Ask the Mediatrician

Can you tell me more about the recommended 1 hour media limit?

Q: When we hear that children should not be exposed to more than 1 hour of screen time per day, does that mean that all media are created equal?  For example, are watching a movie, watching an age-appropriate TV show, and playing an interactive children’s website game all the same? What are the concerns about and benefits of each?
-Needing Guidance on Guidelines in Madison, WI

A: Dear Needing Guidance,

This is an important series of questions. First, let’s talk about the one-hour limit you mentioned. The American Academy of Pediatrics recommends that children over age two be limited to one to two hours of media per day.  This recommendation largely reflects the fact that kids are only awake for about 14-16 hours in a day and in order to keep them healthy, there are a lot of things that need to take place during that time frame.  After family meals, physical activity and play, and school and homework, there is rarely as much as an hour left for entertainment media. So part of the goal of this limit is to help keep media in its place—as a "bonus", if there's time after all the important business of life has been taken care of. 

The other reason for the one-hour limit is in what research has shown about overweight -- that after two hours of media per day, there is a consistent relationship between the number of hours of screentime (of all kinds, whether it teaches kids to read or teaches them to shoot their opponents) and a heavier weight.  Keeping media below two hours a day can help avoid this effect.

The second part of your question is that once you have limited all screentime to one hour a day, does it matter what that hour includes? Absolutely. As you imply, all media are not created equal. Any media content your children are exposed to should be not only appropriate, but also effective for their age. That is, in order for them to get the most out of their media experience, make sure that the content addresses something they're interested in or that they're trying to figure out—whether it’s learning to count or learning what it might be like to have a baby brother.

To address the third part of your question -- In terms of media format, I would say that the more interactive it is, the more effective it will be at teaching whatever it teaches. For example, video games are more effective teachers than TV shows because the player directly affects what happens on screen.  However, there’s no hard and fast rule about which format is preferable. A TV show that asks your children to sing and dance along will give them more of an opportunity to learn than a website that asks them to passively receive the information or story it offers. Whatever kind of media they use, though, remember that media are teachers; they will learn whatever is being shown, so choose content wisely.

Enjoy your media and use them wisely,
The Mediatrician

My teen daughter is addicted to TV. Please help!

Q: I have a daughter who just turned 15 and is truly addicted to watching TV—about 4 hours after school, while eating (she is not overweight), and doing homework. She claims that it relaxes her and that she needs it to unwind after a long day at school and activities. I try to impose limits, but I get huge fights about turning the TV off, and she refuses. Also, the content that she enjoys most are the inappropriate reality shows that have heavy sexual content and people who do not seem to have any high aspirations in life. My daughter herself is intelligent, attractive, and talented as an actress. I do not understand the lure of these shows. I find her behavior aggressive at times and difficult to deal with. She also cannot remain focused on her schoolwork and does forget things. How do you restrict these shows and the amount of time watching TV when your child absolutely refuses to turn it off and claims she NEEDS it to escape? Please help.
-Hoping to Help in Kansas City, MO

A: Dear Hoping,

The most telling part of your question is the fact that you used the word “addicted” in describing your daughter’s behavior around TV. The question of whether there is such a thing as media addiction has been examined in the research a lot recently, particularly around the issue of Internet addiction.  Looking at that research, what you describe does, in fact, sound like addictive behavior, which combines four components:

1. Excessive use, often associated with losing a sense of time, neglecting basic needs (like sleep and homework).
2. Withdrawal, including anger or sadness when, for example, you ask her to turn it off.
3. Increasing tolerance, so that she watches more and more TV or more and more outrageous reality shows.
4. Negative repercussions, which she accepts in order to feed the addiction. That is, she is willing to argue with you and let her school work deteriorate as the price of maintaining her addiction.

So what should you do? First of all, be straight up about what you think is going on. If she denies that she’s addicted to TV (which she almost certainly will), challenge her to prove that she can stop. If she refuses the challenge or accepts it and fails, don’t be angry or disappointed or say "I told you so"—don’t blame or shame her. Instead, set firm limits and explain why you are doing so.

