The Children's Television Act: An Update

By Vandana Y. Bhide, MD, FAAP, FACP

The Children's Television Act (CTA) was passed by Congress in 1990 with the goal of providing educational programming to children that "furthers the positive development of the child in any respect, including the child's cognitive/intellectual or emotional/social needs¹."

Subsequent modifications of the Children’s Television Act required that:

1. Television stations provide a minimum of three hours per week of educational and informational shows targeted to children under the age of 16 during their prime viewing hours of 7 AM to 10 PM. Commercials were limited to 10 minutes an hour on weekends and 12.5 minutes an hour on weekdays.

2. Educational/informational children's shows had to show the "E/I" label on the television screen the entire length of the show.

3. As television transitioned from analog to digital, broadcasters, who can have up to six channels of programming in digital instead of one channel in analog, were required to provide the commensurate amount of children's educational/informational programming.

The FCC is also required to consider whether a television station has served children’s educational needs during the station’s license renewal process. In return for providing such educational programming, broadcast stations were given free access to public airwaves.

So twenty years after the Children’s Television Act was first passed, has it achieved its mission of promoting educational programming for children? Unfortunately, the answer is no.

For example, broadcasters once labeled the The Jetsons educational because it dealt with the futue and The Flintstones informational because it dealt with history. Although the show GI Joe had violent content, it was described by television stations as educational due to its pro-social themes. Networks also labeled Leave it to Beaver as educational because it had pro-social messages.

Children Now, a nonpartisan children’s research and advocacy organization, evaluated educational shows broadcast by the four major networks from 1997-2008. Children’s Now determined that in 2007-2008, only 13 % of programming described by networks as educational and informational was determined to be of high educational quality. 63 % of shows were found to have moderate quality and 23 % minimal quality.

Health and nutrition messages, especially those that addressed childhood obesity prevention, were "extremely rare." ² The report concluded that current television programming does not meet the original intentions of the Children's Television Act.

The Senate Commerce, Science and Transportation Committee concurs. On July 22, 2009, Senator Jay Rockefeller, D-W.Va., Chairman of the committee, convened a hearing called "Rethinking the Children's Television Act for a Digital Media Age." The Senator said he planned to introduce legislation to regulate children's media content, citing his "grave concerns about violence and indecency in the media."

Clearly the Children’s Television Act has failed to increase educational children’s programming in a meaningful way. Even more discouraging is the fact that there have been a number of lawsuits filed by broadcasters in federal courts as well as before the FCC in an attempt to avoid their obligations to provide educational programming as stations convert from analog to digital.

What can pediatricians do to help parents when typically only three hours per week of television programming on a particular station is educational?

First, we can talk to our patients and parents about the educational programming requirements of the act, and what the “E/I” symbol means. Encourage parents to watch programs with their children to evaluate the educational value. Parents and pediatricians can notify the FCC about programming that lacks educational quality.

The FCC is generally responsive to parents who object to programming. For example, in 2007, the FCC entered into a consent decree with Univision to resolve petitions by children's and media organizations to deny the broadcaster's license renewal applications. It was alleged that Univision's children's programming did not comply with the educational requirements of the CTA. Univision voluntarily paid $24 million and developed a plan to comply with the rules of the Children's Television Act.

It is clear that most broadcasters adhere only to the minimum educational programming requirements of the Children’s Television Act. Therefore, the only way to encourage more educational television programming is to encourage the FCC and Senator Rockefeller’s committee to increase E/I programming requirements that stations must provide in order to continue to access the public airwaves for free.

References:

1. "Policies and Rules Concerning Children's Television Programming Memorandum Opinion and Order," Federal Communications Commission Record 6,(1991): p.2114.

2. Executive Summary: Educationally/Insufficient? An Analysis of the Availability & Educational Quality of Children's E/I Programming. Children Now. Htttp://www.childrennow.org/eireport.

