September 29, 2016

Stress and Teens: Does Media Play a Role?

Hansa Bhargava MD FAAP
Staff Physician, Children's Healthcare of Atlanta
Medical Editor, WebMD



Pediatricians are seeing more and more teens suffering from stress. Whether they are complaining of it or having somatic symptoms such as headaches and stomach aches, it seems that stress and anxiety are on the rise. We know that over scheduling, homework, and the pressures of getting into college can contribute to this. But can media also affect it? Is screen time and media a stressor or a remedy for stress?
In a recent WebMD survey published in their Teens and Stress report, 54% of teens were stressed according to parents. Interestingly, 40% of parents turned to the screen  for family stress relief while 58% of teens did. Social media and texting was used as stress relief by almost half the teens. This is on the heels of the Common Sense Media survey reporting that US teens were using media for 9 hours a day. Other recent reports have shown that 94% of teens with mobile devices are online daily with many online constantly.
So it seems that stress is on the rise and media use is on the rise. Although there may not be a direct relationship, some real issues impact stress and anxiety. Consider this: 23 % of teens report cyberbullying, especially girls. There have been reports of “Facebook depression” and loneliness, as kids who aren’t in social media conversations may feel left out. Other negative consequences can also have an impact: many teens are in front of a screen late at night or ‘sleep text’, both of which can contribute to lack of sleep, which in turn can decrease focus and potentially cause irritability and depression. And last but certainly not least, what about the time media consumes? 
Time spent on media is time often not spent communicating with family. Lately, when I’ve gone into a restaurant, I’ve observed that as soon as a family sits down, everyone pulls out a mobile device. No one is really talking. So even the short amount of time not doing homework, playing soccer, or at school is being compromised. Psychologists, community leaders and experts have long reported that family time can contribute to less depression, less anxiety, better academic performance and generally happier kids. But what if that family time is on media?? 
As the AAP reviews our screen time recommendations,  I feel that we, as pediatricians should continue to advise parents about basic principles. 

Parents need to lay down some parameters about when and how media is used. Media is a centerpiece of teens’ lives and is not going away, but just as we don’t give our kids a set of keys to our car and say “just drive”, we need to enforce appropriate media use. And  good modeling is also critical: parents need to put down their mobile devices and simply communicate with their kids. Old fashioned parenting and just talking to your kids can build the foundation to a less stressful childhood and hopefully a happier life. 





August 29, 2016

What’s New and Next? Applying Past and Present Principles of Professionalism for Posting



Terry Kind, MD, MPH
Associate Professor of Pediatrics
The George Washington University / Children’s National

From the latest way to share information, to dire concerns about career-ending posts, to the next new thing, where have we been and where are we going?  Guidelines are essentially meant as a starting point [Kind in AMA J Ethics 2015], to encourage thoughtful posting.  The same principles to guide your professional behavior in real life remain applicable in the online arena as well, but with additional considerations.  Your personal and professional might blend.  The voice you project --and the images you share-- are augmented. And, depending on the context, your post may be ephemeral or everlasting.  Social media has transformed our communication options, and has great potential to improve healthcare, communication, and information sharing. It allows us to innovatively reach out and engage.  And to listen.  

We’ve crafted tips for using social media in clinical care drawing upon ethical and professional principles [Chretien and Kind in Circulation 2013] and tips for use in medical education [Kind, Patel, Lie in Pediatrics 2013 and Kind, Patel, Lie, Chretien in Med Teacher 2014].   When considering new platforms of communication, think about who you are online and offline, who is or may be reading and engaging with what you post, and what are your goals?  Essentially, be a good and thoughtful citizen and share well.  

What does sharing well actually mean?  Just like in pediatrics where we aim to “catch a toddler being good” my colleagues and I sought to explore how medical students are using Twitter in “good” ways, such as for their professional development.  Do they, and if so how?  In this digital ethnographic study, we found that they do use Twitter to supplement their traditional medical school experience. It provides them with access and voice.  Access, to experts and various perspectives, and to communities of support.  Voice, for advocacy, and to craft their own digital identity, and to level the playing field among the various medical hierarchies.   [Chretien, Tuck, Simon, Singh, Kind in JGIM 2015].  

