Ask 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®

Am I limiting my child’s chances of success in today’s economy by trying to limit his screen time?

Q: My 11-year-old son spends every free minute in front of his computer—doing homework (he really does, thank goodness), social networking, playing games, and now creating his own games. Concerned that, one by one, he has dropped sports, playing with friends, getting outdoors, and, frankly, spending time with the family, I have struggled (and been stalemated) for years trying to get him out from behind the screen. He came home from school with a news article provided by his teacher about a 17-year-old boy in England who just sold an app he developed for $30 million. Now I am wondering—are my efforts to get him away from the computer not only futile, but limiting his chances for success in today’s economy? 

Apprehensive about Apps, Ontario, Canada

A: Many parents already believe that their children need media early and often so that they will be prepared to compete in the adult world. That means parents are putting kids in front of screens from an early age, having toddlers and babies use lapware, tablet apps, smartphone games, and other forms of screen-based “edutainment” that often have little real educational value and, in some cases, may be developmentally detrimental.

It is important to remember that the reason a 17-year-old boy developing an app and selling it to a prominent company is news is because it is such a rare event. We need to understand that while there are kids with brilliant ideas and skills, these children have often spent many hours honing and developing these skills, sacrificing other activities in the process. While some may look at this early dedication as a career route, it is similar to becoming a professional athlete or musician: It requires a strict focus, innate skills, hours of practice, and sacrifice of other activities (primarily social). And after all of that, for every child who is able to successfully achieve professional status, there are thousands who will not.

My advice is for you to continue what you are doing—in addition to having some time when he’s on the computer, provide a rich and diverse experiential landscape for your son where he has the choice of many different activities (not just on a computer). Limit his screen time and give him options for other activities. If he isn’t into sports, maybe a book club, art classes, or free time outdoors will interest him. Many children join clubs, sports teams, and other organized activities for the social exposure, not necessarily for the activity itself.

Remember that children are natural generalists, not specialists. It is important for them to be able to sample a broad menu of life and to follow their hearts and minds to find what they are most passionate about. Providing your son with a landscape of diverse experiences and opportunities and seeing where he naturally gravitates will help you raise a child who is as happy, social, and productive as possible—it would be a shame to create a rich but unhappy coder at the cost of losing a brilliant and happy person because he focused his energy so narrowly so early.

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®

My 15-year-old daughter is having pornographic conversations online--what do I do?

Q: I found out that my 15-year-old daughter has a profile on a social network site where she has pornographic conversations with boys. I am beside myself and don't quite know how to react or approach this. She has been acting differently and disrespectful recently and is extremely boy crazy! I am not sure if this is normal teenage behavior or if I need to get her into therapy. We live in a small community, but even here we know of instances where kids have been victims of Internet stalking and abduction. And last year, a classmate of my son’s was abducted, brutally raped, and murdered. I just can't understand why my daughter is getting involved with this kind of behavior. I have blocked access to our computers and wireless devices, but I don't want to totally block her phone access. I am just so upset, angry, and scared—how can I get through to her without driving her further into secrecy?
-Scared for my daughter, in Upstate New York

A: Dear Scared,

You’re right to be concerned about your daughter’s online behavior. Although it is normal for her to be ‘boy-crazy’, there is a difference between liking boys and making oneself vulnerable to exploitation and objectification. Your instinct to communicate with her about it rather than simply prohibiting all media use is a good one. 

Starting with your concerns about the behavior itself may lead to a direct conflict over issues that don’t get at the real problem (like your daughter saying that you “just don’t get the online world”). Focus on the real issue by considering what is driving her bahavior. Your daughter may be attempting to make sense of the abduction, rape, and murder that happened in your community by trying to regain control over her environment. You may want to discuss both the concerning behaviors and underlying influences on the behaviors with a pediatrician, or therapist. Your daughter may need professional assistance work through whatever is going on, especially if she won’t open up to you easily. For all of her bravado and disrespect, your daughter may actually be as frightened as you are--what you need to find are the feelings you share, and then use them to build an alliance.

Try talking with her by asking first about what other kids are saying: “How do your friends feel about it? Are they afraid this might happen to them?” Ask how her friends keep themselves physically and psychologically safe—both offline and online—and whether she does the same things or has different strategies. 