Why Pediatricians Need to Discuss Texting and Driving In Our Offices

By John Moore, MD, FAAP

As part of my daily commute from my home to my office and back, I spend about thirty minutes per day driving on Interstate 81 through central Virginia. That commute has allowed me the fascinating and frightening opportunity to observe first-hand the recklessness and aggression of the modern American driver. Over the last seven years, I have seen drivers of cars, trucks, motorcycles, and vans doing almost everything imaginable except paying attention to the road. I have witnessed people been drinking coffee, scolding their children, applying makeup, and even flossing their teeth.

While hard data on the numbers of drivers texting or surfing while driving are not available, anecdotal and observational studies are very concerning. A recent survey by Nationwide Insurance estimated that twenty percent of drivers either send or receive text messages while driving. That number of people who drive while texting reaches a staggering sixty-six percent when limited to 18-24 year-olds.

The exact impact of texting on automobile safety is impossible to gauge. No reliable data exists to associate texting, distracted driving and accidents. However, anecdotal data continued to accumulate and the potential impact may be staggering. Several recent, dramatic deadly crashes in New York and Florida have been associated with drivers sending and receiving text messages.

Fourteen states, including Virginia, New Jersey, and Washington DC, have taken action to address that issue. In July of this year, police in Virginia began fining drivers caught texting while driving. The penalty for those caught is only $20-$50, but the psychological impact may be more profound. Hopefully, the new legislation in Virginia and other states will make motorists think about their messages and exactly how important that text really is.

As pediatricians, we are faced with the task of helping our patients navigate the complex path from childhood to adulthood as smoothly as possible. We know that teens are at significantly increased risk of automobile accidents. In addition, teens are the quickest adaptors of new, exciting, and dangerous technology. In the case of texting and driving, that combination has proven to be deadly in several well-documented cases. If we can get one teen to ignore their phone and concentrate on the road a little closer, we have made immeasurable difference in their lives. In my opinion, the ability to make huge differences in lives is why we all became pediatricians in the first place.

When Patients Google for Medical Advice

By Jennifer Shu, MD FAAP

If you’ve been practicing in the 21^st century, I’m willing to bet you’ve had patients come into your office armed with the latest “research” they’ve found on the Internet about condition X and either want to know what you think or demand the treatment recommended on the Web. I can’t say that I blame them for trying—after all, the Internet is open 24/7 and is often easier to access than the doctor’s office or nurse advice line. Since the Internet is here to stay, I believe physicians would do well to embrace this relatively new influence on our patients’ health literacy and channel our energy into helping them find the most accurate and reliable information out there.

I had the opportunity to present my views on finding credible healthcare information online at the BlogHer 2009 conference, a meeting of women (and some men) bloggers all over the country who make a living or hobby out of sharing their thoughts with online readers. As a member of a panel of experts moderated by our own Dr. Gwenn O’Keeffe, we had an audience outside of the usual realm of conferences geared toward medical professionals. I hope that by providing Googling-guidance to bloggers seeking health information, this information will then trickle down to their readers, who likely include healthcare consumers such as our patients’ parents.

I’m including some of the tips we provided and hope you’ll share your ideas too:

Look for .gov sites. Governmental sources are credible and reliable. Some great resources are http://medlineplus.gov and http://www.cdc.gov.

Visit medical organization pages. Professional associations such as the American Academy of Pediatrics www.aap.org offer accurate information. Also, consider www.medem.com (which contains a collection of information from multiple medical societies). The American Medical Association www.ama-assn.org and your state or local medical society may also provide helpful resources.

Check into a hospital site. One site with extensive information is http://www.mayoclinic.com/ but many hospitals offer credible web resources. You may wish to check out a local medical center’s site first.

See sites devoted to health information. Some examples are http://kidshealth.org/ (which has information targeted to kids and teens as well as to parents) and www.uptodate.com.

Strength in numbers. If several web sites give the same medical information, there’s an increased chance that it’s credible. Also check that there are multiple physician reviewers and that the information has been verified for accuracy recently.

