Ask the Mediatrician

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®

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 teen daughter's addiction to technology is ruining our family life--what should I do?

Q: I am the mother of three daughters (15, 13, and 11). Although I try to set limits, technology is ruining my family life. My oldest daughter in particular is addicted to Facebook, Skype, texting, etc.—whenever I try to reduce or eliminate her access, she finds a way to be in touch with her friends. Plus, when she does interact with friends via technology, she gets anxious, which leads to increased use. What do you suggest?
-Anxious about Addiction, Metro West suburb, MA 

A: Dear Anxious,

As a teenager, your daughter is pursuing key developmental tasks through her media use—seeking experience, establishing individual identity, and connecting with peers. But the amount of time she is devoting to it, the exclusion of family, and the anxiety she is experiencing when interacting via technology—and the fact that she responds to it by increasing her use—are cause for concern and could be symptoms of addictive behavior. Although the formal diagnosis has not been established in this country, Internet Addiction Disorder is a recognized and serious problem in parts of Asia and Europe, and it is causing real problems for American adolescents and their families.

Address this issue quickly, directly, and with compassion. First, at a time when things are good and you are not in open conflict about your daughter’s media use, sit down and have a conversation with her. Ask how she feels about her media use. Listen to her. She may be unhappy or uncomfortable and may say so if she doesn’t feel criticized or attacked. Then, when the opportunity presents, tell her that she seems anxious when she communicates online, and that you are concerned for her. Ask her what she thinks might help.

It’s possible that she’s feeling lots of pressure to be constantly available. If she acknowledges that that’s the case, enlist her help in finding peace for herself and your family, but be prepared to help her with concrete guidance and boundaries. Offer to take the blame if her friends criticize her for not being available at all times—she can complain that mom takes the phone away to charge it between 9 pm to 6 am, or for even longer if she uses it too much. This way, she can save face while reducing her anxiety, as well as learning to manage her media use in the context of everything else she needs to do in a day.

It is possible, though, that she will resist any and all of your attempts to address the situation with her. If nothing you try works—if she really can’t stop and it continues to wreak havoc for her and your family—you may need to seek professional help.

Enjoy your media and use them wisely,
The Mediatrician®

Can TV help my infant sleep while keeping me awake?

Q: My boyfriend and I just had a beautiful baby boy. He is a month old. I like to leave the TV on even if he is sleeping so that I can stay awake. I was hoping that the noise would be good for him and that it would keep me awake while he sleeps. Is that okay for him?
-TV for sleep?, in Washington

A: Dear TV for sleep?,

You are right that TV can help you stay awake—because humans are animals that evolved to be awake in the daytime and asleep at night, we are aroused and activated by light. Television provides that light, as well as moving, changing images and sounds that grab our attention. The same elements that keep you awake will also keep your baby awake and, thus, can interfere with healthy sleep.

The difference between “calming” and “quieting”
You may notice that older children, even very active ones, will sit quietly in front of the tube even when they won’t settle down for much else. That might make it seem like watching TV calms them down. But what’s actually happening is that the bright light and constantly changing image are capturing and holding their attention—which arouses and alerts their brains. They are being constantly stimulated, and their still-developing brains won’t really let them turn away.

So if TV arouses kids, why do they so often fall asleep in front of the TV? Because, ultimately, all of that stimulation wears them down until they simply can’t stay awake anymore. When in front of the TV, they enter sleep by way of exhaustion rather than by calming themselves to sleep.

But once exhaustion has overwhelmed stimulation and he is asleep, he may become dependent on the TV, music, or other accompaniment when he is falling to sleep, not because it is calming, but because it is what he is used to. Then he may find it difficult, perhaps impossible to get to sleep without it—and may wake up the moment it is turned off. Babies have a self-protective reflex to go on alert when there is a change in their environment. If the noise and light of the TV are the environment in which he drifts off, there is a dramatic environmental change when the TV is turned off and he will go on alert.

The importance of self-calming
Children need to learn to calm themselves and get to sleep without the aid of external technology. This will allow them to cope with stressful situations, manage their emotions and impulses, and get to sleep. Not only will he be able to soothe himself and get to sleep in a variety of situations (a real help to you as a busy parent), but he will be calmer when he is awake. The ability to calm himself learned as an infant will serve your son well as an adult.

You may want to consider taking those precious moments when he is asleep to get some rest yourself. But if you are using TV to keep yourself awake, let your baby put himself to sleep in a quiet, dark space and watch TV in another room. Not only are you helping him to self-calm and preparing him for a lifetime of restful, healthy sleep habits, but you are keeping TV out of his bedroom, which will lower his risk of poor sleep, school problems, aggression, and obesity as he grows up. 

