First Do No Harm: Why Have Parents and Pediatricians Missed the Boat on Children and Media?
2007; Elsevier BV; Volume: 151; Issue: 4 Linguagem: Inglês
10.1016/j.jpeds.2007.05.040
ISSN1097-6833
Autores Tópico(s)Themes in Literature Analysis
ResumoAs a society, we are engaged in a vast and uncontrolled experiment with our infants and toddlers, plunging them into home environments that are saturated with electronic media.1Anderson D.R. Pempek T.A. Television and very young children.Am Behav Sci. 2005; 48: 505-522Crossref Scopus (362) Google ScholarSee related articles, p 364 and p 369 See related articles, p 364 and p 369 Media are like the weather. Everyone talks about the media. Everyone is affected by them. But no one wants to talk about how they are changing and how they can influence us in sometimes extraordinary ways. Just as people—and politicians—seem to be ignoring the threat of global warming, they also seem blithely willing to ignore the impact of media on children and adolescents. Make no mistake about it: the media are changing; in a few short years, your child may be able to click on a pizza commercial on your TV screen and order a pizza directly or go to a website for more information about the shampoo that looks so good. As your teenager passes a McDonald’s restaurant, she may receive a text message on her cell phone with a $1 off coupon for that particular day and store. Ten years from now, your wristwatch may actually be a 5-gigabyte computer that can talk to you. There will be no further need to memorize Lincoln’s Gettysburg Address or the death scene from Romeo and Juliet. Your watch will be able to recite them, probably with an appropriate Midwestern or Royal Shakespearean Company accent, respectively. For interactive toys, the future is now: as of 2000, 60% of the new toys produced by Fisher-Price had a computer chip in them, and toys like Barney Actimate encourage children to play and sing songs along with the TV program that is signaling it2Anderson D.R. Evans M.K. Peril and potential of media for infants and toddlers.Zero to Three. 2001; 22: 10-16Google Scholar—not to mention your child’s or teenager’s exposure to the current escalation of violent content, sex and sexuality, and smoking in the media.3Strasburger V.C. Risky business: what primary care practitioners need to know about the influence of the media on adolescents.Prim Care Clin Office Pract. 2006; 33: 317-348Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar The average American child spends >6 hours a day with a variety of different media,4Rideout V. Roberts D.F. Foehr U.G. Generation M: media in the lives of 8- to 18-year-olds. Kaiser Family Foundation, Menlo Park, CA2005Google Scholar yet parents and pediatricians seem unwilling or unable to deal with the issue.5Gentile D.A. Oberg C. Sherwood N.E. Story M. Walsh D.A. Hogan M. Well-child visits in the video age: pediatricians and the American Academy of Pediatrics’ guidelines for children’s media use.Pediatrics. 2004; 114: 1235-1241Crossref PubMed Scopus (87) Google Scholar, 6Strasburger V.C. “Clueless”: Why do pediatricians underestimate the media’s influence on children and adolescents?.Pediatrics. 2006; 117: 1427-1431Crossref PubMed Scopus (14) Google Scholar For parents, media seem to rank near the bottom of the list of things to be discussed, negotiated, fought over, and regulated. For pediatricians, discussing media seems to rank far below car seats, bicycle helmets, vaccinations, and household safety. Few residency programs teach about the impact of the media.7Rich M. Bar-on M. Child health in the information age: media education of pediatricians.Pediatrics. 2001; 107: 156-162Crossref PubMed Scopus (50) Google Scholar Nor do continuing medical education courses include, or even mention, the media in discussions of broad child health issues like violence, bullying, or drugs. Yet the media may play a significant role in virtually every concern both groups have about children and teens—sex, drugs, obesity, eating disorders, hyperactivity, school performance, aggressive behavior, and suicide.6Strasburger V.C. “Clueless”: Why do pediatricians underestimate the media’s influence on children and adolescents?.Pediatrics. 2006; 117: 1427-1431Crossref PubMed Scopus (14) Google Scholar Research indicates that for aggressive behavior, for example, the media may contribute 10% to 30%.8Comstock G.A. Strasburger V.C. Media violence.Adolesc Med Clin. 1993; 4: 495-509Google Scholar A young teen exposed to a heavy diet of sexual media is twice as likely to begin having sexual intercourse at a young age.9Brown J.D. L’Engle K.L. Pardun C.J. Guo G. Kenneavy K. Jackson C. Sexy media matter: exposure to sexual content in music, movies, television, and magazines predicts black and white adolescents’ sexual behavior.Pediatrics. 