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POLICY STATEMENT Organizational Principles to Guide and Define the Child Health

Care System and/or Improve the Health of all Children

Media and Young Minds


COUNCIL ON COMMUNICATIONS AND MEDIA

Infants, toddlers, and preschoolers are now growing up in environments abstract


saturated with a variety of traditional and new technologies, which they
are adopting at increasing rates. Although there has been much hope
for the educational potential of interactive media for young children,
accompanied by fears about their overuse during this crucial period of rapid
brain development, research in this area still remains limited. This policy
statement reviews the existing literature on television, videos, and mobile/
interactive technologies; their potential for educational benefit; and related
health concerns for young children (0 to 5 years of age). The statement also This document is copyrighted and is property of the American
highlights areas in which pediatric providers can offer specific guidance Academy of Pediatrics and its Board of Directors. All authors have
filed conflict of interest statements with the American Academy
to families in managing their young children’s media use, not only in terms of Pediatrics. Any conflicts have been resolved through a process
approved by the Board of Directors. The American Academy of
of content or time limits, but also emphasizing the importance of parent– Pediatrics has neither solicited nor accepted any commercial
child shared media use and allowing the child time to take part in other involvement in the development of the content of this publication.

developmentally healthy activities. Policy statements from the American Academy of Pediatrics benefit
from expertise and resources of liaisons and internal (AAP) and
external reviewers. However, policy statements from the American
Academy of Pediatrics may not reflect the views of the liaisons or the
organizations or government agencies that they represent.

INTRODUCTION The guidance in this statement does not indicate an exclusive course
of treatment or serve as a standard of medical care. Variations, taking
Technologic innovation has transformed media and its role in the lives into account individual circumstances, may be appropriate.
of infants and young children. More children, even in economically All policy statements from the American Academy of Pediatrics
challenged households, are using newer digital technologies, such automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.
as interactive and mobile media, on a daily basis1 and continue to be
the target of intense marketing.2 This policy statement addresses the DOI: 10.1542/peds.2016-2591

influence of media on the health and development of children from 0 PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
to 5 years of age, a time of critical brain development, building secure Copyright © 2016 by the American Academy of Pediatrics
relationships, and establishing health behaviors.
FINANCIAL DISCLOSURE: The authors have indicated they do
not have a financial relationship relevant to this article to
disclose.
INFANTS AND TODDLERS
FUNDING: No external funding.
Children younger than 2 years need hands-on exploration and social
POTENTIAL CONFLICT OF INTEREST: The authors have
interaction with trusted caregivers to develop their cognitive, language,
indicated they have no potential conflicts of interest to
motor, and social-emotional skills. Because of their immature symbolic, disclose.
memory, and attentional skills, infants and toddlers cannot learn from
traditional digital media as they do from interactions with caregivers,3
To cite: AAP COUNCIL ON COMMUNICATIONS AND MEDIA.
and they have difficulty transferring that knowledge to their
Media and Young Minds. Pediatrics. 2016;138(5):e20162591
3-dimensional experience.4 The chief factor that facilitates toddlers’

