Education

Parental Responsibility to Regulate Screen Time for Children

In 2016, the American Academy of Pediatrics (AAP) revised screen time guidelines for children. The previous guidelines advised no screen time for kids less than 2, and no more than 2 hours in front of the TV for kids over the age of 2. With the advent of smart phones and tablets making screen time and Internet access nearly ubiquitous, many pediatricians and other professionals felt the AAP was long overdue in revising screen time guidelines to be more appropriate for current and future generations of children. Newly revised 2016 guidelines were broken down into four basic age groups with added flexibility to customize screen time to fit the needs of the individual child, as follows:

  • For infants less than 18 months of age:
    • Parents should avoid use of screen media other than video chatting.
  • For infants 18 to 24 months of age:
    • If desired, parent should choose high-qualityprogramming, and watch with children to help them understand what they’re seeing.
  • For toddlers 2 to 5 years of age:
    • Parents should limit screen use to 1 hour per day of high-quality
    • Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
  • For children 6 years of age and older:
    • Place consistent limitson the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity and other behaviors essential to health.

These new guidelines recognize that visual media can be an important tool for development and educationwhen properly utilized. The problem is that many parents do not properly adhere to these guidelines. Contrary to what some may believe, these guidelines do not relax the parameters for screen time. Rather, these guidelines call for increasedparental investmentin actively regulating their child’s media consumption. Examples of inappropriate screen time, at times even commonly witnessed directly by pediatricians in clinic, include some the following:

  • Parents using video streaming on mobile devices as a means of distracting their infants or children.
  • Parents not adequately supervising screen time.
  • Parents failing to set consistent limits on media use.
  • Parents or children choosing to view poor quality programming with little educational benefit.

Adverse effects of unregulated screen time are well understood to include the following: obesity, sleep problems, problematic internet use (e.g. gaming disorders), negative effects on school performance, risky behaviors (e.g. substance abuse, inappropriate sexual behaviors), sexting, piracy, predators and cyber bullying.

Given the common adverse effects of unregulated media use, it is important to recognize that the above guidelines do not indicate AAP’s endorsement of screen time as a primary learning activity. The AAP recommends that parents prioritize creative, unplugged playtimefor infants and toddlers. The amount of daily screen time for older children depends on the child and family, but children should prioritize productive time over entertainment time.

The AAP provides an important but underutilized tool online that helps families build their own custom Family Media Plan (see link below). Pediatricians who wish to emphasize the importance of regulated screen time should consider providing this resource to families in their clinics. The plan provides a customizable template that includes setting important boundaries in the development of healthy screen time behavior.

Lastly, a quote from Bill Watterson, arguably one of the most creative minds of the late 1980s-early 1990s who is known for his authorship of Calvin & Hobbes, helps reinforce the importance of alternatives to screen time:

“We’re not really taught how to recreate constructively. We need to do more than find diversions; we need to restore and expand ourselves. Our idea of relaxing is all too often to plop down in front of the television set [or internet] and let its pandering idiocy liquefy our brains. Shutting off the thought process is not rejuvenating; the mind is like a car battery—it recharges by running.”

Alex J. Foy, MD

 

Sources and Resources:

Build Your Own Family Media Plan

https://www.healthychildren.org/English/media/Pages/default.aspx#home

10 Tips for Becoming a More Active Family

https://www.choosemyplate.gov/ten-tips-be-an-active-family

Children and Adolescents and Digital Media

http://pediatrics.aappublications.org/content/early/2016/10/19/peds.2016-2593

Constantly Connected: Adverse Effects of Media on Children & Teens

https://www.healthychildren.org/English/family-life/Media/Pages/Adverse-Effects-of-Television-Commercials.aspx

Food Insecurity and the Pediatrician’s Role in Fighting Hunger

Problem:

In the United States hunger remains a problem with far reaching consequences especially when it affects our youngest members of society. Though many would argue that food is one of our most basic human needs, it is something many United States families at times must go without. (more…)

Heat Stroke in High School Football Players: A Lack of Regulation Placing Children at Risk

At the start of every school year, thousands of high school athletes come in excited to hit the field.  Unfortunately, heat related death in high school sports, especially high school football, remains a real risk due to lack of regulations and safeguards in place.  However, these injuries and deaths are entirely preventable by proper practices.  Pediatricians have a duty and an opportunity to protect these athletes from environments and circumstances that put them at increased risk for heat stroke and death.

