Ask the Mediatrician

Does my 7-year-old grandson play too many computer games with his dad?

Q: My 7-year-old grandson visits his dad twice a week and told us that he doesn’t play anything with his dad except for the computer. He recently came home from a visit totally preoccupied with a computer game he played while there. His mom doesn’t want him playing this game because it is for ages 10+ as per the recommendations on the game itself. His dad told him the “10” actually meant 10 and under, or over if someone older wanted to play it. We are concerned at our grandson's constant talk and excitement about this game, even when he is away from the computer. We don’t want him so involved in computers that he has no other interests in life. What would be a good amount of time for him to be allowed to play a game like this, and can it cause him to become addicted?
-Grappling Grandma in Columbus, OH

A: Dear Grappling Grandma,

Setting expectations for how media will be used can be tricky in any household, and when a child is living in two or more places, the challenges can be that much more…well, challenging.

I applaud you for checking in about what a healthy amount of computer use can be for a child. The American Academy of Pediatrics recommends that kids over age 2 use screens (including computers and TVs) for no more than 2 hours per day. As a pediatrician and parent, I recommend that they use entertainment media only after they finish the important tasks of life—like school, homework, eating well, exercising, reading, spending time with family, and sleeping. After that, they aren’t likely to have as much as 2 hours left over for entertainment media.

Your question about how much time he should spend using a 10+ game brings up another set of issues. First, know that game ratings are based on what the Entertainment Software Association believes that parents will find acceptable—not based on recommendations from child development experts. And research on this issue shows that children of your grandson’s age learn from whatever media they use and tend to accept its content as “the way things are.” Therefore, content does matter, and increased exposure is likely to lead to greater effects.

Lastly, while we can’t say what will lead to addictive or problem media use, we can describe its characteristics: excessive use, withdrawal when they are not watching/playing/listening to that type of media, and an increasing willingness to accept negative consequences. For guidance on what to do in the case of problem use, see this Q&A about a teen girl addicted to TV.

Whether or not your grandson's use would be characterized as addiction. both he and his father deserve a more full relationship with each other. They should spend time doing a variety of things, which can include—but should not be limited to—playing video games that are ideal for the child.

Enjoy your media and use them wisely,
The Mediatrician

Kids use media for almost 8 hours a day -- Now what?

Yesterday the Kaiser Family Foundation released a report detailing just how much media kids are using.  Dr. Michael Rich, The Mediatrician^SM, was interviewed on NBC Nightly News, and the Center on Media and Child Health sent out the following in email to parents today. 

What's going on?
A new  confirms that media are a constant presence in kids' environments:

• Kids spend more time using media than they spend in school: Kids use TV, music, computers, video games, movies, and print for a total of 7hours and 38 minutes a day.
• Kids have media in their pockets and bedrooms: 66% of kids own a cell phone, 76% own an MP3 player, 71% have a TV in their bedroom, 50% have a gaming system in their bedroom.
• Kids are media multi-tasking: For more than 25% of the time kids spend using media, they are using two types of media at once (e.g. watching TV and chatting online)

Why should I care?

• Kids learn from what they see and hear. All media are educational. Some teach accurate, healthful lessons, while others teach misleading and harmful lessons.
• Kids need time for healthy activities. If media are constantly in use, kids may not have time for the activities that will keep them healthy: eating balanced meals with family, doing homework, being physically active, playing creatively, and, most importantly, sleeping.  

What can I do? Create limits and rules around media. The Kaiser report found that kids whose parents had any kind of rules about media  used 1/3 less media than those whose homes had no rules at all. Keep media in common areas. Keep dinner time TV-free, leave the computer in the family room, and if you don't have TV in your child's bedroom yet, keep it that way. Teach active, critical media use. Engage kids in thinking about the media they use, rather than passively consuming it. These skills will stay with them, no matter how media change. Ask questions. If you have questions about media and kids, or want to see what other parents are asking, log on to www.askthemediatrician.org

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Is it okay that my 11-year-old son is obsessed with driving video games?

Q: My 11-year-old son is obsessed with Formula 1 driving video games. When he wins a race, he wins “money” that can be used to buy more expensive and faster cars to race with next time. It doesn't seem like it's the escape of the driving game that is the impetus for this—he is interested in all things involved in car racing. Is this okay? What might be the potential dangers be?
-Driven to Distraction in Boston, MA

A: Dear Driven,

It is not uncommon for tweens of your son’s age to engage in an area of interest with such intensity (whether it's skateboarding, science fiction, hip hop music, or cars), and it sounds like video games are just another environment where he’s learning about this particular interest. Spending some of his down time playing these games isn’t a problem as long as he accomplishes the important tasks of life, like homework, school, time with family, eating good meals, and getting adequate sleep.

