Ask the Mediatrician

Does spending time in front of screens really raise kids’ blood pressure?

Q: I heard a report on the news that too much time in front of TV or computer screens can raise kids’ blood pressure. Is that just for more action-oriented shows and games? And is even a little screen time a problem for kids’ hearts?
Boggled by Blood Pressure in Providence, RI

A: Dear Boggled by Blood Pressure,

I get a lot of questions about how media affect the social health of kids and teens, but rarely get questions about physical health.  I'm going to grab my stethoscope so I can step up the Doctor part of being The Mediatrician!

You probably heard about about the relationship between the amount of time kids use screen media and their blood pressure because of a new study that was released. Researchers measured kids' resting blood pressure (while they were sitting in a chair), their height and weight, determined how active the kids were by having the kids carry an accelerometer (like a pedometer), and asked their parents how much time the kids typically used screen media (TV, video games, and computers). 

The researchers found that kids who used screen media for more hours had higher resting blood pressure than kids who used them for fewer hours.  Interestingly, this blood pressure difference was entirely accounted for by TV time – there was no significant difference with computer use. Although blood pressure normally increases in response to activity, and one can assume that it would increase more with active video games than with inactive ones, this study only measured baseline blood pressure with the child at rest. The child’s overall activity level also had no effect on their blood pressure. Although blood pressure is definitely higher in overweight kids, and the risk of overweight increases the more they use screens, the increase in blood pressure with greater TV time was found regardless of child’s weight.    

The good news is that kids’ bodies are quite resilient, so having high blood pressure is generally not a problem in the short term. What is a problem is having consistently high blood pressure over years. That can lead to stiffening blood vessels, which means the heart has to work harder to pump blood through the body.  In other words, small amounts of screen time won’t hurt your child, but large amounts over years might contribute to poorer health in the long term. Ultimately, this research should be seen as just another of several reasons why limiting screen time to the AAP limit of 1-2 hours a day remains a reasonable guideline.

Enjoy your media and use them wisely,
The Mediatrician

The Mediatrician Asks YOU a Question!

Dear Readers,

In the past 3 months, I've answered a lot of your questions.  So now it's my turn to ask you!  Do your family's media habits change as the kids head back to school?  How are your habits different from those in the Summer?  Do you purposely make an attempt to change things or do they just change on their own as a result of a more structured schedule? 

I want to hear from you!  Click on the green comments link below this post to respond here, or become a fan of CMCH on Facebook and comment there!

Update! We have received a few comments on our Facebook page, thank you!  We also wanted to post our ideas on how parents might consider changing media habits for school.  Best of luck!

Enjoy your media and use them wisely,
The Mediatrician

How do Facebook and Twitter affect social skills?

Q: We feel "webbed out" of our teenage son’s electronic social life. Are you aware of studies tracking the psychological impact that technologies like Facebook and Twitter have on developing “normal” social skills?
Shut out by Social Networking in Manchester, MA

A: Dear Shut out by Social Networking,

This is a challenge felt by many parents today, but take heart: Social networking is attractive to adolescents in part because it is exclusive to them.  The teen years are all about establishing independence from your parents and becoming an individual.  Take a minute to think back to your teen years -- I'm sure there was some kind of music or TV that defined your generation that your parents just "didn't get."  That probably made it even more attractive to you and your friends.  This is the same idea -- a new kind of media that most parents just don't take part in.  Seeing your son taking ownership of something new is developmentally normal, and that should comfort you.

Because this mode of communication is so new, research hasn’t had time to identify any long-term effects it might have on social skills. That said, preliminary data (see these studies: Teens and Social Media, the Digital Generation project) indicate that, for most kids, using virtual social environments actually helps improve their social skills. Therefore, my recommendation would be to avoid being judgmental and assuming the worst—the vast majority of young people’s interchange in these environments is benign and social in nature.

