Ask the Mediatrician

Should I let my 14-year-old use the ‘Snap Chat’ application?

Q: My 14-year-old daughter has been begging to get ‘Snap Chat’ on her iPod Touch. I searched for information on it and found this and I wasn’t initially impressed… http://www.hercampus.com/school/pitt/snap-chat-sexting-or-friendly-fun. I am tech savvy and know screen shots can easily be saved, but also, if she loses her device and someone else sends something, she could be held responsible. I don’t like the idea of Snap Chat and am weary of my daughter’s “everyone has it” plea. What do you think? What have you heard about it—risks etc.? 

 Suspicious of Snap Chat, Boston, MA

A: Dear Suspicious,

Snap Chat allows you to send and receive photos that are deleted within seconds (along with any digital trace of them, Snap Chat claims). You have done the right thing by looking into your daughter’s request and by researching the Snap Chat application yourself. Your concerns are certainly valid; images can be quickly and easily saved in other ways as well as distributed.

Many adolescents share devices and passwords as a way of showing how close they are, so even if she doesn’t ‘lose’ her iPod Touch, a friend or classmate could easily ‘borrow’ and send pictures from it. And remember that, unless you turn the location function off, most phones attach location and time/date data to every image, so even a silly picture of her cat on her bed can tell strangers where she is at what time.

In addition to doing your own research and trusting your instinct about any app she may want, there are a few questions you should ask your daughter before deciding whether to get it:

• What does this tool do? What is the purpose of this app/device, and what function will it serve in her life?
• How is she going to use it? Is she only going to use it for silly photo sharing with friends outside of school and other activities? Or is this an app that is used in school and can be a potential distraction for class? Also, how will she control images she receives from others?

When you ask your daughter these questions, make it clear that the ‘everybody else has one’ isn’t a good reason for getting this app or any media tool. If she really only wants to use it for making silly faces at her friends, discuss possible alternatives (making silly faces in person...) as well as the possible disadvantages (e.g., the fact that the deletion isn't foolproof and the pic could get distributed anyway, and the fact that immediate deletion could be a problem in the case of bullying--it could remove the evidence). You may also want to invoke the ‘grandmother rule’—that is, ask her if the pictures she’d be sending and receiving are images that she’d be comfortable having her grandmother see. This emphasizes the risk of unintended distribution that comes with sharing digital images.

Remember that you as her parent have the final say in whether or not she gets the app. After speaking with your daughter, come to a conclusion that will best suit her developmental needs, not necessarily her wants.

Enjoy your media and use them wisely,
The Mediatrician®

Do pop-up ads affect young children?

My almost 3-year-old son loves to watch Caillou on Sprout, a TV channel that carries programming for infants and young children. Throughout Caillou, there are many pop-ups that soundlessly advertise Sprout or the next show that will air. These pop-ups distract me as an adult. Have there have been any studies on how they affect young brains?

Perturbed by pop-ups in Quincy, MA

Dear Perturbed,

Because pop-up ads are relatively new, there’s not a lot of research on how they affect children. But there is research on how splitting attention affects kids. And that’s what happens when an animated ad pops up in the corner of your TV screen—two unrelated visual stories compete for your child’s attention.

Research shows that young children are distracted from playing with their toys when TV is on in the background—something similar may occur with pop-up ads. In fact, these ads are designed to capture viewers’ attention, so they may direct young brains away from the program they were engaged with.

For example, while your son is watching Caillou and learning about sharing, he may be distracted from the plot (and the lesson) by a pop-up of Clifford running, or Curious George swinging in a tree. Because these images aren’t part of the Caillou story, they distract your son and interrupt his understanding of the narrative. And remember that while it’s relatively easy for adult brains to switch between tasks, young brains haven’t yet developed the executive functioning skills necessary to make sense of competing information.

As a consumer and parent, you can write a letter to Sprout and let them know about your concerns. Sprout’s website says that “advertisements will never interrupt a program,” and if you feel that pop-ups do interrupt it, let them know. Not many people write to the producers of any media, whether so one or two letters can really make a difference.

Enjoy your media and use them wisely,
The Mediatrician®

Is having music on in the background harmful to toddlers?

Q: I recently read that exposure to background media (TVs, computers, etc.) can affect a child’s development. Is this true for music as well? I play classical music, light rock, and NPR in the background throughout the day with our toddler. I thought it would be good for her. Is it potentially not so good? 