What do you need in order to post well, in addition to Wifi and a charger?  We propose that in the health professions, your posting rests on a platform of public trust [Chretien and Kind in Acad Med 2014]..  Consider security, that is, what online behaviors could jeopardize patient privacy and/or impact your own career security.  Resting on that secure base, then reflect on your own online identity and the relationships you navigate.  This sets you up to discover ways to use social media to improve health, enhance career paths (self and others) and innovate.  Throughout your journey, maintain an awareness of potential challenges and opportunities. 

Ultimately, you should draw upon the same principles of professionalism that you’d employ offline, as online.   I shall leave you with this tweet-sized tip I once shared a few years back.

T is it thoughtful
W is it wise?
E is it educational?
E is if evidence-based?
T is it tweet-worthy?

References/Resources:



July 26, 2016

Fast Food Marketing to Children: What Parents Can Do

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



Lately, children and teens are exposed to fast-food advertising from every angle. Traditional print, TV, and radio ads are ever present.  Marketers carefully place products at child height and colorfully design packaging to attract their attention. Mobile devices and social media accounts are plagued with ads.

Social media sites entice with advergames, contests, points to redeem and free downloads. If your child subscribes to or follows a YouTube channel or Twitter handle, he or she is volunteering to be sent endless “opportunities,” with ads attached. These ads encourage users (your children) to “share” and “invite” friends to participate on the websites – free word of mouth advertising! Facebook, for example, comes with 6 billion fast food ads – 19% of the total ads on the site.

Food stylists make their products look better than they ever do in reality. Advertisements suggest health benefits and a happier, more carefree life. They bait with prices that will feed your children more cheaply than a grocery store, until you switch to higher priced items at the counter. Restaurants default to a less healthy options like French fries and soda, rather than the more costly fruit and milk.

The purveyors of fast food are not on your side. Their success depends on your failure, and they have bigger wallets than you do.



Fast Food Ad Facts

Here are some facts about fast food advertising from the Rudd Center for Food Policy & Obesity



  • In 2012, 4.6 billion dollars was spent on fast food advertising—a hard number for me to get my brain around. 4.6 billion dollars will buy 920 million kid’s meals: 33,000 lifetimes worth of daily happy meals. Imagine the profit that must be generated to make spending that amount of money reasonable. These people are not your friends.
  • Less than 1% of kid’s meals (33 out of 5427) met USDA nutrition standards.
  • Only 3% of kid’s meals met the industry’s own standards.

Fast Food Ads Have Presence in Your Child’s Life


Fast food ads are unavoidable. Your children will see them and will want what they are selling.

There is no evidence that media literacy in any way defends against the effectiveness of advertisements. Knowing that fast food ads are trying to sell you something that is bad for you does not keep you from wanting it. We are grownups, and we fall for the ads.  We cannot expect more of our children than we do of ourselves.
 

In the end, it comes down to committing to do the right thing, and then acting on that commitment:


  • Clean out your cupboards and throw out all the junk.
  • Make a healthy meal plan for the week before you shop.
  • Shop with a list made from that meal plan, and stick to the list.
  • Shop at farmer’s markets and around the outer rim of the grocery store. Avoid the aisles unless there is something on your list that is on that aisle.
  • Prepare meals ahead for busy nights, so that you don’t end up in the drive-through line at the fast food restaurant.
  • Keep healthy snack food available at hand: fruits and veggies, whole grain crackers, cheese, popcorn... Throw out the chips and snack cakes.


Why "Never" is Easier for Kids to Understand than "Sometimes"
 
Remember that “never” is much easier for a child to understand and deal with than “sometimes.” If you never stop at the drive through and never buy junk food, after the first two weeks your kids will rarely ask, even though they saw that yummy advertisement a dozen times and really wanted to try those fruit snacks. Be consistent.

If you sometimes give in, they will ask until your ears bleed. Pestering is powerful when you’re tired and stressed.

Remember, you have the greatest influence on your children’s health. Fast food companies have 4.6 billion dollars on their side, but you have love for your children and the responsibility they handed you with that warm sweet bundle. You win.

June 28, 2016

Diversity in Children's Media

Jacqueline Dougé, MD, MPH, FAAP
Medical Director, Bureau of Child Health
Howard County Health Department
Blog site: DrJacquelineDouge.com


I had an interesting conversation with my older son after watching an interview of Marvel Comic authors and illustrators.  The interviewer asked about the diversity of modern day Avenger characters.  The new Spiderman is African-American and Latino, Ms. Marvel will be Pakistani-American and the new Thor is a woman.  My seventeen year old son was surprised that the characters he grew up watching were going to be of different genders, religions, races and ethnicities.  I asked him what he thought about the increasing diversity of the characters.  His response wasn’t what I expected, “I’m older now and don’t need the characters to be diverse to look up to them.”  Would his response have been different if he had grown up watching diverse superheroes?

