First Do No Harm: Why Have Parents and Pediatricians Missed the Boat on Children and Media?

As a society, we are engaged in a vast and uncontrolled experiment with our infants and toddlers, plunging them into home environments that are saturated with electronic media.1

Media are like the weather. Everyone talks about the media. Everyone is affected by them. But no one wants to talk about how they are changing and how they can influence us in sometimes extraordinary ways. Just as people—and politicians—seem to be ignoring the threat of global warming, they also seem blithely willing to ignore the impact of media on children and adolescents.

Make no mistake about it: the media are changing; in a few short years, your child may be able to click on a pizza commercial on your TV screen and order a pizza directly or go to a website for more information about the shampoo that looks so good. As your teenager passes a McDonald’s restaurant, she may receive a text message on her cell phone with a $1 off coupon for that particular day and store. Ten years from now, your wristwatch may actually be a 5-gigabyte computer that can talk to you. There will be no further need to memorize Lincoln’s Gettysburg Address or the death scene from Romeo and Juliet. Your watch will be able to recite them, probably with an appropriate Midwestern or Royal Shakespearean Company accent, respectively. For interactive toys, the future is now: as of 2000, 60% of the new toys produced by Fisher-Price had a computer chip in them, and toys like Barney Actimate encourage children to play and sing songs along with the TV program that is signaling it2—not to mention your child’s or teenager’s exposure to the current escalation of violent content, sex and sexuality, and smoking in the media.3

The average American child spends >6 hours a day with a variety of different media,4 yet parents and pediatricians seem unwilling or unable to deal with the issue.5, 6 For parents, media seem to rank near the bottom of the list of things to be discussed, negotiated, fought over, and regulated. For pediatricians, discussing media seems to rank far below car seats, bicycle helmets, vaccinations, and household safety. Few residency programs teach about the impact of the media.7 Nor do continuing medical education courses include, or even mention, the media in discussions of broad child health issues like violence, bullying, or drugs. Yet the media may play a significant role in virtually every concern both groups have about children and teens—sex, drugs, obesity, eating disorders, hyperactivity, school performance, aggressive behavior, and suicide.6 Research indicates that for aggressive behavior, for example, the media may contribute 10% to 30%.8 A young teen exposed to a heavy diet of sexual media is twice as likely to begin having sexual intercourse at a young age.9 A child exposed to R-rated movies is twice as likely to begin smoking cigarettes.10 Like the weather, the media are certainly not quiet companions who exert little or no influence.

In this issue of The Journal, Zimmerman and Christakis11 extend our knowledge to young babies and once again demonstrate the power of the media and the importance of the basic principle of medicine: “first do no harm.” Baby videos are now a $100 million business, with a myriad of unsubstantiated claims being made about how they will improve intelligence and school readiness.12 Yet Zimmerman and Christakis found highly significant language delays in babies 8 to 16 months old who were exposed to such videos. As they soberly assess, this may not be a cause-and-effect situation, but it is certainly one that demands caution in exposing babies to videos and much more research to elucidate who may be harmed, how, and why. Despite the lofty claims of the producers of baby videos, there is very little evidence that babies <2 years old can learn anything positive from TV,1 and there is significant evidence from 3 other studies that harm is possible: two studies of children under 2 years old watching Sesame Street also found delays in language development,13, 14 as did a large study of 1900 Japanese infants viewing 4 hours or more of TV per day.15 This is not to say that Sesame Street is not one of the finest prosocial programs ever produced for children. It is; but “to everything there is a season,” and the season for Sesame Street appears to be 2 years and older.1, 16 Why? Television is a complex medium and requires brain maturation and cognitive skills to decipher. Ordinarily, this does not occcur until age 2 or 3 years.16 At birth, the infant brain is “plastic” and develops in response to genetic and environmental cues.17, 18 Numerous studies indicate that a human face is far more effective in “teaching” an infant than a face on a TV screen.16

A second study in this issue by Barradas et al19 reinforces what the American Academy of Pediatrics (AAP) has been saying for a long time: parents need to control the TV set (and other screen media) and serve as role models in using media. Parental TV viewing correlated with child TV viewing, and parents who set rules and “obeyed” the AAP recommendations had children who viewed less TV.19 Unfortunately, several studies show that this is hardly the case. There is nearly a complete disconnect between what the AAP recommends and what parents and pediatricians do6:

What should we do about this sad state of events? First and foremost, both pediatricians and parents need to appreciate the power of the media—to educate, to entertain, and to harm. The research is increasingly compelling. Second, the federal government and private foundations need to fund research to fill in the gaps of our knowledge. To date, for such an important influence on child development, there is precious little money available to researchers. Third, the federal government needs to take its responsibility seriously. According to the United States’ Communications Act of 1934, which first established policies for television broadcasting, the public owns the airwaves, and they are leased back to the networks to produce programming in the public’s best interests. Is that really what is currently happening? Fourth, pediatricians must understand the role that media currently play in their young patients’ lives. Asking 2 media questions in a well-child or well-teen visit would only take a minute: How much time do you spend watching screen media per day? Is there a TV set in your bedroom?6 Fifth, the entertainment community needs to realize that the research has become far more sophisticated since the 1950s and accept that they have a public health role to play in producing prosocial programming. Finally, advertisers and manufacturers of toys and baby videos need to recognize that they, too, have a responsibility—to make prosocial products, to avoid making claims that can not be substantiated, and to limit their advertising aimed at young children.26

Sadly, few parents and pediatricians observe the AAP recommendations about children and media. These 2 new reports and numerous other recent studies27 seem to indicate that they do so at their own—and babies’ and children’s and teens’—peril.