Patient Presentation
An 18-month-old male came to clinic with a fever for 2 days to 101° F. He had a runny nose, mild cough and had been pulling his left ear and complaining of pain. He attended an in-home child care placement where two other children had similar symptoms. The pertinent physical exam showed a mildly ill child with normal vital signs and growth problems. HEENT examination demonstrated copious clear rhinorrhea, normal pharynx and a left tympanic membrane that was red, bulging, with no light reflex and no mobility with insufflation. His right ear was grey with a splayed light reflex and normal insufflation.
The diagnosis of acute otitis media was made and antibiotics were prescribed. During the visit, the child had been offered his mother’s smartphone to play games with. She commented that “he always needs to play with my phone” and that “I often can’t even make a call because he’s playing with it.” The physician took this opportunity to try to educate the mother about electronic media use, but she remained skeptical. The child began tantruming as they were leaving the office, because the mother took the phone from him to answer a call.
Discussion
“This instrument can teach, it can illuminate; yes, and it can even inspire. But it can do so only to the extent that humans are determined to use it to those ends. Otherwise it is merely wires and lights in a box.”
– Edward R. Murrow, Television Pioneer, 1958 Television and electronic media viewing are almost ubiquitous in the current United States culture. About 90% of parents say their < 2 year old children watch some form of electronic media with an average of 1-2 hours/day of television and 14% of 6-23 months old watch 2 or more hours/day. Children under age 6 years watch about 2 hours of electronic media a day and children 8-18 years watch about 6 hours/day. Parents are often not aware of the amount of time a child may be exposed to electronic media. A 2009 study of in-home and center based child care found that in-home child care had more electronic media viewing (~3 hours/day) than center-based care (~1 hour/day) for preschool children. While televisions and in-car DVD players are specific for particular places, parents often are not aware of the other electronic media exposure dismissing the amount of time children may spend with Apple® iPads and smartphones. These can be significant particularly with the use of wireless Internet connectivity.
Negative effects shown in studies of television and electronic media have included poor attention, language development, social skills, memory, reading comprehension, obesity, sleep problems and aggression/violence.
In the late fall of 2011, the American Academy of Pediatrics (AAP) reasserted its recommendations discouraging media use for all children under 2 years of age. The AAP also recommended that children play with their parents in unstructured, unplugged environments and that families should read with their children to “foster their child’s cognitive and language development.” If parents do use electronic media, the AAP recommends parents review the content before the child sees it, watching the media with the child and being aware of what adult content is often inadvertently being viewed by having media on in a room where a child is playing. Additionally, the AAP recommends no televisions in a child’s bedroom. The AAP also recommends limiting 1-2 hours/day of quality electronic media for older children.
Parental perceptions of media restriction shows at least 3 main problems. First is limiting electronic media will cause family conflict. Second, electronic media offers free babysitting, entertainment and potentially educational opportunities. And third, replacement of electronic media takes time “…away from parents and requires monetary and community resources that are not available.”
Learning Point
There is data that supports that educational media has beneficial effects or at least is similar to non-media activities in not having negative effects. Most of this data is for older children though.
A 2011 study of 4 year olds found that a fast-paced television cartoon had detrimental effects on short term executive functioning, when compared to educational television and drawing activities. Educational television and electronic media is positively linked with academic achievement and in cognitive skills such as visual spatial skills and problem-solving skills. Other data supports improved school readiness, language and social skills. But how knowledge from electronic media is transferred to other venues is not fully understood. Data like the study above also does not show an advantage of electronic media over other instructional forms.
Development probably plays a large role in how the electronic media consumption influences a particular child. One study found that “…the association between early television viewing and subsequent attentional problems is specific to noneducational viewing and to viewing before age 3.” Media use in older children and teens has also been found to be beneficial. A study found that the television show “Mythbusters” (an educational television program depicting scientists attempting to scientifically prove or disprove a particular myth) accurately depicts science and engineering culture and therefore can show students what having a career in science, technology, engineering and mathematics may hold for them.
As with many things in life, everything in moderation. Just like too much or too little water causes flooding or drought, or too much or too little sun can cause skin cancer or Vitamin D deficiency, electronic media use should be moderated, and monitored by parents to help their children.
Questions for Further Discussion
1. What positive or negative effects have you seen in your practice regarding electronic media use?
2. How receptive are parents to counseling regarding electronic media use in your practice?
Related Cases
- Disease: Television | Electronic Media | Parenting
- Symptom/Presentation: Ear Pain | Fever and Fever of Unknown Origin | Rhinitis
- Age: Toddler
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Parenting
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Radio Television Digital News Association. Edward R. Murrow Speech. Available from the Internet at http://www.rtdna.org/pages/media_items/edward-r.-murrow-speech998.php (rev.1958, cited 2/21/12).
Zimmerman FJ, Christakis DA. Associations between content types of early media exposure and subsequent attentional problems. Pediatrics. 2007 Nov;120(5):986-92.
Schmidt ME, Vandewater EA. Media and attention, cognition and school achievement. Future Child. 2008:18;63-85.
Christakis DA, Garrison MM. Preschool-aged children’s television viewing in child care settings. Pediatrics. 2009 Dec;124(6):1627-32.
Stout H. Toddlers Favorite Toy: The iPhone. New York Times. Available from the Internet at http://www.nytimes.com/2010/10/17/fashion/17TODDLERS.html?pagewanted=all (rev. 10/15/10, cited 2/21/12).
Council on Communications and Media, Brown A. Media use by children younger than 2 years. Pediatrics. 2011 Nov;128(5):1040-5.
Zavrel EA. How the Discovery Channel Television Show “Mythbusters” Accurately Depicts Science and Engineering Culture. J Sci Ed Tech. 2011:20:201-207.
Evans CA, Jordan AB, Horner J. Only Two Hours? A Qualitative Study of the Challenges Parents Perceive in Restricting Child Television Time. J Fam Issues. 2011:32:1223-1244.
Lillard AS, Peterson J. The immediate impact of different types of television on young children’s executive function. Pediatrics. 2011 Oct;128(4):644-9.
How TV Affects Your Child. KidsHealth. Available from the Internet at http://kidshealth.org/parent/positive/family/tv_affects_child.html (rev. 2012, cited 2/21/12).
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
5. Patients and their families are counseled and educated.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
17. A therapeutic and ethically sound relationship with patients is created and sustained.
18. Using effective nonverbal, explanatory, questioning, and writing skills, the healthcare professional uses effective listening skills and elicits and provides information.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 