Enjoy your media and use them wisely,
The Mediatrician®

Video Games: How much time is too much?

Q: What do you make of a 15-year-old high school freshman who gets straight A’s, does all his homework, has a 3-hour internship per week teaching little ones to sing, swims on the swim team, AND plays Call of Duty 15-20 hours per week? Do you think that is too much time spent on video games, or is this a good use of his downtime? How much game playing is too much? 

A: Your son admirably seems to be balancing schoolwork, personal interests, and physical activity with the amount of gaming he’s doing—and it sounds like he isn’t making unhealthy choices in order to maintain his gaming habit. (Pathological video gaming, sometimes called addiction, is a major problem in China and Korea, where millions of young people need psychiatric care and even inpatient hospitalization to address this issue, and the government is creating legislation to limit the hours teens can be online.)

Science shows that some video gaming isn’t necessarily problematic for kids. It can even benefit players by helping improve overall vision and visual acuity, foster healthy online interactions, and (in certain games) get players up and moving. The key is to ensure that gaming doesn’t get in the way of the other important activities of life—like family meals and sleep. During adolescence, teens undergo the second most rapid and profound developmental spurt of their lives (aside from infancy). Research indicates that unless they get 9.5 to 11 hours of sleep nightly, they are in a constant state of sleep deprivation—which may contribute to lovely morning moods, naps during class, and post-noon wake-ups on weekends. 

Once homework, healthy meals, and sufficient sleep are achieved in a given day, your son likely won’t have time for the maximum of two hours of screen time per day that the AAP recommends for kids age 2 and older. If he does still wish to spend some time gaming, talking with him about what he plays can help him think critically about the content. (Although the violence portrayed in Call of Duty is certainly an issue to consider, your question seems more focused on the amount of time he spends playing them. Read these other Q&As about how “first-person shooter” experiences affect teen gamers, and what’s at risk when even well-rounded kids, like your son, regularly play violent, multiplayer games.) 

Finally, although video gaming is certainly entertaining, it doesn’t really serve as “downtime.” Brainmapping research shows that during the time when our minds are wandering in between directed tasks—like playing a video game or doing homework—a large network lights up. That network appears to be the area responsible for creativity and, possibly, for our sense of self. So kids and adults may need unplugged downtime, in the form of daydreaming without constant stimuli, in order to nurture our creativity and to reflect, which in turn may nurture our selfhood and psychological well-being. 

Enjoy your media and use them wisely,
The Mediatrician®

 

Do cell phones affect kids' sleep?

Q: Maybe I'm jumping to conclusions, but my middle-schooler honestly seems like a zombie during the day since we agreed to let her have a cell phone. She's grumpy and sleepy, though she doesn't seem to be having trouble with friends or school. I have noticed that she’s constantly checking the phone—even bringing it to the dinner table—but when I mention it, she snaps at me. What's going on here?
Phone-miffed Mom in Glen Arm, MD

A: Dear Mom,

It’s likely that what your daughter is doing with her cell phone is affecting her behavior, not the phone itself. Like most tweens and teens, your daughter probably uses her phone primarly as a platform for texting--thus, she may sleep with it on a nightstand or even under her pillow, just in case she receives middle-of-the-night messages. When a text does arrive, her sleep is interrupted and she never makes it to stage 4 REM sleep. This stage is when the dreamwork necessary for resting and repairing brain circuits and moving experiences from short- to long-term memory takes place. Not a good stage to skip since adolescence is the period of greatest physical and intellectual development since infancy!

So it’s little surprise that recent studies suggest that kids who use electronic media before bed—or after they’ve supposedly hit the hay—have a greater incidence of sleep disorders that lead to the sort of prickly behavior you’re describing, in addition to learning problems, mood swings, anxiety, and depression. Lots of parents believe that their teens’ cell phone usage is none of their business, but I would argue that it is as much your business—and just as important—as ensuring that they buckle their seatbelts.  Parents are in charge of setting boundaries to keep kids healthy, and you can do so here.  Discuss with her some reasonable rules about when she needs to turn her phone over to you at night before bed. A previous Q&A addresses how parents can set and enforce cell phone limits; our CMCH website offers more tips on curtailing use.

A final consideration, given your daughter’s dinnertime reaction: Could her grumpiness be on account of what she’s seeing when she receives a text? Kids who are cyberbullied can become hypervigilant about the messages on their phones. They’re often fearful, anxious, or sad because of how they’re being harassed but are embarrassed and therefore reluctant to share what’s happening. Before you delicately broach this topic with your child, take a look at some of these cyberbullying resources that can help steer your conversation.