2006; 117: 1018-1027Crossref PubMed Scopus (361) Google Scholar A child exposed to R-rated movies is twice as likely to begin smoking cigarettes.10Sargent J.D. Beach M.L. Adachi-Mejia A.M. Gibson J.J. Titus-Ernstoff L.T. Carusi C.P. et al.Exposure to movie smoking: its relation to smoking initiation among US adolescents.Pediatrics. 2005; 116: 1183-1191Crossref PubMed Scopus (223) Google Scholar Like the weather, the media are certainly not quiet companions who exert little or no influence. In this issue of The Journal, Zimmerman and Christakis11Zimmerman F.J. Christakis D.A. Meltzoff A.N. Associations between media viewing and language development among children under 2 years old.J Pediatr. 2007; 151: 364-368Abstract Full Text Full Text PDF PubMed Scopus (257) Google Scholar extend our knowledge to young babies and once again demonstrate the power of the media and the importance of the basic principle of medicine: “first do no harm.” Baby videos are now a $100 million business, with a myriad of unsubstantiated claims being made about how they will improve intelligence and school readiness.12Garrison M. Christakis D. A teacher in the living room? Educational media for babies, toddlers, and preschoolers. Kaiser Family Foundation, Menlo Park, CA2005Google Scholar Yet Zimmerman and Christakis found highly significant language delays in babies 8 to 16 months old who were exposed to such videos. As they soberly assess, this may not be a cause-and-effect situation, but it is certainly one that demands caution in exposing babies to videos and much more research to elucidate who may be harmed, how, and why. Despite the lofty claims of the producers of baby videos, there is very little evidence that babies <2 years old can learn anything positive from TV,1Anderson D.R. Pempek T.A. Television and very young children.Am Behav Sci. 2005; 48: 505-522Crossref Scopus (362) Google Scholar and there is significant evidence from 3 other studies that harm is possible: two studies of children under 2 years old watching Sesame Street also found delays in language development,13Nelson K. Structure and strategy in learning to talk.Monogr Soc Res Child Dev. 1973; (1-2, Serial 149).Google Scholar, 14Linebarger D.L. Walker D. Infants’ and toddlers’ television viewing and language outcomes.Am Behav Scientist. 2005; 48: 624-625Crossref Scopus (247) Google Scholar as did a large study of 1900 Japanese infants viewing 4 hours or more of TV per day.15Tanimura M. Okuma K. Kyoshima K. Television viewing, reduced parental utterance, and delayed speech development in infants and young children.Arch Pediatr Adolesc Med. 2007; 161 (Letter): 618-619Crossref PubMed Scopus (44) Google Scholar This is not to say that Sesame Street is not one of the finest prosocial programs ever produced for children. It is; but “to everything there is a season,” and the season for Sesame Street appears to be 2 years and older.1Anderson D.R. Pempek T.A. Television and very young children.Am Behav Sci. 2005; 48: 505-522Crossref Scopus (362) Google Scholar, 16Wartella E. Robb M. Young children, new media.J Child Media. 2007; 1: 35-44Crossref Google Scholar Why? Television is a complex medium and requires brain maturation and cognitive skills to decipher. Ordinarily, this does not occcur until age 2 or 3 years.16Wartella E. Robb M. Young children, new media.J Child Media. 2007; 1: 35-44Crossref Google Scholar At birth, the infant brain is “plastic” and develops in response to genetic and environmental cues.17Anderson D.R. A neuroscience of children and media?.J Child Media. 2007; 1: 77-85Crossref Google Scholar, 18Shonkoff J.P. Philipps D.A. From neurons to neighborhoods: the science of early childhood development. National Academy Press, Washington, DC2000Google Scholar Numerous studies indicate that a human face is far more effective in “teaching” an infant than a face on a TV screen.16Wartella E. Robb M. Young children, new media.J Child Media. 2007; 1: 35-44Crossref Google Scholar A second study in this issue by Barradas et al19Barradas D.T. Fulton J.E. Blanck H.M. Huhman M. Parental influences on youth television viewing.J Pediatr. 2007; 151: 369-373Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar reinforces what the American Academy of Pediatrics (AAP) has been saying for a long time: parents need to control the TV set (and other screen media) and serve as role models in using media. Parental TV viewing correlated with child TV viewing, and parents who set rules and “obeyed” the AAP recommendations had children who viewed less TV.19Barradas D.T. Fulton J.E. Blanck H.M. Huhman M. Parental influences on youth television viewing.J Pediatr. 2007; 151: 369-373Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar Unfortunately, several studies show that this is hardly the case. There is nearly a complete disconnect between what the AAP recommends and what parents and pediatricians do6Strasburger V.C. “Clueless”: Why do pediatricians underestimate the media’s influence on children and adolescents?.Pediatrics. 