February 14, 2014

Friday Night Tykes - Letter from the AAP to NBCUniversal

This latest update to the COCM Blog shows the work of the AAP in action. In January 2014, the Esquire Network began airing a new reality series called “Friday Night Tykes,” which follows several teams of 8-year-olds playing in a competitive football league in Texas. The coaches are depicted encouraging athletes to injure players on the other team, forcing athletes to run to the point of exhaustion and nausea, ignoring basic safety precautions and verbally harassing the young athletes. Recently, two of the coaches have been suspended by the league for encouraging dangerous play or bad behavior. Members of both the Council on Sports Medicine and Fitness and the Council on Communications and Media urged the AAP to communicate with the show regarding activities that are putting children at risk, and concerns about exploiting children for the sake of entertainment. This is the letter that went to NBC, the parent company of the Esquire Network.

February 11, 2014

Stephen B. Burke CEO and President NBCUniversal
30 Rockefeller Plaza New York, NY 10009

Dear Mr. Burke:

On behalf of the American Academy of Pediatrics (AAP), a non-profit professional organization of more than 60,000 primary care pediatricians, pediatric medical sub-specialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults, I write to express our concerns regarding “Friday Night Tykes,” a “reality” television show which began airing on the Esquire Network, a division of NBCUniversal, in January 2014. The intent of the program appears to be to spark a national conversation on “how much competition is too much?,” but we are deeply concerned about the children on these teams, who are subjected to unsafe practices while adults stand back and watch or in some instances, bully them. And all of this is filmed as a means of entertainment.

Pediatricians have long advocated to create safe environments for children participating in sports, including football. This includes acclimating children to the heat and weather conditions, teaching proper tackling techniques to avoid injury, and wearing the appropriate football equipment at all times. The AAP has also advocated for stricter laws so children who may have had concussion must sit out until evaluated by medical professionals. ”Friday Night Tykes” does not seem to take into account any of the medical advice that we or other nationally recognized health professionals have suggested.

In addition to the safety concerns, we are alarmed by the message delivered by coaches on the show who threaten to bench or dismiss from the team players who do not comply with demands. At this age, these children want to make their coaches and parents proud. While the coaches believe they are raising a disciplined team, these threats instead increase the children’s tolerance for being bullied. Research has shown that by age 13, 70 percent of all youth drop out of sports, usually due to the behavior of adults, parents and coaches. Sports can increase children’s self-esteem and help them develop peer relationships. Unfortunately, none of these benefits are apparent in the show.

Finally, using children at risk of serious harm in this way as a source of entertainment raises deep concerns. Regardless of the intent of the show, these children are being exploited for the sake of entertainment and for ratings. Viewers of the show watch in troubling fascination the extreme behavior of adults in their roles as coaches or parents determining how much physical and emotional pain is enough -- or too much for young children. Children are unable to consent to be exposed in this way, nor are they developmentally equipped to understand the complex interplay between themselves, their coaches, their parents, the cameras and the audience.

We would appreciate the opportunity to meet with you, Esquire Network executives and the producers of the show to discuss our concerns in greater detail, and to ensure the safety of the children participating in this show moving forward.

James M. Perrin, MD, FAAP President 

January 27, 2014

Those Super Bowl Ads and Our Kids

Nanette Nuessle, MD

Winter is upon us. Play-off season is here. Beer ads are on T.V.

Research shows that more than $6 billion per year is spent on advertising and promoting alcohol. Children view 1000-2000 alcohol ads annually. According to the AAP Policy Statement on Children, Adolescents, Substance Abuse and the Media (1), many of these advertisements are concentrated during teen-oriented shows and sports programming. By grade school, many children can identify the cute little animals used to promote certain alcoholic beverages as easily as they can identify Bugs Bunny. It sounds appalling, but parents who watch television with their children know this to be true.

What parents might not realize is that there is an established link between ads and teen drinking. "Young people with more positive affective responses to alcohol advertising hold more favorable drinking expectancies, perceive greater social approval for drinking, believe drinking is more common among peers and adults, and intend to drink more as adults."(2)  As adults we know that people who drink aren’t happier. But surprisingly, many of our children and teens believe that they are. After all, they’re shown that you can’t enjoy a sports event without beer. They’re told that the highlight of a holiday party is the mixed drink. Even restaurant ads for dinner with friends often involve alcoholic beverages. Everyone is smiling. Everyone is happy. They are all having a good time with no worries in the world. It’s the power of advertising. Let’s be honest, companies wouldn’t spend the fortunes they do on advertising if it wasn't effective.