Enjoy your media and use them wisely,
The Mediatrician®

My friend's son is up at 4am playing videogames; should I step in?

Q: My friend allows TVs and computers in her young children’s bedrooms, and she does not limit or monitor her kids’ media use at all. I never comment on her choices, which are different than mine, but I recently heard that her 4-year-old gets up in the middle of the night (2 or 3 a.m.!), goes into the family room, and plays video games. My friend jokes about it and thinks it’s funny. I’m worried that he’s possibly addicted to video games and, of course, about his sleep deprivation. Do you have any suggestions about addressing something like this with her? Or is it just a parenting choice that I should mind my own business about? I hate to come across as the snooty, media-conscious mom, but I really am worried.
-Concerned Parent in Boston, MA
 
A: Dear Concerned Parent,

The issue of what is our business and not our business when it comes to other people’s kids is really tough, and not one for which I have an easy answer. Whether or how you comment on her parenting depends most on the nature of your relationship with her. Although “it takes a village to raise a child,” some parents welcome and openly share parenting strategies, while others get angry or embarrassed when others comment on their parenting styles. 

One tactful way to bring up your concern would be to share some solid scientific evidence, rather than criticism, and let the child’s mother come to her own conclusion. For example, the next time she mentions her 4-year-old’s game playing habits, crankiness, or sleepiness, you could express concern by saying something like, “You know, I just saw an article about how researchers found that kids aren’t getting enough sleep to grow and learn well these days, and that TV & video games might be one of the big reasons why.” If you plant the idea of media and sleep being related to each other without openly criticizing her parenting, she might think further about when or how often her child plays these games. 

It is okay to respond honestly when you hear stories of the child being found awake at 4:00 a.m. If it upsets you, show that it upsets you—don’t laugh along. Express everything in terms of your concern for the child rather than from a standpoint of being a better parent. In other words, “Getting a good night’s sleep is so important for little kids, that makes me worried” rather than “I would never let my own child do this.”

Whether it’s by providing her with information and strategies to make better parenting decisions or by showing your true reaction to what you are hearing, hopefully your friend will get the message that this is not something to laugh about. But even if she doesn’t, at least you will know that you’ve done your best to look out for a child in your village. 

Enjoy your media and use them wisely,
The Mediatrician

My son’s PS3 requires access to the Internet, but I don’t want Internet in his bedroom—what do I do?

Q: My 12-year-old son wanted a PS3, partly as a birthday gift and partly out of money he’s saved. This was to replace his PS2 because some of the games he wanted were not available for PS2. His PS2 is in his room on a non-cable hooked up TV so that all of his approved, appropriately rated games can be played without all the gaming controllers, fake guitars, and the like taking up all of our adult space. But, he is not far enough from me that I don’t know how long (or what) he is playing. After buying the PS3, we learned that, in order to play PS3 games multi-player, the device has to have the wireless Internet function activated. That essentially puts a computer in his room where he is not under supervision. That is not okay with us. I gather that we can restrict the games played by rating, but we are not sure if we can restrict access to the Internet. What do other parents do?
-Worried about Wireless

A: Dear Worried,

It seems that your main concern here is that the PS3 would introduce Internet into his bedroom, and that is certainly important to consider—especially since massively multi-player online role-playing games, or MMORPGs, can create a constant pull to engage in them. But the bigger issue here is that keeping the gaming system in his room denies you the opportunity to really engage with him around how he uses that media.

Given your commitment to being a part of your son’s gaming life, it sounds like it might be time to move the PS3 into public space. Doing so presents you with a perfect opportunity to play those games with him. Even if you don’t especially want to play those games, play anyway—you’re not playing for fun, after all (although it may be fun!). Rather, you’re playing to gain a window into his world, which is a space where he has mastery. That means that he can teach you, which shows him that you respect his learning and his growing individuality. In addition, it opens the door for discussion about the content of the game.

Another reason to move the gaming system is so that you can transfer the responsibility of monitoring his media use from yourself to him in a gradual way. As with cars or power tools or alcohol, teaching your son to use media responsibly is a long-term process. It involves introducing it to him when you feel that he’s ready to handle it (as you’ve already done), and taking responsibility for how he uses it when he’s first exposed to it. Over time, as you grow more confident in his decisions, you can gradually transfer more and more of the responsibility to him.

In this case, you can move the gaming system into the family room and sit beside him as he plays the game, asking questions and learning to play yourself. As you grow more confident that he can set limits on his own use and balance it appropriately with other activities, you can move in and out of the room he’s in, reminding him when time is up as necessary and commending him for his management of his time. In that way, by the time he leaves home and is left to own devices to make media decisions, he will have had experience with making choices about whether, when, and what to use.

