December 27, 2015

Podcasts for Kids: Entertainment that Flexes the Imagination Muscle

Kate Vidinsky, M.A.
Communications Director, Tales Untold Media
San Anselmo, California

My first childhood home was a tidy ranch on a flat, tree-lined street in a quiet Northwest Indiana suburb. Beyond that, my memories of the house are murky. And yet, clear as day, I can picture myself crouched in the basement next to my sister, listening intently as stories spun on our record player and my imagination took flight. I feel a shiver move up my spine as I recall the spooky tales we listened to around Halloween each year, and a warmth in my belly thinking about cozy story times with a side of Hanukkah cookies.

I know it’s clichĂ© to say those were simpler times, but my goodness is it ever true. Today, like so many other parents of young children, I’m trying to strike the right balance between modern technology and the “good ole days.” All at once I feel immeasurably grateful for my iPhone, which enables my children to see their long-distance grandparents any time they’d like, and completely frustrated when I see so many eyes focused downward at mobile devices instead of outward at the world’s beauty.

It was this type of parent versus technology tug of war that inspired my husband Nick and me to begin producing podcasts for young children. We feel strongly that kids content doesn’t need to go a hundred miles an hour or shock a child’s senses into submission. It just needs to tell a good story.

During the last few years, podcasting as a medium has surged in popularity. According to a report from the Pew Research Center, the percentage of Americans who have listened to a podcast in the past month has nearly doubled since 2008, and one-third of Americans 12 years of age and older say they’ve listened to at least one podcast before.

Podcasts get straight to the essence of storytelling in an easy-to-use, on-demand format. And with their serial nature, characters can develop, learn and grow along with the audience. For families looking for ways to cut down on screen time while still embracing the power and convenience of today’s technology (and maybe even get some dishes washed or laundry folded in the process), podcasts are somewhat of a home run.

And while it’s not news that listening to stories read aloud aids in language development, recent research has helped pinpoint exactly what’s going on in children’s developing brains when they actively listen during story time. A study published in PEDIATRICS August 2015 used fMRI to observe brain activity in 3-to-5-year-olds as they listened to age-appropriate stories. The researchers found that the children’s brain activity differed according to how much they were read to at home.

Children whose parents reported reading more stories at home showed significantly more activity in the parietal-temporal-occipital association cortex, a hub of sorts in the brain’s left hemisphere that integrates sounds and visual stimulation. In other words, children who regularly practice the art of listening to stories are more adept at visualizing what they hear. Essentially, their brains are in better imaginative shape.

The take home here is we now know for certain that actively listening to stories – as opposed to watching videos or even following along with picture books – increases brain activity, improves the imagination and prepares children for literacy.

Our audio-only podcast app for kids, Tales Untold, is a model for how we can leverage technology to provide children with rich, imaginative experiences, rather than simply plugging them into screens. For when we show children a world, they are outsiders looking in with imaginations gone quiet. But when we encourage them to flex their imaginations while actively listening, they are drawn into their own creation.

Whether it be as an alternative to television in a pediatrician’s waiting room or as a way to cut down on the “are we there yets?” during a family road trip, podcasts are a brain-healthy brand of kid entertainment primed to take off in popularity. I strongly suggest giving them a listen.

November 25, 2015

Mom and Dad: What About Your Screentime?