But he also made another interesting point; characters shouldn’t be created solely to meet a demand for diversity.  My son’s response surprised me. I expected to hear that he agreed with me that there should be more diverse images and characters for kids.

My son and I have had many conversations about race, especially being African-American.  We’ve had more discussions over the past few years in light of news stories that report on the murder and violence of young black men.  In addition, he’s had to address negative biases based on his race in school.  My suggestion of having more kids of color in media was a possible solution to combat negative stereotypes and normalize the idea that different people live, work and play together.  My son is very aware of the lack of diversity in media, and as a recently graduated senior no longer needs to look up to superheroes.  He realizes that diversity in media is important, but to just have characters of different races and ethnicities isn’t enough and shouldn’t be done solely to meet some demand or current trend.
 
In 2013 blog post on diversity in children’s media, Dr. Kevin Clark wrote, “Diversity is more than demographics. We need to think about diversity holistically. Yes, it’s about gender and race, but we need to add a component to go with those demographic components of diversity—being aware of what children hear, see, and do.”  In his blog, he discusses his work to help young children create video games. He realized that even thought he was the same race of the children, African-American, he was working with, their experiences were different.  Race isn’t the only factor that connects or resonates with kids.  In creating diverse media for children, one must also consider whether the content and experiences are relatable and realistic.

Children’s media has the opportunity to create positive and enriching experiences for children.  What children see, hear and read influences their self-identity.  In the 2015 AAP News article on racial socialization, which refers to the process how kids learn to deal with racial issues, the authors discussed the role that pediatricians can play to help parents navigate the issue of race with their children.  One strategy mentioned was to discuss with parents the role that positive cultural and diverse images can have on children.  These images provide a counter narrative to images of negative stereotypes and violence.

Most pediatricians aren’t in the business of developing media, but there are opportunities to promote positive culturally diverse media such as the books recommended to our families and books and magazines displayed in waiting rooms.  In addition, there are opportunities to create diverse media content, i.e. write a book, create videos.

The term diversity is broad and complex.  It must not only have individuals or images that check a box, such as gender, race, religion or sexual orientation, but include the multifaceted layers of being a person.  Our kids are surrounded by and use media, why not have it also reflect the diversity of its users?


Resources to learn more about diverse media for children:

    •    Help your kids find books with diverse characters

    •    Apps and Games with Diverse Characters

    •    DiversityinApps



References:
Anderson A, Ellison A. Helping families navigate race issues should be an ongoing conversation. AAP News 2015;36;2. Retrieved May 28, 2016, from http://www.aappublications.org/content/aapnews/36/8/11.full.pdf

Clark, K., Ph.D. (2013, July 09). Diversity in Children's Media Is More Than Just Race or Gender - Fred Rogers Center for Early Learning & Children's Media. Retrieved May 28, 2016, from http://www.fredrogerscenter.org/2013/07/09/diversity-in-childrens-media-is-more-than-just-race-or-gender/

May 16, 2016

Screenagers

Nelson Branco, MD FAAP
Tamalpais Pediatrics
Larkspur, California
www.tamalpaispediatrics.com

I recently had the opportunity to watch the documentary Screenagers with some friends, colleagues and two of my children.  This documentary about the pervasive nature of screens in our lives and environment is relevant, informative and well done. The movie centers on a physician parent’s decision to give her middle-school aged daughter a smartphone and explores the ways that screens play a role, both positive and negative, in our lives.

This movie resonated with me as a pediatrician and a parent. I have tried to be thoughtful and balanced about both the rules I set for my family and the anticipatory guidance I give about screen time. Time will tell if my children have learned to manage the different screens in their lives, and whether I have modeled responsible behavior. Nonetheless, there are principles that we can use to guide us when giving advice to families and kids around screen time.

The amount of information at our fingertips and the ability to connect and communicate with virtually anyone in our lives is truly incredible.  It’s not surprising that it is so addictive – these devices are useful, entertaining and engaging. When we deny this we lose credibility with the kids in our lives.

