH – American Public Health Association
Brian Wilcox, PhD – American Psychological Association
Footnotes
This
document is copyrighted and is property of the American Academy of
Pediatrics and its Board of Directors. All authors have filed conflict
of interest statements with the American Academy of Pediatrics. Any
conflicts have been resolved through a process approved by the Board of
Directors. The American Academy of Pediatrics has neither solicited nor
accepted any commercial involvement in the development of the content of
this publication.
Policy
statements from the American Academy of Pediatrics benefit from
expertise and resources of liaisons and internal (AAP) and external
reviewers. However, policy statements from the American Academy of
Pediatrics may not reflect the views of the liaisons or the
organizations or government agencies that they represent.
The
guidance in this statement does not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.
All
policy statements from the American Academy of Pediatrics automatically
expire 5 years after publication unless reaffirmed, revised, or retired
at or before that time.
FINANCIAL DISCLOSURE: The authors have indicated they do not have a financial relationship relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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