Hansa Bhargava MD FAAP
Staff Physician, Children's Healthcare of Atlanta
Medical Editor, WebMD
I was driving my 9-year-old son home from school the other day, when he said ‘Mom, no texting when you are driving’. It was at a red light, I explained, but he wasn’t buying the excuse.
As researchers focus on how screen time affects kids, I do wonder, should we focus more on how it affects parents, especially how it affects interaction with their kids?
The science is pretty clear that too much of certain types of screen time isn’t good for children. It can take away precious time from academics and exercise. A recent study reported that teens spend about 9 hours a day on media,, mostly on entertainment and tweens about 6 hours. But what’s the impact on a child if she sees her parents always glued to their phones, laptops, or the TV? This is where the science is less than clear.
Parents seem to love screen time almost as much as kids do. A recent Pew Internet Report found that 75% of parents use social media and have a median of 150 friends on Facebook. This is across age, gender, income and education level.  94% post, share, or comment with 70% saying they do it often.
Although there does not seem to be any clear data on parents’ screen time and relationships with their kids, recent research seems to show the links probably aren’t good. A small study at Boston Medical Center found that 40  of 55 adults took out a mobile device almost immediately when eating with their kids at a fast food restaurant
When parents don’t spend time talking to babies and toddlers, it creates a major gap in their language skills, which could put them behind their peers in reading and language by 3rd grade. We know that not engaging with kids at these stages has a colossal impact on their language and academic development, but what does it mean when parents use screens to tune out from older children?
Some schools recognize this issue and are changing their curriculum style to better engage children. The Atlanta Speech School, which teaches children with dyslexia and other language disorders, mentors parents and teachers to be more of a ‘conversational partner’ and to engage their children in discussions.
Screens are not going away and some interactive screen time may even be a good thing. But my kids and I now have some new rules in our home that apply to everyone, kids and grown-ups. No screen time in the car, at the dinner table, or at bedtime. Hopefully these first steps will help us get to what really matters: good relationships and happy children.

In this brave new world, I think that we can still apply that good, old-fashioned rule: Practice what you preach.


November 11, 2015

Screens in a Pediatric Office

Paul Smolen MD FAAP
Carolinas Medical Center, Charlotte NC
 Author of Can Doesn't Mean Should-Essential Knowledge for 21st Century Parents

Every practicing pediatrician struggles daily with a growing tension in American medicine. This tension is between the emerging prominence of consumer driven data (such as patient satisfaction surveys, insurance company ratings, and online ratings of patient loyalty) and national expert panel guideline measures of quality and positive health outcomes. Unfortunately, what often makes parents happy with their visit to their pediatrician is not always what makes their children healthier. For example, patient satisfaction begins in the waiting room, and pediatric waiting rooms are usually outfitted with screens, media, and marketing messages.

 In today’s world, scoring well on patient satisfaction surveys and practicing good pediatric medicine are occasionally at odds with one another.  My practice began making patient satisfaction surveys public and searchable to parents in October 2015, presumably to enable prospective patients to compare one pediatrician in my community with another. The assumption is that parents who are happy with their child’s pediatrician have good pediatricians.

The converse assumption is that pediatricians are only good when they make their patients’ families happy.  By this logic, I should prescribe antibiotics for a child who may not need them if her family wishes, or hesitate to describe a child as overweight rather than just a little plump for fear of offending his parent, or provide a flat screen TV with commercial programming in my waiting room if that is what my patients want. In the future, my ability to stay economically viable may be contingent on whether most parents who visit my office have a “pleasant experience” or “get a good vibe” as many parenting magazines suggest is a way of judging an unfamiliar pediatric practice. (1)

Pediatric waiting room screen exposure creates tension between patient satisfaction and expert panel guidelines because time spent in a waiting area is part of the pediatric visit.  Parents have come to expect a media experience that likely makes their child’s pediatric visit easier but is contrary to expert guidelines that direct pediatricians to discourage screen time for children under two years of age (2), to limit entertainment screen time in older children, and to strongly promote reading to children. (3) Many pediatric waiting rooms ignore these guidelines and provide what patients want - screens.  Recently, I surveyed many pediatric practices in my community and found that all but one continuously showed child programming with commercials in their waiting areas, regardless of the ages of the patients or reasons for the visits.

    Arguably, television with child-centered programming improves patient satisfaction and may even reduce stress and anxiety for children during a visit.  A recent study demonstrated that an iPad is more effective at reducing anxiety in a child than a dose of Versed! (4). Will the pediatric practices that thrive in the future be the ones with the biggest flat screens showing the most recent Disney blockbuster in their waiting rooms? If the trend toward patient satisfaction is any indicator, the Disney Corporation has nothing to fear.

Maybe in the era of portable screens and streaming of any content, anywhere, anytime, the best solution for waiting room satisfaction is to encourage parents to bring with them whatever will calm and entertain their child - a screen, a toy, a book - and get pediatricians out of the business of entertaining children.  Pediatricians shouldn’t be in the entertainment business anyway.


