Ask the Mediatrician

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

Dear Readers,

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

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

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

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

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

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

Will playing hunting video games cause my son to be more aggressive and desensitize him to violence?

Q: Hello, I am the mother of a 10-year-old boy. We don’t allow violent video games in the house, but we do allow him to play first-person shooter hunting games (Duck Hunter, Cabela’s, Big Buck Hunter, etc.), which he loves, especially as he takes a hunting trip with his father every year. My fear is that his love of these games and hunting is somehow desensitizing him to real violence and is carrying over into inappropriate behavior; he will also often play shooting games with his friends (cops-and-robbers style) and talk about his favorite types of guns and how they kill. My concern has been heightened since the Sandy Hook shooting and subsequent discussions about media violence and increasing gun control measures. My question is, are the hunting video games negatively affecting my son, or desensitizing him to person-against-person violence?

- Humbled over hunting games, NY

A: Dear Humbled,

Hunting is a time-honored tradition carried down from our days as hunter-gatherers. It can teach your son patience and how to use weapons safely, and it can endow him with a respect for life and love of the natural world. Since we no longer need to hunt for our food, your son’s experience of hunting is perhaps most importantly a ritual bonding with his father—and earlier generations.

 The critical issue is what meaning your son makes of those experiences—and what relationship that has to his video game play. He may have a more realistic understanding of the impacts of violence because of his experience with hunting, which could make it clearer to him that the video game images don’t truthfully represent what happens when a bullet hits a living being. One can easily see how someone who is sensitive to those experiences would be even less inclined to shoot or become violent towards someone else, as they have seen the realities of death and suffering.

 While there is research that has examined how young people respond to first-person shooter games where the targets are people (or people-equivalents like aliens or zombies), the Center on Media and Child Health’s Database of Research has not found any rigorous research that explores the influence of playing hunting video games. With person-against-person video game violence, the killing is rewarded especially if it is reflexive and efficient. Video games portray violence as powerful, cool, and the way to resolve conflicts and prevail. They don’t show what it’s actually like when someone suffers the wounds that real-life weapons inflict. Instead, they can make violence feel attractive and desensitize players to the suffering, loss, and grief that can result.

 I would recommend that you talk explicitly with your son about these issues:

1. Ask, in a non-judgmental way, how he feels and what he thinks about hunting. Encourage him to learn from American Indians and other masters of the hunt, to understand and respect the animals he hunts, and to think about how he can honor his prey and never waste a kill.
2. Sit with your son as he plays his video games and discuss the ways that it simulates and that it differs from real hunting. Avoid overt criticism or passive acceptance, but make your concerns known. Although he (and his dad) may be annoyed in the moment, this will show him that you care about who he is and who he will become, that you take the influence of video games seriously, and that you are willing and able to parent him in the digital domain as well as “real life”.

Remember, as irritated as kids can get over active parenting, just having this conversation will encourage your son to think critically about the media he uses and how they may influence him. Continue to observe, sharing your observations when necessary, and keep the lines of communication open when it comes to the media choices he makes.

Enjoy your media and use them wisely,
The Mediatrician®

It feels like 9/11 all over again. Our world has changed—forever. Now what do I do?

Q: I am the mother of a 5 year old, an 8 year old and a 12 year old. I am numb with grief, fear, and rage… yes, rage. Rage at myself and at my society, more than anything else. I am numb, but not immobile. Last night I went through all of our DVDs and video games and threw all the violent ones into the supermarket dumpster (so neither my husband nor I would be tempted to fish them out). It feels like 9/11 all over again. Our world has changed—forever. Now what do I do?
-Now what? in Washington, DC

A: Dear Now,

Stunned, disoriented, discouraged, and grieving, yesterday our job was to listen to our children, assure them that they are loved and safe, and try to reconnect with what’s good in the world, that it’s a place where people care about and for each other, a place where they can explore, and learn, and laugh. In the immediacy of the moment, we adults struggle to gain control over the chaos, to find a reason, seek something, out there somewhere, to blame for the insanity. Each time this happens, we call for gun control and limits on violent video games, movies, and other media. And each time an opposing cry arises in defense of our 2^nd Amendment right to bear arms and our 1^st amendment right to freedom of expression. The political debate heats up and when the dust settles, nothing has changed.

