Media Exposure & Usage in Children – – AAP Policy Statement Update

By James P Lee, MD, FAAP

At this year’s national AAP meeting held in October, the AAP updated their policy statement regarding media exposure and usage in all age groups. It was divided into two sections: 1) infants, toddlers and preschoolers and, 2) older children and adolescents. We’ll tackle the younger age group in this blog.

For the younger age group, the AAP continued to emphasize that evidence for benefits of media exposure of any type for children under 2 is very limited. Children under 2 need hands on exploration and social interactions, ideally with consistent caregivers (I.e. parents) to develop in all developmental areas – cognitive, language, motor and social-emotional. Media exposure is only beneficial for toddlers (after 18 months) if parents are watching, interacting and reinforcing the content.

For preschoolers, only well designed programs, such as Sesame Street, have evidence that support improved cognitive, literacy and social/emotional outcomes. Most apps purporting educational skills are not broad based, are targeting rote academic skills and are not designed for dual audiences( I.e. parent and child) that allows for interaction. As important, skills stimulating ” higher order thinking” such as task persistence, impulse control, emotional regulation and creativity, are best learned through unstructured and social ( not media) play.

Additionally, there are now known health and developmental concerns related to prolonged media exposure. Primary research based on passive TV watching/exposure show an increase risk for obesity ( direct relationship between hours of TV watched and increased BMI) and poorer/ lesser sleep ( again, increased exposure directly linked to overall less amount of sleep). Further, overall child development shows a negative association with increased TV viewing and less attainment of developmental milestones( in all domains). The earlier the age of exposure, the greater number of hours exposed and poorer, non age appropriate content are all associated with poorer “higher order”(executive) functioning in preschoolers. Content is crucial. Educational and pro social content is notably more beneficial than violent, non age appropriate content.

Parental media use also has many implications. Background TV usage has been shown to lessen parent-child interactions and less overall play opportunities. Heavy parental use of mobile devices is associated with fewer overall interactions ( both verbal and non verbal) and is a strong predictor of a child’s own media usage habits as they get older.

The conclusions are multiple and need serious consideration. For children under 2, there is no evidence that media exposure is beneficial and potentially undermines healthy developmental progression. For children 2-5, ” evidence is sufficient ” to limit media usage to no more than 1 hour per day. This allows for more ample time to engage in a wider array of activities that is associated with improved overall healthy development and lessens long term risk factors associated with over- usage (increased weight and decreased sleep). Also, all media exposure should be educational and have pro social content and parents/caregivers should be engaged and interacting with the child during that time.

As digital technology expands and becomes more integrated into our day to day lives, we need to appreciate some of the unintended consequences both now and in the future for our families. Recommendations include having tech-free spaces and times in our homes that include special times and special places. These could include ” get-ready times” in the morning or at bedtime, meal times , play times, etc. that should promote social and alternative activities and discourage use in bedrooms, common spaces, etc. Needless to say, none of this is quick or easy but may ultimately serve as the basis of your parenting philosophy and may start setting the stage of long term rules and expectations in your home. The AAP encourages families to review this topic on their parental website www.HealthyChildren.org. and to develop/ build a Family Media Use Plan. Good luck!