Consider the source. Before getting too concerned about something you read online, consider who authors the site. Some organizations and individuals can look official but may not really provide trustworthy information.

Talk to your doctor. Your doctor should be your sounding board when it comes to making sense of online medical information. If you have questions about something you’ve read, be sure to ask your pediatrician, who can put the information into the context of your own child’s health. Better yet, ask your doctor for recommendations for favorite health web sites so you can go straight to a reliable source.

A Different Take on Social Media: Our patients...Today's YouTube Stars?

“Did you see, I made the news”, said my teenage patient a few hours after being shot twice in the legs.

“No”, I said, “I’ve been busy taking care of the other patients in the ED”.

“Too bad”, he replied. “It was pretty cool”.

I have never thought of having a gunshot wound as pretty cool. However, I am not part of this new generation that expects to be a part of social media, YouTube, Twitter, Facebook, etc.

A moment on the trends I have been seeing….

1. Teens with injuries sustained while doing some activity (likely not a safe or wise activity) that is being taped for production on YouTube. For example, with the warm weather brings the annual “what can we do to make a Slip-and-Slide more dangerous”? The last two teens with splenic lacerations opted to show me the injury as it was happening as depicted by video on YouTube. That is, before coming to the hospital, the patient (or the patient’s friend) took the time to post the video of the injury inducing event to YouTube.

2. Families videotaping injuries instead of helping the child being injured. I recently cared for a young man that was attacked in a local park. When I asked for a description of what happened, his older brother (of adult age) said he could show me the video if I wanted. When I asked why he chose to video the event instead of help his brother, he replied that he thought it would be better for the police and the news to have the video.

3. Victims of violence feeling a sense of accomplishment when their stories are covered on the local news. The gunshot victim provides a classic example.

Perhaps our entrance into social media is not best served by the medical professionals producing their own spots, but instead helping to prevent our young patients (and when necessary, their families) from being the star of these less than endearing media clips.

This is a new health crisis impacting the youth of today. I am at a loss as to the root of the problem. Is it due to the dramatic increase in reality TV? Are kids getting the message that since anyone can post a video on-line they are not worthy unless their video is the most dramatic, dangerous, outlandish, or destructive? What would cause a family member to choose allowing injury to a loved one over stopping an assault? Perhaps in addition to reviewing our patients’ charts prior to a visit, we need to Google them too…then discuss what we find when we see them in our offices!

By Elizabeth Murray DO MBA

Editor's Note:

Dr. Murray has offered us a bird's eye view into the real world of how kids are using social media. Our job is to figure out how to use this information clinically. Perhaps it's as simple as asking "been on YouTube recently?"

R Rated at 40,000 Feet?

As I make my mental checklist to prepare for family vacations, I instinctively remember the booster seats, Ziploc bags to carry snacks, and card games and books for the long flight. But I’ve been caught short-handed on a few flights with my kids due to unexpected entertainment provided free of charge by my airline “hosts” and without the opportunity of refusal. I am sometimes at a loss when my kids are staring right up at the airline’s offering of a violent R movie on the overhead screens. I took frequent transcontinental flights when my elder son (now 12) was an infant and toddler and learned the hard way that my discerning taste for my child was not shared by the airlines. I actually purchased one of the first laptops with a DVD player just so I could use that in a pinch…and I used it shortly afterwards when my toddler son looked up and saw that Matrix was playing right in his view. The Tigger Movie was my quick replacement!

Federal broadcast laws do not apply to in-flight entertainment, and airlines are not required to adhere to motion picture ratings. The Family Friendly Flights Act was introduced in Congress in September 2007 (the 110th session of Congress) to require separate airplane seating areas for kids and families to protect them from violent inflight entertainment. Although it was referred to committee, it did not get referred back to the House and is not law. However, child advocacy groups and flight attendants have continued to work with the airlines and movie studios to lobby for logical guidelines on the selection of movies for inflight entertainment on overhead screens.