Unfortunately, it doesn’t stop with ads. Films and television shows often portray drinking in a positive light, with a drinking scene roughly every 22 minutes on TV, every 14 minutes on MTV (1). Alcohol is usually associated with wealth, luxury and successful accomplishment of daring deeds.

Parents can combat this but it requires active parenting and involvement. Monitoring what children watch, co-viewing whenever possible, restricting certain problematic channels and limiting screen time to 2 hours a day is great over-all advice but for alcohol in particular encourage parents to find ways to avoid the alcohol ads. When possible, record shows and fast forward past the alcohol ads. If this isn’t possible, then mute the ads. Parents can use this commercial-free time to talk and have teachable moments. Discussing what children are seeing, talking to kids about the fact that ads do not portray real-life, telling them that there are consequences to drinking, and all consequences aren’t happy decreases the power of these ads.  Parents can even take the next step and role-play with their children acting out what to do if they are in a situation with alcohol and friends.

As pediatricians, we need to encourage parents to talk to their children about alcohol and to start early. By telling a parent during a 10 or 11-year-old well child visit that this is a good time to start discussing alcohol, you can empower them to have these talks with their children. Remind them that once their children become teens, a parent’s words have less influence than those of their friends.

There are a number of sporting events coming up during this cold, winter season. As advertisements flood our children and teens, it is the perfect to time remind and empower parents to use these opportunities to discuss the reality of alcohol and to be aware of the powerful and lasting effects these ads can have.

Article Referenced in this Post:
American Academy of Pediatrics. Policy Statement. Children, Adolescents, Substance Abuse, and the Media. Pediatrics. 2010; 126 (4): 791-799

Anderson, Peter, et al. "Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies." Alcohol and alcoholism 44.3 (2009): 229-243.

December 31, 2013

New Year’s Resolutions

Sean Palfrey, MD & Robert Sege, MD
Boston Medical Center & the Massachusetts Chapter of the American Academy of Pediatrics

One year ago, the country was stunned by the shooting at Sandy Hook School. Many of us spent the shattered holiday season trying to make sense of how such a tragedy could happen here and what we should do about it. One year later, we have gained little insight, have argued over many possible solutions but agreed on few, and have done little of substance to reduce the possibility that such an event could happen again.

But there are important resolutions we can all make this New Year to our families, our communities and our country in memory of the 20 children killed in Newtown and the thousands of other children killed by gun violence since then across this country.

The first resolution is to make our own families safer. Most parents safety-proof their homes when their children are small, putting knives away and getting poisons like drain cleaners and rat poisons locked up or out of the house. But as our children grow, explore, experiment and act, sometimes impulsively and sometimes intentionally dangerously, we have to continuously upgrade our safety measures. We need to store all potentially life-threatening things, such as guns, bullets and explosives, far out of reach. For greatest safety, they should be out of all homes and out of our daily lives.

The second resolution is to help all members of our community be safe. Homes, schools and workplaces can all be very stressful. Many people at risk of harming themselves or others may seem calm much of the time, but they may not be inside. We know normal children can be naughty and teens will act in risky ways, but we can all  recognize when someone crosses the line and shows truly dangerous behaviors – bullies, challenges, insults, hurts people, harms animals, is a mean drunk or surrenders to drugs that destroy their self-control. Each of us, their families, friends, teachers, and doctors must have the courage and wisdom to identify and help these people on the edge before they strike out and hurt anyone, or many. Professionals are available and waiting to help.

The third resolution is to make our country safer. We have the power and responsibility to speak out to our legislators and ask them to help us build a safer country. Since the Newtown massacre a number of states have acted to require background checks before gun sales and ban military-style assault weapons, but other states are moving in the opposite direction. These are issues that need broad state and national action, and it is the job of our legislators to act on our behalf. Let them know that the lives of our children and friends really matter to us and that they must act to safeguard them.

In memory of the children who died this past year we can at least make these basic New Year’s resolutions to save the lives of our children in coming years.