In part, this is because we are debating this as a difference of “values” and “beliefs,” which we can rarely, if ever, change in others—and because, in our culture, winning (or even losing without giving an inch) is more desirable than coming to a solution. As incomprehensible as the insanity of Newtown is, perhaps the greater insanity is that, despite our anguish and our calls to make a change, the tragedies keep happening—in health clubs, places of worship, movie theaters, elementary schools. Newtown is not the first but the 16th mass shooting this year in the United States of America. Einstein defined insanity as doing the same thing over and over again and expecting different results. If we as a society are not happy with the results we are living, we must examine who we are, how we behave, and what we must change in order to get different results. We must shift from asking, “How has our world changed?” to “How can we change our world?”

If we are to change our world, we have to stop looking for an “other” to blame. As Walt Kelly’s wise cartoon philosopher Pogo said, “We have met the enemy, and he is us.” If we only look for others to blame, we discount our own responsibilities--we might acknowledge that violence in media makes violence seem normal to kids, yet we still say “My kids are too smart to be affected.” We get distracted by academic arguments about whether research methods are adequate to prove that video games cause violent behavior. When we examine the more than 50 years of research from around the world, though, we see consistent relationships between exposure to media violence and increases in fear and anxiety, in desensitization to the suffering of others, and, among some young people, in aggressive thoughts and behaviors. We can argue indefinitely about minutia of research, but the bottom line is that, in our culture, we celebrate violence as a means of resolving conflict, we award fame for notoriety rather than achievement, and, even in the face of innocents slaughtered, we do not think about human suffering very much or for very long.

Regardless of whether media violence contributes to or is reflective of our violent culture, we must change our culture if we are to change the outcomes. We must meet the enemy that is us. In order to create a better world for our children, we need to make some difficult decisions to voluntarily give up some of that to which we think we are entitled. If it puts children’s lives at risk, we cannot cling to an extreme interpretation of a constitutional right devised to prevent Britain from recolonizing us over two centuries ago. And we cannot use freedom of expression as cover for entertaining our children with virtual experiences that serve as behavioral scripts for what happened inside Sandy Hook Elementary School.

Freedom of expression should not be restricted--creative expression is how we make meaning out of the world and how we come to grips with even the most horrific of life’s experiences. In grappling with the immediacy of Newtown, I sought out the wisdom in some of that expression. I turned to Ernest Hemingway, who suggested the simple creation in our own lives of “a clean, well-lighted place”, and to Crosby, Stills, Nash & Young, who sang “Teach your children well, their father's hell did slowly go by.” Media are our shared cultural experience and we never want to lose our poets, troubadours, storytellers and image-makers who help us find meaning together.

For better or for worse, our children, and all of us, learn and are changed by what we read, hear, see, and play. None of us are too smart or too sophisticated to avoid being affected. In his paintings "Four Essential Human Freedoms", Norman Rockwell celebrated "Freedom of Speech". In order to achieve another critical freedom in that series--"Freedom from Fear"--we need to exercise our rights to consume only that which changes us, our children, and our society in ways that are healthy, safe, and reflective of what Abraham Lincoln called “the better angels of our nature.” Now what? Now we can try to make Newtown the starting point for our new world.

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

The Mediatrician®

How can I tell if I am being too strict with my kids' media?

Q: I have 4 boys (ages 11, 9, 9, and 7), and I am rather strict about limiting their screen time: We don’t allow any during the school week, and on the weekend, we allow the boys 1 hour per day. I have also told my oldest son that when he is at someone else’s house, he is not allowed to play games like Halo and Call of Duty—he will be allowed to play them when he reaches the game's recommended age. This puts him in an awkward position with his friends. Am I being too strict? 

-Call of Parental  Duty

A: Dear Call,

I am sure that your sons think you’re too strict, but that’s not necessarily a bad thing—kids need parents to set boundaries, even when they don’t like those boundaries. Knowing how media can affect your children (both positively and negatively) can help you make informed decisions about what boundaries to set around media use.

Research supports the limits you’ve set: Studies show that children who watch television for extended periods of time are at greater risk for sleep disturbances and obesity. They show that individuals who repeatedly play violent video games can become desensitized to both virtual and real-world violence and that they do less well in school.

To move beyond “strict-mom” dynamic and help your sons learn to manage their time and focus their media use, make your sons part of the rule-making process. Sit down with them and collaborate on budgeting their time use, including media time. Then, talk about what kinds of media to use—or not use—during that time. That may be difficult for them, but challenge them to get creative. If your oldest keeps talking about COD and Halo, ask him what he likes about those games and why he thinks you might be concerned about him playing them. When your son is going to hang out with friends, brainstorm with him beforehand about what other fun things they could do. You may want to discuss alternative activities with the parents of your sons’ friends – while many parents hesitate to talk about media use, those who do often find that other parents are seeking strategies themselves and grateful for the dialogue.