In fact, by playing well-designed racing games, he is likely learning a good deal about what makes a car move more quickly—from physics to aerodynamics to internal combustion engines. Such a game will give a relatively accurate idea of how quickly he can go around turns, how far the car will fly after hitting a bump, etc.

There are some concerns about how regularly playing these games could affect a player’s real-life road behaviors, however. In some research studies, those who played racing video games regularly—or even as part of an experiment—drove faster and more recklessly in real life than those who did not. One study found evidence that this may occur because players then perceive themselves as reckless drivers.

These games simply can’t duplicate the risks of real-life driving. In addition to not being able to practice driving skills in real life yet, your son's 11-year-old brain has not yet developed the ability to really think into the future and grasp the concept of potential consequences. You can help make video game racing a more healthy experience for him by offering to play with him or to watch him play. Then you can be there to remind him that, while crashing and rolling a virtual car has few consequences, crashing and rolling an actual car is another thing entirely.

PS - From the results of this forthcoming paper, another thing to watch out for is your wallet -- researchers found that driving a virtual car increased how much players liked that brand of car in the real world!

Enjoy your media and use them wisely,
The Mediatrician

Can toddlers learn sign language by watching DVDs?

Q: In your NPR Parents’ Journal interview, you stated that children under the age of 30 months do not learn anything about language from TV programs, but I disagree.  My 17-month-old daughter is not allowed to watch entertainment TV, but since she was 9 months old, she has watched a baby signing language DVD series about 3 times a week.  Now she knows about 80 signs (and about 60 spoken words), and learning sign language as a family has greatly enhanced our relationships because she can tell us what she needs without crying and throwing a tantrum. I feel strongly that the 1-2 hours of media exposure a week are making her toddlerhood much less frustrating and are worth whatever negative effects are possible. I would love to hear your thoughts on this matter.
-Serious about Signing, Baltimore, MD

A: Dear Serious about Signing,

Thank you for raising this important issue. My own young children signed when they were your daughter's age and I absolutely agree that baby sign language can be a wonderful tool for allowing pre-verbal children to communicate more specifically than they can with cries of distress. It sounds like the simple signs that you and your child are learning are making a world of difference, and the DVDs seem to be giving you a good deal of useful guidance.

In terms of what children under 30 months can learn from screens, research on brain development suggests that they can learn to imitate. Imitation is certainly useful—as you’ve experienced, imitation can provide a tool for asking for something specific, like milk. But their brains are not really ready to develop verbal language.

So what is going on here? Most likely, your daughter is learning to imitate motions from the DVDs and, most importantly, from you. You respond to the motions by giving her what she’s asking for, so the behavior is positively reinforced—and she’ll imitate signs on the screen even if you don’t see them because she knows that you will respond. If you responded inconsistently or not at all to her signs, however, she would probably stop using them.

What that means is that what she sees on screen is only important because you support it. And since you do, her signing is helping her create a practice of communication, which will probably serve her well when she moves on to words. Just know that what’s best for brain development at this age is manipulating her physical environment, creative problem-solving play, and time spent interacting with you—and since signing is something you do together, that works. Screens on their own won’t provide her with any of those three things.

Enjoy your media and use them wisely,
The Mediatrician

Response to controversy over violent video game answer

Recently, I answered a question from a mother asking whether she should purchase the video game Call of Duty for her son.  When the answer was featured on Thrive, the Children's Hospital Boston blog, it ignited controversy and spurred many gamers to comment.  Here is my response:

Thank you for your energetic responses both in the comments section here on the Thrive blog and on Children’s Hospital Boston’s Facebook page to my recent post about Call of Duty and other violent video games; this is exactly the type of public dialogue that I was hoping for when I started my Ask the Mediatrician Web site last year. We all use media in different ways and have very personal opinions about the value it brings into our lives, but their use also impacts society as a whole, and my hope is for all of us to continue to question if we’re using them in a beneficial way.

Related to the some of the responses to the post that said I misrepresented some of the things that happen in the game, I acknowledge that, even though I play video games, I have neither the skills nor the practice time to be a great gamer, so Call of Duty: Modern Warfare 2 was demonstrated to me—I have not played it. I used the air terminal scene as an example of the game’s content, about which those of you with greater gaming experience have far more precise information and experience.

