Ask the Mediatrician

Should I correct Thanksgiving stereotypes my kids see on TV?

Q: I know I’m probably making a big deal out of this, but it really bugs me when my school-age kids watch shows and movies in class or on TV that show inaccurate stereotypes of the first Thanksgiving—grateful Pilgrims and wild “Indians” and lots of peace and harmony. I don't want to ostracize my kids for what they think is true, but isn’t it my place to correct them?
-Stereotype Stickler in Scottsdale, AZ

A: Dear Stickler,

As a parent, it’s your job to raise your children to think and behave in ways that will make them successful throughout their lives, in various realms. That means impressing upon them not only cultural and perhaps religious values but also those gained through history. So if what your kids are learning isn’t in line with your understanding of the actual story of Thanksgiving, start a discussion about what they’ve heard, and consider guiding them through concepts that add nuance and accuracy to their understanding:

• Immigrant experiences. Those aboard the Mayflower were escaping religious persecution. What does it mean to your children that these early Anglo-Americans were as much immigrants as are today’s newcomers to this country? What does the U.S. offer that makes so many people uproot their lives to move here? 
• Conflict of world views. The Pilgrims’ friendship with members of the Wampanoag tribe was centered around learning how to survive in their new environment: Problems erupted when they imposed European cultural values, like property ownership, on people who believed that land could not belong to anyone. Discuss the fact that different cultures have different ways of seeing the world. How can we find ways of acknowledging and living with our differences in a way that benefits everyone?
• How stories change over time. Explain to your kids that many of the tales that endure are often the ones that a select few people—usually those in power—have worked hard to publicize. And sometimes, those are the stories we wish had happened but that don’t really line up with the truth. It’s up to us—kids, included—to learn about and from our actual experiences.
• History has lots to teach us. Discuss how when we’re conscious of and diligent about how we treat one another and honor our past, we can prevent history from repeating in the ways we don’t want and make important changes to our world in the way that we do.

Sure, these concepts are much heavier than the ones in Turkey-Day cartoons, but kids may benefit from them for seasons to come. Here are some more great resources on this topic:   

• Understanding the Real First Thanksgiving
• 5 Ways to Bring Thanksgiving History to Life
• Ask the Mediatrician: How to Discuss Racism on TV?

Enjoy your media and use them wisely,
The Mediatrician®

Do kids in daycare watch more TV than kids who stay home?

Q: I went back to work recently, so now my daughter goes to day care for several hours after preschool. I recently read that kids in day care are watching more TV than kids who aren’t in day care. Should I be concerned about the amount of TV my child is seeing? If so, what can I say to my day care provider about it?
Screen Surprised in Westchester, NY

A: Dear Surprised,

What you probably heard are the results of a new study in the Journal of Pediatrics. The researchers looked at three groups of children to learn more about how much TV they watched. This is what they found:

• Kids in home-based childcare (for example with an aunt or grandmother) watched 5.6 hours of TV per day. 1.8 of those hours were while the child was being cared for by someone other than the parents and 3.8 of those hours were while the child was being cared for by a parent.
• Kids who attended a childcare center watched 3.2 hours of TV per day.  .1 of those hours were while the child was at the center, and 3.1 of the hours were while the child was being cared for by a parent.
• Kids who were cared for by a parent all day watched 4.4 hours of TV per daily.

So what you heard about kids in daycare watching more TV than others is true when it’s a home-based childcare situation, but not when the children are at a childcare center.  Children who were in childcare centers in fact watched the least amount of television among the three groups!  It’s not surprising that of these three groups, it’s the one supervised by people with the most training in child development that sets the strictest limits on screen exposure.

Another thing to take away from this study is that we should also all be paying attention to the amount of time kids are watching TV while they are with a parent. The American Academy of Pediatrics’ guidelines for media use discourage children under the age of 2 from receiving any screen time at all, and they encourage parents and caregivers to limit screen time for kids over 2 (including preschoolers) to 1-2 hours per day.

So why are the numbers in this study so high? Because TV is such a constant presence in our lives that it’s almost invisible to most people. Parents and child care providers may leave the TV on in the background, put it on for the kids so they can get a much-needed break, or even have them watch with the specific goal of learning—after all, educational programming does indeed have merit. But even the most effective shows are designed for a specific age, and if the viewer is younger or older than intended, the show’s benefits are limited. Likewise, too much time spent with even the best programs will take away from other important developmental tasks in your child’s life like engaging in creative play, taking part in physical activity, eating healthy meals, and spending time with family.

For these reasons, just as you discuss what foods your day care providers give to your child, talk with them about the television shows that your child is exposed to while in their care. Emphasize your trust in their intentions as you ask what they have her watch, for how long, and what the intended viewing ages are for those shows. If you’re not comfortable with what you learn, discuss whether the provider can change these habits or, at the very least, whether your daughter can do something else during those screening times. Since the day care providers are acting in your place as your daughter’s nurturer during that portion of the day, it is both your right and your responsibility to discuss what she is viewing and whether their perspective on screen time is reflective—or at least respectful—of yours.

