Ask the Mediatrician

How can I tell if an e-book is appropriate for my 10-year-old?

Q: With the purchase of a couple of e-book tablets for our home, how can we know if the books our 10-year-old triplets will be reading on them are age appropriate? My daughter read a book she heard about in her 4^th grade class during a book report, and it ended up having significant sexual content and very questionable language. If it were a movie, it would have been rated R!
—Troubled Tablet times 3, Kinnelon, NJ

 A: Dear Troubled Tablet times 3,

It can be a difficult task trying to figure out if a book is developmentally suitable for your child. The old adage “you can’t judge a book by its cover” still holds true, even in the age of e-books. Fortunately, there are several ways to make an informed decision about whether it will be a healthy read for your child. If there is a particular book your daughter is interested in reading, like the one she heard about in her book report, review the content in one of these ways:

• Read the book yourself. As a parent, you know your child better than almost anyone else. If you are able to read the book before she does, you can see whether its content is optimal for her and can direct her to other books if you decide it isn’t.
• Sample the story. Even though one small section of the book may not accurately reflect the whole story, a chapter or two can give you a taste of the book’s content (and its level of difficulty). You can go to a library or bookstore, or you can preview chapter or two for free wherever you buy e-books.
• Start a book club. By reading and discussing the book with your daughter—and possibly with other mother/daughter pairs—you can help her process the content and her feelings about it. That may allow her to engage in more challenging material in a supportive environment.
• Check out an expert resource. Since you won’t be able to read everything that your child wants to read, look for reviews from resources you trust (try this one or this one).

When you do find books that meet your daughter’s needs, be sure to share them with others—in your book club, at your child’s school, or even by adding them to a trusted resource list.

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®

How can I encourage parents to be involved in their kids’ online lives?

Q: My 16-year-old goddaughter’s parents are not Facebook friends with her, so when someone stole her phone and posted some degrading things to her account, they didn’t know until I told them. Another friend asked me to look at all her 19-year-old daughter’s pictures and let her know if I saw anything inappropriate. How can I encourage parents to become involved in this important space so they can do the sorts of parenting they’re asking me to do?
-Pixed Up, in Memphis, TN

A: Dear Pixed,

Suggest to your friends that they think of social media like they think of driving a car: Teens may be legally able to do it, but they still need support from someone with more life experience and a fully formed brain to learn to use it responsibly.

The idea of getting involved in teens’ online lives may seem daunting, though. Teens are digital natives, and technologies change so rapidly that it’s hard for their digital immigrant parents to keep up. Unfortunately, many parents feel so uncomfortable or clueless that they don’t even try to parent or protect their children in the digital realm—and both kids and their parents assume that this is private space.

In reality, though, the online world is part of their real world: U.S. 8- to 18-year-olds use media for about half of their waking hours, and for more time than they spend with parents or in school. It has become an important environment for many key developmental tasks of adolescence, like seeking out experience, building identity, and practicing social interaction.

Because such processes can be as confusing and difficult to manage online as offline, your friends have a lot to offer by “friending” their teens and opening conversations about what’s happening online. And this is where their status as digital immigrants can really help—they can ask their teens to teach them about their world. Remaining open and non-judgmental about whatever is shared can make teens respected and valued, which will allow the parents to start a supportive dialogue about life online. For ideas on where to go from there, see this CMCH resource on “The Internet Talk.”

Enjoy your media and use them wisely,
The Mediatrician®

How can I block sexual content in Web searches from my 15-year-old's iPad?

Q: What is the best way I can block websites with sexual content that appear through Web searches on my 15 year old’s iPad and still let him use the Internet for safe sites? The built-in controls are a blunt instrument and block too much or all content.
-Seeking Better Blocking, in Nashville, TN

A: Dear Seeking,

As you’re finding, software controls aren’t very effective at blocking sexual content. They may allow sites that are creatively named while blocking innocuous sites on, say, breast cancer awareness. Also, if your son wants to get around them, he will. That’s why the best software for protecting your son is the knowledge in his head.

First, know that it’s natural and healthy for him to be curious about sex. But as you imply, the world of sex online is a minefield: The images he sees there are likely to be unrealistic, dehumanizing, and treating sex as a commodity—as something to buy and sell rather than an intimate expression of love and trust. That can affect his understanding of sex.

That’s where you come in. As a parent, you can direct him toward online information that will support him in developing positive sexuality (take a look at Scarleteen and GoAskAlice). You can also help him interpret the negative portrayals he sees online by having a candid conversation with him. Ask questions like, “What is really going on there?”, “How do you think that makes her feel?” and “Is that the kind of relationship you want to have?”