1. Q: When should I start searching for a pediatrician, and what are the main things I should look for? PARENTS, 2009

2. AAP Policy Statement: Children, Adolescents, and the Media. PEDIATRICS, Volume 132, Number 5, Nov 2013, pp 958-961

3. AAP Policy Statement: Literacy Promotion: An Essential Component of Primary Care Pediatric Practice. PEDIATRICS, Volume 134, Number 2, August 2014, pp 404-409

4. Tablet-based Interactive Distraction (TBID) vs oral midazolam to minimize perioperative anxiety in pediatric patients: a noninferiority randomized trial. PEDIATRIC ANESTHESIA, Volume 24, Issue 12, December 2014, pp 1217-1223

October 2, 2015

Anonymity and Denial in the Twitterverse

Kathleen Lovlie MD FAAP
Gulf Shores AL
Author of "Practical Parenting: An Un-Politically Correct Guide from the Trenches"

Playwright Tom Stoppard said, “Words are sacred. They deserve respect. If you get the right ones, in the right order, you can nudge the world a little.”

I am old enough to be amazed by social media, with its multitude of words and pictures. It did not exist when I was new. If we wanted enlightenment, we went to the library or read the Post. By the time we found our information, the events were already in the past. We knew people of different cultures existed, and events happened, but it was knowledge that came at a distance, blurred by its time-consuming transformation into letters and pictures.
When we curious children wanted to see what a woman looked like without her clothes, we stole our parent’s National Geographic and leafed through it for pictures of deepest Africa. Kennedy and Lennon were shot, but there were no cell phone videos or instant interviews. The stories unfolded over weeks, with time to adjust and get a little distance.
Social media now comes with immediacy and savage intensity. People’s lives are flayed open and placed on the screen for my perusal. If I presume to know anything about that woman in Africa, she can knock me upside the head minutes later, because she is in reality just a hairsbreadth away. If I pretend to wisdom, the whole world can judge me and let me know where they think are my errors in judgment.
This brilliant transparency should make us more authentic, more determined to write nothing that we would not stand behind to our deaths. We should claim our words without reservation. These words. are. me. Sadly, from a place of weakness and fear it can instead make us deny what we know, as we buffer our truth so as not to be responsible for it.
We write, “Tweets do not replace medical advice; retweets are not to be considered an endorsement.” We backtrack and pad ourselves against risk. The most powerful thing we can do – put out thoughts into words for other people to see – we disclaim and weaken with “tweets are not meant to be advice.”
Of course they are! What would be the point, otherwise?
If we give thought to and write words down, then they need to be true. Words are sacred. We record our words in the hopes that they will “nudge the world a little.” If our words are our truth, then they have earned our faith: we have to stand behind them with our names and our identities.
Weakening our words by buying into a fear of lawsuits and judgment is a betrayal of our selves; it costs us a piece of our souls. Our words are us, and denying them, even in a small part, allows decay to eat away at our own value.
Conversely, since we wrote those words with our very own minds and hands, we should never, in the rush to say something, write down what we know is not truth: those words will also follow us through our lives. People sometimes feel that they can be nasty, petty, or judgmental on the internet because they are anonymous. They can twist the facts just a little to make their point. We must realize that there is no such thing as true anonymity. Even if no one else ever knows who wrote those words, you yourself do.
Persian poet Hafez wrote, “The words you speak become the house you live in.” Write only words that have a strong foundation and the solidity of truth, so that your house is yours alone and can hold up  the hurricane force winds of opinion. Hafez’s words are as true on the internet today as they were in the fourteenth century in ink on paper. Such is the power of words. Believe in them and in your self.

September 14, 2015

Media Diet

Katie Noorbakhsh, MD FAAP
Children's Hospital of Pittsburgh

Media diet [mee-dee-uh dahy-it]: noun - The phrase that changed the way I thought about my children’s interaction with media.

For years, my goal was simply to keep my children’s screen time to less than two hours per day.  The concept of the media diet for my kids resonated with me, in part because I realized I would never take such a simplistic attitude with feeding them. Teaching and modeling how to eat in a healthy manner is far more complex than just limiting yourself to an arbitrary number of daily calories. In much the same way, teaching my children to interact with media in a healthy manner is also more complex than simply limiting their screen time to a number of minutes.