Enjoy your media and use it wisely,
The Mediatrician®

My well-rounded teen wants to play violent, multiplayer games. Should I let him?

Q: My 13-year-old likes to play the Call of Duty games, but only wants to play the multiplayer part of the game. He knows it’s rated Mature, but claims it’s not too violent, bloody, or intense for him—he just thinks it’s fun. My son is very well-rounded: He plays music and sports, and now has gotten into this game. Should I let him keep playing it?
-Game-Puzzled Pop in Metairie, LA

A: Dear Pop:

The answer to your question depends on what you’re concerned about. Given that your son is actively engaged in other activities, it sounds like you’re not worried that it might be getting in the way of other things in his life, so I suspect that your concern is about his exposure to and engagement with the game’s violence.

Many people can play games like Call of Duty without experiencing additional negative effects, but others are affected in much more evident ways. Research shows that when children play violent video games, they are more likely to…

• behave aggressively (and less likely to show prosocial behavior).
• sustain levels of hostility and anxiety after playing, according to the amount of aggression displayed in the game.
• feel desensitized to real-life violence, because when we spend time in a high-adrenaline, high-reactivity environment—even in virtual reality—our expectations for the world and the way we respond to it change.
• have arguments with teachers and physical fights with peers.
• be negatively affected in academic performance, including SAT scores.

We also know, however, that video games in general can be beneficial teaching tools and even have some positive effects on the brain: They can increase kids’ visual attention (though they also tend to make snap decisions based on what they see) and encourage children to communicate positively with their online game-playing peers. But the question is often whether these potential positives outweigh the potential negatives of video games that are this violent.

One way to address your concerns with your son is to ask him about his game play. What does he enjoy about this game? The interaction with other teens? The narrative itself? He probably enjoys the production values, which are quite high in games like this as more captivating the graphics and stories are, the better they sell. It also sounds like he may be using this game as a way to decompress between activities, and as long as it isn’t interfering with other important parts of life, that isn’t necessarily a bad thing. But whatever it is that draws him to the game, there may be a different video game (or another activity) that could fill the same role without the potential negatives. 

Talk with him about that possibility—and, if he still wants to play Call of Duty (which I suspect that he will), offer to play it with him once. Let him teach you about it. You can take that opportunity to ask questions about it and point out parts that worry you. Whatever you decide, I encourage you to remember that people are changed by any media they use, and so your questioning this game is excellent practice for future “Can I please, Dad?” discussions with him.

We’ve received several parents’ questions about Call of Duty. Read more:
•    How does Call of Duty impact teen boys?
•    More Mediatrician advice on violent video games

Enjoy your media and use them wisely,
The Mediatrician®

Further thoughts on “Is my son addicted to Wikipedia?”

Recently, I answered a question from a mother who wanted to know whether she should be concerned that her teen son was spending several hours a day on Wikipedia. When the answer was featured on Ask the Mediatrician and discussed on the Center on Media and Child Health Facebook page, several readers challenged whether this boy's intense interest in Wikipedia or excessive internet time was really that bad compared to other things he could be doing. I agreed with many of these comments and realized that I had not made my thoughts totally clear.

I am so glad to see parents engaged in this issue, and I agree with many of the respondents that the Internet is a place where positive things can happen for media-savvy teens. As I mentioned in the original post, Wikipedia’s crowd-sourced content is extremely valuable for research purposes, especially when students understand the importance of evaluating the sources being used in the articles. In fact, I agree with the growing pushback among some thoughtful bloggers and educators who see Wikipedia, used correctly, as an important information source. As several commenters pointed out, the kind of in-depth exploration and clarification of entries described by this mother is an important aspect of using a source like Wikipedia.  Curious young people interested in research, academia, or literature can use it to detail, clarify and help shape the public’s understanding of topics in which they’re interested.

But this parent’s concern was not over Wikipedia as a source or even the internet as a place to spend time, but about her son’s behavior. He has problems with time management, sleeps poorly, and is clinically depressed. Her research led her to articles about internet addiction, but nothing on Wikipedia per se.

There is no scientific evidence that Wikipedia in particular or the internet in general have a negative effect on young people. However, new research published just this month reveals that kids who spend more than two hours per day watching TV or using a computer are more at risk for exhibiting psychological difficulties, regardless of whether they were sedentary or engaged in physical activity (although the risks of depression were even higher if they didn’t exercise regularly).

It is very difficult to know whether this particular teen I was answering the question about was affected by his screen media use or whether he took refuge in it. Do his online activities contribute to feeling out of control? Or are they an attempt to overcome anxiety or depression by working on a website which he could edit and help control?

