6 Ways to Moderate Screen Time in your Home

Melissa Arca MD, FAAP

The upcoming week, April 29^th to May 5^th, is National Screen Free week. We can encourage parents through our practices and through the media to use this week as an opportunity to make a media use plan, set guidelines, rules and expectations as to how their family will use media and screens for the rest of the year.

We’re living in a media world. No doubt about that. In fact, media follows us wherever we go these days. And our kids are honestly the most savvy among us. They get the hang of navigating iPhones and the various apps faster than you can figure out what your password is.

Media is here to stay and for the most part, it’s a great thing and has led to greater efficiency, communication, and sharing of valuable information.

But we knew there would be a down side. Our children are as fascinated and addicted as ever. We absolutely must moderate their media consumption and make sure the good outweighs the bad.

This is something my husband and I struggle with on a daily basis. We certainly don’t want them magnetically connected to some form of electronics for a good part of the day. So we have rules. Not always easy to enforce, but important and well worth the effort.

Set timers

I have found this to be the best and least confrontational way to set time limits on my kids’ media time. Whenever they sit down with one of their favorite TV episodes or need to hop on Dad’s iPad for a quick Minecraft game, I set a timer. I tell them ahead of time how long the timer is being set for (usually 20-30 minutes) and when it goes off, we move on to another activity.

Aim for no more than 2 hours total screen time per day. When you think about it, that’s actually a lot during a busy week of school, homework, and extracurricular activities. To help getting them to bed on time…turn off all media 1 hour before bedtime. Studies have shown this will help everyone get to sleep (and stay asleep) faster.

Get involved

Know what games and shows your children are playing/watching. Be sure they are age-appropriate and not filled with violent acts. Check Common Sense Media whenever you’re in doubt as you can find just about any movie, show, game, app, or book to determine age-appropriateness.

Play with them too. What about a game of bowling on the xBox or watching their favorite show with them? Being able to take part in something they enjoy will be a great time of connecting, instead of feeling disconnected.

Go outside

When everyone starts complaining that they’re bored, and why can’t we play our favorite video game?…head outside. It’s the best cure I know for whining, grumpiness, and complaints of boredom.

Be a good role model

Want your kids to spend most of their day screen-free? Well, I hate to break it to you, but then you must too! I am so guilty of constantly checking my phone for new emails, almost to the point of obsession that it gets to be ridiculous.

Put down that mobile media. Turn off the TV. And practice what you preach.

As a bonus, do your best to spend the weekends off social media. When I started doing this…wow…it was amazing how much more quality time I had with my family and more time to get to some much needed household chores.

Have screen-free zones

No TV’s or other electronics in the bedrooms. No screens (including, or especially, phones) at the dinner table. I am so adamant about these screen-free zones that just the other day I scolded my husband for bringing his iPad into our son’s room while we did some bedtime reading.

 I do not budge on this rule.

Be flexible

Rules are good but it’s also good to have some leeway. So, while I’m pretty strict about our screen-free zones, I’m pretty lax about the amount of screen time our kids (and us) get on the weekends. We love Friday night movie night and waking up Saturday morning watching cartoons, drinking coffee, and reading the paper.

Rules are great…but sometimes, they really are meant to be broken.

A New Year’s Resolution – Phone Etiquette For Our Children

Cori Cross, MD, FAAP

It seems that every year it becomes more common to see younger and younger children walking around with cell phones.  Seeing six and seven year olds with an iPhone is hardly a novelty nor is watching older tweens and teens totally ignoring the world around them while they text like it is an Olympic sport.

One blogger mom took a novel approach when she gave her 13 year-old son an iPhone this Christmas.  The present came with a set of rules and conditions. She laid out what was expected of him and even more importantly she gave him guidelines for proper etiquette.

But what is proper etiquette? For my generation, having good manners was something that parents were expected to instill in their children and everyone knew what good manners were.  We were taught to look someone in the eye when speaking, to give someone your full attention, to not interrupt, to keep quiet if you don’t have something nice to say, and not to gossip or spread rumors.  We were also taught to be modest, not to brag, to respect others privacy, and to be on even better behavior when we were out to dinner or in a public place. 

It seems that for many parents the addition of cellphones into the family paradigm has allowed all semblance of good manners to vanish.  It may be that today there is no universally accepted standard of proper etiquette. This causes many parents not to realize how rude certain behavior is until their children have adopted it. Even worse, when trying to extinguish this behavior in their children, parents often become uncomfortably aware that they are in fact modeling that same behavior.