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Promoting Physical Activity in Children: The role of a Pediatrician

Almost everyone, especially medical professionals, would agree that getting regular exercise is good for your health. Many studies have shown that regular exercise decreases the risk of cancer, heart disease, and premature death in general. In children, increased physical activity has been linked to better performance in school. Despite the clear benefits of physical activity on health and other outcomes, few patients report receiving physical activity counseling from their primary care physician. As physicians and leaders in the community, pediatricians should provide appropriate physical activity counseling to their patients, as well support efforts to better assess and address obstacles to regular physical activity in the pediatric population. (more…)

Addressing the violence in the news with children

Children are indirectly exposed to acts of violence and terrorism almost continuously via the media.  News media continually cycles global events onto screens in every household. The stress of witnessing a shooting is no longer limited to the bystanders and civilians caught on the scene, but is spread diffusely across state and national borders to viewers in their homes including children. Pediatricians can help children and their caretakers process these tragedies better.  

Exposure to such news stories can contribute to a stressful environment for the child. In recent years the AAP has focused on ‘toxic stress’ in a child’s life. Toxic stress has been defined as “the excessive or prolonged activation of the physiologic stress response systems in the absence of the buffering protection afforded by stable, responsive relationships” (National Council of Science: Excessive stress disrupts the development of brain architecture). A growing body of evidence suggests that ecology and biology interact to effect development, i.e., the ecobiodevelopmental framework. In the case of toxic stress, a stressful ecology inculcates lasting detrimental effects in biology and behavior. It can lead to development of poor coping skills, unhealthy lifestyle choices, chronic cardiovascular diseases and serves to perpetuate health disparities to mention a few.

Opinions vary on the extent and significance of the effect of exposure to news media coverage of acts of terror and violence. Increasingly, after such an incident, many articles emerge suggesting how parents should talk to their children about violence. Unfortunately, many children do not have the “buffering protection afforded by stable, responsive relationships” with their parents. Parents themselves may face a difficult time coming to terms with the same tragedies. This gap can be bridged by the pediatrician, school and public policy.

Pediatricians can routinely screen for toxic stress. The AAP has put forward many helpful resources which advise parents on how to talk to their children regarding media violence, tragedies they may have witnessed, school shootings and disasters. Whenever such news is circulating, pediatricians can ask parents if they have trouble communicating with their children about it, expand on their anticipatory guidance using the pre-existing AAP guidelines and recommend appropriate resources to them.  Further, pediatricians in collaboration with mental health professionals can meet with parent-teacher associations to share how children are able to best process these events.

Schools can engage their own mental health services and counselors to have a discourse with children in an age-appropriate manner. In the absence of adequate resources, these sessions could be done in groups and limited to when the event is local.

Finally, state government officials can improve funding for mental health services for children and implement strategies to incentivize an increase in the mental health professionals catering to the pediatric population. Legislators can formulate guidelines for Social and Emotional Learning (SEL) curriculum for grades K-12 as exist for pre-kindergarten. As of December 2015, free-standing guidelines for Social and Emotional Learning exist only in the states of Illinois, West Virginia and Kansas. Bills proposing training of teachers and principals to address social and emotional development needs of students have been previously introduced in the U.S. House (H.R.850; H.R.497) and the U.S Senate (S.897) in 2015. In the same year, a bill (HB 3289) was also introduced in the Texas Legislature proposing formulation of a local school health advisory committee to address mental health concerns existing in school efforts and to make recommendations to the school district concerning the integration of social and emotional learning into the academic curriculum.

