Pediatricians Update Digital Media Recommendations for Kids

It's not so bad to hand your child an iPad once in a while depending on how it's used.

Playing a game together or Skyping with Grandma? That's OK.

Helping your little one calm down or trying to keep peace in the house? Not so much.

New guidelines announced by the American Academy of Pediatrics today say parents not only need to pay attention to the amount of time children spend on digital media - but also how, when and where they use it.

For children ages 2 to 5, media should be limited to one hour a day, the statement says, and it should involve high-quality programming or something parents and kids can view or engage with together. With the exception of video-chatting, digital media should also be avoided in children younger than 18 months old.

"Digital media has become an inevitable part of childhood for many infants, toddlers and preschoolers, but research is limited on how this affects their development," says one of the lead authors of the statement Jenny Radesky, M.D., a developmental behavioral expert and pediatrician at University of Michigan C.S. Mott Children's Hospital.

Radesky coauthored the statement for children ages 0-5 with Dimitri A. Christakis, M.D., M.P.H., of Seattle Children's Hospital. The AAP also put out a separate policy statement the same day for older kids (ages 6 to teenage).

"In children over three, the research is solid: high-quality programs like Sesame Street can teach kids new ideas. However, under three, toddlers' immature brains have a hard time transferring what they see on a screen to real-life knowledge," Radesky says. "We don't yet know if interactivity helps or hinders that process."

"What we do know is that early childhood is a time of rapid brain development, when children need time to play, sleep, learn to handle emotions, and build relationships. Research still suggests that excessive media use can get in the way of these important activities. Our statement highlights ways families and pediatricians can help manage a healthy balance."

Too much time using digital media in the wrong way is linked to children's quality of sleep, child development and physical health, the statement notes. (Heavy media use in preschool is associated with small but significant increases in body mass index.)

The guidelines recommend banning digital media use an hour before bed, turning off devices when not in use and keeping bedrooms, mealtimes and parent-child playtime screen free.

Although there are specific instances when using digital media as a soothing tool is helpful, such as on airplanes or during medical procedures, parents should also avoid using media as the only way to calm down children, authors note. Using devices as a common soothing strategy may limit children's ability to regulate their own emotions, Radesky says.

"We have to be realistic about the ubiquity of digital media use. It is becoming ingrained in our culture and daily life. For this reason, it is even more important that parents help their children understand the healthy ways to use media from the earliest ages," Radesky says.

"Videochatting with grandparents, watching science videos together, putting on streaming music and dancing together, looking up new recipes or craft ideas, taking pictures and videos to show each other, having a family movie night ... these are just a few ways media can be used as a tool to support family connection," Radesky says.

Radesky notes that it is crucial that adults interact with children during use, to help young children apply what they're seeing on the screen to the world around them. Research shows that for the youngest children - ages 18-36 months - this is essential, she says.

Authors acknowledge that well-designed TV programs such as "Sesame Street" may help improve literacy and social outcomes for children ages 3 to 5. But many apps parents find under the "educational" category are not evidence based and include little input from developmental educators.

Parents may want to limit their own screen time, too, the authors say. Heavy parent use of mobile devices is associated with fewer verbal and nonverbal interaction between parents and children and may be associated with more parent-child conflict.

Pediatricians are also encouraged to help parents be "media mentors"-role models and guides for how to pick good digital content. Doctors have an opportunity to educate families about brain development in the early years and importance of hands on social play for language cognitive and social emotional skills. They can also guide parents to resources for finding quality products.

"Pediatricians have the opportunity to start conversations with parents early about family media use and habits," Radesky says. "We can help parents develop media use plans for their homes, set limits and encourage them to use devices with their children in a way that promotes enhanced learning and greater interaction."

Here's a breakdown of the new AAP guidelines for parents of children 0-5 years:

  • Avoid digital media use (except video chatting) in children younger than 24 months.
  • If digital media is introduced to children between 18 and 24 months, choose high-quality programming and use the media with your child. Avoid solo use by the child.
  • Do not feel pressured to introduce technology early. Interfaces are so intuitive that children will figure them out quickly once they start using them.
  • For children ages 2 to 5, limit screen use to one hour a day of high-quality programming. Watch with your child and help them understand what they are seeing.
  • Avoid fast-paced programs and apps with lots of distracting content or violence.
  • Turn off TVs and other devices when not in use
  • Avoid using media as the only way to calm your child. This could lead to problems with limit setting and ability to self-sooth and regulate emotions.
  • Test apps before your child uses them, and play together.
  • Keep bedrooms, mealtimes and parent-child playtimes screen free. Parents can set a "do not disturb" option on their phones during these times.
  • Set a rule: No screen time an hour before bed.
  • Use resources such as Common Sense Media, PBS Kids and Sesame Workshop for finding quality products.
  • Consult the American Academy of Pediatrics Family Media use plan.
  • Ask your pediatrician if you need help.

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