It may be that as a society we are in desperate need of an Emily Post. Someone to clearly state a set of rules that parents can enforce with their children so that as families and as a society we don't become experts at interacting in a virtual world but inept when it comes to knowing how to behave in the actual world.  For me as a mother, that list would look something like this:

• ·      Don't answer your phone while in the middle of a conversation with an actual person. You can call the person back. You don’t need to be accessible at every second. If it is an emergency, then say so to the person to whom you are speaking, “Excuse me. I hate to be rude but my mom is calling and I really should answer it.”
• ·      Look at a person when talking to them.  Don’t carry on a conversation while you continue to text or stare at your phone.
• ·      Leave your phone in your pocket or bag when out to eat. Don’t place it on the table as if someone more important than the person in front of you may call at any instant.
• ·      Don’t even think about bringing your phone to the dinner table when you’re at home.
• ·      Turn the ringer off when you enter a restaurant or other quiet public place. This is why the phone has a vibrate feature.
• ·      If you need to take a phone call while out to eat, step outside. This is more polite and will remind you that you are there with someone else who is waiting for you.
• ·      Don’t forward along hurtful or gossipy information or photos.
• ·      Think before you speak, text, post or forward anything.
• ·      Don’t post every mediocre accomplishment or thought you have during the day. 
• ·      Lastly, a word of advice, spend your time actually doing things, don’t waste it documenting your life for all to see as if you are some B-list reality star. 

Television in the Bedroom

Nan Nuessle, MD, FAAP

Do your children have a TV in their bedroom? Many children do. In fact, 30% of children under the age of 3 have a television in their bedroom, and the percentage rises with age. By the time they are teens, many kids have a television with a cable or satellite box, a computer, and a mobile phone charger in their bedroom.  A 2008 study showed that when a child has a television in his bedroom, he is at a higher risk of poor school performance, sleep disturbances, obesity and smoking.  New studies have shown that devices such as computers, DVD players, game consoles and mobile phones have similar effects. The good news is that the above study showed that the health problems and poor school performance improved if the electronic devices were removed from the child’s bedroom.

When a television is in a child's bedroom, his television viewing increases dramatically. Some studies show a seven-hour increase, from 21 hours to 30 hours of TV a week. Parents may or may not know the content that their children are viewing. Furthermore, each hour viewing TV is an hour spent not exercising, not conversing with family members and, frequently, not attending to homework. An hour not exercising is felt to contribute to obesity. An hour not conversing with family members can stunt a child's social development. An hour watching TV instead of studying, or while studying, can interfere with academic success. Additionally, once a television is in a child's bedroom, parents find it difficult to remove it.
Here are some interesting statistics. By 5th grade, half of all children have a TV, DVD player or game console in their bedroom. Over 20%, have a computer in their bedroom and over 15% have a mobile phone. What does all of this do to their sleep? 57% of these children admit to using electronics after bedtime, with over 25% engaging in 3 or more such activities after they were supposed to be asleep. Just this lack of sleep alone can contribute to academic failure and to obesity. Even when an electronic device isn’t being used at night it can still cause sleep disturbances. Electronic devices emit a blue light. This blue light is particularly important in sleep disturbances.  Blue light affects melatonin, a chemical in our brains that tells us to sleep. Thus making it more difficult to fall asleep. Some investigators claim that even if you do fall asleep having a blue light source in the bedroom while you are sleeping will decrease the quality of that sleep.
What should we do with this information? First, realize that you are not alone. Next, remove televisions, DVD players, computers and game consoles, and smart phones from all bedrooms. Your children and teens may resist this, but stand firm.  Allow them to use these devices in a family setting where the content can be supervised. Then, consider setting up a central charging area in your home for laptops, tablets, readers and mobile phones. Finally, now that your children are watching less television, playing fewer video games and spending less time on their mobile phones, get active and do fun things together as a family.
Points to remember:
1. TV and other electronic devices in the bedroom are associated with many medical problems and with poor school performance.
2. Blue light emitted from these devices can affect sleep quality.
3. Removing these devices from the bedroom can help correct these medical problems and improve school performance.

No More Sting

Jeanine M. Swenson, MD, FAAP, FACC, LMFT

Pediatrician, Pediatric Cardiologist, and Family and Systems Psychotherapist

This parenting journey is certainly an interesting series of changes for both children and parents.  One of the more nerve-wracking transitions for parents as children grow and approach the teenage years can be the area of relationships.  Even mentioning “birds & bees” can make many parents sweat.  Naturally we want to make sure that our teenagers enter the real world with the “big present of love” – information and lessons regarding health, safety, respect, nonviolent conflict resolution, emotional intelligence, relationships, and their bodies.  One of the harder parts of this mission is imparting this message gradually when teens are developmentally ready and in the best place to hear our caring and concern.  Rather than a single event where we sit down and give kids “the talk,” a series of discussions, when kids are ready, may be a more fruitful and rewarding process.  Our schools do a fine job of teaching the facts about sexual education. However, one extra needed ingredient may be the connection of all of this information with patience, your knowledge of your child, and our guiding beam of family values.  