Adopting such a multi-pronged approach will better preserve the childhoods of the current generation and safeguard their adult lives as well.

References:

1.       National Scientific Council. Excessive stress disrupts the development of brain architecture. Journal of Children’s Services. 2014 Jun 10;9(2):143-53. Accessed July 11, 2016. URL: http://developingchild.harvard.edu/wp-content/uploads/2005/05/Stress_Disrupts_Architecture_Developing_Brain-1.pdf

2.       Shonkoff, J.P.; Garner, A.S. Technical Report: The lifelong effects of early childhood adversity and toxic stress. Pediatrics. 2012. doi:10.1542/peds.2011-2663

3.       Committee on psychosocial aspects of child and family health, committee on early childhood, adoption, and dependent care, and section on developmental and behavioral pediatrics. AAP Policy Statement: Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics. 2012. doi:10.1542/peds.2011-2662

4.       Busso, D.S.; McLaughlin, K.A.; Sheridan, M.A. Media exposure and sympathetic nervous system reactivity predict PTSD symptoms after the Boston marathon bombings. Depress Anxiety. 2014 July ; 31(7): 551–558. doi:10.1002/da.22282

5.       Marie Leiner, M.; Peinado, J.; Villanos, M.T.M.; Lopez, I.; Uribe, R.; Pathak, I. Mental and emotional health of children exposed to news media of threats and acts of terrorism: the cumulative and pervasive effects. Frontiers in Pediatrics. 2016. doi: 10.3389/fped.2016.00026

6.       Collaborative for Academic, Social and Emotional Learning. Identifying K-12 Standards for SEL in all 50 States. 2015. Accessed July 9, 2016. URL: https://pedsadvocacy.files.wordpress.com/2016/07/a46cb-state-scorecard-summary-table-for-k-12-12-16-15.pdf

7.       Collaborative for Academic, Social and Emotional Learning. Identifying Preschool Standards for SEL in all 50 States. 2015. Accessed July 9, 2016. URL: http://static1.squarespace.com/static/513f79f9e4b05ce7b70e9673/t/55df7c05e4b031d82f728c5d/1440709637809/preschool-table-8-27-15.pdf

8.       Texas Education Agency. Accessed July 9, 2016. URL: http://tea.texas.gov/index2.aspx?id=2147495508

 

Gohar Warraich, M.D.

 

Let the Kids Play

Remember the days of playing hopscotch, kickball, or tag? Or maybe you can recall the joys of swinging from the monkey bars or the release from climbing on the jungle gym? Doctors, parents, and others are concerned that kids are losing out on physical activity during their school day to increase the amount of instruction. Working with schools and lawmakers should be our focus to protect recess and physical education time.

When schools  replace physical education and recess with more instructional time and academic work, children lose valuable benefits from free time and play.  The benefits include:

  • Children need a release time from the classroom. They need to expend their energy.
  • Studies have shown that children are able to focus in the classroom when they have recess time.
  • Other studies have shown that children feel more positive and secure when recess is a part of their day.
  • Children learn best by experience. The playground and gym provide this type environment for learning. They provide opportunities for problem solving, interpersonal communication, and other learning that cannot be taught as effectively in the classroom.
  • Increases in diagnoses of childhood obesity ADHD have occurred in the pediatric population.  Additional physical activity for those patients through recess and physical education could have beneficial effects.Recess and physical education also provides a much appreciated break for the classroom teachers.

As Mark Twain has echoed, let’s not let school get in the way of education. Let’s remember there is a time to read and a time to run. May we champion those policies and rules that protect recess and physical education.

Jacob Jones, MD

References

http://pediatrics.aappublications.org/content/131/1/183

https://news.stanford.edu/2015/02/11/recess-benefits-school-021115/

 

Consciously Supporting Concussion Awareness

In recent years, public interest has increased surrounding concussions/mild traumatic brain injuries (MTBI). This is due in large part to the recent hypothesis that concussive forces from contact sports may be a risk factor for the development of chronic traumatic encephalopathy (CTE), a disease seen most often in former boxers and professional football players.