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PEDIATRICS Volume 138, number 5, November 2016:e20162591 FROM THE AMERICAN ACADEMY OF PEDIATRICS
learning from commercial media 5 years of age11,12 and continue studies have used a 2-hour cutoff
(starting around 15 months of age) to create programming that to examine obesity risk, a recent
is parents watching with them and addresses evolving child health and study of 2-year-olds found that BMI
reteaching the content.5,6 developmental needs (eg, obesity increased for every hour per week
prevention, resilience). Evaluations of media consumed.21 It is believed
The interactivity of touchscreens
of apps from Sesame Workshop and that exposure to food advertising22
enables applications (apps) to
the Public Broadcasting Service (PBS) and watching television while
identify when a child responds
also have shown efficacy in teaching eating (which diminishes attention
accurately and then tailor its
literacy skills to preschoolers.2 to satiety cues)23 drives these
responses, thereby supporting
Unfortunately, most apps parents associations.
children at their levels of
find under the “educational”
competence. Emerging evidence Sleep
category in app stores have no such
shows that at 24 months of age,
evidence of efficacy, target only rote Increased duration of media
children can learn words from live
academic skills, are not based on exposure and the presence of a
video-chatting with a responsive
established curricula, and use little television, computer, or mobile
adult7 or from an interactive
or no input from developmental device in the bedroom in early
touchscreen interface that scaffolds
specialists or educators.2,13 Most childhood have been associated with
the child to choose the relevant
apps also generally are not designed fewer minutes of sleep per night.24
answers.8 Starting at 15 months of
for a dual audience (ie, both parent
age, toddlers can learn novel words Even infants exposed to screen
and child).2,14 It is important to
from touchscreens in laboratory- media in the evening hours show
emphasize to parents that the higher-
based studies but have trouble significantly shorter night-time sleep
order thinking skills and executive
transferring this knowledge to the duration than those with no evening
functions essential for school
3-dimensional world.9 However, screen exposure.25 Mechanisms
success, such as task persistence,
it should be noted that these underlying this association include
impulse control, emotion regulation,
experiments used specially designed arousing content26 and suppression
and creative, flexible thinking, are
apps that are not commercially of endogenous melatonin by blue
best taught through unstructured
available. light emitted from screens.27
and social (not digital) play,15 as
Many parents now use video-chat (eg, well as responsive parent–child
interactions.16
Child Development
Skype, FaceTime) as an interactive
media form that facilitates social Digital books (also called “eBooks,” Population-based studies continue to
connection with distant relatives. books that can be read on a screen) show associations between excessive
New evidence shows that infants and often come with interactive television viewing in early childhood
toddlers regularly engage in video- enhancements that, research and cognitive,28–30 language,31,32 and
chatting,10 but the same principles suggests, may decrease child social/emotional delays,33–36 likely
regarding need for parental support comprehension of content or parent secondary to decreases in parent–
would apply in order for infants and dialogic reading interactions when child interaction when the television
toddlers to understand what they are visual effects are distracting.17 is on37 and poorer family functioning
seeing. Parents should, therefore, be in households with high media use.37
instructed to interact with children An earlier age of media use onset,
In summary, for children younger
during eBook reading, as they would greater cumulative hours of media
than 2 years, evidence for benefits
a print book. use, and non-PBS content all are
of media is still limited, adult
significant independent predictors
interaction with the child during
of poor executive functioning in
media use is crucial, and there
HEALTH AND DEVELOPMENTAL preschoolers.38 Content is crucial:
continues to be evidence of harm
CONCERNS experimental evidence shows that
from excessive digital media use, as
switching from violent content
described later in this statement. Obesity to educational/prosocial content
Heavy media use during preschool results in significant improvement
years is associated with small but in behavioral symptoms, particularly
PRESCHOOL MEDIA AND LEARNING
significant increases in BMI,18 may for low-income boys.12 Notably,
Well-designed television programs, explain disparities in obesity risk the quality of parenting can modify
such as Sesame Street, can in minority children,19 and sets associations between media use
improve cognitive, literacy, and the stage for weight gain later and child development: one study
social outcomes for children 3 to in childhood.20 Although many found that inappropriate content