-Background Beethoven 

 A: Dear Beethoven,

 The concern about background visual media (TVs, computers, etc.) is that, because what they show is designed to grab and hold viewers’ attention, they distract children from brain-building imaginative play and distract children’s parents from interacting with them. Music or talk radio listened to without free (visually stimulating screen savers and flashy album covers on a screen)isn’t as attention-grabbing, but pose similar challenges. Here are some things to keep in mind:

1) Be mindful about what your daughter is paying attention to. Toddlers have not yet developed the executive brain functions that adults use to choose where to focus and direct their attention. Research shows that, even for school-aged children and adolescents, the effect of listening to music while doing homework (an activity that requires a good deal of attention) depends on whether the music has words that they understand. If it does, some of their attention gets directed to the music and their homework takes longer and has more mistakes. For young children with less-developed executive function, coloring, building with blocks, or imaginative play and the resulting requires all of their attention -- and all their attention may get dragged to the music or words. Music can boost brain development when used as a primary activity, imagining scenes that the music evokes, learning the words and singing along, beating time, or dancing.

2) Is the content intended for her—or for you? When you use media of any kind with your daughter, choose content that you can enjoy together. Toddlers will usually tune out the content (but not the emotional tone) of adult talk radio, and it may distract you from her. Save the adult-oriented content for solo car rides or your child’s nap time. That way little can distract either of you from the interactions between you and your daughter that are the single most important stimulus to her developing language, critical thinking, and relationship skills.

3) Leave space for ‘media-free down time’, when all media, including those in the background, are off. This will help keep your child from becoming over-stimulated, help her learn to self-soothe, and will give you both time to interact without any media distractions. Time outdoors without media will calm and focus her, allowing her to fine-tune all of her senses and observe -- feeling the breeze against her skin, watching ants march back and forth to their anthill, and hearing birds sing (the original twitter…). No media can compete with the natural world for building a calm and focused mind.

 Enjoy your media and use them wisely,
The Mediatrician®

My children's school uses TV during rest time, lunch time, and recess--what should I do?

Q: At my children’s elementary school, TV is used every day in kindergarten during “rest time.” For the older students, how TV is used varies depending on the teacher or assistant teacher. Some use it during lunch to keep kids quiet or in lieu of recess when it’s raining or cold outside. Do you know of any research or writing in this area?
—Screens at School?, in Albany, NY

A: Dear Screens,

Unfortunately, research shows that TV is often used in schools or daycares as a way to keep kids quiet—not as a learning tool. That means that kids getting more screentime than parents think.

More importantly, TV isn’t helpful—and is likely a harmful addition—to the activities you mention:

• Use rest time for rest: Although TV can quiet kids, it doesn’t help them rest and will keep them from sleeping.
• Use lunch time be for eating...and socializing: Eating while watching TV makes kids less in tune with whether they’re hungry or full, exposes them to advertising, and gives them less time to socialize, which is an important part of school.
• Use recess for exercise: We also know how important physically active recess is—even on days when kids are stuck inside.

To address this issue, talk to your children’s teachers and to the school’s principal. Ask about the school’s policy on TV in classrooms, and ask how TV is integrated into the overall curriculum. Let them know that using TV to keep kids quiet during lunch or recess will not benefit the kids, and offer information to help them make better educational choices--and to use these technologies in ways that are positive in the classroom.

For more information, see this post: How can we get our 6-year-old's teacher to make better media choices in the classroom?

Enjoy your media and use them wisely,
The Mediatrician®

How do I keep my toddler from throwing a tantrum when I turn off the DVD player?

Q: Each morning while I shower and get dressed, I let my two-year-old son watch 10-15 minutes of an innocuous video. This has worked well to keep him safe and still while I shower, but he pitches a fit every time I turn the movie off, despite the fact that we do this same routine every day and have discussed several times that movie watching is just for when Mommy is in the shower. This is the only transition in his routine that turns him into a screaming monster every single day. I don’t think it’s good for either of us, but I’m not sure what else would be as effective at keeping him safe while I’m in the shower. Any suggestions?
-Showers and Storms, in Boston, MA

A: Dear Showers,

Based on how long your shower routine takes (10-15 minutes) and your son’s reaction to the video being turned off, my guess is that the shower and the video don’t finish at the same time. Toddlers have a hard time leaving a story unfinished, especially when the reason for doing so (in this case, how long it takes you to get ready) has nothing to do with them. And explaining to them that they have to fit to your schedule, as you’ve found, doesn’t really work.

To set you both up for a successful morning routine, think about ways to fit your rhythm to his. Spend some time watching him play to see how long he focuses on one toy or activity. Then, arrange your morning routine so it works with his natural play time, giving him the time he needs to complete an activity before transitioning to the next thing. Here are some other ideas to try: 

• Change the routine. Instead of playing a DVD every morning, introduce other developmentally optimal toys or activities for him to use during that time, such as books, blocks, flexible figures, or imaginative play sets.
  
• When using DVDs, use those that include 15-20 minute stories or segments. Be sensitive to when each segment ends, and stop the DVD at one of those natural end points. Allowing the story to finish should help keep your mornings storm-free.
  