2006; 117: 1427-1431Crossref PubMed Scopus (14) Google Scholar:AAP Recommendation: Parents should control the TV set. Real world: The 2005 Kaiser study found that more than half 8- to 18-year-old children report no rules about TV.4Rideout V. Roberts D.F. Foehr U.G. Generation M: media in the lives of 8- to 18-year-olds. Kaiser Family Foundation, Menlo Park, CA2005Google Scholar However, if you ask only parents, you will probably get a very different rendition, as several studies have shown.AAP recommendation: Children 40% of all 3- to 4-year-old children.24Vandewater E.A. Rideout V.J. Wartella E.A. Huang X. Lee J.H. Shim M. Digital childhood: electronic media and technology use among infants, toddlers, and preschoolers.Pediatrics. 2007; 119: e1006-e1015Crossref PubMed Scopus (313) Google Scholar Nearly two-thirds of teenagers have a TV set in their room.25Roberts D.F. Foehr U.G. Rideout V.J. Brodie M. Kids and media at the new millenium. Kaiser Family Foundation, Menlo Park, CA1999Google ScholarAAP recommendation: Pediatricians should take a media history. Real world: Less than one-third of pediatric residency programs teach about media effects.7Rich M. Bar-on M. Child health in the information age: media education of pediatricians.Pediatrics. 2001; 107: 156-162Crossref PubMed Scopus (50) Google Scholar Despite most pediatricians agreeing with the AAP recommendations, only one-fourth always discuss these recommendations with parents.5Gentile D.A. Oberg C. Sherwood N.E. Story M. Walsh D.A. Hogan M. Well-child visits in the video age: pediatricians and the American Academy of Pediatrics’ guidelines for children’s media use.Pediatrics. 2004; 114: 1235-1241Crossref PubMed Scopus (87) Google Scholar What should we do about this sad state of events? First and foremost, both pediatricians and parents need to appreciate the power of the media—to educate, to entertain, and to harm. The research is increasingly compelling. Second, the federal government and private foundations need to fund research to fill in the gaps of our knowledge. To date, for such an important influence on child development, there is precious little money available to researchers. Third, the federal government needs to take its responsibility seriously. According to the United States’ Communications Act of 1934, which first established policies for television broadcasting, the public owns the airwaves, and they are leased back to the networks to produce programming in the public’s best interests. Is that really what is currently happening? Fourth, pediatricians must understand the role that media currently play in their young patients’ lives. Asking 2 media questions in a well-child or well-teen visit would only take a minute: How much time do you spend watching screen media per day? Is there a TV set in your bedroom?6Strasburger V.C. “Clueless”: Why do pediatricians underestimate the media’s influence on children and adolescents?.Pediatrics. 2006; 117: 1427-1431Crossref PubMed Scopus (14) Google Scholar Fifth, the entertainment community needs to realize that the research has become far more sophisticated since the 1950s and accept that they have a public health role to play in producing prosocial programming. Finally, advertisers and manufacturers of toys and baby videos need to recognize that they, too, have a responsibility—to make prosocial products, to avoid making claims that can not be substantiated, and to limit their advertising aimed at young children.26American Academy of PediatricsChildren, adolescents, and advertising.Pediatrics. 2006; 118: 2563-2569Crossref PubMed Scopus (126) Google Scholar Sadly, few parents and pediatricians observe the AAP recommendations about children and media. These 2 new reports and numerous other recent studies27Strasburger V.C. Wilson B.J. Jordan A. Children, adolescents, and the media.2nd ed. Sage, Thousand Oaks, CA2008Google Scholar seem to indicate that they do so at their own—and babies’ and children’s and teens’—peril. The author acknowledges the help of Professor Daniel R. Anderson with the preparation of this manuscript. Associations between Media Viewing and Language Development in Children Under Age 2 YearsThe Journal of PediatricsVol. 151Issue 4PreviewTo test the association of media exposure with language development in children under age 2 years. Full-Text PDF Parental Influences on Youth Television ViewingThe Journal of PediatricsVol. 151Issue 4PreviewTo assess associations among youth television (TV) viewing and parental TV viewing, parental knowledge of the American Academy of Pediatrics (AAP) recommendations to limit children’s TV viewing time to ≤2 hours per day (knowledge), and parental limits on the frequency of children’s TV viewing (rules). Full-Text PDF
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