December 15, 2013

Let’s Co-Opt Powerful Food Marketing Strategies to Help Parents Raise Healthier Eaters

By Natalie Digate Muth, MD, MPH, RD, FAAP

When my son turned 3, we took a big gamble for his birthday “treat” at preschool. We didn’t bring cupcakes, brownies, or cookies. We didn’t even bring 100% fruit popsicles or juice. Instead, the night before his birthday my veggie-hating child and I sat down together, cutting up pineapple, broccoli, and cherry tomatoes; arranging blackberries, blueberries, and black olives; and generally having a great time getting ready for his birthday together. I smiled big but secretly fretted. Was I setting my son up to be the laughing stock of his preschool? Would he even eat his own birthday snack?

Our concoction turned into a beautiful array of Sesame Street characters – a blueberry and blackberry Cookie Monster, pineapple Big Bird, cherry tomato Elmo, broccoli and olive Oscar the Grouch. The experiment was a success. The three- and four-year-olds, my son included, were eager to gobble up their Sesame Street friends. This test capitalized on what even the most novice food marketers know well – the way to a child’s mouth is through his heart – in particular with beloved characters, sure to make any given food more exciting.

Unfortunately, this insight typically goes towards marketing unhealthy food, with 98% of food ads for kids consisting of pure junk. A recent report from Yale Rudd Center found that in 2012, the fast food industry spent $4.6 billion marketing mostly unhealthy product to kids. Unlike other developed and wealthy nations, the U.S. has done disgustingly little to regulate manipulative advertising to kids, and despite bold promises to self-regulate, the food industry has done a lousy job.

In an effort to counter junk food marketing, last month Let’s Move joined with Sesame Street to announce a campaign to promote fresh fruits and vegetables to kids. Starting in mid-2014, the Produce Marketing Association and its growers, suppliers, and retailers will get to use the Sesame Street characters’ likeness to promote fresh fruits and vegetables!

My own mini-experiment and real peer-reviewed research suggest that this strategy will work! For example, one study showed that simply placing an Elmo sticker on an apple doubled the number of kids who would choose an apple over cookies. By rearranging vegetables and fruits in a way that appeals to kids’ imaginations, an “I-won’t-touch-anything-green” kid eagerly reached over to take a bit of the dirty, grouchy, and oh-so-loveable broccoli Oscar at my son’s birthday party.

As pediatricians and vocal advocates in the media and online, we need to not only continue to push for commonsense restrictions on advertising to kids and put pressure on celebrities, corporations, and organizations who engage in tactics to get our kids to prefer junk but also support efforts to promote healthy foods, such as Let's Move's partnership with Elmo and Rosita.

Natalie Digate Muth, MD, MPH, RD, FAAP practices general pediatrics at Pediatric Medical Associates in Vista, California and is Healthcare Solutions Director at the American Council on Exercise. She is author of the book “Eat Your Vegetables! and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters” (Healthy Learning, 2012) which aims to help empower parents to set their kids up for lifelong healthy habits, without the mealtime battles.

November 14, 2013

Attack of the Hand Held Devices

Mary Ian McAteer, MD, FAAP
Private practice pediatrician
Indianapolis, Indiana

I am all for establishing screen time rules for children, but how about screen time rules for parents?  Every day I see instances where my families have their devices situated between themselves and real life experiences in front of them.  They are busy texting as they walk into the office. They ask me to “hold on” while they take a more important call. Occasionally, they even Google a diagnosis or medication while we are discussing it in the exam room.

It is not just children that are glued to their devices. Parents seem equally unable to disconnect.  The image of a family walking through the park talking to each other and taking in the scenery has been replaced by a baby in the stroller tapping away at his iPad, a parent bent over a phone balanced on the handles, the other parent walking beside them chatting away on a Bluetooth. 

Our children learn to communicate by watching and imitating their parents.  It is heartbreaking to see a family out for dinner, what should be a shared family experience, and instead, everyone is intently interacting with their own personal device. This is a missed opportunity both for shared family time but also to teach and model appropriate social interactions for a child. Conversations are difficult enough without being distracted by a smartphone and interrupted by devices beeping, ringing and vibrating. 

Children first learn the rules of polite social interactions from their parents, but even older children and teens need these behaviors reinforced. Unfortunately, it seems that for many parents having a quiet child at a restaurant is the goal and if that is more easily achieved by handing him a smartphone or an iPad many parents see that as a “win.”