Until a few months ago, we had a habit of starting our mornings with cartoons. I have three children under five and work in the Emergency Department.  A thirty minute cartoon at 6 a.m. allowed us to ease into my post-shift mornings, limiting my role as a human jungle gym just long enough to finish a mostly-hot cup of coffee. And thirty minutes of cartoons is not a big deal. The trouble begins with ‘just one more.’ “Just one more show. Please, mom?” Just one more cup of coffee. OK, kids? Just a few more minutes of peace. Before I knew it, three hours of our day could evaporate into brightly colored, overly enthusiastic, two-dimensional story lines. Add on a request to play an iPad app (It’s educational!) or a family movie night (It’s a classic!) and I started to worry how we would manage screen time when our children were older and the demands became more challenging.

The concept of a “media diet” pops up in marketing  and communications  literature from the early 1980s. The term gained popularity in the news media  in the 1990’s with the introduction of the v-chip and increasing discussion of how types of media might impact young children. The August 2000 publication of the Journal of Adolescent Medicine featured two articles that addressed the concept.  In Media and youth: access, exposure and privatization  Donald F. Roberts discusses the results of a survey regarding the volume and breadth of media exposure among American children. Jane Brown’s article, Adolescents' sexual media diets  lays out a media food pyramid, illustrating types of media consumed and the range of involvement, from passive to active, as individuals select and interact with different forms of media. There have been a smattering of articles investigating media diets since then, primarily focusing on the violent or sexual content of media consumption.

A true media food pyramid with specific goals for how our children should be consuming information has yet to be described. However, if media is a diet, then early morning cartoons are probably the doughnuts and juice of television. My kids don’t start their mornings with a thousand calories of doughnuts and juice (although given the opportunity, I’m confident that my two and four year old would be happy to do just that), and I have no problem saying no to cookies and candy at the grocery store. We fill our cart with fruits and vegetables; yogurt and cheese; peanut butter and whole grain bread. At home we cook and eat together. This is all intentional. Healthy habits start young. Healthy eating is key to the development of a healthy body image  and to preventing obesity, heart disease  and diabetes. I don’t have to count my children’s calories because counting isn’t the goal. The goal is healthy choices.

In order to transfer the rules of the kitchen table to our coffee table effectively, I had to cut out the junk. No more morning cartoons. Even after late shifts in the Emergency Department. This was a direct threat to my hot coffee drinking preferences. But I did it. We woke up and went downstairs and started our day with no TV. And the kids? They protested vehemently. They cried. They yelled. They begged. They pouted. And then they played. The next few mornings were similar but the protests waned. Now we regularly start our days playing games that the kids make up. (My personal favorites include “Sharks and dinosaurs” and “Sitting in traffic.”)

Without the cartoons, we suddenly had an empty basket to fill with healthy media choices. I considered books and music to be the vegetables and fruits – always available and encouraged in our house. But what are healthy ways for young children to interact with television, computers and phones? I started by showing them how I could look up information on our computer. A map to illustrate how rivers go to the ocean to illustrate how rivers go to the ocean. An interactive website to lern the parts of a mushroom. I showed my four year old how to practice his letters in Microsoft Word and hit Ctrl+P. Our printer cartridge is out of red and orange right now, but he has never been more enthusiastic about sounding out his name.

The more I think about the media choices I make for them, the easier it is to manage their screen time. I no longer guiltily wonder if volcano videos at the museum or Face-timing with grandparents “count” as screen time. I don’t count calories and I don't count media minutes. We aren't close to exceeding our daily limits. And when my husband and I hire a sitter and go on a date, I don't hesitate to let the kids splurge on their favorite treats: pizza, popsicles and a cartoon movie.

August 28, 2015

Want Kids to Get Enough Sleep? Turn Off Screens at Bedtime


Don Shifrin MD FAAP

Clinical Professor Pediatrics

University of Washington School of Medicine

Twitter: @peddoc07

From toddler to teen there aren't many mothers who don't answer the question, "Is your child getting to bed on time and getting enough sleep?" with a horrified look and a resounding "Are you kidding?"

From separation anxiety for parents at 18 months to separation anxiety up to 18 years about their electronic devices, children’s, tweens’, and teens’ sleep debt rivals our national debt. What can be done?