For many parents, the world today seems very different and scary from the one we inhabited when growing up in the twentieth century.  Media and screen time fills more space for our children and youth, and much of this entertainment contains more sexualized and violent content.  Esteemed family therapist Dr. David Walsh calls it a culture of “yes,” where parents are given the difficult task of saying “no” – the job of balancing instant gratification with lessons about hard work, safety, consequences, and the real world.  Sadly, it seems like an unbalanced tug of war as media companies have billions of dollars and we are short on time and energy these days.   There seem to be so many forces out there pushing our children to grow up quickly.  We really want to be helpful, but may have few examples or models to turn to when it comes to these personal conversations. 

A new school year often brings a unique opportunity for families. We may find renewed energy to think about where we all stand in our family life.  This thoughtfulness allows us to take stock of current family needs and choose the family life that we want to live. 

Many good families are trying to do their best, but different times may call for different and new strategies.  As the experts on our kids, we hold the secret when it comes to understanding their personality, learning style, temperament, and the ways that they are motivated.  This relationship and our bond with our children has proven in countless research studies to be the most important factor in long-term success. However, we may need new information in this new century to combat the growing influence of media in our children’s education in many areas.  I encourage you to cultivate this rich soil. 

Media, Technology & Children: How to Guide Learning

By Ricky Y. Choi MD, MPH, FAAP
follow him on twitter.

The tech revolution is transforming my life.  I have reconnected with long lost friends on Facebook.  I consistently find excellent places to dine within a short walking distance when I travel to a new place (or get lost).  I can find obscure information in seconds or blast my latest blog post to millions of people with just a click.  As a parent and a pediatrician, I wonder about the ways that these technologies can benefit children and the use parameters we should have to minimize harm.

In my house, my children engage in imaginary play with dolls, make elaborate crafts with colored paper, and read books.  They also use my iPad.  Through this amazing piece of interactive technology, my children have practiced the correct stroke order for Korean characters, learned where milk comes from via YouTube videos, and came to the researched conclusion that no satellites orbiting the earth are the color pink.  Because my parents live 2700 miles away, most of my children’s interactions with their grandparents are over Skype video chats.  So much so, in fact, calling them “grandma Skype” and “grandfather Skype” is no longer funny, it's a reality.  While a second best to actually being together, the weekly video calls have supported a relationship that hand written letters and phone calls never could.

The AAP has policy positions on screen time and social media, as they relate to health, highlighting the link between excess television viewing and obesity, poor sleep, and decreased activity.  In today’s world, discussions about media use are no longer talking about passive media consumption.  We must now include interactive technologies such as touchscreens and body sensors.  Watching TV on the couch is not the same as playing tennis with a Wii remote.  And beyond setting boundaries, how should children actually use technology, and how should we as parents and health care professionals guide its use for learning?

The National Association for the Education of Young Children and the Fred Rogers Center for Early Learning and Children’s Media at Saint Vincent College have released a position statement that it is worth reviewing.  They take the position that “when used wisely, technology and media can support learning and relationships.”  While this position statement was directed towards educators, I find their recommendations to be easily applicable to parents - who are, after all, a child’s first teachers. They offer a thorough evidence based discussion on the range of ways that these new technologies can enhance learning.  It is more than consent to “pass back” the iPad to your child in the back seat.  Their guidelines are specific and inline with the AAP’s policy statements:

•   No screen time for children under 2 years of age

•   Technology should be developmentally appropriate

•   Technology should be used to support specific educational goals

•   It should be used with specific intentionality not for the sake of using the technology itself

•   Parents/Teachers should seek to link on and off screen activities

•   Technology should augment, not impede, or be a substitute for social activity, play, and learning.

I was also pleased to find their report included a discussion on the role of technology for children with autism and developmental delay.  In fact they seek the “Intentional leveraging [of] the potential of technology and media for the benefit of every child”.

This report even makes an important equity argument.  Lower income families own fewer media devices and so can get left behind.  Drawing an interesting parallel between “technology handling” and the importance of teaching “book handling” skills, the report argues the value of exposure of these technologies in a structured classroom environment to low income children so they learn how to both use these technologies and benefit from them.  Furthermore, they suggest that together with good teaching, this could “accelerate learning and narrow the achievement gap”.

Technology has, and will continue to have, a growing role in our lives.  Parents, pediatricians, and educators are clamoring for guidance on how to maximize the benefits of technology while minimizing the harm for children.  This position statement is an important contribution to this discussion. 

Turnoff Week - September 19th-25th

By Corinn Cross, MD FAAP

Next week, September 19-25th, is National Turnoff Week. Parents are encouraged to use this upcoming week as a seven-day hiatus from televisions, video games, web surfing etc. Instead, families are encouraged to spend a screen-free week together.

