Start media guidance early

From the lunch line to the playground, “flossing” is a familiar sight with most children-and it has nothing to do with teeth.

The Floss Dance, popularized by the video game Fortnite, is just one example of how media influences children, and it’s important to be mindful about how children and families are using-and impacted by-the media they consume. Early and frequent education for parents is key to establishing healthy media use practices, and to avoid family anxiety from major changes in the later years, according to a talk at the 2019 American Academy of Pediatrics (AAP) Annual Conference and Exhibition in New Orleans, Louisiana.

Corinn Cross, MD, FAAP, a pediatrician in Pacific Palisades, California, gave a lecture on media use in a session titled, “From E-books to Fortnite: How to Help Families Incorporate AAP Media Recommendations at Every Age,” at the conference on October 25, 2019 and repeated on October 26, 2019. Cross, who helped develop the AAP Family Media Use Plan Toolkit, says the goal of the session was twofold.

The first goal was to help pediatricians understand the importance of early implementation of a family media plan and conscious use when it comes to media and screens. “Infants are being introduced to screens in their first year of life, pediatricians need to change when we start discussing screens to better mirror the changing times,” Cross says.

The second goal was to teach pediatricians how to counsel parents on setting up a “scaffolding” of screen rules and expectations in the toddler years with the understanding that this scaffold will be used to build more appropriate guidelines as children age and family dynamics change.

Discussions should start with new parents, even those with infants, on how to set boundaries when it comes to media use, creating a plan that is consistent and starts when children are young can reduce issues as the children grow.  Parents don’t always realize the impact of media use and how media decisions made when a child is young will play out as the child ages.

In addition, “Parents may need to adjust their own screen use,” Cross says. Many parents are unaware of how their own media use is interpreted by their children. According to Cross, studies have shown that screens are changing face-to-face interactions, the very presence of a screen-even when not in use-decreases the quality and intimacy of face-to-face conversations. “Studies have shown that even with a phone face down, conversations around the table were more superficial because people felt they could get interrupted at any time,” Cross says. “When phones were not present, people had deeper conversations.”

This is important as families try and make space for quality time, and should be “a reminder to parents that just the presence of a phone at the dinner table may hinder their children and teenagers from discussing things that are bothering them.”

The presence or absence of a mobile device has more impact on the quality of a face-to-face interactions than age, race, or gender, she says, and they never seem to be far away. According to Cross, 73% of parents in 1 study had a phone with them at a fast food restaurant with their children, and around 40% of parents were using them constantly. “Children would increasingly act out around distracted parents and of course ultimately get in trouble, but it goes unrealized that they are often acting out in an attempt to get the parents’ attention,” Cross says.

Although media use is a given these days, Cross says it’s important to consider the impact, and what is being lost to screen time.

“The idea of displacement, distraction, and a worthwhile use of time is really how we should be gauging if this is a good use of time at any age. What are we displacing when we use these screens? Are we displacing family time, exercise time? Are we not interacting with people in the same way? Is what we’re doing on them a worthwhile use of time?” Cross asks.

Research suggests that screen use is so rampant, that some young adults who go to college with devices may have a difficult time turning them off to study. Constant device use may be linked to depression and anxiety when the device is taken away. Recent studies have reported that teenagers who are heavy media users and are then suddenly denied access to their phones, experience high levels of anxiety, she says, and perform worse on mental tasks.

Pacing and content matters when it comes to setting up a media plan, and parents should be aware of how their children are using screens and guide them towards age-appropriate content. From sexting to violent video games, the AAP offers tools to help parents understand why boundaries are important and how to set them.  

Self-regulation is important, but Cross says children who have poor self-regulation are actually using devices more. “Pediatricians need to ask parents what their goals for their children are. Lifelong emotional regulation, creative, higher order thinking, and self-regulation-these are all taught best through unstructured and social play not screens” Cross says.

Pediatricians should offer advice and resources from an early age, the AAP Family Media Use Plan toolkit is one resource that pediatricians can suggest to their patient’s family to complete prior to a well-child visit. Using resources prior to meeting with the pediatrician, allows parents to pinpoint issues they may be struggling with and allows busy pediatricians to focus their counseling where needed. “The toolkit is meant to really guide the parent and teach them as they go along. By having parents use the toolkit prior to the visit, pediatricians may be able to decrease the education they need to do in the office,” Cross says.

She also suggests offering the toolkit when parents have issues with sleep or behavior. “Finding out how screens fit into a family and child’s day to day life can give a pediatrician a lot of insight into what may be going on and how to help.”