Social networking can certainly become a problem when used excessively or if your son strongly objects when you ask him to limit or stop using it—these can be warning signs of potentially addictive behavior. In order for him to have time left over to be able to pursue the wide variety of experiences he should have in his teen years, I recommend that adolescents spend no more than 1-2 hours per day with screens (including TV, video games, and computers).

Another thing you may be interested in doing is figuring out how people use these technologies to connect with others so that you have more knowledge about why he spends so much time with them.  In order to show him that you value his expertise in this area, you could ask him to teach you how to set up your own profile.  I suggest that you make it clear you're not looking to spy on him, and that he doesn't even have to be your friend on Facebook (that’s part of his life where he’s looking for privacy). However, do allow him to show how facile he is in this environment. In the process, he will share more about what he’s doing there, directly or indirectly, and you will have nudged open the door to communication about this space instead of forcing yourself through it or slamming it shut.
>>Recommended Video: 60 Minutes' introduction to Facebook

Enjoy your media and use them wisely,
The Mediatrician

My 4 year old is obsessed with the Disney Channel, what should I do?

Q: Recently my 4 year old daughter has found a new, almost obsessive interest in the Disney Channel shows (Hannah Montana, Wizards of Waverly Place, etc). TV was never a problem before, but now she would rather watch these shows than do anything else. I also think that these shows may be too big-kid for her. What do you think, and how can I get her away from the TV without fuss?
-Hung-up on Hannah in New York, NY

A: Dear Hung-up on Hannah,

Kudos to you for being so attentive to your daughter and for paying attention to what she watches and how she responds to it. You report an obsessive quality in her watching, and that observation can help direct you toward a good approach for dealing with it.

First of all, your instinct that these shows are too old for her is right on target—their themes of pre-teen romance often make them too advanced even for their "tween" target audience. Part of what’s tricky here is that the very fact that these shows are too “big-kid” for her may be part of the reason she's attracted to them. Your daughter wants to be a big kid and do big-kid things, and sometimes using media that’s too advanced seems to satisfy that desire.

Therein lies the key to addressing this issue: finding out what exactly it is that your daughter likes about these shows. To do that, just ask her. In her response, listen for the ways she's telling you what she’s getting from the shows, and then you can find more age-optimal ways to fill that need. If she’s attracted to the sparkly clothes, have her play dress up. If it’s the music or dancing she likes, look for shows that include those elements, but are more geared toward kids her own age, or better yet, encourage her to make up her own dances with her friends and sing along using wooden spoons for microphones. 

Remember that, at this age, kids want to be with their parents more than almost anything else, so the more involved you can be in these activities, the easier the shift away from TV will be. But do know that separating her from these shows or from the TV in general without any fuss isn’t a realistic goal. Kids are always going to fuss about things like this—it’s part of figuring out where your boundaries are. To make this shift go as smoothly as it can, though, I recommend trying to find alternative activities that are as attractive as or more attractive than TV. Then she will be drawn toward these activities instead of away from the TV.  If she does watch, watch with her or talk with her about it so you can make sure it’s a positive experience.

Enjoy your media and use them wisely,
The Mediatrician

Are Star Wars and Disney Princesses the only options?

Q: I went into a party store to look for decorations for my son’s upcoming birthday party and everywhere I looked, the choices were either Star Wars or Disney princesses. Are we raising our boys to be violent and our girls to have Cinderella expectations of the world?
Pondering Party Supplies in Tulsa, OK

A: Dear Pondering Party Supplies,

That’s a great observation and a great question, I see the same pattern with clothing and toys these days.  The problem is that these media characters portray a very narrow and extreme version of what it means to be an adult man or woman in society. 

As you noticed, a lot of the commercial products designed for boys feature media characters that are aggressive, competitive, and violent.  These images encourage boys to use violence to resolve conflicts and to be in constant competition with other men, rather than learning to peacefully problem-solve and cooperate with others. 