Minecraft is cool.  It really is – spend some time with a Minecraft-savvy tween and you’ll see.  Social media at it’s best is fun and interesting. Texting can be a good way to communicate – more immediate than email but not as intrusive as a phone call. Video games can teach kids to try, fail and try again.  Movies and TV help us relax, share stories and learn.

There are well-documented negatives, of course. Few of us may qualify for the DSM-V diagnosis of Internet addiction, but we all react to the jolt of dopamine that we get from a new email or text.  Minecraft can take over time that could be spent playing outside, reading, doing homework or being creative with another medium besides animated blocks and elements.  Teens can use social media and text messaging to bully, harass or hurt their friends and schoolmates. Violent video games can expose kids to sights and sounds that we would like them to avoid, and can be addictive as well. Movies and TV shows can model unhealthy behavior and unwelcome stereotypes.

 As parents, we work hard to protect our children from harm. In my practice, most families are aware of the need for rules around media and limit their young children’s screen time.  I see it become more difficult in the middle and high school years, once smartphones become ubiquitous. I also see parents who think nothing of pulling out their smartphone while waiting, or while I am talking to or examining their child.


 I’m sure most of us have done the same. We often use the excuse that we are doing “work” when we’re on our screens.  We should remember that teens can use the same excuse.  Their “work” is to connect with their friends and form an identity. Social media, texting, Skype and email are all ways to do that – more efficiently and more pervasively than the phone calls and hanging out that our generation did as teens.

If we are going to teach our kids to use screens and media wisely we need to monitor and track our own use.  Are we reaching for the phone as soon as it dings, even if we’re in the middle of a conversation?  Do we stand around checking email or social media while waiting in line or sitting with our kids in an office? Do we have screen-free times for the whole family?

We can’t expect our kids to learn to eat vegetables if we aren’t serving and eating them ourselves, and we can’t expect kids to use devices and media responsibly if we aren’t doing it as well.

 Screenagers touches on these same points, and uses stories and examples to illustrate these topics. This movie won’t break any new ground for pediatricians – these are topics that we talk and think about every day.

What I liked about this movie is that it gathers interesting information and presents it in a balanced and engaging way. It opens the door for consideration and conversation. I wish more documentaries about parenting, families and kids did this as well.

The movie is being screened in many communities. I highly recommend you see it and engage your colleagues, kids and other parents in the discussion. For information about the movie, visit their website: www.screenagersmovie.com.

April 25, 2016

Young I.V. Parody Rap Videos

Ivy Pointer, MD, MPH
Pediatric Intensivist
WakeMed Health and Hospitals
aka Young I.V.


I have never been afraid to act like a fool for a good laugh and if you’ve seen any of my Young I.V. videos, you will have seen plenty of footage of me acting like a fool (I hope you laughed).  People often ask me “How did you get the idea to start doing this?”

Well, I wish I could say that I planned it out from the beginning but it sort of happened spontaneously.  I had seen many of the Holderness family videos (ed. note - a Raleigh NC family that makes parody videos about various topics) and thought to myself, wow that looks like fun.  So I decided to write a rap about my entire family having gastro for 3 weeks. I shared the lyrics with some colleagues at work who thought they were hysterical.  Since I really will do anything for a good laugh, I turned the rap into a music video and even enlisted the participation of my entire family.

Fast forward about a year, and I have now produced 23 videos on various pediatric topics, with several more raps written and ready to produce. The topics range from helmets, vaccines, and car seats to food allergies, croup, and reflux.
 
At first I joked that the goal of Young I.V. was to rap with Jimmy Fallon. Of course, that is still totally a goal, but as the videos started to gain some popularity outside my inner circle, I realized that these videos could have a broader reach and purpose.

In our social media, digitally-driven, entertainment-addicted world, I am hoping these videos can compete with all the other messages parents are hearing about how to keep their kids healthy and safe.

The goal of Young I.V. is to bring awareness to children’s health issues and educate the public in a nonthreatening and entertaining way.  I hope you’ll enjoy and share them but most of all, I hope you laugh!

