Sunday, November 9, 2014

Toddlers and Tablets: A Good Combination?

boy on tablet
If your toddler regularly has his hands on your smartphone or tablet, he isn’t alone. According to a 2013 study by Common Sense Media, 38% of children under 2 have used such mobile devices.

The question is: Should toddlers be using these mobile devices? And if so, how much exposure is OK?
As parents grapple with this question, so do pediatricians. Under its most current guidelines, the American Academy of Pediatrics recommends doctors tell parents to discourage screen media exposure for children under age 2, but doesn’t outright ban all screen time for toddlers.
Now, as technology has advanced and children are using mobile devices at younger and younger ages, the academy is discussing whether it should be giving more specific advice to parents. At the annual meeting of the American Academy of Pediatrics Oct. 13, two pediatricians squared off in a point-counterpoint to discuss the pros and cons of giving toddlers access to electronic devices.
Dimitri Christakis, MD, MPH, professor of pediatrics at the University of Washington, also directs the Seattle Children’s Hospital Research Institute’s Center for Child Health, Behavior and Development and has long researched the effects of media exposure on children.
Donald Shifrin, MD, is a practicing pediatrician in Bellevue, Washington, and has been caring for patients for 37 years.
Give Tots Access to Electronics? Yes, With Caveats
“Up to 30 minutes [a day] of high quality, interactive screen time is OK,” Christakis says. He emphasizes this is his opinion. “Ideally, it would be with a caregiver and more importantly it does not replace other quality time. It should not be done at dinner or at a time when a parent would normally be talking to their kids.”
Research on the use of mobile devices by toddlers is scarce, but Christakis offers guidance from other research on the effects of media exposure on children.
  • Pay attention to content. Focus in particular, he says, on the amount of image change that is on the screen. Overstimulation can lead to problems. For instance, he says, the “Powerpuff Girls” is an animated show with ”frenetic” animated action. In contrast, he displayed a “Mr. Rogers” segment in which the soft-spoken actor demonstrates to young viewers what is involved in going to a restaurant, being shown to your seat and getting ready to order. Exposure to very rapid image pacing can hamper a child’s executive function skills, which are involved with thinking about solutions, accessing information, and other tasks, he says .
  • Consider the potential for interaction with parent or caregiver. Does the device encourage interaction with the child? If so, that is a plus, he says.
While others say more research is needed on mobile devices and toddlers before making a decision, Christakis says parents need answers now—and pediatricians need to acknowledge that passive television viewing is very different than a parent and toddler playing an interactive game on a mobile device.
Bottom line: “It’s never been more difficult to be a parent and manage children’s digital lives,” he says. “Simplistic recommendations no longer work. Parents have to spend a lot more time thinking about how their children watch, how much and what. They can rightfully look to pediatricians for guidelines.” Parents and pediatricians should recognize there are differences among media, he says: “A screen is no longer a screen is no longer a screen.”
Give Tots Access to Electronics? Not So Fast
“For children under 2, social interaction with a three-dimensional person is the more prudent way to go at this point,” Shifrin says.
When pediatricians advise parents on the use of mobile devices by children under age 2, he says, ”we are dealing with hunch. We don’t have any evidence to back this up.”
He offers this guidance for parents faced with the question of mobile device use by toddlers.
  • Parents teach more than a screen. Shifrin cites a study in which children exposed to language teaching by a screen didn’t learn as well as those taught by a person. “There is very little ‘serve and return’ we see with apps,” he says. When a parent reads a child a book, there is typically much interaction, he says. If there is a picture of a dog, for instance, a parent is likely to say “Look at that doggie!” and “What color is the dog?” to trigger interaction. Is using a tablet equivalent to reading a book? “We don’t have that knowledge,” he says.
  • Beware of mobile devices as default options. “We’ve all had kids in our offices where parents were trying to take away the tablet so we could do an exam,” he says. “There was a small degree of frustration [by the child]. What do the parents do? Give it back. The question of self-control comes in here as well. We have to think about the fact that these toddlers are going to default to the screen. It’s not a good thing to start defaulting to. We used to struggle with the TV. Now, parents are struggling trying to disconnect children from digital devices.”
Bottom line: A pediatrician’s job is ”helping families navigate the shallow and sometimes deep waters of parenting,” he says. “Media use in children is the largest single purveyor of time for children. Our job is to be prudent when we consider what that means in terms of family and health.”

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