The beauty-focused messages that girls see on their tea sets and Halloween costumes teach them that they are valued not for who they are, but for how they look, and that their goal in life is to be an object of male desire. It starts with princesses in fairy tales and carries all the way up through fashion magazines, advertising, and beauty pageants as they get older. Research has shown that these images can lower self esteem and even lead to eating disorders.

So, what can you do to minimize these effects? For one thing, you can expose your kids to media that portray the kinds of women and men you’d like them to become. Such images can help give them other ideas of who they can become and how they can act. In addition, watching media along with your kids can allow you the opportunity to challenge images you find problematic and highlight those that you consider to be positive. Pay attention to the lessons that these media are teaching, and talk about those lessons with your kids. By addressing them directly, you help your children think critically about what they see and you send the message that what they see is not necessarily the only way things can be.

Enjoy your media and use them wisely,
The Mediatrician

What are some good kids’ movies for my 5 year old to enjoy?

Q: They don’t seem to make enough good kids’ movies that don’t feature in-your-face dialog, terrifying characters, fast cuts, or just over-the-top crazy stuff designed mainly for adult audiences (that I have to spend half the movie explaining to my 5 year old). As a Mediatrician and film buff, can you recommend a few of your favorites, either classic or contemporary?
--Frustrated by Films in Framingham, MA

A: Dear Frustrated by Films,

In addition to being the Mediatrician and a film buff, I also have a 5 year old! Some of my kids' favorites are short films featuring Kipper, and classics I've introduced them to like Singing in the Rain, and The Music Man. But I think the important bit of guidance I can give you is not a list of my favorite movies but rather advice on how to find what may become your daughter's favorites!

The trick to choosing good movies for your child lies in combining your knowledge of the movie with your understanding of your child: What are her likes and dislikes? What scares her? What does she enjoy? One approach is to find a movie you loved when you were her age and then watch it together. In addition to giving you an opportunity to share something that was important to you, it can also help you remember how children of her age see and process movies. For example, I remember seeing Snow White when I was 5 and being terrified not by the witch but by the forest coming to life, and tree branches tearing at Snow White as she runs. But I also remember the wonderful experience of seeing The Incredible Journey, where 3 pets who were left behind find their way, through natural and man-made obstacles, back to their people.

Such memories can remind you of the sorts of things that a child might find frightening (which are not always the things you might expect) and the sorts of things they might enjoy (which don’t have to be masterpieces and don’t have to be new and flashy). The two things a 5 year old wants are a good story and something to share with you. For ideas of classic movies that can provide both, I recommend Ty Burr’s The Best Old Movies for Families: A Guide to Watching Together.

I also suggest that whether or not you know the film you are about to share, pay attention to your daughter’s reactions to it. That way, you can respond immediately to her needs (whether for comfort, explanation, or a change of activity) and learn more about what will work for her in the future. 

>>See related question: My daughter was scared by a movie, what do I do?
>>When we posted this question on our Facebook page, our fans listed these movies as their favorites at age 5:

• Apple Dumpling Gang
• Shirley Temple movies
• Sword and the Stone
• Old Yeller
• Swiss Family Robinson
• Thomas the Tank Engine
• Blues Clues
• Pete’s Dragon
• Charlie and the Chocolate Factory
• An American Tale
• The Muppets Take Manhattan
• Kipper
• Winnie the Pooh
• Sound of Music
• Mary Poppins
• 10,000 Leagues Under the Sea
• Bed Knobs and Broomsticks
• Peter Pan
• Follow that Bird
• Charlotte’s Web
• Herbie the Love Bug

Enjoy your media and use them wisely,
The Mediatrician

Will video games cause seizures in my children?

Q:  The manual for my teenage son’s favorite video game contains a warning that says that some games cause seizures and that parents should watch for seizure symptoms or ask their children if they’ve experienced any symptoms while playing.  I can’t monitor every minute of game play, and if I asked my son about it, I’m not sure he would admit any symptoms if he thought it might lead me to limit his game time.  How worried should I be?
Stressed about Seizures in Boston, MA

A:  Dear Stressed about Seizures: 

Wow, I’m impressed that you actually read the “fine print.” Most people don’t do this and it can be important. 