On my most recent flight with my kids, now 7 and 12, we were fortunate. The boys had their portable entertainment available but the overhead fare was reasonable for their eyes. But searching the airline websites for last month’s movies showed me that they might have been faced with Gran Torino, Dark Knight, or Quantum of Solace. US Airways, Delta and countless other airlines assert their prerogative to screen any movie for the enjoyment of all of their passengers and to edit them as they see fit.

So what is a parent to do to protect his child from inappropriate inflight films? While airline spokespersons have suggested that a parent contact a flight attendant who might be able to switch the family to “obstructed view” seats during the flight, we all know that the planes are usually filled to capacity these days. This is a chancy option at best. So here are my tips for a safer flight:

1) Choose an airline that has signed onto the principles of the Family Friendly Flights Act or at least have individual screens for each passenger. This includes Southwest, Virgin Atlantic, and Jet Blue.

2) Check on airline website for the movies that are scheduled for the upcoming month. This may or may not be helpful if you are purchasing ticket months ahead, but it will give you a heads up about the relative risk of your 2 year old watching Gran Torino or Watchmen.

3) Either purchase/borrow a portable DVD player (we bought one for about $60 at Christmas) or consider renting from an airport facility or from the airline itself. Alaska Airlines rents onboard digEplayers (personal entertainment players) to passengers with 24 hours notice. InMotion Entertainment has stores in major airports and will rent you a personal DVD player and DVDs for the flight or the whole trip. In a pinch, as I have done, use the DVD player in your laptop. For those with really good eyes, you may hand over your iPod pre-loaded with an appropriate movie for the little ones! In the case of a VERY curious preschooler, a blanket “tent” might make a fun diversion to keep her eyes on her movie and off the overhead screen.

4) Of course, try to limit your kids’ screen time on the flights. Bring books, music, playing cards and travel games for the whole family. Kids often love the one-on-one time with a parent held captive right next to them for 6 hours straight. Scrabble, Mastermind, and many other classic games come in travel editions. My younger son cajoled my husband into reading a 300 page adventure novel to him on a series of flights when he was four.

5) Provide feedback on inflight entertainment to EVERYONE in the travel industry. I have been receiving more post-flight surveys these days and I make comments on the movie issue even when it is not the topic of the survey. I applaud those flights in which I am not scrambling to “distract” (Horton Hears a Hoo followed Yes Man on our transatlantic flight…good option but the kids were already asleep for the G movie!) and I draw attention to the times that I am not so pleased (The Day the World Stood Still did not make my cut on a recent flight due to apocalyptic scenes).

Letting airlines know that you will be looking elsewhere for your travel needs is the best way to protect all of our children from these films. Airlines are traveling movie theatres but are not members of the MPAA and do not have to follow MPAA rating guidelines. So your efforts to keep your child from a PG-13 or R movie while at home are being undermined by the airlines’ lack of commitment to families. The airline industry needs your dollars and advocacy may start with consumer decisions. Until the friendly skies change, however, travel with kids means travelling prepared. Bon voyage!

By Mary Beth Miotto, MD, FAAP


Editor's Note:

Readers may be interested in checking out www.kidsafefilms.org, an organization dedicated to this very issue.

Sexting: dangerous but is it a crime?

“Come gather round people wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
Then you better start swimming
Or you’ll sink like a stone
For the times they are a changing”

Bob Dylan’s song of protest (voted #59 of the top 500 songs ever written by Rolling Stone) seems as prescient today as in 1964, especially as COCM members recognize the latest teen-technology on-line behavior:sexting. Research studies reflecting usage reveal that between 20-25% of all teens have sent or posted semi-naked or naked pictures. A higher percentage says that exchanging sexy content makes dating or hooking up more likely.

Teens have been recently charged with disseminating child pornography in 9 states, many have to then register as sex offenders. Meanwhile,the media (as usual) has sensationalized the issue by the way it has covered the topic, often confusing parents, teens and even pediatricians.

