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®

My 10-year-old-daughter was frightened by a pornographic video, what do I do now?

Q: My 10-year-old daughter had a sleepover with 3 friends. It turns out that one of the girls brought a smartphone and pulled up some porn. My daughter is still quite traumatized by what she saw, and my husband and I are trying to figure out how to counsel her. The girls saw three explicitly pornographic videos, which she described to me in detail. What can do to support her? What implications might these images have on our young daughter’s developing views of sexuality?
-Culture Shocked in New Delhi, India

 A: Dear Culture Shocked,

It’s tricky when kids who are forming their sense of themselves as sexual beings are exposed to portrayals of sex in the media, which are often unrealistic and dehumanizing. It can certainly affect their understanding of how sex and relationships work. To address that challenge, first help your daughter make sense of what she saw. Nurture her and share her discomfort, asking empathetically about her feelings, and, most importantly, listen to her without judgment. Let her talk as long as she needs to, and ask questions when it feels right.

Then take some time to put what she saw in context. Explain that, just like her favorite movies, pornography is a manufactured fiction that exaggerates, sensationalizes, and makes superficial something that can be a very special experience of intimacy and trust. What she saw was made-up stories and the people in them are actors who were paid for what they did. Talk with her about what I call “the five C’s” of healthy sexual behavior:

• Closeness
• Commitment
• Consent
• Contraception
• Consequences

These are rarely present in media portrayals of sex but are extremely important in real life. Spend some time with her looking for positive representations of relationships and intimacy that include those 5 C’s. Direct her to resources you trust for healthful, accurate, age-appropriate information on sex and sexuality.

To help her manage future situations like this, let her know that she doesn’t have to stay in a situation that makes her uncomfortable. Encourage her to say that she doesn’t want to watch those videos, or if she doesn’t feel comfortable doing that, to make up a reason to leave the room. Let her know she can always call you to come pick her up, and that she can always talk to you.  

Finally, use this as an opportunity to discuss internet safety more broadly. Let your daughter know that while the internet can be a wonderful tool, you can’t take everything you find at face value—there are people who are trying to sell items or ideas, and they don’t always have your daughter’s best interests at heart. Giving your daughter the skills to navigate the internet and offering yourself as a resource when she needs help will equip her to trust her own instincts in the future if she is exposed to something she finds confusing or upsetting.  

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®

How important is outdoor recess for children in elementary school?

Q: Hi, I am a parent of a first grader who attends public elementary school. Her school offers the option of having an outdoor recess period after lunch or an indoor free-time in the school’s media center (essentially an extension of the library, featuring several computers, tablets, and eReaders). When I first heard about this option, I thought it was great and could potentially sharpen her tech skills. However, it seems that she chooses the media lab more often than outdoor recess (she says she likes the ‘games’), and I worry that she isn’t socializing with her peers enough and participating in enough physical activities (even though she has gym three times a week and is in good shape). Any advice you can offer will be appreciated—thanks!
-Ruminating over recess, in NH

 A: Dear Ruminating,

You have reason for concern about your daughter missing out on outdoor recess. In addition to being a great way to get exercise, recess has many cognitive, social, emotional, and physical benefits for children (see the recent American Academy of Pediatrics policy statement here).

Outdoor recess offers a break from the normal pressures of the school day and provides an opportunity to experience nature, not just physical activity. Nature has rhythms and rules of its own, that software can’t duplicate. Watching a robin feed its young or ants carrying food can be a wonderful way to learn about these rhythms and can also help calm and center oneself.

In addition, unlike solo media center play, outdoor recess is communal. That means it’s great for social development, which is a key task of elementary education. Having a safe, supervised time for free play allows kids to play games, create imaginary worlds, and develop a social structure where they learn to confront challenges and resolve conflicts. While computer games and videos can introduce content from reading to science, and can even help socialize kids with anxiety or who are on the autism spectrum, they are much simpler than the endless complexity of nature and face-to-face interaction with peers.