The reason these seizure warnings started to be included on video games is because in Japan in 1997, 700 children suffered seizures while watching this scene in an episode of Pokemon.  Doctors believe it was the rapid flashing of lights and colors that triggered the seizures in children who were already predisposed to what is known as photosensitive epilepsy. Since video games may include similar flashes of light, the warning about seizures started to be included on packages. The warnings are there so that manufacturers will be protected against lawsuits; you may notice fine-print warnings about other side-effects on cans of soda or bottles of aspirin -- it's the same idea.  

I'm guessing that you and other readers of this blog picture seizures as convulsions where muscles stiffen or jerk out of control.  But it's important to know that there are many types of seizures, and they can be as subtle as a kid staring into space or at a screen without much movement, and not responding to your voice.  Here is an example of what this kind of seizure looks like. 

The number of children predisposed to photosensitive seizures is very small and the number of those who will actually have seizures triggered by television or video games is even smaller.  However, there is not any easy way for a parent to determine whether your child is at risk. So I offer the following recommendations: 

• Try to limit your child‘s screen time (video or TV) to 1 hour at a sitting and a total of 2 hours per day. 
• Place the television/video game in a “public” place so you can periodically check on your child while he plays. 
• If possible, the first time your child plays a new game, watch or play with him/her.  You will be able to watch his/her responses to the game.  To keep an eye on possible seizure symptoms, look to see if your child goes through periods of staring, where they aren't moving their bodies and aren't responding to you.  If you notice this, I recommend you call your doctor and eliminate all electronic screen time until your son has been evaluated. 
• If your child is becoming addicted to the games or television, becoming unreasonably upset when you ask him to turn it off, you may want to watch closely to ensure he is not having subtle seizures.  The seizures can inhibit the children from doing well in the game, thus frustrating the child so he wants to do it again and again until he masters it. 

I also recommend that you read this story from a woman whose daughter was having seizures in response to computer games; she wanted to tell her story to let other people know what they faced and how they got help.

Enjoy your media and use them wisely,
The Mediatrician

What should I do about video games on playdates?

Q: My son is entering 3rd grade and is an only child. When he has playdates at his friends’ homes, sometimes the moms allow video games above my son’s age level, usually because my son’s friends have older siblings. It makes me uncomfortable, but I’ve noticed that a lot of parents don’t appreciate it when I ask that they not play any video games during the playdate—it’s viewed as trying to control what happens in their home, or as some judgment upon them for allowing the younger child to play age-inappropriate games. I don't want to tell my son he can never go to their houses, so do you have any advice?  I usually try to have kids over to my house so that it’s not an issue, but at some point, the other parents want my son to come to their home.
-Problems with Playdates in Evanston, IL

A: Dear Problems with Playdates,

This can be one of the more uncomfortable challenges of parenting. I applaud your choice of inviting kids to your house, because two things can happen then: You have some control over what the children do, and you can model other appropriate types of activities. When your kids are going to other homes, there are a few approaches you can take:

1. Have an open discussion. Ask the parent who’s taking the kids what they’ll be doing on the playdate—and mention the plan when you’re bringing kids to your house. That way, you set the expectation that you will share your plans with each other. If there are any activities you're not comfortable with, whether it's video games or swimming or football, speak up and share your concerns.
2. Explain what your child needs. You can tell other parents what your kids like to do or what they need at that time of day. For example, you could say, “I find that he really needs some physical activity after sitting all day in school. Will the guys be playing baseball or something?” That way, you are framing the conversation positively instead of as a series of things they can't do.
3. Frame violent video games as something your child doesn’t tolerate. Think of it the way you’d think about a peanut allergy—if your child were allergic to peanuts, you’d never send him to another child’s house without informing the parents about it. In the same way, when you address this issue, you are providing important information about your child to adults who are taking responsibility for him. You could say, “My son is gets really scared by video games with guns—would you mind steering the boys toward other activities so he’s not put in the awkward position of having to either say no or play them anyway?”