Enjoy your media and use them wisely,
The Mediatrician®

My daughter can't sleep because of a scary news story, what can I do?

Q: In spite of telling my 6-year-old daughter about stranger danger, she kept running to the front door and opening it as soon as the doorbell rang. One day, I told her the Elizabeth Smart kidnapping story and explained to her that it is not safe to run to the door when strangers ring the bell. I told her to let adults do the talking when that happens. Ever since I told her this story 4 months ago, she comes to our room scared at night and says that she wants all the lights on in the house. She’s worried that some bad guy is going to come and get her from her bedroom window. I guess I was the one who invited the trouble by telling her Elizabeth’s story, but now I don’t know how to convince her that that is not going to happen and that we will be there for her. What should I do?
-Facing Fears, in Scottsdale, AZ

A: Dear Facing Fears,

There seem to be two questions at play here: how do you address the terror your daughter has been experiencing ever since hearing this highly publicized story, and how can you teach her not to answer the door (unaccompanied) without scaring her? Fear reactions to media are quite common for young children in particular, even from descriptions of said media. In fact, a survey of 5-12 year olds showed that 37% of the children were scared by something they saw on the news, and they were most often affected by stories of stranger violence.

Studies about how to help kids deal with scary news stories show that it is effective when parents actively help their children understand what they are seeing and hearing.  However, since she heard about the story secondhand rather than seeing it herself, it sounds like you are doing all of the right things by trying to calm her fears.  Since she is still too scared to sleep, I would suggest that you discuss the situation with her pediatrician to determine whether it would be helpful for her to work through these fears with a therapist. In addition, because it sounds like some of your anxieties might have come through when you told her Elizabeth Smart’s story, it might be worthwhile for you to meet with the same therapist to talk about strategies for handling the situation moving forward. As parents, our own fears and confidence in dealing with such situations communicate far more powerfully than the words we say, so it’s possible that managing your own anxiety can help alleviate some of hers.

Regarding the issue of answering the door, part of the challenge with teaching young children to be cautious with people they don’t know is that they are often put in situations like playgrounds, new schools or sports teams where they are being encouraged to interact with people they don’t know. Your daughter runs to the door because she’s excited to try out her new social skills.

So how can you encourage her skills while maintaining her safety? One option is to make it clear to her that it’s great for her to answer the door—but only with you hard at her heels. Your presence will communicate that you are confident in her social skills, but that you are also there to support her no matter who is at the door. This will help her on the path to developing the kind of caution she will eventually learn to exercise on her own. 

Enjoy your media and use them wisely,
The Mediatrician®

Is it okay for my kids to fall asleep in front of the TV?

Q: My children like to watch TV before bed, and they often fall asleep while it’s still on. I have a feeling that that's not good for them, but I’m not sure why. Can you offer any guidance?
Uncertain about Sleep in Duluth, MN

A: Dear Uncertain about Sleep,

Many parents find themselves in your situation because it seems to make sense to use TV as a way of slowing kids down from the activity of the day and preparing them for sleep. But you’re right to be concerned—research shows that TV actually does the opposite -- it makes their brains more active instead of less!  Part of the reason is that looking at something bright like a TV screen turns off the brain chemical that makes us sleepy and turns on the brain chemical that gets us ready to be active.

What I would suggest is to set up bedtime rituals with your kids that gradually move them toward sleep and do not include media.  Doing the same sequence of events every single night can help ensure that kids get enough sleep and that their sleep is undisturbed.  This routine could involve a bath, some reading, talking about the things you're thankful for, turning on a night-light, tucking the child in with his or her blanket or stuffed animal, or any other winding down activities you can think of. 

A question I have thought about a lot is "Why are so many kids—like most of those I see in my practice—getting less sleep than they need to keep their bodies functioning at their best?" Part of the answer is that they have so much going on during the day.  They wake up very early for school, have sports or drama or something else that extends their after-school time, come home to eat dinner, do their homework, and find that it’s suddenly very late at night. And then they start using media—especially if they have TVs or computers or video games in their bedrooms. They stay awake to use them, and when they fall asleep in front of the screen, it’s because they’ve stayed awake until they can’t possibly stay awake anymore. As a parent, you can help break the cycle by keeping screen media in public areas (out of bedrooms), knowing what activates and what calms your children, and knowing what kinds of things are helpful for kids' sleeping patterns at different ages.

Enjoy your media and use them wisely,
The Mediatrician