The more that his sexual education can occur out in the open and in contact with you, the less of an impact the schoolyard or Internet “sex ed” will have.

Enjoy your media and use them wisely,
The Mediatrician®

Is age 7 too early to learn keyboarding?

Q: My 7-year-old twin granddaughters have spent less time with computers than most kids their age. Recently, their school has started to teach keyboarding. Those who have spent a lot of time on computers are learning quickly, while my granddaughters are feeling a bit behind. I think that the girls will eventually catch up (and have reaped many benefits from less computer time in early childhood), but their mother is worried—both that they will stay behind and that it’s too early to for them to learn keyboarding. What can I tell her?
—Early-Childhood Ally in Winnetka, IL

A: Dear Ally,

First, there’s no need for your daughter to worry that her twins will be left behind. Although their peers are ahead of them right now, their developing brains should pick up this new skill fairly easily.

In terms of when to introduce computers, here’s a good rule of thumb: Introduce any media tool when children actually need that tool to complete the important tasks of daily life, including schoolwork. If the school is using computers in a thoughtful, education-focused way, then it isn’t too early to teach skills that will help your granddaughters use them effectively.

Recommend to your daughter that she talk to the teachers or principal and ask what role computers play in students’ learning. For example, what are the expectations about how kids use computers? What other tools are they learning to use for tasks that computers aren’t best for? And how are skills like online safety and cybercitizenship being taught?

Talking about this with the school should ease her mind—or, if she learns that the school isn’t using computers as thoughtfully as she’d like, it will provide an opportunity for her to offer suggestions.

Enjoy your media and use them wisely,
The Mediatrician®

Am I being paranoid if I don't want to post pictures of my baby on Facebook?

Q: I am a new mom, and I’m not sure how I feel about posting pictures of my baby on Facebook. Nearly all of my friends do it. I can understand the need to remain connected to family and friends and to show off your beautiful child, but this makes me uneasy. As we know, once something is posted, Facebook owns that content, even after we delete it or cancel our account. Plus, anyone can copy it and use it however they want. None of my peers seem worried about this—am I being paranoid? What impact will having one’s entire life documented online have on these children as they reach adolescence and adulthood?
—New Mom in Medford, MA

A: Dear New Mom,

You’re right—when you post information online, it can spread rapidly and never really goes away, and you give up control over how it’s used. That’s true of all kinds of images, from the mildly embarrassing (a five-year-old naked in a tub) to the overtly incriminating (a teenager holding a beer at a party). Because the technologies are so new, we don’t know what effect these postings will have on kids as they grow up (other than what we can guess from how they respond to snapshots of their 5-year-old selves in the tub)—either emotionally, professionally, or legally.

So when deciding how to manage sites like Facebook, think about what you do know—remember that pictures of your child will end up not only on your friends’ pages, but can be reposted on their friends pages, and their friends’ pages, and on and on. If you want to show off your beautiful baby to lots of people you don’t know, then posting on a social media site like Facebook is fine. But if what you’d really like to do is share images of your baby with specific people whom you love and trust, then I would suggest setting up a personal photo account and sending links to that instead. 

In the end, go with your gut. If you don’t feel comfortable posting your baby’s picture on Facebook, don’t. You can always share pictures in other ways. Or choose carefully which to post for the public to see and which are really just for friends and family, and share them accordingly. 

Enjoy your media and use them wisely,
The Mediatrician®

When is it time for my daughter to get an email account?

Q: At what age do you think it is appropriate for a child to have a personal e-mail address? I have a 10 year old who wants one, but I don’t feel she is old enough. I think she can be trusted and has proved to be responsible, but it’s the world out there I worry about. How would we block inappropriate e-mails?
-eQuestioning in Mansfield, MA

A: Dear eQuestioning,

Treat personal email like any other tool: When it’s the right tool for the job at hand—whether that job to communicate with loved ones or to send homework to a teacher—that’s the time to introduce it to your child.

But that doesn’t mean her email needs to be private. In fact, as your child starts using this tool on her own, your supervision and guidance can help her learn to navigate that world safely and successfully. Start with an email service that allows you to access her account, set controls, and review emails yourself before she sees or sends them.

As you and she gain confidence in her email skills, give her more independence and freedom bit by bit—perhaps by checking less often and starting to let her monitor her own email, with the clear and explicit understanding that you are passing to her the responsibility to keep her email healthy and safe.

And no matter how much freedom she has with email (and with texting, which has already eclipsed email for peer-to-peer communication), check in with her continuously, and make sure she feels safe, supported, and able to reach out for your help. For more information, see these other answers:

• How can I protect my child when she's learning to use email?
• How should I get my kids set up with their first email account? 

