Fortnite, TikTok, Red Dead Redemption, Snapchat, and Youtube — these are just a handful of the games and apps parents are concerned their kids are spending too much of their time using. But does regular or even constant media use denote an addictive disorder? Counseling kids, teens, and families on appropriate media use is fraught with ideas of screen time, “sharenting,” and the appropriate time to get a cell phone. While the role of media in kids’ lives is constantly changing and most rules on media use are set individually by parents, pediatricians can have helpful roles in facilitating meaningful media use for the next generation. Here are some tips to clear the confusion and help you counsel families into healthy lives online and off.
Addiction or Abuse?
While the World Health Organization added “gaming disorder” to the International Classification of Diseases (ICD-11) in 2018, pediatrician and media enthusiast Dr. Michael Rich, MD, MPH says that “video game addiction” is a bit of a misnomer. Dr. Rich responds to questions from parents regarding media on his website, “Ask the Mediatrician” as part of his work in the Center on Media and Child Health at Boston Children’s Hospital.
In a response to one concerned mom, Dr. Rich explained why classifying gaming disorder as an addiction is inaccurate and even dangerous: “Parents of children and teens who are, like your son, struggling with problems controlling the amount of time they spend with media, do not see their children the same way as they would see an addict, and subsequently delay getting their child to care.”
According to the Clinic for Interactive Media and Internet Disorders (CIMAID) at Boston Children’s, video game “addiction” is instead more akin to binge eating disorder, which is why their preferred term is Problematic Interactive Media Use (PIMU).
Using this intentional language with patients helps pediatricians and families create a compassionate path to caring for a teen or child who can’t put the phone, controller, tablet, or computer away. It also helps parents to seek help early, when media use is “problematic,” and not taken to extremes.
Out of Screen Time
Past recommendations have ranged from 1-3 hours of screen time a day for young children and none for babies. While the latter recommendation remains, as the internet races into classrooms, parents, teachers, and pediatricians have come to realize that the concept of “screen time” is no longer practical. The length, content, and relationship of a child to digital media will largely rely on the discretion of the child’s parents, which is why the AAP recommends families use the Family Media Plan tool to set clear expectations in the household.
With apps like Youtube Kids a hit with toddlers and older children given the use of laptops and tablets in the classroom, it’s easy to see the problem of “screen time” isn’t going to cut it anymore. Screens and media use are a part of our daily lives. While digital screen time regulation is available for some devices including Apple and Amazon products, the duration of a child’s use is best determined by caregivers in coordination with pediatricians.
Fortunately, media is also a force for good. In a recent meta analysis by JAMA Pediatrics, children and teens who spent more time playing video games and watching TV were more likely to perform poorly in school, and the effects seemed more negative for adolescents.
Keeping a Healthy Media Diet
Without screen time guidelines, what should you recommend parents do to encourage healthy media habits? The good news is that regulating a media diet is deceptively simple: families should encourage self-control and intention when using media devices, and set expectations depending on their child’s age and development.
For Toddlers and Younger Children (age 2-5)
Since toddlers and younger children are more likely to use their parents’ devices, parents should be co-watching or co-playing educational videos and games before or while their child is using them. Just because apps like Youtube Kids are labelled as “kid-friendly” and safe, inappropriate content can still appear. The AAP recommends up to an hour of high quality media use a day for young children.
For Older Kids (age 5-11)
There’s no consensus on when a child should receive their first cell phone or other technology, but they should be made aware early and often that these devices are tools, and are not to be used as distractions from responsibilities or problems.
Safe internet browsing and online communication is essential, but there should also be discussions about how to react to inappropriate content. It’s an unfortunate truth, but kids are likely to be exposed to it via their own browsing or a friend’s, whether they intend to see it or not.
The AAP recommends for children older than 5 that parents should “place consistent limits on 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”
For Adolescents (age 12+)
Teenagers should hopefully take on the responsibility of safe and reasonable media use mostly on their own. Parents should set clear rules on a technology curfew, however, to ensure their teens are getting enough quality sleep, exercise, and other healthy activities.
For Everyone (Parents too)
Modeling appropriate device behavior is important to teach children to use them wisely. Families will have their own preferences, but some healthy tips include:
- Using HealthyChildren.org’s Family Media Plan Tool to set family expectations for where, when, and for how long media is used, and what it’s used for
- Abstaining from use while driving
- Charging phones and tablets out of the bedroom, or at least across the room so that they are not used in bed
- Parents may also choose to enact a bedtime routine that requires devices are off for a certain period before sleep
- Putting devices down or away while having conversations or meals
- Posting photos and personal information with care and consent
- Using, playing, and watching media together — engaging with a tween over Fortnite will help parents understand the game their child enjoys and offer quality time together
- Discussion of how advertising works and what companies can do with a child’s email address or with location tracking
- Digital Sabbath — a day off from devices may be heresy for some kids and frankly, anarchy for some parents, but can be an important tool to spend time together and to recognize the role that media plays in our lives
While technology is likely a permanent part of our daily lives, its use does not have to be compulsive, constant, or overwhelming. When talking with kids and parents about their media use, ask them to answer thoughtful questions about why they are using their devices and how using their devices makes them feel.
Important conversations around tech could include questions such as:
“Does texting my friends make me happy, and how can I let Mom know that it’s important?”
“Does watching Youtube past curfew make me happy or make me tired and do worse in school/sports/activities the next day?”
“How do I feel about Grandpa posting baby photos of me on Facebook?”
“Am I using my tablet when I’m angry, sad, lonely, or afraid? Why?”
“What can I teach Dad about my favorite video game or Youtuber? Can we play/watch together?”
“If my phone is in my room at night, can I be responsible for not using it while it charges?”
“Where does advertising come from and why?”
Engaging in conversation with children, especially as they grow older and come to have an almost innate sense for how technology changes and how they can influence it, allows parents and pediatricians to set reasonable expectations. When these expectations are met, families can come to have meaningful, mindful relationships around technology, and use them less to distract toddlers or escape from homework, but to communicate and engage with the things kids care about.
At the end of the day, teens and kids are likely to have periods of heavy use and periods of light media use. Adjusting to new rules can be a tough time for any family. If parents express fear that that less use of tech will lead to boredom, remind them that could be a good thing -- families can use temporary boredom to foster new skills, spend quality time together, and let creativity grow.
Technology is useful for pediatricians too -- are you using it to your practice's best advantage? Learn how to approach managing your practice as a modern physician with "How to Succeed as a 21st Century Pediatrician," hosted by PCC's Chip Hart and pediatrician Dr. Todd Wolynn of Kids Plus Pediatrics in Pennsylvania.