Well, first - you gotta ask. So ask (and I often do ask teens and tweens directly, not just their parents) in a neutral voice, what could possibly be keeping them up that late? For children and middle schoolers it is often screens. I admit that high schoolers with school, activities, athletics, and homework often have only 3-4 hours during the day to get 'everything' done. (Not very efficient however if they are multi-tasking with social media, YouTube , Spotify, texting). That said, they still need as much sleep as they can (and do) allocate.

Then ask, especially about teens, when do they go to bed in the summer (generally late) and when do they wake up (usually later)? This delayed sleep phase in summer is normal, but is a huge detriment once school starts. But it will tell you unequivocally how much sleep their bodies desire to get if left alone without an alarm to wake them. Now translate that to the fall and school. There is no way you can guarantee them the 9-10+ hours they are probably getting in summer, and definitely should need during school.

That means that every minute of sleep they are losing is vital, because they are already, by definition, incurring a sleep debt Monday-Friday. Then, and only then, can you state that when they take their devices to bed, next to the bed, or cease using them right before bed, their brains will not be sleepy for 15-30 minutes at a minimum. And they need every one of those precious minutes for rejuvenation for school attention, focus, homework, and athletics.  

Parents now are paying rapt attention as they have, by their own admission, been pleading with their kids to cease and desist taking their devices to bed. I make the point that their bed is a sacred place where it is OK, and a must, to disconnect. You will get pushback and the usual denials. As well as the dreaded FOMO (fear of missing out). But the time you can put in clinically to alleviate this habit is well worth the effort to try to insure them at least 8 hours of uninterrupted sleep. And the moms will love you for it!

Oh, and be sure to follow up at the next visit.

July 11, 2015

The Facebook Imperative

Gregory Lawton, MD, FAAP
The Children’s Hospital of Philadelphia
A Musing Pediatrician on Medscape

The average first time diaper changing parent is twenty six years old and will be in a preschool carpool at the age of thirty-one.

According to the Houston Chronicle, seventy-nine percent of Facebook’s 200 million North American users are between the ages of twenty-one and thirty-four.

This means that for every toddler struggling with toilet training, there is a very likely a parent with a smartphone and Facebook app nearby.

This is not a parent who surfs the web. She scrolls through a Facebook News Feed or the Twitter trends.  He does not actively search for information (other than using Google). Rather, based on his likes and preferences, information is directed to him in the form of hashtag messages, birthday notifications, and alerts.

Most pediatric practices in the United States have a website that boasts practice hours, staff members, and general policies. Websites, however, are passive information repositories. They don’t reach out and engage the app-using, smartphone-touting, social media consuming parent.

The next time a high school in your area has a pertussis outbreak, consider what message you want to push out on your practice’s Facebook page. When an ice storm cuts power to both your office and the computers of your patients, perhaps a Tweet will reach more parents on their mobile devices. When an unexpected change in a clinician schedule means there are suddenly five or six extra appointment slots for those coveted physicals, maybe an announcement on social media would be the best way to fill those slots.

For these scenarios to become reality, however, three things need to take place.

First, the American Academy of Pediatrics needs to publish specific guidelines for practices enlisting social media for the purpose of communicating with families. What constitutes appropriate content? Who can post and who monitors the site? What statements are needed to mitigate liability?

Second, it is important for large healthcare organizations to recognize that an institution social media presence is not a substitute for a local office presence. In order for a practice Facebook page to reach YOUR patients, in YOUR neighborhood, it needs to be YOUR practice’s page. To be sure, it can link back to the mother ship, but it needs to be local.

Third, pediatricians need to become more adept at using social media at the practice level. This means moving beyond links to YouTube uploads or vacation pictures. Think about a post that the flu vaccine is in and you have a wide open flu clinic on Thursday. Consider a tweet when there is a local story about Lyme Disease or the uptick in driving accidents around prom season. Announce the retirement of a beloved nurse or clinician in the practice.

For the social media-savvy, communication minded pediatrician who thinks about taking care of the healthcare needs of the entire practice population, Facebook is where the patients are. Twitter is where the teens are. It’s time to enter this arena.