• Give him safe options that will keep him close by. You want your toddler to be in eyeshot (or at least earshot), so bring him and his toys in the bathroom with you. When my children were toddlers, they had a kitchen set in the bathroom, and they had "breakfast" ready for me when I got out of the shower.

The more imaginative the toys and activities you give him during that time, the better! Try things he can watch, figure out, or imagine with, like an ant-farm or puzzle. Then, after your shower, ask your son about what he did—have him show you the block-tower he made or explain the game he invented. This will not only re-engage him in what he did but will also build a sense of accomplishment.

Enjoy your media and use them wisely,
The Mediatrician®

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How can I stop my son from texting while driving?

Q: I’ve been begging my teen son not to text while driving, but I know he does it anyway. What can I do to get him to stop?
--Texting and Driving in Beverly, MA

A: Dear Texting and Driving,

You’re right to be concerned--according to a new study from the CDC, one third of U.S. teens report texting while driving. The issue has come front and center this past week, when an 18 year old became the first person in Massachusetts to be convicted of causing a fatal car crash while texting.

But stories like this and state prohibitions on texting and driving may not get the reaction you're looking for from your son. Research shows that knowing it's dangerous doesn't necessarily deter some young adults from texting while driving. And because his brain won't be able to fully process long-term consequences until he's in his 20s, the idea that an accident like this could happen to him may just not feel real.

To get the message across, try approaching the issue in a way:

1. Make sure to touch on consequences that he can grasp. Although it's important to talk about the very real dangers of texting while driving, it might help to also discuss those that are closer to what he has experienced--like not being allowed to drive. The young man who was convicted this week had his license revoked by a judge for 15 years.
2. Work with him to establish clear rules for cell phone use. He'll want to have his cell phone with him when he's in the car, but it doesn't have to be a distraction. Ask him what would help him keep his eyes on the road--turning the phone off completely? Leaving it in the glove compartment or the trunk? If he owns the solution, he is more likely to feel ownership of it and to abide by it.
3. Together, create real consequences for not abiding by the rules. Agree ahead of time on what happens if he does text while driving. Maybe for a period of time he loses the privilege of driving the car--or of having a phone.
4. Praise what he does well, and follow through on the consequences when he slips up. Both will reinforce how important this issue is.
5. Model the behavior you'd like to see--and put your phone away while you're driving, too. He will listen far more closely to what you do than to what you say.

Enjoy your media and use them wisely,
The Mediatrician®

What can I do for my 15-year-old son, who has Asperger's and ADHD and seems addicted to video games?

Q: My son is 15 and displays symptoms of video game addiction, including lying and sneaking to try to gain access. He has Asperger’s and ADHD, and regardless of what medication regimen we try, the gaming obsession remains. I recently asked the psychiatrist to hospitalize him and treat him as they would other addicts, but they just changed his meds. Anyway, even if he were treated, he needs the computer for school. Do you have any advice for me?
-Dealing with Addiction, Orlando, FL

A: Dear Dealing with Addiction,

Unfortunately, more and more families share your story. Whether through sleep deprivation, anxiety, or social isolation, teens struggling with problematic video game or internet use are suffering, and their families are disrupted. And research shows that young people with ADHD may actually be more susceptible to problematic video game or internet use.

Part of why it’s so hard to find good treatment is that these symptoms have yet to be recognized as a formal psychiatric diagnosis in the U.S. (unlike in South Korea and China, where clinics, hospitals, and “detox” centers treat Internet Addiction Disorder). Still, there are steps you can take to help your son:

1. Keep working with mental health professionals. Make sure that his providers recognize and respect these particular problems.
2. Optimize his treatment. Just as youth with ADHD learn more effectively in the controlled computer environment than in the chaos of a classroom, they are also at higher risk for problematic internet behaviors. Similarly, the social awkwardness of Asperger’s syndrome feels more manageable online. That may be why there’s some evidence that problematic behaviors may decrease or disappear underlying issues are addressed in therapy and any medication is optimized.
3. Move his computer and internet access into common space. Your presence will help you help him regulate his computer behaviors. Be aware that smartphones and many portable digital players are wireless internet-capable, so treat them similarly.
4. Find diverse activities that fill his needs. Look for pursuits that have clear rules, and achievable goals, and that allow him to move at his own pace. Rock climbing or a martial art like tae kwan do or karate would build his mindfulness and self-discipline, while also providing exercise and positive social interaction.
5. Get him outside. Being immersed in nature has a calming and focusing effect. It can also be an effective context for treatment—wilderness therapy has worked wonders for some of my patients and could be a good option for your son.

Remember, too, that when used in moderation, computers and video games can help young people with ADHD and Asperger’s learn, grow, and thrive in ways that they cannot in more traditional educational and social contexts. For more information and resources, take a look at this website.

Enjoy your media and use them wisely,
The Mediatrician®

Could my 14-year-old son's anxiety be related to playing video games?

