From interactions with my patients and their families, I am increasingly concerned about the impact of digital media on our children who are growing up in environments saturated with technology. I had the mother of a two-year-old patient insist he was getting his “own” tablet as a present, and she became very upset when I cautioned her about the impact of unsupervised use of media. She insisted that she only used educational programs and that her child would be “left behind” if she did not buy him a device. The American Academy of Pediatrics (AAP), the American Psychological Association, (APA), Common Sense Media and many other experts and organizations have expressed concern about this issue as well. This is true in the United States and also in developing countries, like India. Child psychologist Dr. Malavika Kapur states: “Based on field and clinical experience, psychodynamic and behavioral theories and most of all from a developmental perspective,…indiscriminate viewing of visual media, especially with violent content, interferes with normal development.” The people who sell us this technology are themselves concerned and are limiting or banning their own children from using these devices. Concerned parents in Silicon Valley even have their nannies sign contracts so their children are not exposed to “screens.”

So what do we do? The following is a summary of the expert recommendations with my own comments and opinions as a pediatrician who has worked in general practice and in the academic world and as a parent. I use the word “media” to include all kinds including digital (computers, tablets, smartphones, educational computer toys), as well as TV and videos.

Young children are particularly vulnerable to exposure to media and devices as this is a crucial period of brain development. I had a parent proudly tell me that their child’s first word was “Alexa”, but I’d really prefer Mama or Dada to be that first word. Children two and younger need to explore with their hands and interact with trusted adults (parents, babysitters, daycare providers) to develop language, physical, social, emotional and other skills. Any use of media should be with parents who watch with them, reteach and reinforce its messages with them. They simply do not have the ability to learn from digital media as opposed to human interactions. An exception might be made for using video chat (Skype, Facetime, WhatsApp) to talk to family in other states and countries.  These programs are wonderful for grandparents and so long as parents are there to help interpret what’s going on, this is okay although it’s not a substitute for a real-life grandparent.

For children who are between the ages of 3-5 years, it’s tempting to use media to get a break from all that energy and maybe get some laundry done. When my children were little, they watched Sesame Street, Mr. Rogers, and Thomas the Tank Engine. They later moved on to dinosaurs and nature-related shows and documentaries. I think it’s important to recognize that while this is “down time” for both the kids and parents, try to be “present” during this time so you can chat about the content. Parents often try to pick educational programs, and some programs like Sesame Street are known to have some beneficial outcomes. I think it’s important to recognize that as parents, we are allowed to take breaks; however, many apps and shows that are supposed to be “educational” are really focused on rote academic skills. At these ages, parent-child interaction and unstructured social play are still critical to developing important thinking and social skills which toddlers lack, including impulse control, emotional regulation, creativity, and task persistence. Excessive TV watching at this age has been associated with cognitive, social, emotional and language delays. Additionally, excessive media use during preschool years is associated with increased risk for obesity possibly related to food-related ads, decreased physical activity and watching TV while eating/ snacking, which, as we all know, makes for “mindless overeating.” Excessive media use has been associated with decreased sleep even in infants, maybe from the screens’ “blue light” and the content watched.

Content is so important. I have had patients who were “expelled” from daycare for hitting and hurting other children. While some children are more “physical” than others, I often find that many of these children have been watching inappropriate or violent content. A patient of mine would sit on her parent’s lap while the parent played “Call of Duty”. She regularly hit children and was asked not to return to daycare. I think it’s preferable to watch media with your child but unquestionably something gentler.

There are times when parents use media to soothe a child, for example, during a plane flight or a doctor’s office visit. That’s not unreasonable and is sometimes necessary, but it is also important for children to learn how to regulate their emotions and soothe themselves. Boredom is not a bad thing and is known to stimulate creativity.

It’s not just the kids. Parent media use also decreases parent-child interactions. And parents who use devices heavily have kids who do.

The AAP recommends “…time limitations on digital media use for children 2 to 5 years to no more than 1 hour per day to allow children ample time to engage in other activities important to their health and development and to establish media viewing habits associated with lower risk of obesity later in life. In addition, encouraging parents to change to educational and prosocial content and engage with their children around technology will allow children to reap the most benefit from what they view.”

In summary (Adapted from AAP)

  • For children younger than 18 months, limit media use other than video-chatting.
  • Do not feel pressured to introduce technology early; children will figure them out quickly once they need to.
  • For parents of children 18 to 24 months of age who want to introduce digital media- choose high-quality programming/apps and use them together (co-view) with children, because this is how toddlers learn best. Letting children use media by themselves should be avoided. Use only quality products (eg, Common Sense Media, PBS Kids, Sesame Workshop).
  • In children older than 2 years, limit media to 1 hour or less per day of high-quality programming. Co-view to promote enhanced learning, greater interaction, and limit setting. Help children understand what they are seeing, and help them apply what they learn to the world around them.
  • Avoid fast-paced programs (young children do not understand them as well), apps with lots of distracting content, and any violent content.
  • Turn off televisions and other devices when not in use.
  • Monitor children’s media content and what apps are used or downloaded. Test apps before the child uses them, play together and ask the child what he or she thinks about the app.
  • Keep bedrooms, mealtimes, and parent-child playtimes screen free for children and parents. Parents can set a “do not disturb” option on their own phones during these times.
  • No screens 1 hour before bedtime, and remove devices from bedrooms before bed.
  • Try not to use media as a calming device unless absolutely necessary (we have all been there with a screaming child); work on setting limits, finding alternate activities, and other ways to calm children. See references below for ideas on how to implement these.

Resources and References

  1. AAP Statement- Media and Young Minds- Council on Communications and Media: Http://pediatrics.aappublications.org/content/138/5/e20162591
  2. For parent resources on finding appropriate content, ideas and how parents can limit their own media use: https://tinyurl.com/nrcwvdv
  3. Developing a Family Media Use Plan: https://tinyurl.com/hv3bh48
  4. https://www.commonsensemedia.org
  5. https://www.apa.org/topics/kids-media/
  6. A Dark Consensus About Screens and Kids Begins to Emerge in Silicon Valley https://tinyurl.com/y49jm6zj
  7. Let Children Get Bored Again by Pamela Paul: https://www.google.com/amp/s/www.nytimes.com/2019/02/02/opinion/sunday/children-bored.amp.html
  8. What’s the Hurry? Let Children be Children by Malavika Kapur: https://tinyurl.com/yy76bovh
  9. Silicon Valley Nannies Are Phone Police for Kids https://tinyurl.com/ybure8an

–Svapna Sabnis is a pediatrician, mom and a wife. She is in private practice and is Clinical Associate Professor of Pediatrics Medical College of Wisconsin and Clinical Adjunct Professor at the University of Wisconsin School of Medicine and Public Health. She is an immunization advocate and Director of Immunize Milwaukee and the Wisconsin Council on Immunization Practices.

She loves to teach medical students and residents, was awarded the Best Doctors in America 2010- 2019. She is coauthor of a textbook –Pediatric Decision Making Strategies. She likes to garden and dabbles in watercolors in her free time. She’s still trying to have it all and achieve balance in her life.