But the real question here is this: should laws made to protect children be used to prosecute them? I believe that misses the point. Pediatricians and parents should look beyond the headlines to the convergence of adolescence and these electronic devices that allow instant communication decisions from immature teen brains.

These kids are not threats to society.They’re reckless hormonal narcissists who are tasked with growing up in a sexualized society. Their previously private thoughts are now revealed all too publically. They often are the real victims here: assaulted by a desire and opportunity to get older-younger.

Parents need to become aware that the media has ensured that adolescence occurs well before Tanner stage II. The media has framed the issue, but not focused on real solutions. That's where we can help enormously with our pediatric knowledge and media skills!

So what is the Pediatrician’s role when it seems that teens are more connected to their devices, and each other, but disconnected from their parents? It doesn’t have to be complicated.

1) Don’t wait until a health maintenance appointment to frame the issue of texting/sexting. Rarely does a teen or tween appear in the office without a cell phone. (Or receive a call during the appointment).

2) Remind them that a text or sext, once sent, is out of their control permanently. Examples abound from the pictures of Vanessa Hudgins (HSM 1,2,3-oh google her) or Michael Phelps and his famous bong picture.

3) Ask about whether parent is concerned about texting as nauseum. Most will agree
about the numbers, but will be clueless as to potential solutions.

4) Advise visiting ThatsNotCool.com (go there yourself). A great site with tools and guidance, prime parenting directives actually, to buffer cyber-stalking and cyber-pressures. The site also has great posts that could be taken from the site to stimulate a discussion in your examination rooms, newsletters, websites.

Note that as the January archives article revealed, uncovering the problem does not imply you have to solve it. Expressing awareness and concern, could, hopefully, motivate parents to seek opportunities to learn and engage in collaborative conversations that would lead to constructive solutions.

“Come Mothers and fathers throughout the land
And don’t criticize what you don’t understand
Your sons and your daughters are beyond your command
Your old record is rapidly aging
Please get a new one
If you can’t lend a hand
For the times they are a changing”

By Don Shifrin, MD, FAAP

What if every pediatrician was on twitter?

Is the absence of pediatricians on social media platforms a public health issue for children? It might be. Misinformation predisposes children to risk. We all can identify instances where poor decisions for a child were made on corrupt information obtained online.

And as doctors we complain. We see ourselves as victims. Our patients are reading someone else’s information and opinion. And most of us handle matters by taking precious time to get the facts straight. Time that could be better spent on anticipatory guidance or counseling in other areas.

But to some extent the issue of bad information is our responsibility.

As pediatricians our response to online misinformation tends to be reactive. For some reason we never think that we should be the ones generating the information and dialogue. As the group charged with the well-being of the next generation we need to be proactive. We have a commitment to see to it that we are visible and vocal online.

So what can you as a fellow of the AAP do?

Contribute to a blog. It doesn’t have to be your own blog. There are many that would be happy to host you as a guest author. Offer practical input on the issues that you see creating confusion in your parent base. If every fellow of the AAP posted one blog post annually on the absent association between vaccines and autism, for example, there would be 60,000 online entries which would likely dominate search engines.

Comment regularly on news sites, blogs or anywhere there’s dialog on children’s health. With no input from those of us with the facts, discussion will be dominated by a vocal minority, many of whom have an agenda not representing the interests of the parental reader.

Begin a Twitter account. Just a few minutes a day cultivating relationships with peers, patients and ‘followers’, AAP fellows have the potential to change minds and influence thinking. Twitter is a platform for the dissemination of ideas, thoughts and information in ‘tweets’ of 140 characters. Assuming just 250 followers (I have 1,000), the news of a measles outbreak associated with undervaccination, for example, could instantly reach 15 million individuals with a single tweet from AAP members.

The battle for the health of our children and the sanity of our parents is now fought online. A commitment to online literacy through active involvement by AAP Fellows in social media should be seen as a critical advocacy role.

By Bryan Vartbedian, MD, FAAP