Turnoff Week is supported by the American Academy of Pediatrics and the Council on Communications and Media. The most recent statistics show that the average American child spends over 1000 hours a year watching TV and playing video games. To put that in perspective, they only spend 900 hours a year in school. Television, video games, computers and now cell phones are becoming an increasing part of everyday life for the American child. Although there may be many advantages of living in such a technological era, there are well-documented detriments as well.

America is quickly becoming a nation of overweight individuals, and obesity is highly correlated with increased screen-time. Studies have shown that children who spend 4-6 hours a day in front of screens have a higher risk of being obese. All this screen-time is at the expense of less time spent playing sports, doing outdoor activities, reading and having family time.

Pediatricians can help parents by encouraging families to take part in Turnoff Week. As pediatricians, we can discuss the challenges of implementing a screen-free week and provide families with tools to help make the week successful.

1. Have a plan for each day in order to help keep children occupied.
2. Encourage outdoor play.
3. Schedule a family game night.
4. Involve children in dinner. Allow them to create a menu and help with the cooking.
5. Go on a family outing. Fall is a great time to go apple picking or to a pumpkin patch.
6. Plan a trip to the library.

These are just a few ideas of ways to pass seven days without a television. As the Turnoff slogan goes, "Turn off TV. Turn on life."

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?"

Discussing On-Line Profiles - A New Addition To The Well-Child Exam

Through social networking sites, teens can now hangout with their friends without leaving their homes. But unlike sitting in a friend's basement, you're not always sure who else is there. There are unseen risks involved with virtual communities. Depending on the settings of one's web profile, personal information, photos, etc. may be open to anyone who wants to see them. Teens may be more lax about what they share on-line. They may say and do things on-line that they would shy away from in person. Teens may also feel pressured by their virtual community to post comments or pictures that may be inappropriate or illicit unwanted attention.

With how common these sites have become in everyday adolescent life, it would be wise for us as pediatricians to begin to include them in the teenage well-child exam. On-line activity and its risks can easily be worked into the "activities" part of a HEADSS exam. Incorporating it into the HEADSS exam can open the door to discussing the risks involved with putting personal information on-line as well as how to protect one's self and maintain one's privacy.

A recent study published in January's Archives of Adolescent and Pediatric Medicine has shown that adolescents may be open to advice regarding how and what they display about themselves on-line. In this study, a physician using MySpace sent an email to 18- to-20 year olds who displayed risky behavior in their on-line profiles. She informed them that the information they were sharing was open for anyone to see and advised that they take steps to maintain their privacy. 42% of the interventional group versus about 30% of the control group (P=0.7) made some sort of protective change whether it was reducing references to sex and substance use or changing their web profile setting to private.

These results were based on an unsolicited email from an unknown physician. It is likely that advise from one's own pediatrician with whom they have had a relationship for many years would be much more influential. Although there are many things to cover at the teenage well-child visit, given how much time teenagers spend on-line and in these virtual communities it is incumbent upon us to find the time and make the effort to discuss the risks involved.

By
Corinn Cross, MD, FAAP
COCM Website and Blog Editorial Advisory Group Member

Tips For Helping Parents Manage Media

Today we welcome Guest Blogger Brandy King, librarian at the Center on Media and Child Health (CMCH) at Children's Hospital Boston.
Though you may have considered the health effects of media use from a clinical or research standpoint, do you ever wonder how real-life parents navigate today's media world with their families? If you are a already parent yourself, you may be curious to see how other parents handle this aspect of life in their own homes.

Each month, the CMCH e-newsletter features one parent's story about media, which have covered topics such as video game addiction, using a DVR to manage media use, and even taking action on what movies are shown on airplanes. For example, this past month, Callie in Michigan wrote:

"When I get home from a long day, all I want to do is put on the TV and be entertained for a little while. It helps me relax and get my mind off the whirlwind of the past few hours. I know that my kids are no different in this respect; when they get home from school, they need a break. Though I always encourage them to pursue non-media activities, I know that this is one part of their day when they just need to relax. However, I have always been cautious of what it is they see and hear during this time, preferring that the programs are somewhat educational.
A few months ago, I decided to subscribe to a Digital Video Recording (DVR) service because I found myself constantly missing shows I enjoyed. I never expected that the DVR would become such a useful tool for my kids' viewing as well!...."

Callie goes on to talk about the many benefits of the DVR she didn't expect with tips that will surprise you. In addition to learning from other parents experiences, our site has other tip guides to pass on to your families. In this case, we have a DVR/VHS guide.

Check out the complete list of Parent Perspectives, and if you're interested, contact us about writing your own!