My recommendations:

• Talk to your daughter about her recess choices. Acknowledge and discuss how gender may play a role in her choice of media. Explain to her the benefits of being outdoors, and share with her some of your favorite childhood experiences of playing outside or on a playground with friends.
• Encourage her to balance her playtime, and suggest trying to go outside at least twice a week to start. Once she chooses to go outside, talk to her regularly about her experiences in a way that lets her reflect on the good and access your help addressing the more difficult. Compliment her on her successes and encourage her to increase the frequency of her outdoor play as the school year progresses.
• Communicate your concern and your plan with your daughter’s teachers so that they are aware of the situation. They can help encourage your daughter to choose outdoor recess, help her habituate to the playground dynamic, and let you know how she is doing. 

Although this is less likely the cause, make sure that her choice of media center over playground is not social avoidance because she feels ostracized or bullied (in which case, make sure to address that issue with both her and the school). If she is choosing the media center because she enjoys it more, your job is to help her recognize the unique pleasures of hanging with her friends and exploring the world.

Enjoy your media and use them wisely,
The Mediatrician®

How can I ensure social media safety for students with special needs?

Q: At the therapeutic day school where I work, we’ve been encountering a number of internet and social media issues with our students (all kids with emotional/behavioral special needs). I would love to get your thoughts and ideas on how to best educate our kids and their parents on how to understand and appropriately use media.In particular, we’re struggling to balance the kids’ appropriate desires to connect and be curious with their clinical needs and vulnerabilities. Taking a “just say no” approach doesn’t seem sufficient.

- Seeking social media stability for students, in Boston, MA

 A: Dear Seeking,

Think of social media as tools that amplify social interactions. They are fast and “sticky”—that is, information spreads quickly and never really goes away. That can create real challenges, especially for students who have trouble with checking their impulses or managing their emotions.

For those reasons, teach your students, teachers, and parents to treat online interactions as seriously as in-person ones—and to manage them in similar ways:

• Keep your messages simple. One parent I know helps her son remember who it’s okay to connect with on Facebook by remembering “the 2 F’s for Facebook”: friends and family.  This is the kind of message that is easy to repeat and remember. Another effective one is the grandma test—asking kids, “Would you be okay with your grandma seeing what you want to post? If not, then don’t post it!”
• Focus on ways of managing their emotions before they go online. If you teach them to take 10 deep breaths before saying anything when they’re upset, teach them to take 10 deep breaths before they post anything online—and then to walk away from the computer until they're calm and thinking clearly. To help them build empathy, ask them to look at anything they're about to post as if they were on the receiving end of it, and then make a decision about whether to actually post it. 
• Supervise students as they go online until they show that they can manage themselves well there. A child who wouldn’t be left unsupervised in person shouldn’t be left unsupervised online. Make sure that when she goes online, there is an adult present with her. As she learns to use positive strategies for deciding when and what to post, you can gradually allow her to have more freedom.

It may be helpful to communicate about internet safety concerns with parents as well. Consider hosting an afterschool lecture or workshop about how to support students in using the internet and social media in positive ways.

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®

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®

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®

Making ‘friends’ with your children’s media—and how it can help you parent

The Mediatrician® contributed to the following post on A Platform for Good, the Family Online Safety Institute's resource page and blog.

Last winter, a father read an angry letter his 15-year-old daughter had posted on Facebook. In response, he put nine bullets into her laptop and posted the video online. Within weeks, it had garnered millions of hits and tens of thousands of comments.

Why so much attention? Certainly the shock value of his rage drew people’s attention. But he also verbalized some very common frustrations of parenting digital natives, and graphically played out a response to the powerlessness that parents often feel. Communicating feelings and finding ways to feel empowered are both important processes--but parents need ways to do so that support children’s healthy development, rather than terrifying and humiliating them.

Parents need a new way to relate to their children’s use of technology. They need information and skills that can help them see, understand, and feel welcomed to engage with the positive capabilities of these powerful tools. Here are some research-based ways to develop a friendly relationship with your children’s media use, teach your children to avoid possible pitfalls, and even use media to help you parent. Continue reading here.