The bottom line is to make your comments or suggestions focus on your child, NOT on the parents' rules or how they run their homes. And if all else fails, laugh about it and take it on yourself, saying it’s your own issue, and thanking them for being accommodating.

Enjoy your media and use them wisely,
The Mediatrician

What do I say to my kids when celebrities go wrong?

Q: My kids love David Ortiz. When we watch Red Sox games, they wear his jersey and cheer loudest for him. Now that he's in the news for possibly using performance-enhancing drugs, though, I’m not sure what to tell them about their hero. What should I do?
-Parent of Papi Fans in Danvers, MA

A: Dear Parent of Papi Fans,

CMCH is located just down the street from Fenway, and most of us are Red Sox fans too, so you're asking the right Doc! It’s always tough to talk to kids about how their heroes might not be perfect, and David Ortiz's case is particularly difficult because he was always known as a squeaky clean, all around good guy. I would view this situation, though, as an opportunity to teach your children some important lessons.

One lesson is that celebrities are people, too. Most of what we know about them is from what we've heard in entertainment news, which is usually written to sell the story, not to report reality.  If your kids are surprised at a celebrity's behavior, you can use it as a chance to talk about how the media tells stories about people which aren't always true. 

So if we don’t really know our heroes, what is it that we admire about them? The answer is usually that they’re exceptionally talented at what they do. Ask your kids what they like about David Ortiz (or Justin Timberlake, or Miley Cyrus), and when they point out that he always seems to hit a home run when the team really needs it, you can explain that they can aim to do that for their own teams too.

Often, we either hold celebrities to higher standards than we hold other people to or we excuse them for inappropriate behavior. Neither of these extremes is healthy. Instead, focus on the learning that can come from a revelation about any such hero. In this case, watch for the consequences that Ortiz ends up facing, and discuss them with your kids. Ask them which of his actions they'd like to try to carry out in their own lives and which actions they wouldn't copy. And watch how Ortiz handles the situation—there are ways to do so that could be worth modeling too.

Enjoy your media and use them wisely,
The Mediatrician

How do I know when my child is ready for TV?

Q: I read your response about baby videos and learning, and I'm wondering -- rather than relying on age, is there some developmental signal that indicates a child can handle/process television and such?
-Ready, set, go? in Wellesley, MA

A: Dear Ready, set, go?,

This question gets at one of the difficulties of scientific research: Age tells us approximately what stage of development a child should be near, but children of the same age are not all at the exact same place in their development. In addition, children have very different temperaments—one four-year-old will be terrified by violence while another is fascinated by it.

The available research, however, is based on age, and there is no good evidence that kids under age two and a half learn well from screens—and that is the very earliest that any child, even the ones farthest along in their development, might be able to learn from screens. Although it’s tempting to argue that your child is smarter than other children and therefore might be able to learn from screens earlier, intelligence has nothing to do with it. A smart two-and-a-half year old is still a two-and-a-half year old.

So to answer your question more directly: No--research does not describe specific developmental signs that will tell you when your child is ready to watch TV or ready to view a certain kind of content. But there are still things you can do to make sure it's time, like thinking about why you want to introduce it and what your children will get out of the experience. For example, once kids reach age 3, research shows that some educational TV can actually help them learn pre-reading and pre-math skills. But in general, the longer children can be encouraged to entertain and educate themselves, the better off they will be. Their imaginations and problem-solving skills will grow as they interact with the physical world and the people in it.

At whatever age you do decide to introduce TV, here are my recommendations for how much to allow them to watch, how they should watch, and what they should watch.

Enjoy your media and use them wisely,
The Mediatrician