But, these same parents are surprised and frustrated when their children don’t know how to sit quietly in the pediatrician’s office while their parents try to have a conversation with their doctor. Or, they don’t know how to look a person in the eye when they are asked a question.  Yet, is it really surprising? How should these children know how to interact if those modeling behavior for them seem constantly distracted by a device and don’t look them in the eye when speaking.  Couple this with the fact that almost all of their opportunities to learn and practice social interaction have been eliminated or smoothed over by handing them a device?

I would argue that even on long car rides or tournaments, where these devices seem very handy, that it is in fact better to use these opportunities to engage each other in creative conversation or word games to pass the time -- together.

As a member of the older generation of pediatricians, I accept the positives of constant connectedness and the relationship building potential of social media.  I am getting used to it and enjoy connecting with more people than ever, even with cool emoticons.  But I see the need to encourage our younger generation of parents to slow down a little and use trusted ways of teaching communication and social development.  They should take the time to enjoy the spontaneity of childhood, dedicate time to fully participate in face-to-face discussions, turn off distractions when a task needs to be accomplished or an experience simply shared.  This can be a slow, sometimes painful process, but it needs to be prioritized in this fast paced, glamorous world of multi-media society.

August 14, 2013

Social Media Makes Me A Better Pediatrician

Heidi Roman, MD, FAAP

About two years ago I started writing more regularly- reflections on being a new mom, thoughts on my changing perspective as a pediatrician. I kept a notebook that quickly filled with musings that occurred to me during clinic, questions parents asked, things that came up with my son. I realized that a lot of other parents had the same kinds of questions I did. They too were Googling questions and looking for credible sources of information. So, I started actively creating and curating child health information via social media. I'm still a neophyte compared to many online pediatricians that I respect and follow. Nonetheless, I'm a relative veteran compared to most of my colleagues. I’m often asked about how and why I do this. When I answer that I think being online is making me a better pediatrician, I get some curious and quizzical looks. I admit that I  didn’t expect it when I started all of this, but being involved in social media is shifting the way I think about medicine and ultimately making me a better doctor. Here’s how.
          I write more. I write, on average, a post a week. Writing has made me a better doctor and mom, in many ways. When a parent asks a question on a topic I’ve recently researched and written about I can direct them to useful resources without a moment’s hesitation. And, writing makes me read more too. I now have a set of go-to sources for quality child health information that I am well acquainted with and that I can use quickly in clinic or to research a topic.
          I think more. Writing makes me think. Insightful comments from readers make me think. Listening to the amazing online community of patients makes me think. My point of view is challenged. My mind is opened. I’m a better doctor.
          I make more connections. After I started blogging, I joined Twitter. I thought it might be a good way to share my work. But, I’ve found that, for me, Twitter is so much more. For me, Twitter is about the thoughtful, generous, intelligent community of people that I follow. Every day, they bring me the latest information in medicine, child health, parenting, and general news. They enable me to say to my patients’ parents, yes I did read that study on sleep that just came out and here are some thoughts. Or, there are some new car seat regulations and here’s what you need to know.
          I am a more effective child advocate. By being more connected, I am both more aware of the current policy issues affecting kids and more effective at spreading the word.
          I’ve started to become more “digitally literate.” There is no debating that this is where healthcare is going. It’s good to be in the thick of it.
          I have more hope for healthcare. Thanks to social media I have met,people both online and in real life who are working every day to make healthcare better. People with innovative ideas and incredible drive who I am excited to join. People who give me hope that, with the help of new technology and hard work, we will improve our broken healthcare system.

Sure, there are limitations to social media. Nothing replaces face-to-face communication. I’ve also learned to take breaks now and then. Regain perspective. I’ve learned to dip in and out of the social media stream and not worry too much about missing something. If it’s important or compelling, it’ll come around again. I’m certain that the ways we share information will continue to change and evolve. Perhaps, this will all sound quaint in five years. But, for now, I think all of this communication and knowledge sharing is a good thing for patients, their families and for me.

Editor’s Note:  For AAP Members, the Academy has a wonderful webpage entitled, “Making the Most of SocialMedia” This resource is full of helpful tips and advice so login and check it out.