Research, legislation, and documentaries have sought to better define the incidence and risks of concussions, its relationship to these 2 diseases, and to increase public awareness of this issue. Currently, legislation is pending in both the U.S. House of Representatives and the Senate that has the potential to further achieve these goals by increasing general awareness about concussions and giving parents and youth the ability to make informed decisions about the sports in which they participate. We as pediatricians can advocate for the safety of our patients by contacting our local representatives and asking them to become cosponsors for the “SAFE PLAY Act” (H.R. 829).

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September is AAP’s National Obesity Awareness Month — Get Involved!

September serves as the AAP’s National Obesity Awareness Month—an appropriate occasion for pediatricians to take a more active role in combating childhood obesity. Pediatric obesity has increased two to three fold over the past several decades in the US (more…)

Giving our patients a HEAD START!

Head Start began in 1965 with the aim to provide children from low income families with skills to be ready for and to succeed in kindergarten and in life. It now serves nearly 1 million children from birth to age 5 years with comprehensive early learning services in classrooms, home-based programs and family child care partners. Pediatricians should promote Head Start in patient visits and through advocacy efforts at local, state and federal levels. (more…)

Regulating the Quality and Availability of Our Children’s Pre-Kindergarten

Texas House Bill 4 introduced this session seeks to regulate the quality of pre-kindergarten programs that eligible Texas children receive. The measure includes a provision to authorize state payment up to $1,500 per child to the schools to ensure the programs are effective. It requires that teachers be certified or have at least eight years of experience and that the student:teacher ratio be no more than 18:1. It also requires reporting of data to the state to regulate quality and track outcomes in these existing pre-kindergarten programs. Programs must also have a curriculum and a family engagement plan to maintain “high levels of family involvement and positive family attitudes toward education”. It does not expand enrollment, nor would it increase from the current half-day model.

Current opposition to the bill is reminiscent of 1971 and the failure to establish universal childcare for all American children. At that time, the Comprehensive Child Development Act had passed both houses of Congress. Before being signed into law, it was vetoed by President Nixon. Various repudiated the legislation as the “Sovietization” of American children. Opponents argued that the law took the rights of child-rearing away from parents and placed them with the government. They characterized the act as an attempt to indoctrinate American children, and further stated that children should stay at home with their mothers. This same argument is being revived today by some opponents of House Bill 4. Other opponents are rejecting this bill because they believe more could be done by expanding pre-kindergarten enrollment to allow every child to participate. Others withhold support claiming a lack of evidence to support early childhood education as effective.

With many more women fully employed now, childcare and early childhood education is a clear necessity for most families. High quality early educational programs have demonstrated substantial effects on social and cognitive outcomes for children. Some studies also show a reduction in crime and arrests of the participants in their later adult years. Two aspects which are crucial for a program to be effective are limitation of class size and the amount of individualized attention that each child receives.  House Bill 4 lacks content to address those aspects, and it does not include a requirement to expand pre-kindergarten programs from half-day to full-day

As of May 7, 2015, House Bill 4 has been approved by both the House and Senate in Texas. When this bill is signed into law by Governor Abbot, we will have taken a step to help some Texas children reach their full potential. I encourage my colleagues to continue to advocate for all of our children. Universal early childhood education will benefit Texas families. Continue to raise awareness for this need by writing your state legislators to expand pre-kindergarten programs to give every Texas child the opportunity to benefit.

Stephanie Bousquet, MD

Sources:

Badger, E. (2014, June 23). That one time America almost got universal child care. Retrieved May 5, 2015, from http://www.washingtonpost.com/blogs/wonkblog/wp/2014/06/23/that-one-time-america-almost-got-universal-child-care/

Barnett, W. (2011). Effectiveness of Early Educational Intervention. Science, 975-978.

The Raising of America: Early Childhood and the Future of our Nation [Motion picture]. California Newseel with Vital Pictures.