As a pediatrician and health scientist, I don’t like labeling problematic internet use with the sensational and imprecise term “addiction.” (As a parent, I know how negative it sounds, especially as it relates to kids.) Television addiction, an equally inaccurate term, has long been discussed as a problem behavior, but neither it nor “internet addiction” currently meet established standards for formal psychiatric diagnoses as I’ve mentioned in a previous column. Some doctors say the term “pathological use of the internet” would be more accurate, even arguing that it merits inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the handbook of psychiatric and behavioral diagnoses. As both a clinician and a parent, I take a pragmatic rather than dogmatic approach: I really don’t care what it is labeled, but if a child’s internet use might be affecting his physical, mental or social health, it is worth a try to alter or eliminate that use and see whether the child improves. If there is no difference, the child’s issues may be unrelated or have preceded his media use. If things get better, the problem is taken care of.

There is still much to be learned about how we are affected by the way that we use media. Discussions such as these, where we share observations and experiences with the goal of greater understanding and control of our media environment, will be a key part of our efforts to improve our health and citizenship in the Media Age. Thanks to all our CMCH fans on Facebook who commented on this post. It is conversations like this that make Ask the Mediatrician the resource it is intended to be. Let’s keep the conversation going!

Enjoy your media and use them wisely,
The Mediatrician®

How should I explain to my child that her favorite pop star is having emotional issues?

Q: My 6-year-old adores singer/actress Demi Lovato: She watches her Disney Channel show, "Sonny with a Chance" (with supervision), listens to her albums, and went to see Demi as her first concert this summer. But now the media are reporting that Demi just checked into rehab for "physical and emotional issues” that may involve an eating disorder and cutting issues. My daughter shares a playground and bus ride with older kids who are bound to be talking about this. There's almost no way we can keep her away from the story, so how do I even begin explaining concepts like rehab, eating disorders and cutting to a 6-year-old?
Star-Struck-Down Dad in Boston, MA

A: Dear Dad,

The most important conversation you can have with your daughter about this issue is one that separates this pop star’s image from who she really is as a young girl. That may require a discussion of how everything we see on TV or hear in music is created: It’s not reality, in the way that you and your child live your everyday lives. Brain development research shows us that children under the age of 7 or 8 have a hard time distinguishing television fantasy from reality, so help your daughter understand that there is a real girl behind the character Demi plays on TV and in concert, and that that girl is under considerable pressure to make lots of people around her happy.

You may want to explain that people treat celebrities differently than they would if they weren’t famous, and that even though the attention feels good at first, it can be very isolating. Imagine not being able to walk down the street or even go to the beach without being swarmed by people you don’t know! Even with lots of people paying attention to them, celebrities often feel very alone and very sad, because that attention is to their image rather than who they really are. And in trying to manage painful feelings, people sometimes do unhealthy things to manage that pain.

You know your daughter best, so you can judge how many details she can handle about how Demi has hurt herself, whether it be cutting or substance use. But research has shown that some girls are already talking about their weight and dieting at age 5. So out of this tragic situation for a beloved idol may come a great teachable moment for your daughter: This is an opportunity to find out whether “fat talk” is already happening among the girls on the playground and the bus. You can explain that to your child that her body should be fed and exercised to be healthy, but that “fat talk” comes out of wanting to be what other people expect rather than who you are—that dieting is not always about being healthy, but about trying to manipulate our bodies to satisfy other people. This is exactly what got Demi into trouble, and what she would never want to happen to her fans.

As your child gets older, you’ll likely have to have similar conversations when other role models make public mistakes. (Read our advice on the topic here.) Keep in mind that research reveals a correlation between teenagers who strongly idolize celebrities and negative self-esteem, though mild celebrity interest doesn’t seem to have the same effects. Remember, the entertainment and advertising industries create and amplify celebrity worship to sell that fictional persona for big profits. In turning human beings into products, media create illusions about stars that are difficult for them to maintain.  Ironically, as stars grow more powerful, they feel less in control. As they grow more loved, they feel more alone. And as the human being behind their character suffers, they can act in unhealthy and unsafe ways in their desperate attempts to regain control of their lives and make themselves feel better.

Enjoy your media and use them wisely,
The Mediatrician®

How do I decide which health websites to trust?

Q: There are so many medical/health websites, resources, blogs, etc. out there on the Internet. For example, just Google, "help with sleep"—more than 33,000 pages show up! Are there guidelines fo  r those not in the medical field with regards to assessing the quality of the website? For example, should they all be affiliated with a medical university or medical organization?
Confused by Dot-Com Docs in Boston, MA

A: It seems that most of us should be asking this question, as more than three-quarters of Internet users have searched for health information online. (In addition, a growing number of us are turning to our cell phones to query mobile web browsers about medical issues and use dedicated health applications.)