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2 FROM THE AMERICAN ACADEMY OF PEDIATRICS
and inconsistent parenting had will allow children to reap the most • For parents of children 18 to
cumulative negative effects on low- benefit from what they view. 24 months of age who want to
income preschoolers’ executive As digital technologies become more introduce digital media, advise
function, whereas warm parenting ubiquitous, pediatric providers that they choose high-quality
and educational content interacted to must guide parents not only on the programming/apps and use them
produce additive benefits.39 duration and content of media their together with children, because
child uses, but also on (1) creating this is how toddlers learn best.
Child characteristics also may Letting children use media by
influence how much media children unplugged spaces and times in their
homes, because devices can now themselves should be avoided.
consume: excessive television
viewing is more likely in infants be taken anywhere; (2) the ability • Guide parents to resources for
and toddlers with a difficult of new technologies to be used in finding quality products (eg,
temperament40,41 or self-regulation social and creative ways; and (3) Common Sense Media, PBS Kids,
problems,42 and toddlers with social- the importance of not displacing Sesame Workshop).
emotional delays are more likely sleep, exercise, play, reading aloud,
and social interactions. Realistically, • In children older than 2 years,
to be given a mobile device to calm limit media to 1 hour or less per
them down.43 pediatric providers will need to know
how to help parents find resources day of high-quality programming.
finding appropriate content, tools Recommend shared use between
Parental Media Use parent and child to promote
for monitoring or limiting child use,
Parents’ background television ideas for play or activities in which enhanced learning, greater
use distracts from parent–child to engage rather than digital play, interaction, and limit setting.
interactions44 and child play.45 and how parents can limit their own • Recommend no screens during
Heavy parent use of mobile devices media use (see HealthyChildren. meals and for 1 hour before
is associated with fewer verbal and org for examples); each of these can bedtime.
nonverbal interactions between be built into the Family Media Use
parents and children46 and may be Plan (see the American Academy • Problem-solve with parents facing
associated with more parent-child of Pediatrics guide to developing a challenges, such as setting limits,
conflict.47 Because parent media use plan at www.healthychildren.org/ finding alternate activities, and
is a strong predictor of child media MediaUsePlan). calming children.
habits,48 reducing parental media
Families
use and enhancing parent–child
RECOMMENDATIONS
interactions may be an important • Avoid digital media use (except
area of behavior change. Pediatricians video-chatting) in children younger
than 18 to 24 months.
• Start the conversation early. Ask
parents of infants and young • For children ages 18 to 24 months
CONCLUSIONS: CLINICAL
IMPLICATIONS children about family media use, of age, if you want to introduce
their children’s use habits, and digital media, choose high-quality
In summary, multiple developmental media use locations. programming and use media
and health concerns continue to exist • Help families develop a together with your child. Avoid
for young children using all forms Family Media Use Plan solo media use in this age group.
of digital media to excess. Evidence (www.healthychildren.org/ • Do not feel pressured to introduce
is sufficient to recommend time MediaUsePlan) with specific technology early; interfaces are so
limitations on digital media use for guidelines for each child and intuitive that children will figure
children 2 to 5 years to no more than parent. them out quickly once they start
1 hour per day to allow children
ample time to engage in other • Educate parents about brain using them at home or in school.
activities important to their health development in the early years • For children 2 to 5 years of age,
and development and to establish and the importance of hands-on, limit screen use to 1 hour per day
media viewing habits associated unstructured, and social play to of high-quality programming,
with lower risk of obesity later build language, cognitive, and coview with your children, help
in life.49 In addition, encouraging social-emotional skills. children understand what they are
parents to change to educational and • For children younger than 18 seeing, and help them apply what
prosocial content and engage with months, discourage use of screen they learn to the world around
their children around technology media other than video-chatting. them.

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PEDIATRICS Volume 138, number 5, November 2016 3
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6 FROM THE AMERICAN ACADEMY OF PEDIATRICS
Media and Young Minds
COUNCIL ON COMMUNICATIONS AND MEDIA
Pediatrics 2016;138;; originally published online October 21, 2016;
DOI: 10.1542/peds.2016-2591
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly


publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright © 2016 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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Media and Young Minds
COUNCIL ON COMMUNICATIONS AND MEDIA
Pediatrics 2016;138;; originally published online October 21, 2016;
DOI: 10.1542/peds.2016-2591

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
/content/138/5/e20162591.full.html

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly


publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2016 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from by guest on January 10, 2017