Enjoy your media and use them wisely,
The Mediatrician®

How can I find educational video games for an 8-year-old boy who likes war stuff?

Q: Do you have suggestions for how to find appropriate media, such as educational video games, for different ages, such as an 8-year-old boy who likes war stuff? I’d like to help direct him to more creative sites. 
-Seeking solutions, in Burlington, VT

A: Dear Seeking,

It’s not always easy to know which video games will be exciting and engaging for a child and will teach him things you’d like him to learn. And you’re right: he will learn from whatever he plays, so your impulse to direct him toward games that teach positive lessons is a good one.

Remember that many boys of this age are interested in “war stuff,” and it’s actually developmentally appropriate for them to sort out how to resolve conflicts and master the complexities of winning and losing at this point in their lives. This often why they might like books about war and war-based games, like football and chess.

That said, there is a distinct difference between playing first-person shooter video games and reading war stories or playing chess, where the images of conflict are created in the player’s imagination. Video games are created by adult imaginations, informed by greater life experience and psychological defenses—and the best-selling games, which generate the greatest marketing “buzz”, are increasingly graphic and realistic. Because the player is not creating the images from his own experience bank, he may have difficulty handling or even forgetting these intense and scary virtual experiences.

The trick is to understand with him what he likes about war games—whether it’s that they allow him to role-play, that he likes being part of a developing storyline, or that they challenge him to strategize or solve problems—and then to look with him for games that present these challenges but that set game conditions and teach skills you want him to experience.

To do that, when he mentions a specific game, ask, in a non-judgmental way, “What do you like about this game?” Then, take a look at some parent-oriented reviews, many of which will give you more information about the game than the marketing or even the ESRB rating. You can take many games out of your library or demo them at a game store or on a website. If you think the game is a good match for him, great! If not, use the parent reviews to look for another that he’ll like and that educate him in the ways you’d like to educate him.

Enjoy your media and use them wisely,
The Mediatrician®

Do you have any last-minute tips for holiday shopping?

Q: I'm doing last-minute holiday shopping, and I still don't know what to give! How do I know what to choose for the children in my life? The choices are overwhelming!
-Holiday harried, in Medford, MA

A: Dear Holiday harried,

Never fear! Even as time grows short, you still have time to take a breath and think about what to give the children on your list this holiday season--whether you're giving media or non-media gifts. No matter what you choose, remember to keep the CHILD first:

• Creativity: Think creatively about who the child is & customize your gift.
• Homework: Do your homework to make sure the gift matches the child.
• Imagination: Stimulate their imagination with gifts they can use creatively.
• Learning: Encourage learning with gifts that peak their curiosity.
• Donate: Teach about giving by helping a child make a donation.

Take a look at our media shopping gift guide if you're considering giving media gifts. If you're looking for non-media gifts, check out our non-media gift ideas. And remember, some of the most meaningful gifts are free.

Enjoy your media and use them wisely,
The Mediatrician® 

My teens want to start a blog together--what are the pros and cons?

Q: We have a 16-year-old daughter and a 14-year-old son who are at the same school. They have voluntarily given up Facebook because of the time drain it can be, and both have fairly heavy academic loads. They are interested in starting a blog together. What are the pros and cons?
-Benefits of Blogging in Roseville, CA

A: Dear Benefits,

What a great way for adolescent siblings to connect and use their creativity together! This kind of self-expression that can be incredibly powerful—even therapeutic—for teens pursuing the developmental tasks of finding themselves and connecting with their peers. But it can also be as much of a time sink as Facebook. To help them focus their efforts and make the time they spend on this project rewarding and positive, ask your teens these questions:

“What is the mission of your blog?” Do they want their blog to focus on sports, or music, or issues in their school, or what it’s like to be a teenager? Maybe they want to offer their different age, grade level, and gender perspectives on issues that interest them both. Having a vision and mission will help them focus their blog, limit the time they spend updating it, and create a unique niche in the blogosphere that will draw readers.

“Who is your audience?” Knowing who they’d like to have read and respond to their blog will help them focus their posts. They should choose what they write with an understanding that the blog will be accessible and interesting to many people—like teachers, coaches, grandparents, friends, and crushes—and not just to their intended audience.

“How will you handle comments?” Blog comments can lead to productive, exciting conversation, but they can also be a breeding ground for gossip and attacks. If your teens want to allow comments on their blog, encourage them make themselves moderators of the comments, so that no comment actually posts without their approval. That can help them create a space for thoughtful, responsible, useful communication—and prevent the bullying behaviors that could occur there.

Enjoy your media and use them wisely,
The Mediatrician®