My Video Game Confession

Hugo Scornik, M.D., F.A.A.P.

            Let me start this post with an introduction. I am an overworked general pediatrician practicing in Conyers, Georgia and by no means do I consider myself a child media expert.

            And now the confession:  a few years ago, after hearing months of pleading and begging from my boys, ages ten and eight at the time, I let them purchase Call of Duty, the wildly popular, yet violent, video game. The game is rated Mature, for ages 17 and up, with “blood and gore, intense violence, and strong language” according to the label.

            When my kids brought the game home, I was surprised to learn that they already knew how to play since they had been surreptitiously playing at their friends’ house. Their eyes lit up as they blasted their way through the various levels.  In one particularly vicious scene, the player is asked to sneak up behind an enemy soldier and choke him with a chain. My young kids howled with delight. I observed them and wondered to myself, “What have I done?”

            But after a couple of months, a curious thing happened. My kids gradually lost interest in Call of Duty. They moved on, now more obsessed with playing basketball outside. While I realize that buying the game may not have been my best parenting moment, it seems that no permanent damage was done. My kids were no more violent. Their grades never slipped. They still enjoyed plenty of outside time and activities with their friends. In fact, I felt a bond develop between my kids and me as they implicitly thanked me for trusting them with the game.

            How can this be? Why do some children (and adults) become obsessed with video games while others easily maintain a healthy balance? Why are some not able to properly separate fantasy and reality while others seem not to be affected at all? I was curious enough to conduct a literature search but could find no clear answers. On the one hand, habitual video game play has been shown to increase short term aggression in children (Anderson et al, Pediatrics, 2008) and can become so excessive in some as to be described as “pathological” (Gentile et al, Pediatrics 2011). On the other hand, I could find no definite cause and effect between criminality and video game playing. It’s also interesting to note that according to FBI crime statistics, violent crime among youths has hit historic lows at the same time that video game popularity has soared.

            As pediatricians grapple with the impact of video games on children, it’s easy to state that no child should ever be exposed to these games. But this may be too simplistic; remember that long before there were X-Boxes, the corruption of our youth had been blamed on everything from comic books to rock and roll music. Furthermore, other exposures may have a much larger impact. Exposure to a dysfunctional family, to a violent neighborhood, or a mental health disorder is far more likely to create a violent individual.

            So in my clinic, I do ask about video game play but I also attempt to put this habit in the larger context of the world in which the child is living. I often fall back on common sense and experience when crafting my advice knowing that being overly dogmatic usually doesn’t work. As a parent, I try to strike this same balance, even if it means occasionally trusting my children’s instincts over my own. 

The Search for Google (Mount Rushmore Road Show)

Vandana Y. Bhide, MD, FAAP

Ever notice how pervasive the internet is in our daily lives? “What do you think about dressing up as Abraham Lincoln for Halloween?” I asked my son. I thought I would dress up as George Washington, his friends could dress up as Thomas Jefferson and Teddy Roosevelt and we could start a Mount Rushmore Road Show.

My son rolled his eyes and said nothing. I was worried he might be on Facebook “unfriending” me or placing an ad on Craig’s List: “For Sale, Lame Mom. Uses whole sentences to text. Takes notes at Parent -Teacher conferences. No, It’s NOT ok to contact me with other services or commercial interests.”

Maybe his mind, like the American advertising community, had already moved past Halloween onto the critical Christmas shopping season, which starts directly after Back to School shopping season. (I am still trying to figure what to do with those ten protractors for $20* I bought in the Back to School Specials frenzy).

But no, he texted me, “i want 2 dress up as google toolbar.”

Naturally we started our Google costume search on Wikipedia. When I moved to the United States from India at age five, one of my most prized possessions was a complete set of the Encyclopedia Britannica. It took my parents a long time to save up enough money to buy me a set. In fact, I have kept the 1978 edition until this very day to peruse on those late nights when I don’t get 30 junk emails (Note: place Unsubscribe in subject line), 20 email newsletters from Mailchimp or a notice urging me, “Vandana, read LinkedIn’s update about Dr. Extraordinarily Smarter and More Accomplished than You and on the verge of winning a Nobel prize.” 

Next we searched Google for Google (my son on an iPad, me on my iPhone).  Apparently I wasn’t feeling lucky because the search yielded only sponsored sites selling skull and crossbones ice cube trays, toxic waste candy, zombie blood energy drinks, and ketchup/mustard packet baby costumes.