If your daughter is able to live with these limits, she will discover for herself how much more fulfilling her life is when she has time to connect with family, to exercise, and to complete the other important activities of daily life. If the limits continue not to work, or if you feel that you can’t set them, reach out to professionals. Like depression or anxiety, a good therapist or pediatrician should be able to help you address this issue or direct you to someone who can.  Whether researchers agree that media addiction is a "real" issue or not, overuse that disrupts your child's life in this way is certainly a problem that needs to be addressed. 

Here are a few resources that might be helpful:
>>One mom's experience with her daughter's video game addiction
>>Helpguide.org (on Internet addiction, but applicable to TV as well)
>>Childnet International factsheet (see p. 3 for suggestions for parents)

Enjoy your media and use them wisely,
The Mediatrician

Disney is offering full refunds for Baby Einstein videos--should I turn mine in?

Q: I hear that Disney is offering full refunds for Baby Einstein videos, but I don’t really understand why. I received some of these videos as baby shower gifts and my 7-month-old son seems to enjoy them. What do you recommend?
-Buzz on Baby Videos in Ft. Lauderdale, FL

A: Dear Buzz,

It’s true! After years of pressure by the Campaign for a Commercial-Free Childhood (CCFC), Disney is offering a full refund (or exchange for another product) for any Baby Einstein video bought within the past 5 years.

The CCFC called Disney to task for marketing these videos as educational (even the name "Einstein" implies that the videos will help kids become geniuses), even though none of the scientific research shows that they increase learning.  In fact, the research that has been done on the effects of media exposure on babies shows either no effects at all or associations with negative health outcomes, like language delays.

Why might these be the results? Because your baby was born with a brain that is developing in response to his environment. The activities that are best for his brain development include face-to-face interaction with people, manipulation of objects in his physical environment, and open-ended, creative, problem-solving play. No electronic screen, regardless of the content it shows, can provide any of these learning situations.  >>Related question: How will TV affect our 3-month-old?

For that reason, I recommend that you take advantage of Disney’s offer of a refund for your Baby Einstein videos. If, like many parents, TV or baby videos are one of the ways you keep your child entertained while you get things done around the house, check out this post for ideas on other activities your child can do while you make dinner or take a shower.  You could even use your refund to buy a toy that your son will get much more out of; check out this great list of toy ideas for young kids.

Enjoy your media and use them wisely,
The Mediatrician

Should I take my kids to see Where the Wild Things Are?

Q: Where the Wild Things Are was one of my favorite books growing up and now my 5 and 7 year old kids love it too.  I'm eager to see the movie but I'm not sure if I should take the kids with me.  The trailer looks kind of dark and I'm not sure they'd "get" what's really going on.  What do you think? 
-Wondering about Wild Things in Boston, MA

A: Dear Wondering,

Books and movies have very different ways of creating worlds. When we read a book—even if it’s illustrated—our minds add sounds, other images, and detail to the story. That means that what we imagine will be limited by what our brains are ready to create. Movies, however, describe worlds much more fully, with sounds and music and visual images, and so they make meaning for us.

This means that a story like Where the Wild Things Are, which can be great for adults in any medium, might work for children in one medium but not in another. For example, an adult who reads the book may see darkness in Max’s emotions, but a child who reads the book may not see that darkness at all, simply because her brain is not ready to create that darkness on its own.  In contrast, the world of the movie is so fully formed that it will pull her into that darkness whether she’s ready for it or not.

What that means for your children depends on their age and sensitivities. At almost any age, they will perceive the fear and anger and sadness in this movie. The younger they are though, the less likely they will be able to understand that this movie is about managing and living through those feelings—what they will walk away with is those feelings themselves, not resolution of them. That’s all their experience so far has prepared them for.

For all of these reasons, if you’re considering sharing this movie with your children, I strongly recommend that you see it first, talk to people who have already seen it, or read parent reviews from Common Sense Media.  Then think about what you know of your children as individuals to help you make your decision. In some ways, this movie is a great representation of how kids Max's age think, and adults might be able to learn a lot from that.  But the kids themselves certainly won't come away with the same understanding as you do.

>>See the movie trailer

Enjoy your media and use them wisely,
The Mediatrician

How can we get our 6-year-old’s teacher to make better media choices in the classroom?