Whether you’re searching the Internet or an app for advice on sleep or are just trying to understand your child’s health conditions better, remember that the ‘net is just a tool to access information: It’s a great place to begin your research, but shouldn’t be the final word in healthcare—a trained medical professional can help you assess what you learn online.

Keep these three tips in mind when evaluating online health sources:

• Consider the ‘Rules of Media Literacy.’ These are a series of questions you should ask yourself when looking not just at medical websites, but any media outlet—magazine or newspaper articles, radio or TV stories, etc. The questions are intended to help you think critically about the messages presented.

•    Who is the author of this message, and what is its purpose?
•    What techniques are used to attract your attention?
•    What lifestyles, values, and points of view are represented?
•    How might different people interpret the message differently?
•    What is omitted from this message?

(This tutorial on evaluating medical resources from the National Library of Medicine presents other great points to consider.)

• Ask yourself: What is this website trying to sell? When you take sleep advice from a site that peddles medications or mattresses, it’s likely skewed toward convincing you that these products will solve your problem. You don’t have to always discredit the advice on commercial sites, but do consider them in light of their being primarily marketing tools. Also, question non-commerce sites with repeated advertisements for the same product.  The advantage of going to the website of a medical school or hospital, for example, is that those institutions are selling their reputations as repositories of up-to-date, fact- and evidence-based health information.

• Visit multiple websites; compare advice. It’s a good sign when you see similarities among the health recommendations at multiple sites—this will be true on medical school and professional organization sites. Bookmark the sites that communicate the way you like best and go there first the next time you have a health question.

Our CMCH research blog and the Medical Library Association’s User’s Guide both have more advice on finding and evaluating reputable medical sources online. Additionally, here are two resources written in Spanish: Salud en la Web: cómo encontrar información confiable and Guía de MedlinePlus para una búsqueda saludable en Internet

Enjoy your media and use them wisely,
The Mediatrician®

Is my son addicted to Wikipedia?

Q: For the past several months, my 16 year-old son has been spending several hours a day on Wikipedia, reading and editing entries. (Also he has been treated for depression for the last four months and is doing better now.) In general, he doesn’t manage his time well—he sleeps in at the wrong times and is always late. But we find it difficult to control his Internet time because he needs to use the computer for homework so we never know what he is really doing. I’ve searched for scientific papers specifically on Wikipedia habits, but all I find are articles on internet addiction. Should I be concerned? What can I do?
-Worried about Wikipedia in Boston, MA

A: First of all, your web searches may have been pointing you to the right articles: Even if it seems like an inappropriate term to categorize your son’s behavior, internet addiction refers to unhealthy patterns of internet use, regardless of which websites your child is surfing. Wikipedia may be the website he’s hooked on right now, but it’s the access and availability of content on the internet that fuels addictions, not necessarily the content itself.

Is it reasonable to be concerned? Absolutely. I'm not sure if your son has a lot of good friends, but research shows that teens who don't think they have strong friendships are more likely to be depressed if they are using the internet for purposes other than communication (email, IM'ing, social networking).  So from a health perspective, it’s worth changing your son’s patterns. You can help your son to become a better user of this tool (a computer with Internet access) and one who manages his time effectively by starting with these tips:

1. Move the computer to a public space away from his bedroom. It’s unlikely he would stay up nights in the dining or living room clicking around. Restricting his access to these locations also gives you more of a shared role in his computer use, allowing you to be available if he has school project questions or just needs help staying on task.
2. Teach your son to triage his nightly homework. Divide assignments into three categories: Ones that don’t require a computer (such as reading textbooks or completing worksheets), ones that require using the computer without being online (typing an essay, for example), and ones he needs to be online for (researching, posting to a class blog, etc.). As much as possible, have him move through assignments in that order. When writing a paper, he may need to do online research, then write; have him close the browser after he’s finished with the research portion.
   
   Also, consider having him estimate how long each homework task will take: 15 minutes to finish a math worksheet, 30 minutes to write book report, etc. See how close he realistically comes to each goal. Then, encourage him to make those deadlines on similar future assignments—this is a skill that will serve him well way beyond high school.
3. Discuss Wikipedia’s strengths and weaknesses. As an encyclopedia written and edited solely by volunteers who have expertise on an array of subjects—one that has been praised for its demonstrated accuracy, in fact—Wikipedia is a great place for your son to begin his general research on a topic in order to become familiar with its terminology, major dates, key issues, and other nuances. To move his research from the crowd-sourced arena (where entries are only as accurate as the people who contribute to them) into a more scholarly realm, he should then use either the article’s footnotes or databases from his school or public library to find peer-reviewed articles that can further his study. You may also consider sharing with him this resource on evaluting the quality of sources.

Enjoy your media and use them wisely,
The Mediatrician®