Laird Harrison


October 21, 2016

SAN FRANCISCO — Children as young as 18 months of age can benefit from the use of electronic media, according to a new guideline issued by the American Academy of Pediatrics (AAP) and a policy brief issued by the US Department of Education in conjunction with the Department of Health and Human Services.

Both documents recommend limiting time spent looking at electronic screens, and both shift the emphasis to helping families use electronic media constructively.

"Eighteen months is about the age when, cognitively and attention-wise, kids are ready to start," said Jenny Radesky, MD, a developmental behavioral expert and pediatrician at the CS Mott Children's Hospital in Ann Arbor, Michigan, who is a coauthor of the AAP guideline.

"But we also want to make it clear to parents that we're not saying that you have to introduce media then. It's fine to remain a low-tech family, because kids will catch up, especially when they go to school," she added.

The AAP guidelines were released at a panel discussion today at the American Academy of Pediatrics (AAP) National Conference and were published online in Pediatrics.

One of the authors of the government policy brief, Libby Doggett, PhD, from the US Department of Education, was also on the panel.

Children need laps more than apps. Dr Dimitri Christakis

As in the past, the AAP generally discourages the use of electronic media by children younger than 2 years of age. "Children need laps more than apps," said Dimitri Christakis, MD, from the Center for Child Health, Behavior and Development in Seattle, who is another of the AAP guideline's coauthors.

But both the AAP guideline and the government policy brief make exceptions for video chatting with loved ones for children younger than 18 months.

For example, parents on military missions overseas can connect with their babies over Skype.

"When video chatting, children under 16 months show no learning gains, though there may be a benefit in promoting bonding when physical distance limits frequent in-person interactions," according to the government policy brief.

Children can begin to learn from digital media starting at about 18 months, but children younger than 2 years should not be left alone with media devices, the AAP and the government recommend. However, the government recommendations make an exception for children with disabilities who need assistive technology to communicate.

Both documents recommend that children from age 2 years to school age be exposed to no more than 1 hour of high-quality programming per day.

High-Quality Programming

The AAP made clear what constitutes high-quality programming by including Jeff Dunn, chief executive officer of Sesame Workshop, in the press conference. He touted research showing the educational and behavioral benefits of the Sesame Street children's television program. And Jim Steyer, chief executive officer of the Common Sense advocacy group, was on hand to describe his organization's directory of beneficial children's media.

Caregivers should model good media use, use media with their children, and discuss the content, both documents say. An online tool developed by the AAP can help caregivers devise a plan for media use.

"For early learners, technology can provide concrete engaging opportunities for education," said Dr Doggett. "This will only happen if families are cognizant of time limits, but more important is the content of what they're using."

For early learners, technology can provide concrete engaging opportunities for education. Dr Libby Doggett

Both documents recommend a shift from the traditional effort of restricting screen time to carving out screen-free time, starting at school age. Children need at least an hour of exercise daily, a full night of sleep, and some time unplugged, especially during family meals, they say.

Once children own their own devices, parents cannot very well limit the media children are consuming, Dr Christakis told Medscape Medical News.

"There is no way," he said. "So I've flipped it. Make sure they are off, unplugged, at least 2 hours a day."

The AAP guideline drew praise from children's media researcher Stephanie Ruest, MD, from Brown University in Providence, Rhode Island. "The easily accessible online media use plan available on the website can empower parents and caregivers to create personalized media-use limits and plans for their children," she told Medscape Medical News in an email.

During the panel discussion, the recommendations prompted some pediatricians in the audience to ask how they should respond to their patients' questions.

"What is the concern about children having screen time before 18 months of age?" asked Anne Francis, MD, from the Elmwood Pediatric Group in Rochester, New York. "There is a lot of pushback from parents. Does this cause harm?"

Some evidence suggests that it does, Dr Radesky responded. The introduction of media that is "not PBS-type media" to children that young is associated with worse executive function, sleep-onset difficulties, shorter total duration of sleep, and increased body mass index, she said.

Risk vs Benefit

In her own practice, Dr Radesky said she tries to take a compassionate approach to parents who are overwhelmed and might, for example, want to set their baby in front of a television for a half hour while washing dishes. "I always say, if that's going to make you a better, more engaged parent, then do it."

Pediatricians can feel challenged to add the use of media to everything else they want to discuss with patients, said David Lloyd Hill, MD, from Wilmington, North Carolina.

But asking about media will reveal a lot about how families approach education, sleep, financial challenges, and other social issues. "If you pull this bit of yarn, you get the whole ball," he explained.

The guideline authors and Dr Ruest have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) National Conference. Presented October 21, 2016.

Pediatrics. Published online October 21, 2016. Abstract


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