Q: I have a 6-year-old daughter whose early media years were spent watching carefully selected educational shows. Last year, she went to all-day kindergarten, where her teacher showed G-rated Disney movies and even some PG movies to “give the kids a break.” Our daughter was confused that these movies were shown in school and found the content disturbing. She was allowed to leave class during movies, but we remain concerned that the school seems to leave video entertainment to teacher discretion. Is there any research that would be helpful in guiding a school to make better, more deliberate media choices?
-Caring about the Classroom in Santa Fe, New Mexico

A: Dear Caring,

As you imply, neither the fact that the movie is made by Disney nor the G-rating make the movie appropriate for kids this young.  Almost all Disney movies tell the story of a character losing someone (or something) important such as a parent (think Bambi and The Lion King). This kind of dramatic hook strikes right to the heart of children’s primal fears—and even when everything works out at the end, the fear has usually already set in. Given that and the fact that every single G-rated movie made between 1938 and 2000 contains interpersonal violence, it’s no wonder that your daughter was disturbed.

Showing these films in school raises questions of what’s appropriate for kids of certain ages, and in fact, even within age groups kids can have very different reactions.  But showing them how to create down time might be the larger issue. First of all, movie time is not down time. It may quiet kids, but it also has a tendency to get their minds worked up even if their bodies have slowed down.  In addition, research tells us that all media are educational, even when it's used for entertainment.  A child’s brain doesn’t shut off just because a movie has turned on. She learns from whatever she sees.

Secondly, you might wonder why kids' school down time is filled with media instead of recess or free play.  Using films as pure classroom entertainment does kids a disservice—films should be used as part of a rich educational experience, rather than as a “break” from it. For example, when learning about different kinds of sea creatures, a kid-focused documentary about dolphins could really bring the topic to life!

It sounds like your daughter is confused by the movies because they are being used for entertainment, not as a way to enrich a particular lesson. I recommend having a conversation with your daughter’s teacher, asking him or her to explain how showing movies in this way supports educational goals. You can certainly talk about the appropriateness of different kinds of films, but I would recommend that a more useful discussion would be about how films can be used in positive educational ways. An additional option would be to see if the teacher could provide alternative activities while the movie is playing.  This way, who choose not to watch the film are entertained in other ways and won't feel embarrassed to opt out of the movie.

>>See related question: My daughter got scared by a movie, what should we do?

Enjoy your media and use them wisely,
The Mediatrician

Can I blame the "Slut List" on all the sex in the media?

Q: I’ve been hearing about the high school in NJ where older girls are putting freshman girls' names on a “slut list”—and the worst part is that being on the list is considered a good thing! I can’t help thinking that all the sex in the media is to blame for girls thinking it's a badge of honor, but maybe I'm overreacting. I want to talk to my 13 year old daughter about this, but what should I say? 
-Suspicious of Sexy Media in Princeton, NJ

A: Dear Suspicious,

I wouldn't blame the entire situation on media, but I do think you're right that the way American media promotes sex has something to do with this. On TV, in music videos, and in celebrity culture, girls are shown as sexy at younger and younger ages. 

So why do these teens want to be on the slut list? Perhaps because they see this type of behavior the way media portrays it—as empowering and attention-getting. At this age, their brains aren’t yet developed to the point where they think these things through.

As a parent, you can help provide the reflection and perspective that your teen daughter doesn’t yet have. How? By asking her open-ended, non-judgmental questions. Because you can ask her about the story instead of about her personal experience, this is a safer way for her to discuss these issues with you, and if you respond with curiosity and openness rather than horror or disapproval, you are more likely to get somewhere useful in the conversation.

For example, try asking your daughter how she feels about this story, why she thinks girls wanted to be on this list, and why she thinks sexual behavior is a way of determining popularity. Even if she says something like, “Oh mom you’re so old fashioned—everyone’s doing this,” you can teach her to think critically about “the way things are” by questioning it yourself. Keep asking questions you truly don’t have the answers to, like, “But why do they do this? Can you explain it to me?” In this way, you encourage her to reflect on how others see people who are on this list, how those who are on it might feel, whether this is an "honor" that will serve them well into the future, and whether they actually wanted to do whatever they did to get on that list. Additionally, you are teaching her to consider what defines her (is it her clothes? her sexual behavior? something else within herself?)—and that is a lesson that will serve her for the rest of her life.