 We moved on to eBay. No Google toolbar costumes but we were able to bid on some Angry Birds Halloween costumes and Albert Einstein wigs.  We also auctioned off 10 protractors, shipping included anywhere in the continental United States.

I figured some industrious and creative Mom had already thought of the Google costume and posted a How To video on Youtube, but no such luck.

Finally I went Amazon.com because one can buy ANYTHING on Amazon. I didn’t find a Google toolbar but I did find a couple of protractors (on sale for a mere 10 for $5 with $4.95  shipping!) to put on my Wish List. Those helpful folks at Amazon were kind enough to make some shopping suggestions based on items bought by people who also searched for protractors.

I clicked a flashing advertisement with the enticing tagline, “Come on over to the dark side with dark chocolate mini candy bars.” We learned there was 1 gram of fiber per 5 mini chocolate bars. So we only have to eat 150 candy bars to get the recommended daily intake of fiber.  My son thought the candy bars were practically a health food and plans on substituting them for broccoli.

Of course I had to pin the picture of fiber-full dark chocolate bars on Pinterest and then on my Facebook wall so that everyone interested could “Like” the Dark Side! I couldn’t leave Facebook (keep me logged on this computer, Check) without contacting the 5 friends with birthdays this month, see status updates on 22 friends, no lie, play a couple of games of word scramble, print out coupons for more protractors, check out friends tagged on photos, say “Maybe” to the 18 events to which I was invited by people I’m not sure I know,  “Like” the 400^th “Baby’s first steps” pictures of someone I don’t recognize and whew, I am exhausted!

I told my son we absolutely had to get off the internet because we had exceeded the two hour screen time limit recommended by the American Academy of Pediatrics.

Let’s see what Mayo Clinic Center for Social Media, KevinMD and Dr. Oz are tweeting about (dark chocolate) and we’ll call it a night!

Ultimately, my son nixed the Mount Rushmore Road Show mother-son bonding idea (South Dakota or bust!) as well as the Google toolbar costume. I tweeted to the world @VeeMD “My son is dressing up as a Mad Scientist for Halloween and I am dressing up as a Petri dish.” (Less than140 characters.)

*when bought with qualifying $50 minimum purchase

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. 

EMR: Communication and Patients

Nancy M. Silva, MD, FAAP

Our office went “live” with Electronic Medical Records (EMR) in March of this year.  This was and still is a difficult change to master.  EMR is supposed to streamline the work process, improve healthcare, and improve communication with our patients.  But does it really?

In the beginning, it felt as if all communication between everyone within the office and with our patients had been altered and damaged forever.  So, no, initially, EMR didn’t help or improve anything.  Frankly, it hurt a lot. 

First, everyone in the entire office needed to learn the new system.  This made wait times unbearably long.  Why?  Think of every step that an office visit entails.  There’s the phone call to make an appointment.  The front desk staff has to learn a new way of doing that.  There is new paperwork for a patient to fill out.  There’s a new registration process, which now includes capturing a photo.  There is the nurse’s and the doctor’s assessment.  There may also be office lab tests.  Lastly, and most importantly, were all the apologies given to the patient that included explaining the new process and why EMR would eventually be better for everyone.  The growing pains were excruciating.  Throughout the process, we learned that constant communication with our patients and their families was crucial.

It has been difficult to communicate in the exam room with a computer in the room.  It is literally a physical barrier.  Neither the patients nor I liked it.  That is until I figured out how to still be human with a computer in the room.  Mostly, I divide myself in two.  I explain that first we’re going to get through all the “virtual paperwork.”  Then, I’ll be hands on and have time for questions.  That divide is necessary in order to meet the EMR requirements while still being a caring doctor.  Since creating the division, the parents seem happier.   They know the course of the visit.  They know what to expect.  And they know their doctor is not just going to be looking at the computer screen the entire time.  There is still time for humanity; communication up front is the key.

On the flip side, there is an aspect of EMR that the patients and I do enjoy.  Improved communication! 

So, what has improved with regards to communication?  Parents have more options.  Now patients can call or email questions.  Parents receive more information, more quickly, and more efficiently with less errors.  The pharmacy can email prescription refill requests directly to the doctor.  Laboratory results are received more quickly.  Hence, I can give parents their results more quickly as well.  Any day parents receive an answer more quickly regarding their child’s health is a great day.  Responses to phone calls are also quicker.  In addition, they are now more accurate.  Now, there is no misunderstanding as to what advice I gave the nurse to discuss with the parents.  Everything is written in the EMR.  Messages aren’t getting forgotten or lost, as there is an electronic trail.  In addition, we can look back at every piece of advice ever given.  This is helpful with a prolonged or complicated illness.  I also enjoy showing parents their child’s growth charts on the screen.  The parents seem to understand the visual much better. Lastly, at the end of the visit, most parents receive an educational handout, either specific to that well child age and visit or to their child’s current illness.  Parents are happy to review what you just discussed, as opposed to relying solely on their memory.

