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®

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®

Ratings Reality: Who rates our media and what that means for children

CMCH staff member Kristelle Lavallee contributed the following post to Thriving, Boston Children's Hospital's pediatric health blog.

Are you looking to take the family to a movie but aren’t sure whether your child should see The Hunger Games (PG-13) or Bully (unrated)? If you base the decision on the Motion Picture Association of American (MPAA) ratings, the answer seems pretty cut and dry—“maybe” to Hunger Games, and “no” to Bully. But are the movie ratings the best guide to making healthy media choices for your children?

Based on the best-selling novel, The Hunger Games is a fantasy story where teenagers are pitted against each other in a battle to the death broadcast on live TV. In contrast, Bully is a “slice of life” documentary about peer-on-peer bullying in American schools.

Both movies center on children and teenagers, but the fictional Hunger Games, portraying “intense violent thematic material and disturbing images” (MPAA’s description) was given a PG-13 rating, while the documentary Bully with “some language” (MPAA again) was rated R. The producers of Bully knew that accepting an R rating would greatly limit the film’s impact as an educational tool for young viewers, so they chose to release it unrated. But when a film is released without an MPAA rating, it comes at a price: Fewer theaters are willing to show it, and those that do will treat it the same way they treat films unrated for extreme violence or sex. Continue reading here.

Am I overreacting if I don't want my husband to play games like Grand Theft Auto with our 5-year-old?

Q: My husband plays X-box games rated for those over 16 or over 18, like Call of Duty, Grand Theft Auto, and Modern Warfare. He allows our 5-year-old son to play these games with him. I do not know anything about X-box, but I feel they are not suitable for a child that is so young. Am I over-reacting like my husband suggests? 
-Fear of Gaming, in Ireland

A: Dear Fear,

Trust your parenting instincts on this—you know your child better than anyone. Your concerns are not an over-reaction, but are supported by scientific research.

In video games, players gain or lose points for behaving in certain ways. They practice those activities over and over again, getting better and better at these “behavioral scripts.” While your husband’s adult brain can tell what’s fantasy and what’s reality, your son’s can’t—and won’t be able to for at least 3 more years. Instead, he will use these experiences to build his understanding of what the world is like and how people behave in it.

Using virtual violence as entertainment makes children of all ages less sensitive to the real-life suffering of others. It makes world seem more violent, which leads to anxiety—especially among the youngest users. And although they are unlikely to go out and do the things in real life that they do in video games, some users will think and behave more aggressively. If your son is having trouble with nightmares or aggression toward other kids, it could be related to playing these games.

Even if he isn’t visibly experiencing these kinds of problems, though, talk with your husband about what you’d like your son to learn and what kind of person you want him to become. Then brainstorm fun activities they can do together to accomplish those goals. And remind him that your son’s childhood is fleeting—their time together will build both memories and the person your son will be, so choose them mindfully.

Enjoy your media and use them wisely,
The Mediatrician®

Is The Hunger Games movie too scary for younger fans of the book?

CMCH staff contributed to the following post on Thriving, Children's Hospital Boston's pediatric health blog, about the movie The Hunger Games. The post is written by Thriving blogger Tripp Underwood.

The movie The Hunger Games opens today, and record tickets sales are expected to make the grisly, post-apocalyptic, survival tale one of the spring’s biggest blockbusters. Like the Harry Potter and Twilight series before it, The Hunger Games film is based on a book written for young adults that has captured the imaginations of readers of all ages.

Considering the ultraviolent nature of The Hunger Games’ plot line—24 teenage protagonists are pitted against each other in a fight to the death—is all this hype a good thing for young, would-be fans? The intended age for young adult novels is 12 to 17, but the books’ popularity has piqued the interest of much younger readers. Not wanting to sully their younger children’s budding interest in reading, many parents across the country have allowed them to read the story.

But just because your child has read The Hunger Game books, does that mean she’s ready to watch it’s bloody action unfold on the big screen? The answer will vary from child to child, but it’s a question parents of younger Hunger Game fans need to ask.

“[Reading about violence] is a gut experience as opposed to a head experience,’’ said Michael Rich, MD, MPH, director of Children’s Hospital Boston’s Center on Media and Child Health, in a recent Boston Globe story. “A movie is very direct. You are seeing it, you are hearing it, as compared with translating it from black ink on a page into something in your own mind.’’ Continue reading here.

With video games, how can I help my kids know when enough is enough?

