Category: addiction

Children and Media- Young Children

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

Children and Media -Screens in Teens

At first, it was insidious. I would be at a restaurant with my family and I would see another family dining nearby. The children were using some kind of device, maybe a GameBoy to occupy them before their meal arrived. I noticed that the adults were able to have a real conversation. It was tempting to consider getting such devices for my kids as well as we dealt with children who interrupted our talk and demanded our attention- like normal children would. Growing up, I was a voracious reader, and I remember my mom making me put my books away and insisting I join the conversation at dinner. So I persisted with the rule for my children- no books or screens at the dining table.

I never had any absolute rules on computers and video games. Things were negotiable if a reasonable argument could be made. My older son made it easier on me by preferring being outdoors to video games. Luckily for me, he set a precedent and my younger son didn’t realize he could have asked us for a game system.

Now it seems like the devices at dinner time are ubiquitous, and it’s not just the children anymore. Everyone is checking their social media, texting their friends, catching up on the news and seemingly going out of their way to avoid human connection and conversation. I’ve seen kids connect by looking at each other’s social media accounts and comments they receive. That’s the entire conversation! They are often sitting in the same room texting each other instead of talking or playing, or maybe texting someone else because they don’t care to spend time with the person they are with. I find that incredibly rude, and yet  I catch myself fishing my phone out to check something non-urgent when I’m with friends. I avoided social media for a long time, but I recently succumbed to Instagram, mostly to keep up with my talented artist friends. I love seeing what they are up to and sharing my own amateur watercolors. I discovered that my niece who lives in another state is an incredible artist. Although I really signed up to see what others were creating, I suddenly find myself checking on whether people are commenting on my posts.

Don’t get me wrong, I love being able to look things up whenever I need to, read my newspapers, do my crosswords, play words with friends, check my email. I can even put in prescriptions for my patients on my phone.

My 16-year-old uses his phone to keep in contact with his friends, play games, browse some social media but also to do school-related activities. The lines are blurred between work and fun. I bought him a flip phone in sixth grade and a smartphone in eighth grade. With the smartphone came new rules (responsible use, parent access to his phone and any social media). Phones can be used to play games that are fun, entertaining, educational or destructive. I have preteen patients develop sleep problems because they won’t (or cannot) stop using the phone or playing video games. I’ve read that kids have shadow social media accounts that their parents follow, and real accounts that their parents don’t know about.  I’ve read that one can hide porn behind the seemingly innocent Calculator app. Kids have always known how to fool their parents. At some point, you have to throw your hands up and hope that you taught them well. But every child’s maturity level is different. Smartphones can be dangerous in the hands of an immature, impulsive child. It can be used to bully, threaten, intimidate, access porn, post inappropriate selfies or pictures of others, destroy a reputation, or ruin a young life. I had patients (really all girls) who shared nude pictures of themselves with boys which were then forwarded to the boyfriend’s friends. The girls were traumatized, grades plummeted, and they became anxious and depressed.

Smartphones are incredibly convenient and frighteningly addictive. And we put them in the hands of young people who have not yet learned to moderate their impulses. We wouldn’t give them unrestricted access to alcohol, drugs or cigarettes, would we?

Pandora’s box has been opened! We can use our phones for good and for evil. As adults let’s put our own oxygen masks on first, examine our own use of media, and then help our kids have better balance. Let’s get them back in the yard with their friends, balance the screen time with outdoor time. Maybe some star gazing, a hike, have real adventures.

For American Academy of Pediatrics guidelines on Children and Media https://tinyurl.com/y95q9w4c

And if you really want to learn about the importance of play in children’s lives I recommend Malavika Kapur’s book “What’s the Hurry? Let Children be Children”. Disclaimer- she is my mom. https://tinyurl.com/ycx97ke3

http://Other interesting articles https://www.nytimes.com/2018/10/26/style/phones-children-silicon-valley.html https://www.nytimes.com/2018/10/26/style/digital-divide-screens-schools.html https://www.nytimes.com/2018/09/20/business/media/google-youtube-children-data.html

https://www.theatlantic.com/magazine/archive/2018/11/raised-by-youtube/570838/

https://www.theatlantic.com/magazine/archive/2018/07/the-dangers-of-distracted-parenting/561752/

https://www.commonsensemedia.org/research/zero-to-eight-childrens-media-use-in-america-2013

by Svapna Sabnis

memory and nostalgia

Memory, nostalgia are a part of food.

One of the socio-psychological infrastructure of a community is it’s food practices and rituals. The rituals, mores related to it, have a binding quality. At the same time these are the reason for oppression in many ways. But how are they oppressive? Lets break it down in a way where one can dissect and examine it.

Food is an integral part of a life as it provides the nutrition needed but also a social fact wherein it is consumed in an environment that has the companions, significant others that participate in the process. If the food is bought, it has a easy albeit a monetary value but is also a matter of affordability and can be seen in two ways. If you can afford to buy optimal, nutritious and good food, then you belong to the high income economic bracket. If you are unable to buy it but instead buy sub-optimal, low on nutrition, cheap food then you belong to the low income category. There are variations to this which can be explained but that is another write-up.

Food interrupts lives on a daily basis and this interruption is something of an ongoing challenge. It is in a sense oppressive as one is always having to think of food for the self, for the offspring and maybe a partner if that is available. First it is in this sense about tastes, likes and dislikes of all the people mentioned second it is about tradition that may or may not be healthy and third, it is about preparation- which is all work with a set agenda. This is an interruption because it keeps one away from engaging in otherwise useful pursuits. (And yes, there is an argument to be made for making this interruption a useful pursuit in and of itself).

Some of the tropes that come to mind, growing are stories around food, festivals, rituals, ways of life that are still the binding factor for families and communities.

Food is about the nostalgia and at the same time a battleground for oppression.