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®

Should we keep kids away from media after the Boston Marathon bombings?

Dear Readers,

Our hearts hurt after Monday's explosions at the Boston Marathon. The pain and shock in our community is palpable, and it’s hard to know where to go from here.

But there is also a remarkable upsurge of help and love that sprang out of the shadow of this event. The Center on Media and Child Health is at Boston Children's Hospital, one of the many area hospitals that leapt to care for those who were injured in this attack. In situations as horrifying as this, Fred Rogers say “Look for the helpers”. Well, we are looking—and we see them everywhere. 

There are many wonderful resources to help guide you in talking with kids about this event (like Helping Kids Cope with Tragedy, How to Talk with Children about Boston Marathon Bombs, Helping Children Process the Boston Marathon Bombings). In addition to making space to talk with children and process their feelings about what’s happened, think about how to use media in ways that offer support:

• Limit exposure to the news for children of all ages. Think about who is in the room before turning on the news and when deciding how long to leave it on: 
  • Babies and toddlers: Even very young children who don’t understand what they’re seeing can sense and respond to fear in the adults around them.
  • Preschoolers and school-age kids: For those old enough to make sense of images on the screen, seeing them even once can really make an impact—and seeing them replayed over and over again can escalate feelings of fear. Younger children may even think that the explosions are happening again each time they are shown on TV.
  • Tweens and teens: Older children, too, need space from the images. They are more likely to understand that the images are real and so may feel a greater sense of threat, and that can compound when they hear the reports repeatedly.
• When they do see media images, look for the “helpers.” Ask kids to point out the people they see helping. Everyone from EMTs to policemen to people simply standing on the sidelines or actually running jumped forward to help those who were injured. Looking for the stories of bravery and selflessness can help kids feel hope.
• Look for messages of support, which can bring comfort. It may help kids—especially older kids—to feel a sense of unity and community when they see messages of support from people around the U.S. and around the world. Take a look at images of people in Kabul holding up signs expressing support, or messages of love projected onto the sides of buildings in New York.
• Connect with far-away family and friends. Mobile phones and streaming video can let kids see the faces and hear the voices of loved ones, which may help reassure and comfort them.   
• Listen to favorite songs and read favorite books. Media like these can be particularly comforting in times of great stress.  

Remember, too, to make media-free space for processing and healing. Bring kids outside for a walk in nature, which can help with calming and feelings of well-being, and make time to connect and let them know that you love them. 

Peace, health, and freedom from fear to you and your loved ones,
The CMCH Team

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®

We gather together.

Thanksgiving is considered a time of reflection, giving thanks, family togetherness, and, of course, delicious food. But when all the toasts have been made, the plates cleared, and the leftovers tucked away, it can be easy to fall into a state of media mindlessness—dozing off in front of the TV, checking cell phones for scores and status updates, and scrolling through endless tweets about just how much food everybody ate.

Thanksgiving break offers an opportunity to do just that, break the usual habits and get back to reflecting and connecting.  Make a conscious effort to turn off your media and engage with your loved ones. Whether your teen is home from college, your middle schoolers are on school break, your toddler is bored in the house, or you have extended family visiting, there are great activities that you can enjoy together:

• Enjoy some media-free time. One skill that has suffered in our “constantly connected" media-driven culture is the ability to sit quietly and think. A global experiment in turning off electronics for 24 hours raised loud and angry objections from the 1,000 college students across 5 continents… but 2 weeks later, they realized how rich their lives, relationships, and internal worlds were. “I’ve lived with my best friends for 3 years – this is one of the best days we’ve spent together.” See how long you can go without – and see what you discover in yourself and those you love.
• Get outside. Toss a football with your son, all too soon he won’t be interested in playing catch anymore. Take a walk hand-in hand with your daughter. Just sit and watch the lengthening shadows dapple the last few leaves on the trees.  
• Have family game time. Play cards, board games, or (after the turkey is digested) active games such as Twister, where you jostle, laugh, succeed and fail as a family.
• Be spontaneous. Do something that you don’t have time to do in your regular schedule, like visit a museum. From local town attractions to larger city institutions, many communities have exhibits that are geared for family enjoyment. Surprise yourself, from learning about your town’s history to looking at the stars, museums offer opportunities to be together that is both enlightening and fun!
• Eat, cook, and clean up as a family. While the big turkey dinner gets all the attention, there will be other opportunities to eat together as a family. Flex your creative muscles to come up with clever reincarnations out of leftovers. Be Iron Chefs and see who can come up with the most creative dish. If you are not already doing it, this is a great time to start the daily tradition of having a sit-down family dinner – the single most successful strategy for avoiding obesity, but also a host of physical and mental health problems. But leave the TV off and the phones in another room – the benefits of the meal come from focusing on each other and what you have to share.
• If you use media, use it together. Watching TV, checking email, surfing the web, texting, tweeting, updating, and gaming can distance us from each other, but they don’t have to. During the long Thanksgiving weekend, try using media as a family activity where everyone participates. Watch your college student’s latest YouTube video, see a family-friendly movie, or play a video game that everyone can enjoy (just don’t expect to beat the kids… ever). This can be a great time to model mindful media use as part of as healthy, diverse life and spend time together in ways that are healthy and enjoyable.

 Hug your kids, eat well, 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®

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 my kids experience nature when we live in a media-saturated city?

Q: I live in a big city with my 3 year old son and 1 year old daughter, and I’ve noticed that children who live in such cities spend a lot of time playing on cement playgrounds and on the Web. I know that spending time in nature is good for children’s development, but how can we take advantage of that given where we live? Do we need to take them to the country to get those experiences?

—Nonplussed about nature, in São Paulo, Brazil

A: Dear Nonplussed,

Although the internet and playgrounds offer their own benefits, nature offers experiences and sensations that can’t be replicated in or replaced by any human-made environments. For example, being in nature can give children a sense of connectedness to the outside world—they can watch clouds morph or a butterfly moving from flower to flower, and they can watch things unfold that are outside their control. This is a great experience to have at any age. But getting outside can be a challenge in areas where there are safety concerns or few public green spaces.

A visit to somewhere with more accessible outdoor areas—whether a farm or a state park or a town square—can be a wonderful experience for a child, but you can also help her notice the nature right where she lives. Cities often have parks where children can explore and play. Children can also bring nature into the home by planting flowers in window boxes, tending a terrarium in their room, or taking care of pets.

Integrating safe outdoor spaces and indoor nature into any child's life can help build her connection to nature, which supports healthy development. And it can help her learn to balance media time with the wonders of nature as she navigates through her modern world, no matter where she lives.

For more information and for tips on how to integrate nature into a child’s everyday life, check out:

• Last Child in the Woods, by Richard Louv
• Children and Nature Network
• National Wildlife Federation
• Crianças: contato com a natureza equilibra o sistema imunológico (video in Portuguese)

Enjoy your media and use them wisely,
The Mediatrician®