I apologize for any inaccuracies in my description of where certain events occur or how points are scored. These mistakes were not intentional and distracted from the goal of the post, which was to offer parents information about the effects that research has shown violent video games to have, and to encourage them to make their own decisions about how to parent their children using that information.

Setting aside the specifics of this particular game, it’s important to address what the research shows about violent video games in general. As individuals, we draw conclusions based on our experience, but health research is necessarily held to a higher standard—it must be based on observations of large groups of people. Therefore, physicians advise against smoking not because every individual who smokes gets cancer, but because smoking cigarettes increases your risk of getting cancer. Similarly, many research studies have shown that the majority of violent video game players do not go out and start shooting people—but they do show that those who view violent movies or play violent video games experience a consistent, measurable shift in their attitudes and behaviors toward greater fear and anxiety (especially in children), desensitization to suffering, and, in some, increases in aggression.

The positive and negative effects of media on children deserve special attention because children’s brains are different than adults’ brains. For example, while children can say that an experience is “only make believe,” developmental psychology has demonstrated that until they are about 7 or 8, children’s brains have not developed to the point where they can reliably distinguish fantasy from reality. Even with older kids, the major concern is not that they will unthinkingly copy what they experience in violent media but that these media (like all media) will affect their expectations for normal human behavior. That means that experiences with violent media are more likely to contribute to everyday bullying than to the rare school shooting.

Video games, which present environments and conditions to which the player must respond in certain ways to do well, function as “behavioral scripts” which the player practices over and over. Interactive electronic media that immerse participants in a “virtual reality” are among the most effective teaching technologies we have. What children do, they will learn. Content matters. Therefore, as a pediatrician, I would steer parents and kids toward video games that are sports-, logic-, or strategy-based, instead of those that center on violence. And, as Steve said, in the end, it is parents themselves who know their kids best. They know what’s best for their family and we are offering them information with which they can make their own decisions.

It’s been great to hear from all of you. Let’s keep the conversation going!

See recent research on violent video games:

• Longer you play, the more hostile you feel: Examination of first person shooter video games and aggression during video game play
• Chronic violent video game exposure and desensitization to violence: Behavioral and event-related brain potential data
• Immersive virtual environments versus traditional platforms: Effects of violent and nonviolent video game play

Racy magazine covers seem to be everywhere -- how can we object?

Q: As I shop in “family-friendly” stores, I am shocked to see the cover photos of popular magazines bordering on soft-porn. I am not surprised at the publishers, but I am surprised at how unaware stores are of this offensive content. No wonder our children think everything in our country is about sex and materialism -- this is how they see the world portrayed in much of our media. I think what disturbs me most is the acquiescence to it by those of us who don’t approve. Parents and a few still-modest women are concerned, but how do we object without sounding like we are overreacting?
-Miffed by Magazines in Seattle, WA

A: Dear Miffed by Magazines,

As social standards change over time, magazines and other media will always be “pushing the envelope” in order to grab and maintain the public’s attention. As a result, there are more sexual images, just as there are more violent images, in mainstream media than there have been in the past. What one person finds offensive may not bother another person. Those who are concerned often give in, possibly because they feel helpless to protest. Media are everywhere, most parents feel overwhelmed, and they do not feel that they have anything to say other than that they are offended, which makes them feel embarrassed for being prudish. But you can respond to these images rather than being offended, and do so in ways that are effective if you have facts, rather than opinions.

Research shows that kids don’t necessarily imitate what they see in sexualized media, but they do pay attention, because they are learning about the world and the way they should behave in it. What they see teaches them about what is normal and what is attractive, so it guides the way they present themselves. Sexualized images also may build insecurity, which can motivate us to buy cosmetics, clothes, even cars, to feel better about ourselves. While making sales is the goal of advertising and the publications in which they are published, this insecurity can have unfortunate outcomes. Among adolescents, who are at their most self-conscious and insecure developmental stage of their lives, this can lead to real health problems, including anxiety and depression, eating disorders, body-building supplements, and substance abuse.