When she describes her feelings and coping strategies to you, try to listen without judging. If you can hear her views and explanations in a respectful way, no matter how outrageous they may seem, she will respond positively, open up more, and allow you to be on her side. Hopefully, your daughter will have the drive to take control of her life as a young woman--and the insight to come to her own conclusion that she needs to curb provocative and unsafe online behaviors.

If she is not developmentally ready to do this, then let her know, gently and with respect, that you do get the online world and that these behaviors are as dangerous as texting while driving or not putting on her seatbelt. Explain that, just as you would take away the car keys if she were to use poor judgment while driving, you will need to restrict her online access while she learns to care for herself and others in that environment. Explain that you know she can care for herself, and then set clear guidelines about what she needs to do to show you that she's ready to be a good--and much less restricted--digital citizen.

Enjoy your media and use them wisely,
The Mediatrician®

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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®

How do I stop my teen from sharing inappropriate Facebook posts?

Q: We have stopped our 17-year-old daughter from using Facebook a number of times due to angry and inappropriate postings. We put unrecognizable passwords in, but she keeps creating or restarting Facebook pages. I believe she has one now, and I can’t find it. She has probably blocked me. Is there any way of totally blocking Facebook from our home? She is unable to control her reactions and what she says. We are at a loss.

-          Facebook Frazzled in Acton, MA

A: Dear Frazzled,

Frankly, it is difficult, if not impossible, to block Facebook from her (remember, in the days of smartphones and free wifi sites, blocking from your home is not enough). However, it sounds as if keeping your daughter off of Facebook—even if you did manage it—wouldn’t solve the problem. Her angry posts probably reflect what she’s feeling in real life, and it sounds like she’s looking for an outlet for those feelings.

 It is important to remember where your daughter is developmentally as a teenager. At this stage, it is normal for your daughter to be exercising her independence and expressing how she feels. Social media sites serve these developmental needs well because they can be crafted by each user. The best way to address your daughter’s postings is by opening the doors of communication and engaging her in a conversation about them.

It may be helpful to start the conversation by asking her general questions or just having her share what’s going on in her life. This will help you understand your daughter’s point of view, and may even lead you to understanding the reasons behind her angry postings. As both a parent and pediatrician, I’ve seen many kids acting out because they have been victims of others’ hurtful actions or were exposed to inappropriate talk or behavior. Finding the source of your daughter’s anger can allow you to help her deal with her emotions and experiences in a developmentally healthy way.

Once you’ve talked it through and are both in a calm state, you may also want to remind your daughter that what she puts online reflects back on her and that inappropriate or angry content may have negative and long-lasting repercussions. Suggest some alternative means of expressing herself, such as talking with her friends, keeping a private journal or blog, or confiding in another trusted adult (or even a therapist) whom she feels respects her. Be sure to let her know that you are always there as a resource and that you support her in her efforts to deal with whatever she may be going through.

For more information on internet safety, please see:

• CMCH Internet Safety
• Facebook Safety Center

Enjoy your media and use them wisely,
The Mediatrician®

How do I help my 14-year-old cope with the Aurora movie theater shooting?

Q: My 14 year old son has been anticipating the release of the new Batman movie ever since he saw the trailer last year. He pre-ordered his tickets for opening weekend and was all set to go with friends when he heard about the theater shooting at the midnight showing in Aurora Colorado. The news scared him so much that he decided to stay home. He was invited to a different movie last night but declined the invitation. My son is passionate about movies and usually leaps at the opportunity to go… I want to talk to him about what happened in that movie theater, but don’t know what to say or how to address it. Any advice you can offer will be truly appreciated.

  ~Scared of the Screen, USA

 A: Dear Scared,

 Like your son, my first reaction to the tragedy in Aurora Colorado was one of horror. After my initial shock, I felt a deep sadness, sadness for the victims and their families, for the lessons we humans have difficulty learning, and for the loss of our movie-going innocence. Terrorism, intentional or insane, only works if we are terrorized. Your instincts are right on the mark: talk with your son, help him cope with his fear, anger, and sadness, and show him that he can live without fear and reclaim his love for the movies.