Enjoy your media and use them wisely,
The Mediatrician

How can we help our teen son manage media so they don't interfere with his life?

Q: Texting, cruising the Internet, and Facebooking are interfering with my son’s academic goals and adding stress to our family life (we have three kids, 16, 13, and 9). He is very bright and wants to excel in school, but the lure and addictive quality of social and entertainment media undermine his nightly goals. We’ve already eliminated weekday TV and gaming, but taking technology away completely seems to encourage sneaking and secrets. What facts and tips can you share that will help my wife and me and, ultimately, our son learn to manage media wisely?
-Determined Dad in Short Hills, NJ

A: Dear Determined Dad,

First of all, you’re doing something very positive by actively engaging your son in this conversation. Parents often feel completely out of touch with their children’s media lives, and as a result, they simply throw up their hands and walk away from them. Your involvement here is very important and worthy of praise.

In order to help your son improve his media management, build on the foundation you’ve already laid: his nightly goals. Sit down with him and have him think through what he wants to get done in a day—which, in addition to any other priorities he might have, should include homework, extracurricular activities, a family meal, adequate sleep, and exercise. Then have him identify why he wants to get those things done. Once this is done, help him budget his time. It will soon become clear what sorts of guidelines he will need to set for himself in order to meet his priorities--keeping TV and gaming out of his bedroom, for example, will make it much easier for him to meet his goals.

You'll also want to have him think through what happens when media won't stop interfering—remembering that the purpose of these consequences is to make it so that he can get done what’s important to him. For example, if Facebook is getting in the way of his schoolwork, will he voluntarily turn off his WiFi for the evening, with help from you? When he can’t sleep because of texts, will he turn his phone off and leave it in the living room over night?

Learning to organize your life, prioritize tasks, and manage your time is one of the key tasks of high school. As your son moves toward the independence of college and adult life, these media can be presented like driving -- a freedom that comes with responsibility. How he responds to this conversation will tell both of you about his ability to manage these things in his life and what kind of freedom he’s ready for. Given what you’ve described, it sounds like he’ll rise to the challenge.

Enjoy your media and use them wisely,
The Mediatrician

Do violent and sexual media affect suburban kids’ attitudes toward sex?

Q: It seems to me that many suburban parents have a hard time admitting that violence and sex in the media can affect their children. They think that this is an inner city or gang issue. But I’m worried about the issue of increased college sexual assault, including the statistic that 1 in 4 women experience sexual assault or attempted sexual assault during their college years. Can a weekly diet of violent and sexual media for teens from good families affect their attitudes and behaviors when they’re in college, contributing to the high numbers of college sexual assaults?
-Unsettled in the Suburbs in Glencoe, IL

A: Dear Unsettled,

You seem to be asking 2 questions here, so I’ll try to address each. The first is whether media can affect kids’ behavior and their attitudes toward violence and sex. The simple answer is yes—being regularly exposed to sexual and violent media can affect both. But not, perhaps, for the reason that seems most obvious. Parents you talk to who aren’t worried about this issue may be thinking, “My child is not going to go out and kill someone because they played a shoot-em-up video game.” And they are almost certainly right. Imitating extreme behaviors portrayed in media is rare.

But media does shift kids’ understanding of what’s normal. A steady diet of sex and violence as entertainment creates expectations that are both unrealistic and potentially destructive. When music videos show women being coerced into sex and enjoying it, for example, kids start to think that this kind of sexual behavior is acceptable, even desirable. And a recent study showed that teens who listen to music with sexual and degrading lyrics tend to have sex at younger ages. When such beliefs combine with the peer pressure and substance use common in college environments, you often end up with a perfect storm for sexual violence. 

The second question seems to be whether the environment in which kids grow up makes a difference in how much they are affected by media. You are absolutely right that these media don’t only affect kids in the inner city—in fact, rates of domestic and sexual violence are consistent across socioeconomic circumstances. They may be more evident in urban areas because city homes are closer together than those in the suburbs, making it easier to notice any problems. But just as violence occurs in all kinds of communities, media affect all children’s beliefs about sexuality, whether suburban or urban, well-off or struggling. For that reason, even parents who feel the most sheltered need to pay attention to what their kids are watching.

