patient advocacy

Common Concerns in Pediatric Digital Media Use

It’s a new decade, and parents and pediatricians are worried about the modern perils of childhood; this includes digital technology and toys. How does a constant parade of screens and buttons affect a child’s growth, health, and happiness? Is any screen time good for children? By reviewing AAP literature, it’s possible to see a way through the anxiety and to a childhood of healthy, positive relationships with technology.

AAP Recommendations

Especially in infancy, the AAP explains, toys and play should be about creating and supporting warm interactions with a caregiver and child. This kind of play encourages social skills, fine and gross motor skills, and creativity.

Here are the AAP’s current recommendations:

  • For children under 18 months, avoid screen-based media except video chatting.
  • For children 18 months to 24 months, parents should choose high-quality programming and watch with their children. High quality programming can be screened through tools like Common Sense Media for content that is educational and helps promote positive social or intellectual development.
  • For children 2 to 5, limit screen time to one hour per day of high-quality programming.
  • For children 6 and up, establish consistent limits on the time spent using media and the types of media. For example, 30 minutes after homework for an 8 to 10 year old to watch TV or play a video game, but not 30 minutes of each. For a teenager, parents may place expectations to remove cell phones at bedtime, or restrictions against certain websites, apps, or games deemed inappropriate.

What does this mean for parents “on the ground,” the active and busy home front, as it were, of digital media use?

Device Advice for Parents and Pediatricians

To help parents navigate the uncertain world of digital toys and media for children, it’s important to remember that while interactive play and physical toys are the best possible choices for children, parents are not alone in giving a tantrum-having toddler their iPhone to gain a moment’s peace in the check-out lane. According to the AAP, “Data presented in 2015 suggests that 96.9% of children have used mobile devices, and most started using them before 1 year of age.”

Yet parents say they are trying hard to put boundaries around their child’s media use -- 94% according to an APA survey. The difficulty, many parents say, is that limiting technology use is a constant battle, because what seems excessive time to parents is benign and fun to kids.

Addressing Common Digital Media Use Concerns

Marketing and Ads

Children, just like adults, are prone to want toys and digital technology that is temptingly advertised to them, as well as popular among their peers. Talking to children about why they see ads and commercials, and how companies earn money by making them want things can help kids learn to discern between persuasive and informational text. is a site with resources for parents and teachers to help children understand these differences, and why they are important in making wise purchases and decisions.

Interactivity and Social Skills

When children engage with screens alone or even with a caregiver present, there is little to no social engagement, and the AAP cautions: “Recent investigations have revealed that during children’s play with electronic toys, there were fewer adult words, fewer conversational turns, fewer parental responses, and fewer productions of content-specific words than during play with traditional toys or books.”

Parents can help by joining in their child’s screen time whenever possible, and by taking care to pull the child’s attention from the screen to have meaningful play and conversation without screens. Parents can take time to chat with kids before bed, while driving, or while doing chores together. If there are boundaries around when a device should not be used, such as with guests or at meals, these rules should be enforced consistently to demonstrate to the child an appreciation of social interaction in person rather than on a device.

Lack of Exercise/Physical Play

Luckily, many kids have no problem expressing their energy in physical play, even with technology in their lives. The important thing for parents is to introduce plenty of opportunity and encourage this physical play daily. Family activities such as walking, hiking, bicycling, and swimming can help children balance physical activity with screen use. Young children will find physical play almost anywhere, from pots and pans on the floor to helping caregivers clean. For school age kids, in addition to a healthy diet, sports teams and other extracurriculars are useful in keeping a balance between technology and activity.

Online Safety & Self-Image

Children using technology unsupervised should always be advised of the dangers of distributing their name, age, location, photos, and other personal details about themselves. Pediatricians can help offer advice to parents to have important conversations with their child about who to trust online, and in which situations they should seek an adult’s advice. For example, parents may wish to emphasize that online bullying is never acceptable (displayed or received).

Self-image and esteem is also a concern among kids and teens, especially when the influencers they follow online amass huge followings. According to a Pew Research Center study, 26% of teens say these sites make them feel worse about their lives. Much as with advertising and marketing, parents should have the tools to explain to children that even famous celebrities aren’t perfect, as much as the internet may display them to be.


For younger children, boundaries around bedtime are as important as supervising their online consumption. For adolescents, it may be more difficult to directly control their bedtime use. Honest communication about the need for good sleep and the consequences of losing it should be an ongoing conversation in families. A meta-analysis in by the JAMA Network cautions that device use around bedtime could lead to poorer sleep, daytime sleepiness, and fewer sleep hours total.

Device Dependence or “Addiction”

Researchers shy away from using the words “digital media addiction” or “video game addiction” to address overuse issues in children. Children overusing devices may have an underlying problem they are attempting to assuage with their device, and young children simply have fewer tools for self-discipline. While serious concern about a child’s overuse of a device may be referred to a behavioral health specialist, everyday boundaries can help teach kids these limits. Understanding what a child consumes and plays online is the first step, with the next being time limits, either by a parent’s prompting to put the device away or by the device’s built-in screen time settings, available on many devices such as the Kindle Kids tablet/ereader. There are also apps available for parents to limit their child’s use to a certain amount from their own devices.


How can you be sure that your child is using their school-issued tablet or computer to do homework? Unfortunately, you can’t -- not all the time. Pediatricians and parents can have honest talks with kids about using devices with intention -- like for completing a project or researching a topic -- and to fulfill responsibilities before using devices for entertainment. Children have developing self-discipline, so on-going management is usually for the better. While working towards a relationship of discipline and trust is ideal, parents can opt to use apps and settings to restrict where their child can go online with their school device, and for how long. Both PC and Mac laptops have parental settings available on the device.

Common Themes

Did you notice similarities in addressing the most common digital media use concerns? Here’s a refresher. The most common concerns for children using technology can be addressed with:

  • Consistent boundaries around the device, including around length of use, bedtime rules, and reneging of privileges
  • Parental settings and apps can help limit children’s use of certain devices
  • Clear and supportive communication around online safety, the necessity of good sleep and exercise, and the intentions of advertisements
  • Avoidance of using devices as a distraction
  • Guiding a child’s device use by example (e.g., not using a mobile phone while driving or at dinner)
  • Guiding a child’s intention for device use, encouraging productive work or play and discouraging device use to disguise emotional needs or fears

Young children have limited emotional control, and even teenagers have trouble understanding the full extent of consequences. Without the ability to see into the future and tell what effects screens have on children’s health, technology can cause a little anxiety. This anxiety is natural. AAP guidelines allow pediatricians to give parents a fuller picture of what responsible use should look like for a child. This responsible use and a balance of healthy habits will enable kids to grow, learn, and make responsible choices for the rest of their (probably device-filled) lives.

If you’re concerned about your own digital media use and how it affects your practice online, you’re not alone.

Digital media is all part of being a modern pediatrician. Do you know all the ways social media and video can bring trust and new patients to your practice? Check out our webinar with PCC’s Chip Hart and Dr. Todd Wolynn of Kids Plus Pediatrics in Pittsburgh, Pennsylvania to hear their thoughts on "How to Succeed as a 21st Century Pediatrician".

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Allie Squires

Allie Squires is PCC's Marketing Content Writer and editor of The Independent Pediatrician. She holds a master's in Professional Writing from NYU.