“What’s the Tea?” Current Recommendations on Media Use in the Pediatric Population

With the increasing use of technology in modern society, children have more access than ever to media and screens. Thus, the amount of time children spend playing video-games (who has heard of Fortnite?), on Snapchat, #Instagram, or TikTok, among others, has flourished, and this has become a hot topic amongst parents and pediatricians alike. For pediatricians, this shift towards a growing digital landscape is a moving target – society’s understanding of the impacts of social media and video games, particularly those of violent nature, is constantly shifting, and affecting how physicians address children’s medical needs. Pediatricians should be cognizant of this changing environment to best assess their patients’ electronic footprints and help guide recommendations.

Video games have been around since the 1950s, but they have become a growing force in the community particularly since the 1990s. With this rise came the concurrent increased exposure to “virtual violence”; while previously the exposure primarily occurred through platforms such as television, the exposure increased dramatically with the proliferation of computers and handheld consoles for video games. Discussions regarding the benefits and detriments of these violence-containing media have been polarizing, particularly regarding  short- and long-term behaviors, medical implications, and psychological effects.

Meta-analyses (2014, 2017) suggested that exposure to violent video games can pose a possible risk factor for aggressive behavior. Other studies found that addiction or depression may be sequelae from video-gaming, violence-containing or otherwise. Nevertheless, other studies have suggested some positive aspects of gaming. The 2014 meta-analysis also suggested that violent video games may also provide prosocial benefits and cooperative play that could foster cooperative behavior and empathy. Additional studies have been performed to evaluate the benefits of video games, with some suggesting improved spatial skills, improved efficiency with attention allocation, emotion-regulation tricks called “re-appraisal”, and “prosocial” and helpful behaviors.

Unfortunately, we lack enough data fully delineating causal effects from video games, and violence-exposing media at this time. Needless to say, this clears very little up. Are social media, video games, and violence-containing media good or bad? Should we let our children partake in these activities, or not? This is difficult to assess, and frankly, not useful to delineate the black and white of video games and social media, particularly in the rapidly changing technological environment.

What may be practical for families to do when raising their children in this technology-ubiquitous world is to follow 2016 American Academy of Pediatrics (AAP) official recommendations from three policy statements, published in Pediatrics® 2016, for media use in children: 

  • Avoid screen media for children younger than 18 months – if a parent chooses to continue with media, they should choose “high-quality programming” and interact with their child during the use.
  • Limit screen time to 1 hour in children ages 2-5 years old. Interactions and “co-viewing” media can help children interpret what they are seeing as well as form bonds with the adults they interact with
  • Find a balance of screen time with limits for children 6 years and older – emphasize the importance of healthy sleeping patterns, physical activity, and other healthful behaviors. Families should consider using the Family Media Use Plan tool with HealthyChildren.org, linked here: https://www.healthychildren.org/English/media/Pages/default.aspx
  • Have pre-determined media-free time together, as well as media-free locations
  • Continue to discuss the benefits and detriments regarding online media use and safe, appropriate media behaviors with children

Additional considerations that families should keep in mind include: 

  • Role-modeling media use for children in the whole family, not just the children
  • Avoiding technology use to regularly distract or soothe children
  • Understand that it is acceptable for older children and teens to be online; finding that balance between appropriate amounts, which foster typical teen development, and too much; this requires communication, trust, and frequent re-evaluation
  • Continue to encourage appropriate behaviors both on and off-line
  • Be mindful of red flags with a child’s online behavior; mistakes will be made, but be more cautious with behaviors such as bullying, sexting, or self-harming images
  • Provide education about privacy and online dangers (such as predators, sexting)

What can pediatricians and other providers do when faced with counseling regarding media use for their families in which media plays a large role in a child’s life? Suggestions from the AAP include:

  • Consistent discussion about the quantity, as well as quality, of children’s media consumption
  • Continue to encourage mindful screen-time, including co-viewing and co-playing
  • Recommend that parents screen what children are watching, particularly those younger than 6 years, and avoid virtual violence – children younger than 6 years are found to have difficulty delineating the fantasy of video-games from reality
  • Consider partaking in advocacy, and maintaining discussions with policy-makers or legislators. Minimal legislative action exists to decrease violence exposure in the media, and no single governing body monitors the content and ratings of games. Pediatricians can advocate for limiting access to violence-containing media for minors, as well as encourage increased creation of “child-positive” forms of media. 

Many questions still exist regarding both the short- and long-term impacts of exposure to violence in the media and video games. Parents and pediatricians alike require frequent reassessment to keep up with the changes in the interactive digital world. Constant discussions with children are recommended to continue to encourage safe and appropriate media use and video-gaming as they navigate through the vast realm of technology. Frequent re-consideration is critical as the landscape continues to evolve. 

Lori Xu, MD


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