How can you help reduce these negative effects? First, don’t just pretend that these media don’t exist—have open discussions about them with your kids. Help them come to their own conclusions about the problems in these portrayals, and help them notice healthier models. Such conversations allow kids to work through these issues with you, instead of on their own when they get to college. They may even help your kids keep themselves safe.

Enjoy your media and use them wisely,
The Mediatrician

How can I get my husband to stop playing violent video games in front of our toddler?

Q: My husband loves to play X-Box and used to play in his home office with the door wide open. My toddler would saunter in and watch him play on occasion. He played Halo, Batman, and Street Fighter, all with my son’s watchful eyes nearby. With my constant reprimanding and insistence that he stop playing any violent games around our son, this has decreased a little. However, I can tell that my husband doesn’t see any negative consequences of playing games with loud noises and lots of physical contact. What can I do? Do you have any studies I can use to back up my argument?
-The Gamer's Wife in Toronto, Ontario

A: Dear Gamer's Wife,

Since 1970, there have been over 700 studies on the effects of media violence on kids.  Almost all of these studies show that when kids repeatedly see violent images in the media, they are likely to experience one or more of these three outcomes:

1. Becoming fearful or anxious about the violent situations they have seen (this may play out as nightmares in kids your son's age)
2. Becoming less sensitive to the suffering of others (the more violence you see, the less you are horrified by it)
3. Becoming more aggressive in both thought and behavior (though this is the most rare of the three effects, it does happen)

Kids can’t distinguish between fantasy and reality until the age of 7 or 8. Although your husband’s adult brain can experience media violence and understand that people don’t get blown down by machine gun fire, stand back up, and start shooting again, your son has no way to know that yet. He’s not comparing these images to what he knows of reality because he’s in the process of building his understanding of reality—and that will include whatever he sees in the media, whether it's true or not.

When you discuss this issue with your husband, you may want to emphasize that you are not insisting he give up video games all together, but rather that he might look into playing other kinds of video games -- those that are sports-, logic-, or strategy-based, instead of those that center on violence.  Hopefully you can come to an understanding that when he picks up the controller, he should think about the content of the game and decide whether it’s time to close the office door.

>>Related Questions: How can I talk to my husband about media violence?  and Why do different kids respond differently to media violence?

Enjoy you media and use them wisely,
The Mediatrician

Are American Girl dolls a better choice for my niece than the more sexualized Barbies or Bratz?

Q: I wondered if the Center has any research on the American Girls phenomenon. Unlike Barbies and Bratz, these dolls are not sexualized, and they also have connections to history and culture through each doll's storybook.  I am guessing that they are probably a better alternative for playtime fantasies (at least for families who can afford them -- the dolls cost $95 each). But they are also linked to all kinds of merchandising, encouraging families to buy accessories like furniture, clothes, and even pets to go along with them (also pricey).  What do you think about the pros and cons? My niece is 8 years old and I am thinking ahead to the holiday season.
-Talking about Toys in Somerville, MA 

A: Dear Talking about Toys,

Though there is no research specifically about these dolls, research does show that the best toys for encouraging imagination are ones that allow the child to make up characters, stories, and situations.  As you mention, these particular dolls and their accompanying books do have the advantage of focusing on history and on who the characters are. The stories do not focus on romance, and the dolls and their story-book counterparts are proportioned fairly normally in comparison to many other dolls out there.

However, American Girls dolls come with specific names, characters, and back stories, which reduces the demand for the child to create all of those things. Additionally, the child is likely to start to want additional dolls with predetermined names, characters, and back stories to populate her world of play. Some of the stories, like that of a relatively new doll whose character is homeless, have caused controversy for other reasons.

In short, the less that a doll, or any toy, does on its own—the fewer pre-written stories they come with, and the fewer bells and whistles that determine how a child plays with it—the better the toy is for challenging, stretching, and energizing the growing brain.

Enjoy your media and use them wisely,
The Mediatrician