Ask the Mediatrician

Is it okay for my toddler to watch the same Sesame Street movie over and over?

Q: What is the consequence of watching the same Sesame Street movie over and over? It's Sesame Street and it's a movie, and it's only about 1 hour long. So it's not TV, it's not computer, it's not passive. We watch it together and we interact throughout it, with singing and dancing along. My daughter is 2.5 and she would be happy to watch this 2 times a day.
-Watching over and over, in Cambridge MA

A: Dear Over and over,

Your daughter is right at the age where she can really learn from screen media. It is developmentally normal for her to want to watch the same movie over and over (and over and over) again—that’s how she masters the material. The scenario you describe is probably working well for your daughter for a few reasons:

1. The content is developed to support prosocial learning. Part of what your daughter mastering is an understanding of how communities form and how people interact within them. Sesame Street portrays a society where all types of people and puppets from all types of backgrounds (religious, cultural, political) are able to form a successful, dynamic society. And, in fact, research has found that many children who watch Sesame Street exhibit gains in prosocial behavior, as well as in academic readiness and achievement and self esteem.
2. You are watching with her. She learns from what she watches not only by processing what she sees on her own, but more importantly by processing it with you. You help her make sense of the content in ways that work with who she is and what interests her.
3. You are interacting with the material. By dancing and singing along with the movie, you help move her learning beyond skills and drills and into complex communication. You are using the movie as a catalyst for the kinds of interactions and lessons you want her to learn.

In short, you are co-viewing developmentally optimal, research-based educational programming with your daughter in ways that encourage interaction with the material and with you—and that is likely to have a positive effect on your daughter’s academic and social skills. Just remember to make sure that it doesn’t get in the way of the other important things in her day, like sleep and unstructured play.

Enjoy your media and use them wisely,
The Mediatrician®

How can I stop my kids from being 'catfished'?

Q:The Manti Te’o “catfish” story makes me wonder how I can best prepare my teens for future online friendships. My teens say that kids meet through friends-of-friends online and off, but online they just lie about personal information. I’ve always thought that practicing strong communication skills, honesty, integrity, and trust would help my kids grow up to be emotionally healthy adults, but can these traits fully develop if they don’t practice or value them online? How can I help my kids avoid catfish schemes without becoming bottom dwellers themselves? 
-Swimming in murky waters, Chicago, IL

A: Dear Swimming,

To answer your questions about how your teens present themselves online—and how they can avoid catfish schemes—let’s first talk about what’s going on with them developmentally:

1) Adolescents are right in the middle of developing self-awareness and individual identities. Because they are figuring out who they are, they may experiment with different behaviors and personalities—both online and off. Sometimes it seems as if they change personalities as often as they change their clothes.

2) Because their identities are still fluid and forming, adolescents often present, in person or through social media, a mix of who they are and who they aspire to be. So a shy girl may post a picture of herself in a bikini or a boy who doesn’t drink alcohol, but wants to be included in the party crowd, will post a story about getting drunk.

So your adolescents’ online portrayals of themselves do appear dishonest, but it is usually experimental and aspirational - who they think they are or want to be right now - rather than deceitful on their part. “Catfishing”, such as what occurred in Manti Te’o’s case, is more intentional, a deliberate effort to deceive. It may be the work of a shy or insecure person who feels inadequate trying to attract someone they like, so they create a fake online persona. This fictional character can be completely different than the actual person,  and may even use someone elses’ photos, life story and gender (as in Manti Te’o’s case) in hopes of attracting attention. Other  “catfishing” schemes are scams, that try to draw vulnerable people into “relationships” in order to get them to send them money.

It is important that your kids use social media to connect with people they already know, whether through school, the community or through trusted friends and family. They shouldn’t send money or locating information to people whom they do not know – and they shouldn’t arrange to meet those people in person, unless they are in a safe public place and are accompanied by friends or family.

Perhaps the most effective and developmentally optimal way to approach this is not solely as a social media or internet issue, but about how an honest portrayal of themselves can help your kids connect with others in real and substantial ways. Encourage them to think about how they would respond to discoveries that their friends or romantic interests were not who they represented themselves to be. Good relationships are built on honesty and trust. Social media is a great way to connect with people of like interests and a useful venue in which to explore how to communicate and build relationships. Done with foresight and care, it can provide a good foundation for lasting friendships.

Enjoy your media and use them wisely,
The Mediatrician®

Is it ok to let my kids play with the iPad when I need a break?