 While the motives behind this attack may never be clear, it is important that we do not reflexively blame media violence as the cause behind these heinous acts. Research has shown that some young people have measurable increases in their aggressive thoughts and behaviors after viewing violent media, however, this is actually the least prevalent response. Most young people can use violent media without becoming violent themselves.

 All of us (adults included) are desensitized by violence as entertainment. The more we see violence, the more normal it becomes, particularly when the violence is coupled with a pleasurable feeling, such as comedy, romance, or exhilarating action. As a result, we increasingly accept using violence as a means of resolving conflicts, prevailing over others or calling attention to oneself.

 When I was a filmmaker, I went to screenings all the time, watching violence without flinching. But after working in a medical emergency department, where I saw, firsthand the realities of violence, suffering, and death, I can no longer enjoy, or even tolerate violent movies. Shocking as it is, Aurora provides just such a “teachable moment” for your son, and for us all. Faced with the reality of violence, it is much harder for him to dismiss violent movies and videogames as “only make-believe”. Use this tragedy as an opportunity to discuss and deconstruct media violence with your son. Talk with him explicitly about violence as entertainment and violence as reality. Ask him about the feelings he has while playing a video game or seeing a movie, and how those feelings compare to what he is feeling about Aurora.

 To help him manage his anxiety, go and see a movie with him. Let him choose the movie. Not only will this help alleviate his fears about venturing out to the theater, but it will give you both a chance to think about the film and talk about it afterwards. Be sure to discuss how you both enjoyed (or didn’t enjoy) the film and the experience of viewing it as part of an “instant” community of moviegoers. It would be sad for him to lose this shared cultural experience, a moment of time when he sat in the dark with strangers, sharing laughs, fears, tears, and dreams.

 Enjoy your media and use them wisely,
The Mediatrician®

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®

Should I use the movie "Bully" to talk about bullying with my 10 year old?

Q: My 10-year-old son will be starting middle school in the fall. So far, he has had a pretty sheltered, drama-free experience at a great elementary school. I want him to be aware that bullying goes on and that he needs to tell someone if anything like that ever happens to him. I have thought about taking him to see the movie “Bully,” but am afraid that it will make him fear going to middle school. What do you think?
-Bothered about bullying, in Minneapolis, MN

A: Dear Bully Bothered,

Your concerns echo those of many parents who have children transitioning from one school to another. You are doing the right thing by trying to start a conversation about bullying with your son. However, your instincts on using “Bully” to introduce the subject are right on track. It may be too intense, since it includes a lot of physical and emotional child-on-child violence, as well as the suicides of bullying victims. Try opening the topic in another way.

One way approach could be to take your son for a drive and start the conversation in the car—that way, you won’t have to face each other as you talk, and his attention will be focused on the conversation (provided that he doesn’t have a book, DVD player, radio, or cell phone). Chances are your son isn’t so sheltered that he hasn’t heard about bullying, and he probably has some concerns of his own. Begin the conversation by allowing him to vocalize his thoughts:

1. Start with open-ended questions: “How are you feeling about starting middle school? What are you excited about? Worried about?”
2. It may help him talk if you depersonalize the topic, ask: “What worries do your friends have about school?”
3. If bullying hasn’t come up yet, you can present the issue from your own perspective, saying, “One thing I’m worried about is bullying, which we know can be an issue in some schools. Have you heard about that happening?" And "Please talk to me if you see anything that makes you uncomfortable. Together we can figure out a way to deal with it, and you’ll be helping to keep your school safe.”

When children and their schools see bullying as a community issue, they solve the problem by focusing on the needs of the bullies, victims, and the school community to make a positive change. This approach helps heal the community as a whole and is more effective than using a system of punishment, which often doesn’t address the core of the problem. Presenting the issue this way can help give your son a sense of shared responsibility for his school environment and will not only make him aware of bullying, but also empower him and his schoolmates against it.

For more information and resources check out:

• http://www.stopbullying.gov/
• http://www.ncpc.org/topics/bullying/what-parents-can-do

Enjoy your media and use them wisely,
The Mediatrician®