Magazine publishers and media producers do not seek to offend anyone with sexualized images, they want to get your attention. You are their potential customer. They want to know what you think and feel. Communicate with the magazines, advertisers, and consumer products companies and let them know. Don’t underestimate the power of sending a letter to corporate executives, they understand that they need to make you happy if they want you to buy their products. As consumers, we can create change by voting with our voices and our wallets. And don’t forget to give positive feedback, both in your communication and your business, to those companies that provide images, ideas, and products that make you healthier and happier. 
>> Tips on writing a letter
>> Related question: How can I convince networks not to play violent commercials during family programming?

Enjoy your media and use them wisely,
The Mediatrician

Is playing violent video games a healthy way to deal with tragedy?

The following question was submitted to Education.com's "Just Ask" forum. A number of professionals, including The Mediatrician, were asked to provide a response based on their area of expertise.  

Q: My nephew and niece’s mother died on December 6, due to a tragic accident. She was shot by her 13-year-old son. How can I tell if they are dealing with this tragedy in a healthy way? He continues to play violent video games with graphic shooting and killing people. Is this normal behavior?
-Aunt Jan

A: Dear Aunt Jan,

First, let me extend my deepest sympathies for your tragic loss. Any death in the family can be extremely difficult to deal with, and a situation such as this carries especially heavy challenges. For your nephew, the feelings that accompany this tragedy are likely to be even more complex and upsetting. I strongly recommend that both he and your niece start therapy, if they haven’t already. They will need it simply to manage their emotional responses to losing their mother, not to mention processing through the circumstances surrounding that loss.

Your question about whether it’s normal for your nephew to be playing violent video games at this point is a good one. He may be trying to regain some semblance of control over the world by using virtual guns in a controlled, virtual environment. Shooting and killing video game characters may be his way of trying to make sense of the real-life, accidental situation.

Video games, which present environments and conditions to which the player must respond in certain ways to do well, function as “behavioral scripts” which the player practices over and over. Interactive electronic media which immerse participants in a “virtual reality” are among the most effective teaching technologies we have. What children do, they will learn. Content matters. Therefore, as a pediatrician, I steer parents and kids toward video games that are sports-, logic-, or strategy-based, instead of those that center on violence   The challenge with the games is what they are teaching.  I recommend to parents that when they buy a game, they carefully choose it for the content their child will learn from it and then spend time with their child discussing that content.  

In your case, playing violent video games may not be the healthiest way for him to process through this, especially without the guidance of an experienced therapist to help him sort through both his virtual and real experiences. A therapist, in addition to helping your nephew work through his emotions, might be able to figure out his motivation for playing these violent video games and work to find healthier ways of achieving the same goals.

My deepest sympathies,
The Mediatrician

Q: Do kids experience media differently than adults do?

Q: In trying to convince my husband that we need to consider our kids' media exposure, I get the feeling that he thinks they are just "mini adults" and that what doesn't affect us won't affect them. But the way I think about it is kind of like how we determine how much medicine to give a child. Am I correct that we give children a different dose of medicine not just because they weigh less but because they process it differently? Is it the same with media?
-Medicine Mom in Glencoe, IL

A: Dear Medicine Mom,

Yes, you are absolutely right. One of the things that makes being a pediatrician so interesting is that a growing, developing child is a constantly morphing being. Different components of her body and mind develop at different times, through infancy, childhood, and adolescence. We give different types and doses of medication to children not just because they are smaller, but also because medications have different effects on people in different phases of life.

For example, many medications that affect developing brains are not used at all, or are used in very small quantities, with kids. Why? Because a medicine that may be effective in relieving an adult's runny nose may result in seizures when a child takes it. Likewise, kids who take Tetracycline before age 8 will have their permanent teeth turn dark--but that's not true of adults who use it.

As with drugs, the developing brain and body are not only more sensitive to the effects of media but are also developing in response to those inputs. In other words, when a child is exposed to content that is new to her, such as violence or sex, she will take it at face value, learning that this is the way violence and sex operate in the world. She will integrate it into her life experience almost as if she experienced it herself. That makes it extra important to choose what your children see and hear with great care.

One example of how media affect children differently than adults is that, under the age of 7 or 8, kids can’t distinguish between fantasy and reality. Research has shown that TV shows or movies that show people transforming in some way, as The Hulk does when he's angry, are absolutely terrifying to a child--even though the transformation is obviously make-believe to an adult. And don’t be fooled…kids will say that they know it’s only make-believe, but that doesn’t mean that they truly understand that it couldn't happen in real life. Hopefully, you and your husband can learn together how to think about media experiences through your children's eyes and ears before you make decisions.

Enjoy your media and use them wisely,
The Mediatrician