Here is my most popular video:
https://youtu.be/48DOigw98TM

And my newest on Back to Sleep:
https://youtu.be/vghgMc84Zek

Find all of the videos at:
www.youngiv.org
https://www.youtube.com/channel/UCFwd3xAmX7x0_pa2D34wbIw

March 29, 2016

Practical Screen Time Advice for Parents




Paul Smolen MD FAAP

Carolinas Medical Center, Charlotte NC
Creator of the blog, Portable Practical Pediatrics

Author of Can Doesn't Mean Should-Essential Knowledge for 21st Century Parents

This COCM post is an adaption of a post from Dr. Smolen’s blog, Portable Practical Pediatrics.
 
You can find some fascinating stuff in a pediatric journal. The other day I was reading my copy of Pediatrics, and I found an article that I thought parents and pediatricians might find interesting and meaningful. The article talks about the activation that occurs in a child's brain when he or she is stimulated by storytelling or being read to. This subject is getting a lot of attention because of its relevance in today's electronic-rich environment where screens have begun to substitute for the storytelling/reading experiences of the past. The article speaks to the core of childhood:  a child’s imagination, language skills, and cognitive development.
   
    I watch the daily struggle that parents have with regard to limiting screen time for their children. As they wait in my office, parents often try to distract and placate their children with a smartphone showing an animated video game or movie.  Cartoons on a little screen seem magically to tame even the most upset, misbehaving, out of control child. Children love these devices, and parents often use them to reward certain childhood behaviors or simply to distract a bored, annoying child.  The peace and quiet is instantaneous!  Everyone appreciates the quiet, but is the method of achieving it—with screen time—good for the children? I'm not so sure.

    Followers of my blog, www.DocSmo.com, will remember the post (1)  about a study (2) showing that an iPad, given to children just prior to surgery is as effective at relieving anxiety as the potent sedative Versed.

    No one would advocate giving Versed to children on a regular basis to relieve anxiety or boredom. This is clearly not in their best interest.  If giving Versed regularly to children to relieve anxiety isn't beneficial, is frequent use of screen time with the same goal any better? Could today’s use of screens be the “Soma,” the negation of negative feelings, that George Orwell warned us about in his novel 1984?

    In the Pediatrics study, researchers used active MRI scans to measure brain cortex activity while young children (three to five years of age) were read to. (3) They found that children with “greater home reading exposure” showed greater cortical brain activity while listening to stories in the lab. They conclude that active imaginary verbal activities such as reading to children, developed the children’s ability to create “mental imagery and narrative comprehension.” Is anybody surprised? I certainly am not.

    We know that reading to children is good for their brains, but the word is still out on screen time. Common sense tells me that children who are not instantly pacified with screens learn more self-control; they learn to be more patient without the screen to fill the void of time. Learning to be patient without demanding to be distracted is actually a skill that children need to learn. Psychologist Dr. John Rosemond believes that children around the world generally stop interrupting their parents’ conversations—a skill that requires patience—by their fourth birthday. (4) Do we observe this tendency in contemporary American children?  No. Perhaps learning to cope without screens while the pediatrician is tending to a sibling is something that children need to master and that we as pediatricians should foster.


    But we live in the times that we live in. Telling parents just to say no to screens is not practical and not likely to happen.  How can we encourage parents to achieve a healthy balance for their children? How can we encourage parents to limit time with virtual, passive devices like screens and, at the same time, help children to develop active imaginations with less need for high stimulus, passive entertainment?

    I think parents should adopt what I call the Zero Sum Solution:  for children over two years of age who are too young to read on their own, parents should read to them for at least as much time as they permit the children to have screen time. Older children who are good readers should earn screen time by reading for an amount of time equal to their screen exposure. It is important to note that the reading/storytelling time should precede their screen time.  No reading, no screens. Using this strategy, children may relax with a screen only after they have spent an equal amount of time stimulating the parts of the brain that use mental imagery and more active verbal engagement. I think the Zero Sum Solution is a practical means of balancing screens with traditional imagination and verbal formation. It also shifts screen time to an activity that is earned, not expected. Oh, and by the way, I do occasionally see children who learn to love reading as much as most children love screens. These book lovers always seem to succeed in school.  Just saying...


References:
(1) See more at: http://www.docsmo.com/electronic-anesthesia-pedcast/#sthash.LxEVOnb4.dpuf

(2) Pediatric Anesthesia Volume 24, Issue 12, pages 1217–1223, December 2014 – http://bit.ly/V1Pcmf

(3) Pediatrics Volume 136 Number 3, October 2015  pp 466-478

(4) Psychologist John Rosemond's developmental milestones for children