Finally, instead of focusing on a game’s recommended age (a rating decided by the Entertainment Software Ratings Board, part of the video game industry), look at the game yourself and decide whether you want your sons to experience and learn from it. Understanding your sons’ personalities—and knowing that they will learn from and be changed by the media they use—can help you work with them to set developmentally appropriate expectations.

Enjoy your media and use them wisely,

The Mediatrician®

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 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®

Where can I find books for young advanced readers?

Q: My 8-year-old son is a precocious reader, and I am having a hard time finding books that are both age-appropriate and challenging enough to keep him engaged. I worry that the books at his reading level are too violent or contain other content that he’s not ready for. Where can I find books (lots of them!) for avid young readers?  -  Baffled by Books in Brookline, MA

 A: Dear Baffled,

Many parents of advanced readers face this challenge—more intellectually challenging books often contain more mature content. And because children don’t yet have much life experience to compare stories to, whatever they read will influence their beliefs about the world. For example, stories that include violence may make violence seem more normal, creating an increased tolerance for aggression in real life. The problem is particularly tricky for those (including many boys) who are drawn to adventure, sci-fi, fantasy, and other genres that often contain more such content.

Fortunately, there are some great free resources that can help you choose books that will appeal to your ravenous reader—and send messages you’d like him to receive:

• Books That Guys Read: A list of books recommended by teachers, librarians, parents, and publishers specifically geared towards young male readers.
• Early Expert Readers: Short description of what makes a child an ‘early expert reader’ and gives a brief list of books that are developmentally appropriate for advanced young readers.
• Books for Early Readers: Short list of elementary school librarian recommended books for young readers (printer-friendly).
• Parent’s Choice: Books reviewed by the Parent’s Choice expert panel and categorized by genre and reader age.
• A Mighty Girl: A list of books (and movies) that are female-centric and organized by genre, reader age, and even price.
• Public Libraries: librarians can often recommend great books for children based on their reading level and interest. Libraries also provide you with a nearly unlimited selection of books so you won’t go broke buying them!

Once you’ve selected a book (or several!), share them with your son—or if he’s reluctant to take direct suggestions, leave them lying around the house so he can discover them for himself. And if there’s a book he really wants to read that concerns you, evaluate it for yourself or even join him in reading it. When my son first picked up Harry Potter at age 6, for example, my wife read it along with him so they could talk about it and work through any of the questionable content.

Also remember to share developmentally suitable books that you love—that can be a great way nurture your relationship and quench his thirst for a good read.

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®

My 17-year-old is having serious anxiety since he started playing Call of Duty--is there a connection?

Q: My 17-year-old son started playing Call of Duty a few months ago. Since that time, he has had more trouble than usual falling asleep and has been waking up in the middle of the night. Last night, he woke me saying he felt like he was having a panic attack—racing heart and hyperventilation. I hadn’t associated it with his Call of Duty play, but when we talked about it last night, I realized that the timing lined up. Is there any evidence of violent video games bringing on stress or anxiety in young players?
     —Shoot or Scare, in Vancouver, British Columbia, Canada

A: Dear Shoot or Scare,

The key question is this: Did your son realize the association between the time when he started playing Call of Duty and his increased general anxiety punctuated by panic attacks?

The research shows that at his level of brain development, your son is more likely than an adult to have increased fear/anxiety after playing violent video games, but less likely to have the insight necessary to make the connections. He will be address this problem more effectively if he “discovers” the relationship himself and devises a solution. If he has not made the association, it will work better if you explore with him what might be stressing him at the moment, gently steering him toward his own observations rather than telling him yours.

The reason that kids get so involved with Call of Duty (the biggest selling video game to date) and other action games is that they are designed to put players on high alert—to get their adrenaline flowing and their hearts racing, ready for unexpected turns of events. Adolescents seek new experiences and sensations—it is an integral developmental task at your son’s age. Video games are one way in which they can vicariously experience fear and mastery of that fear in a situation that is not life-threatening.

Gently encourage your son to stop playing for two weeks or so and see whether his anxiety lessens. If it does, he may want to decide whether playing the game is worth living with the symptoms. If it doesn’t, the adrenaline rush of gaming may have unmasked an underlying anxiety—he may want to take a closer look at what else is happening in his life, and consider seeking help from a talk therapist to develop effective coping strategies. See this related post for more information.

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.