So, three months later, I would say, the answer is yes.  The work process has become more efficient, healthcare has improved, and communication has eventually improved as well.  Mind you, there are still growing pains.  Updates in the electronic world are frequent.  Adjustments occur daily and are both inevitable and necessary. 

Everything seems to have changed with the introduction of the EMR.  However, communication is still paramount.  I still maintain a personal human touch, just with more options on how to do so.  

The Kids Are Doing It Right! For The Most Part

John E. Moore, MD, FAAP

Assistant Professor of Pediatrics, Virginia Tech-Carilion School of Medicine

Physicians, and especially young physicians, are becoming increasingly more active on social media. More than ninety percent of physicians younger than 30 have a social media presence. Twitter, Facebook, and Pinterest have become a part of modern medicine for residents, med students, and junior partners.  For them, a life and career without Facebook is inconceivable.

The rest of us are slowly catching up as well. According to recent surveys, almost half of the physicians in my demographic group (41-50) use social media. We are slowly embracing Facebook in our personal as well as professional lives. I am happy to see more and more pediatricians show up on my Twitter feed.  Slowly and painfully, physicians are entering the new digital world, and I think we are better off for it.

We still have a lot of work to do, though, to make this digital world as painless for all physicians as possible. Specifically, we media-savvy, wired-in pediatricians need to provide real leadership in the area of digital media. In countless surveys, new residents and med students say they want more guidance from their mentors about social media. They want recommendations on navigating social networks that go beyond, “Don’t friend your patients.”

As administrators, thought leaders and program directors, we need to do more to educate our learners. In a survey from 2010, Terry Kind et al. found that only 10 percent of medical schools even have social media policies in place for their students. Of those that address social networks, many only offered statements about what was forbidden, discouraged, or frowned upon. Sadly, only 7 out of 132 medical schools encouraged thoughtful and responsible social media use.  It’s  2012; we need to do better.

Specifically, we need to provide guidance in the proper use of social media. While our learners honestly understand the technology better than we do, we “older” physicians have a much better understanding of risk management and medical ethics. We need to instruct our learners about why they should be extremely cautious in “friending” their patients. We need to show them why they need to think about the photos they post and exactly how they word their status updates. We need to demonstrate to them why they should never talk about their patients online.

We also need to highlight the positive features of social media as well. We need to emphasize the patient education that we can provide over Facebook. We need to express how physicians need to take part in the medical discussions that occur on Twitter every day. We can explain the value of a timely blog post.  We can show the power of social media in advocating for our patients and our profession.

Over the last two years, we have made huge strides. In 2009, very few physicians were active in social media and ever fewer saw the value in it. Now, most doctors will agree that social networks have a role in modern life and in modern medicine even if they are not actively engaged themselves. We have done a good job convincing physicians to join the social media age; now we need to make sure we are all doing it correctly.

Editor's Note

AAP & COCM RELEASES NEW MEMBER GUIDE TO SOCIAL MEDIA:

The AAP Council on Communications and Media, the Council on Clinical Information Technology and the Department of Communications have teamed up to create a new resource: the AAP Member Guide to Social Media.

This interactive, web-based document offers a look at the ways pediatricians can engage in social media, whether that means following the AAP “feeds” that interest them, sharing Facebook and Twitter posts, or blogging as individual pediatricians.

The guide includes links to AAP platforms, including the main news feeds on Facebook and Twitter; the Healthychildren.org feeds offering parenting content; and numerous feeds serving readers of publications such as AAP News, Pediatrics and the AAP Red Book. Tips and resources are provided to help pediatricians contribute to the burgeoning but tricky world of online social conversation, including advice on how to comply with the Health Insurance Portability and Accountability Act; the Healthcare Blogger Code of Ethics; and tips on how to vet blogs and comments with their practice or institution.

The guide offers links to exemplary social media sites of AAP members and includes a list of popular parenting blogs that AAP members can explore and join the conversation.

For more information about AAP social media or the guide, contact Gina Steiner, in the AAP Department of Communications, at 800-433-9016, ext. 7945, or gsteiner@aap.org.

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.