Q: I'm a pediatric nurse practitioner, and we have three boys ages 5, 7, and 9. Several parents/patients have told me that they have the same problem as I do enforcing video game time limits. Certain kids just seem “addicted” and can’t wait until they get more. Do you have any visual time charts, contracts, or other concrete examples of how to work with your kids on knowing when enough is enough? 
-PNP Parent in Bozeman, MT

A: Dear PNP Parent,

Try approaching this issue with a positive rather than restrictive approach. Instead of limiting video game time, focus on creating a daily schedule with your sons where there is enough time to do everything that is important to them.

Search online for “hourly calendars,” and print a copy for each child. Then, ask them to think about all the things they need to do in a day—like eating meals as a family, school, homework, active play (outside, if at all possible), spending time with friends, and getting enough sleep—and help them remember others that they forget. For each task, have them choose a color, think through how long it will take, and color in the time blocks needed.

They will see their time filling up with important activities, and they will see what time is still left. Talk about what they can do in that time. Perhaps they can spend some of it playing video games, but offer them attractive alternatives as well, like organized sports or hobbies. In this way, they will have some ownership of mindful, directed “down time” rather than simply sliding into video gaming.

By focusing on what they do want and need to do in their limited time, you can avoid making video games a forbidden fruit. Whatever choices they make, remember that they will learn from what they experience, so exercise your judgment about the content of any media they use.

• For information on video game addiction, take a look at this post: My 10-year-old son is miserable since I took away Call of Duty--what do I do?
• For ideas on creating a family media agreement, click here.

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®

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 Wilmington, DE

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®

My 10-year-old son is miserable since I took away Call of Duty--what do I do?

Q: My 10 year old used to be an avid skateboarder and baseball player—until Call of Duty on XBOX Live arrived. I didn’t in my wildest dreams think that he would become addicted to a video game. I have a 21 year old who played all of the games but was never ruled by them. Since my awakening, I have removed the game, but my son is miserable. How long does it take to deprogram him?
—Problem Gaming, in Kansas City, MO

A: Dear Problem Gaming,

More and more young people are being referred to me for Internet or video game behaviors that are causing real problems in their lives. It sounds like your 10-year-old son falls into that category. Unfortunately, time away from the game may not be enough to deprogram him—he probably needs professional help.

Even though our healthcare system that doesn’t recognize video game addiction as a formal problem, there are still steps you can take to help your son. You’ve already taken the first step: removing the game (though if he is indeed addicted, he will find other ways to keep playing). The next step is to find and make an action plan with a therapist who understands this kind of problem.

In the meantime, when talking about this with your son, frame this as a health issue, not as an issue of misbehaving. Your son's excessive game play could be a symptom of another issue—like social anxiety or depression—and it could be his way of taking refuge in a world he can control. Explain that you see how miserable he is, and that although he may not understand yet, the goal here is not to punish him but to make his life better.

For more information about signs, symptoms, and treatment, click here. Also check out this related post: My teen daughter's addiction to technology is ruining our family life--what should I do?

Enjoy your media and use them wisely,
The Mediatrician®

Could my 14-year-old son's anxiety be related to playing video games?

Q: Is there a connection between excessive video game playing and increased anxiety levels? My son is 14 and has some basic anxieties like walking the dog at night that I feel are made worse by the first-person shooter games he plays. I’d love to understand if you have seen any connections here.
-Grappling with Gaming, in Westfield, NJ

A: Dear Grappling,

As a parent, you are the best monitor of your son’s well-being. If you have seen an increase in his anxiety that has paralleled his increase in first-person shooter (FPS) game play, then it is probably worth seeing what happens if he cuts back on or eliminates playing these games. Research supports what you are observing—it has found that children and adolescents frequently respond to media violence with increased fear and anxiety, because action entertainment makes violence seem more prevalent than it actually is.

Suggest that your son stop playing video games for a while. This will be easier said than done—he will not want to stop playing, and he will probably resist in every way he can. Talk about your concerns with him, and remind him that his resistance may, in fact, indicate that he might be developing an addictive relationship with gaming. If nothing else, he will stop because he wants to prove he can. Then pay attention to his behavior and see whether his anxiety diminishes.

If he doesn’t think he can stop gaming or the anxiety doesn’t go away—that is, if either piece is limiting his life in some way—then it would be good to have him evaluated by a therapist. And remember that anxiety can affect a teen’s well-being in subtler ways, such as through increased distraction, which could appear to be ADD/ADHD.

Finally, encourage your son to pursue other activities he enjoys. Increasing physical activity and getting outdoors can reduce anxiety and increase quality of life in all kinds of ways.

Enjoy your media and use them wisely,
The Mediatrician®