Q: Is there a connection between excessive video game playing and increased anxiety levels? My son is 14 and has some basic anxieties like walking the dog at night that I feel are made worse by the first-person shooter games he plays. I’d love to understand if you have seen any connections here.
-Grappling with Gaming, in Westfield, NJ

A: Dear Grappling,

As a parent, you are the best monitor of your son’s well-being. If you have seen an increase in his anxiety that has paralleled his increase in first-person shooter (FPS) game play, then it is probably worth seeing what happens if he cuts back on or eliminates playing these games. Research supports what you are observing—it has found that children and adolescents frequently respond to media violence with increased fear and anxiety, because action entertainment makes violence seem more prevalent than it actually is.

Suggest that your son stop playing video games for a while. This will be easier said than done—he will not want to stop playing, and he will probably resist in every way he can. Talk about your concerns with him, and remind him that his resistance may, in fact, indicate that he might be developing an addictive relationship with gaming. If nothing else, he will stop because he wants to prove he can. Then pay attention to his behavior and see whether his anxiety diminishes.

If he doesn’t think he can stop gaming or the anxiety doesn’t go away—that is, if either piece is limiting his life in some way—then it would be good to have him evaluated by a therapist. And remember that anxiety can affect a teen’s well-being in subtler ways, such as through increased distraction, which could appear to be ADD/ADHD.

Finally, encourage your son to pursue other activities he enjoys. Increasing physical activity and getting outdoors can reduce anxiety and increase quality of life in all kinds of ways.

Enjoy your media and use them wisely,
The Mediatrician®

Are static images on TV harmful to toddlers?

Q: When our 14-month-old son was born, his pediatrician told us to avoid screen time, so we do not allow him to watch TV and we rarely have it on while he is awake. But, we subscribe to a music service that streams through the TV. When the songs play, the album covers are shown on the TV screen. A friend told me that seeing the album covers has the same neurological effects as if he were watching a TV show. Another friend says that because the album covers are static images, there are no detrimental affects. Can you please clear this confusion up for us?
-Music Mystified, in Los Angeles, CA

A: Dear Mystified,

Your second friend—the one who says that the effects are reduced because the album covers are static images—is closer to right. Our brains are wired to pay attention to things that change in our environments. That’s why we turn to look when someone walks into the room or when the image on a TV shifts.

It’s also why screens can draw the attention of even young children who can’t yet understand what they’re seeing. The static image of an album cover almost certainly won’t hold your child’s attention in that way. However, he may turn to look each time the image changes, which could interrupt his play.

I would recommend watching your son while the music service is on. Does he turn away from what he’s doing to look at the screen? Does he pause in his play?

If so, a simple fix would be to see if your TV has a brightness control and, if so, to turn it all the way down. If it doesn’t, hang a sheet over the screen when your son is in the room. That should help reduce any distraction and allow him to focus on free play, which is one of the things he most needs.

Enjoy your media and use them wisely,
The Mediatrician®

Will media affect my 4-year-old's ability to pay attention?

Q: I’m wondering if you would consider the results of research that has examined relationships between media and inattention to be conclusive. It seems that even on this website, some researchers find a connection and some don’t. Do the results lean in one direction more than the other? I have a 4-year-old son who is following in his father’s media-obsessed footsteps, and my very serious concerns are going unheard.
-Anxious about Attention, Amherst, MA

A: Dear Anxious,

You’re right that individual studies on this topic have mixed results. But, as you imply, parents (and pediatricians) have to make decisions for their kids well before there’s definitive proof of what is healthful. My approach as a parent and recommendations as a pediatrician are based on what seems to be the safest route. In this case, if there is a chance that watching lots of TV may increase the risk of attention problems, that risk outweighs the benefits.

To be more specific, some studies do show that when kids are exposed to screen media in their early years, they may struggle with tasks that require attention when they are even a bit older and may display more behaviors associated with attention deficit/hyperactivity disorder. And perhaps more importantly, the research overall shows that it’s important to limit screentime and to use it in focused ways to help support children’s ability to pay attention.

That’s part of why it’s important to set media limits for your son. He needs lots of time to do other things—like play outside, eat dinner with you, read books, and explore his physical world. Including screen media in the list of activities can certainly be beneficial, when the content is designed for kids of his age, when it’s used in small quantities that match his attention span, and whem it doesn’t replace other important activities of daily life.

One way to approach your concerns about your son with his father wo  uld be to together observe how your child acts before, during, and after media use. What specifically do you see that worries you—even if it’s not directly related to attention? Is it that he asks constantly for more TV time? Is it that he can’t settle down after watching a show? Does he seem to behave more aggressively after than before? As the two of you observe and talk about this, think about how you usually make decisions for your son’s health, and apply those same principles to the question of media use.

Enjoy your media and use them wisely,
The Mediatrician®