I have two kids, ages 7 and 2. My eldest is given access to the iPad on car trips and once in a while at home. My younger son likes to sit by his brother while he plays and of late, has been pointing to it and asking for it. There are some days when I have given in, especially during fussy mealtimes or when I need to work and keep him occupied. My question is, will allowing him to play on the iPad once in a while adversely affect his development? Is it a terrible idea to let him use it sometimes just to give Mommy a break?

 - iConcerned, USA

Dear iConcerned,

There’s nothing inherently harmful about using tablets for either of your kids, and it may have some benefits. Tablets require that kids interact with the device both mentally and physically, with their fingers and hands not just watching. Particular kinds of learning can happen when a child sees that his action (like touching an image of a cow) makes something else happen (like a “moo” sound), and tablets can offer that kind of engagement in unique ways.

To keep it positive, pay attention to how long they’re using the iPad – your 2-year-old has a significantly shorter attention span than your 7-year-old. Observe him using it once or twice and you will see that after 15-20 minutes, he will probably look up for something else to do. When this occurs, direct him to another sort of play, with blocks, imaginary play, or going outdoors. This way the iPad becomes part of a rich and diverse menu of experience rather than drawing him back in for another cycle.

 The content each child is using should be developmentally optimal for each child—and that means having different content for each. Here are some tips to manage time and content:

• Choose content with each child in mind. You can use parent reviews from Common Sense Media to decide which apps, books, and games to try out, choosing a variety of activities such as finger painting, making music, and, for your 7-year-old, activities and games with reading, math, and science. Observe closely how each child responds and interacts with the content he is being exposed to, then help each of them choose content that will both interest and challenge them.
• Use it with them sometimes. The way that kids best use technology to learn and grow is with adult interaction and guidance, bonding with them and “scaffolding” their explorations.
• Use the tablet as part of their rich experience, rather than a babysitter. Continue to foster the same expectations for tablet time with your 2-year-old as you have done with your 7-year-old. While it is okay employ the tablet to smooth car rides or even to grab a few moments to work, I would recommend against using it at mealtimes for a host of physical and mental health reasons. It is important that the iPad doesn’t become an expected (or demanded) part of the daily routine and remains a special, once-in-a-while activity.

Enjoy your media and use them wisely,
The Mediatrician®

The Mediatrician’s tips for choosing family-friendly holiday films

The holiday season is often filled with family traditions that are passed on from generation to generation, year after year. From special foods, activities and decorations, to visiting with family and friends, this is the time of the year when we celebrate traditions and look to share them with our children and the ones we love.

Many of these traditions include media, whether listening to a favorite holiday album, browsing online catalogues for gift ideas, or watching televised specials, media can be a wonderful addition to your holiday traditions. Each year brings new holiday films, and many of us remember movies from our own childhoods that we look forward to watching and sharing with the children in our lives. To help you and your family maximize the enjoyment that movies can bring, here are several tips for helping you choose holiday movies wisely: 

1. Choose the movie based on the age of the youngest child in the group. This will help ensure that the content will be appropriate for everyone watching, and not just for the older children and adults.
2. Consider each child individually.In addition to accounting for each child’s age, pay attention to who they are and where they are developmentally as well as their personality.  Choosing a movie with individual temperaments in mind will help everyone avoid feeling confused, anxious, fearful, or even bored during the movie.
3. Start smart family media traditions early. Start smart family traditions while kids are young. Getting teens to enjoy time-honored holiday movies rather than the latest blockbuster –“that everybody else is watching”- has a better chance of succeeding if you start the tradition at a young age. Your enthusiasm and presence can have more influence than hundreds of commercials and marketing ploys.
4. Research the movie before you share. Even if a holiday movie seems light-hearted and fun, it might contain a scary or inappropriate scene, if you haven’t watched the movie yourself or are not sure if a movie’s storyline or message is appropriate, ask trusted friends who have seen the movie for their opinions. Also check out review sources such as Common Sense Media and Movie Review Intelligence. Remember that a movie’s MPAA rating is not based on what is developmentally appropriate for children, so be sure to use additional sources before you make your decision.

Remember to watch the movie together as a family or group, use the pause or fast-forward buttons as needed (for questions, conversation, or to skip scary parts), and talk about what you watched. Hopefully, you will find a film that you and your loved ones can enjoy as a holiday tradition year after year.

Happy Holidays!

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®

Will my young kids be 'missing out' without a smartphone?

Q: I am mom to a 3-year-old and a newborn. I’m careful about the amount and content of my kids’ screen time. I occasionally try to find simple computer games for my toddler to develop keyboard and mouse skills, but I wonder if these skills will be relevant for her in the future. I’m starting to see more and more coverage about kids’ overuse of apps and wonder if my kids will miss out by having zero smartphone exposure.
—App Anxious, Belmont, MA

A: Dear Anxious,

There is a significant amount of research on children and TV viewing, but we are still learning about the effects of tablet, smartphone, computer, and other interactive technology use on their health and development.

It sounds as if you have two questions:

• What is my child learning at this age? Babies and toddlers are learning how to connect with others, how to creatively solve open-ended problems, and how cause and effect work, particularly in their interactions with the physical world. If the app or device you are considering will support one or more of those key tasks, then it may be worthwhile. But remember that an app or device can never replace you as a parent. Continue to prioritize personal interaction, play, or even using an app together.
• How will this help my child in the future? Given how quickly technology changes, the mouse-clicking and finger-swiping skills that your child is learning now probably won't be useful by the time she’s in high school. Think about how dramatically iPads have changed they way we use computers in the past 2 years. Who knows what the technology will be in the next 5, 10, or 20 years? On the other hand, when your daughter experiences cause and effect through direct experience—like building a tower of blocks and knocking it over, or smiling at you and seeing you melt—she develops basic awareness and skills that she will need to navigate the world of the future. Focus on building those skills.

As long as children are given exposure to loving care-takers and an environment where they are able to complete their age-appropriate developmental tasks, they won’t ‘miss out’ by not using apps. Remember is that apps are tools and should be evaluated by how well they will help your child learn now and develop skills for the future. If you choose to bring apps into your kids’ lives, pick apps that you will use with them and that teach real-world skills that they can build upon as they develop.

Please see the below to help you choose developmentally conscious apps:

• PBS Parents
• Common Sense Media

Enjoy your media and use them wisely,
The Mediatrician®

What should I do when my 8-year-old won't stop asking me for a cellphone and other gadgets?

Q: My 8-year-old son sees a lot of kids around him with iPods, iPads, video games, and phones, and keeps asking us for them. Even though we have explained that he doesn’t need all of these electronics and expose him to lots of other activities, the peer pressure is getting to him. What can I say to my son when he asks for yet another gadget [Video]?!
-ifrustrated, in Pawtucket, RI

 A: Dear ifrustrated,

What you’re describing makes perfect sense. Kids at this age start to really focus on fitting in with their peers, and that’s part of why there’s such a strong pull to have what everyone else has. When it comes to technology, this developmentally normal behavior can make it extra challenging to maintain the boundaries you’ve set—especially when other kids have their own gadgets or are allowed to spend more time using them than you allow your son.

Your son is showing that he needs to be involved in making decisions about when and how he uses media. And as he grows and spends more of his day in school or at other people’s houses, he will have more responsibility for maintaining those boundaries himself. Part of your role as a parent is to help him learn to be responsible for his media use whether you are with him or not.

So when your son asks for another gadget, don’t say no right away—instead, involve him in the decision. Have a conversation with him in which you:

• Treat media as ‘tools’—not as playthings. If he’s asking for a smartphone, ask him, “What do you want to use it for?”, and then listen to and discuss his answer. For example, if he wants one because “everyone else has one”, explain that media are tools to be used for a specific purpose. Say that you understand it’s hard not to have what other kids have, especially when it seems like everyone else has it. Let him know that that is not the right reason to get that tool right now, and that you understand if he’s upset.
• Talk about how he sees it fitting into his day. Ask him what he likes to do when he’s not engaging with media [Video], and talk about where those things fit into his day. Then talk about how media can fit in without replacing those other things. By building his schedule around what he does want to include, rather than focusing on limiting media time, you can avoid making media—or this particular gadget—into the ‘forbidden fruit’.
• Address cost. If you would be fine with him having a particular item but feel that the cost is too great, use it as an opportunity to teach him about saving money for something he wants.
• Have him help set rules. If and when you do decide that it’s time to incorporate a new media tool into his life, have him be part of the process of setting rules around how and how often he uses it. Then, as he shows you that he can handle this responsibility, increase his freedom to build his confidence and sense of mastery.
• Remind him that all media—including those he owns—are subject to house rules. Be consistent and up front with the house rules you set around media [Video]. Make sure your son knows that the rules apply to all media, even those his friends bring over and those he buys himself.

Enjoy your media and use them wisely,
The Mediatrician®

My teen loves a role-playing game involving torture, what should I do?

Q: My 16-year-old son loves playing role-play games on the Internet. We recently became concerned, though, when we found out that the plots often involve torture. We are wondering why he is attracted to this kind of play and if there are any long or short term risks we should know about. We wonder if we should totally restrict his Internet access, but realize that this is not truly a realistic option. We do our best to keep the lines of communication open, but we need some guidance as to how to talk about our concerns with him.
-Tongue-tied, in Beverly, MA

A: Dear Tongue-tied,

Seeing your child engaged in this kind of play can certainly be alarming, and your impulse to talk to him about it is right on—but your discussion needs to be driven by reason rather than emotion, or it can backfire. Understanding what might be going on can help.

Kids are often drawn to media violence because it scares, upsets, or alarms them—they are attempting to master the troubling experience. But children who repeatedly engage with it until it doesn’t bother them can become desensitized to not only virtual violence but to real violence as well. This is a big part of the problem with exposure to media violence; it makes violence seem more common than it actually is and changes our beliefs about what’s normal.  

Another contributing factor may be your teen's “big” feelings, which may include a good deal of anger. His interest in these games may be driven partly by a need to explore those feelings. However, engaging in simulated torture is not a therapeutic way to do that. Short-term effects could include signs that he is more on edge, such as increased anxiety, sleep disturbances, and irritability. In the long term, he may see violence as a more acceptable way of addressing conflict.

It sounds like you’ve already set the groundwork for open communication about media messages, and talking about the issue of torture need not be very different. Still, there are some particular approaches that may be helpful in addressing this issue:

• Help him find a way to explore the “big” feelings. Restricting internet access won't make the feelings go away. That's why it can be helpful to have him work with a therapist to find a different, more therapeutic outlet for them, like sports or martial arts.
• Keep computer in public space, like the dining room table. That way he can play in areas where you can see what he’s doing and discuss it with him.
• Open a conversation about this game by playing with him, or sitting beside him while he plays. Ask him to teach you about the game and to explain what’s going on in it, how he feels playing it, and what he finds enjoyable about it. Listening to him can help you learn what needs this game is filling, and can open the door to brainstorming other ways to meet those needs.
• Set limits on content. It may be difficult to be reasonable rather than emotional at this point, but try saying something like, “As your parent, just like I can’t feed you junk food, I can’t let you practice hurting others. I see that you find it exciting, and I know that your rational mind understands it’s only make-believe, but getting used to even simulated torture changes you. I don’t want you to change that way.” Then work with him to find games that excite him but don’t include torture.

Remember that his media interests can offer a window into what he's processing internally, so a combination of setting limits on the content and helping him find another way to explore and process the feelings should serve the whole family well.

Enjoy your media and use them wisely,
The Mediatrician®

With all the gadgets we have at home, how can I monitor my kids' internet use?

Q: I have a 5 and 10 year old and am wondering how I can monitor their internet use. We have a wireless Lynksys system, a Macbook, Wii, Xbox, and a Windows computer. Any thoughts?
-Surfing, in South Jersey

A: Dear Surfing,

There are a number of software and firmware products that claim to monitor and/or restrict children’s internet use, but these products vary in quality, may not be compatible across devices, and I have yet to hear of one that stymies the children more than it stymies the adults trying to use it. Technological fixes can’t take the place of engaging with your children and educating them about internet safety.

First, remember that children of different ages (like your 5- and 10-year-old) have very different developmental capabilities. Teach them separately, giving them the internet skills and tools they need as they become capable of managing them in ways that are both healthy and effective. Ask them to tell you why they are going online, and discuss the specific goals they have while surfing the web.

Here are some technological and non-technological tips that can help as well:

• Place your computer in a centrally located area of your home (such as a living room or kitchen desk) where you can easily see them using the computer.
• Have separate passwords for the computer and internet access (wireless router). My 6- and 8-year olds don’t know either password, so they have to ask to go on the computer—and they have to ask again to go online. That means that, while using the computer, they won’t end up online by accident or on purpose without my knowing and providing supervision.
• Pay attention to your children’s use of smartphones and tablets, as these devices often have apps that seamlessly take the user to the internet. Password protect these devices the same way you do home computers and gaming systems—and enter that password yourself each time rather than giving the password to your child.
• Get comfortable with the hardware and software in your home. This way you will be able to teach your children how to safely and effectively use the internet by modeling it with your own online activity and by routinely and regularly interacting with them when they are online. 

Enjoy your media and use them wisely,
The Mediatrician®