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AAP Media Recommendation

On Monday Oct 17th, 2011 the American Academy of Pediatrics came out with their most recent policy statement featuring recommendations regarding media use and children under age 2.  Click here for a video from the statement release and click here for a copy of the actual Policy Statement published in Pediatrics on Oct 18, 2011.

Before I go too far, what is the American Academy of Pediatrics?  According to their website, the American Academy of Pediatrics is “an organization of 60,000 pediatricians committed to the attainment of optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults.”  The American Academy of Pediatrics (AAP for short) comes out with many recommendations related to child health and development in a variety of areas including: Sudden Infant Death SyndromeADHD, and of course Media (all links are to their press releases regarding their recommendations).

In 1999, the American Academy of Pediatrics came out with their first recommendation regarding children’s media use (focusing appropriately for that time, on television and videos).  For those who need a quick recap of what the world was like in 1999 when this statement came out here you go. Who Wants To Be a MillionaireFriends, and ER ranked in the top 3 most watched television shows (see Nielsen Ratings and The Classic TV Show Database). As for children’s television shows: Teletubbies first aired in 1997 and The  Baby Einstein Company was founded in 1996 by a stay-at-home mom and former school teacher.   In 1998, Nickelodeon first aired SpongBob SquarepantsBlues Clues first aired  in 1996, and Dora the Explorer became a regular series on NickJr in 2000.  (Just for as a reference point Sesame Street began in 1969).

This 1999 Media Education statement provided pediatricians with 9 recommendations including recommendations for what pediatricians should recommend for parents. Among the recommendations, pediatricians were urged to “become educated about public health risks of media exposure” and to “urge parents to avoid television viewing for children under the age of 2 years” (AAP 1999, page 342).  A dozen years later, the AAP has released a statement focusing on recommendations specifically for children under age 2.

The release of this statement has caught the attention of quite a few large media outlets, many academics, and a considerable number of parents.  In reaction to the press and parent comments I have seen, I want to address a few key points from this new Policy Statement.

First, I want to comment on what these policy statements are.  The AAP makes these recommendations primarily for pediatricians (and of course parents too).  These statements attempt to recap all of the scientific studies related to the topic.  Note, these statements are NOT the findings from one study conducted by the AAP, these statements are compiled based on a search of related research conducted by a range of researchers.  I keep seeing parents comment about the “AAP’s study”, this document is NOT a study, it’s a policy statement based on some research.

Second, while many research studies are included in this document, many of the studies referenced are correlational, not experimentally controlled studies which would be necessary to determine causation (See previous post Science: Cause and Correlation).  When research finds a positive correlation between two things that means they just change in the same way. For example, height and weight are often correlated: the taller you the more you weigh and often times the more you weigh the taller you are. Does that mean that if I am currently 5’3” and want to 5’8″ that I should start gaining weight?  Nope- that would only work if there was a CAUSAL direction between weight and height.  Get it?  This is an IMPORTANT distinction to understand when reading the research that was used to back up this AAP recommendation.  There may be fundamental differences between children who watch a lot of television compared to children who don’t and those differences may actually be the forces that are driving the findings like language delays, etc.  Importantly, one study that the AAP statement references by Linebarger and Walker (2005) explicitly states that lower language scores were RELATED to viewing certain programs at young ages, meaning that it could be that kids who had lower language scores were more attracted to or interested in these types of programs.

Third, the world infants and toddlers live in today is very different from the pre-DVR, pre-Ipad, and pre-iphone days infants and toddlers were born into 12 years ago (when the 1999 statement was released).  It’s shocking that the AAP failed to recognize or discuss the media of today when the number of infants and toddlers using newer media technology like iPads continues to grow.  Recent research by PlayScience reports almost 80% of children age 2-5 have access to smartphones and 19% to tablet computers.  The entire policy statement focuses on the same media from 1999: television and videos and fails to discuss the realities of the media children are using today which are increasingly interactive and increasingly present in their daily lives.

Finally, the news needs to be careful with how they report this and the potential fear factor they are causing in parents.  Media is a part of almost all Americans lives.  Televisions and screens are everywhere from restaurants to gas stations, from taxis to new cars, and in classrooms and homes.  We live in a screen-filled world. Absolutely, parents should be careful of EVERYTHING their children are exposed to including but not limited to: media, music, unhealthy foods, unsafe playgrounds, germs and diseases… the list goes on.  Media is a part of that and parents should be concerned to some extent and they should be aware of the research that has been conducted, but unfortunately, this policy statement and the media’s reaction and reporting of it are failing to give parents complete, accurate information that allows them to make the best decisions for their children.

Example of a toddler's art created on an iPad

My last comment is probably the most important.  Clearly, parent interaction and real-world experiences are key to healthy child development. No one is advocating that children should only learn from screens or interactive digital devices.  But most of research that has been done today has been conducted on a small group of children and with very little regard to the context in which children are watching/using screens.  We don’t know much about infants use of newer interactive media like tablets or touchscreens.  We do not know the influence of media for all types of children.  I could imagine that for a single mom working two jobs the benefit of having her child sit in front of Sesame Street or play an educational ipad game for 20 minutes while she calms down after an emotionally exhausting day at work could have benefits well beyond the potential consequences discussed in this AAP policy statement.  I could also imagine that technology could be used to enhance learning by providing pictorial examples of things children don’t have access to (like images or videos of Lions in the wild), etc.

At the end of the day parents need to make smart decisions for their families based on the information that is available to them.  Knowing the potential consequence of media exposure is important but so is being able to understand where it can be potentially beneficial even for very young children.

References:

American Academy of Pediatrics (1999).  Committee on Public Education. Media Education.  Pediatrics, 104, 341-343.  http://aappolicy.aappublications.org/cgi/reprint/pediatrics;104/2/341.pdf

American Academy of Pediatrics (2011).  Policy Statement: Media use by Children younger than 2 years.  Council on Communications and Media.  Pediatrics, 128, 1-6.  As of October 19, 2011 available for free form this link: http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-1753.full.pdf+html

Linebarger D.L, Walker D. (2005).  Infants’ and toddlers’ television viewing and language outcomes. American Behavioral Scientist, 48(5):624 – 64. http://abs.sagepub.com/content/48/5/624.abstract

New York Times Comments by Parents regarding the AAP’s new recommendation http://community.nytimes.com/comments/www.nytimes.com/2011/10/19/health/19babies.html?sort=oldest&offset=2

PlayScience http://playsciencelab.com/LabReport/MobilePlaygrounds_LabReport.pdf

Related Resources/Blogposts

Children’s Technology Review Hey Doc, What About My Child’s iPad?

Moms With Apps Updated Policy Statement from the American Academy of Pediatrics

The Washington Post The AAP reaffirms no screen time for young children even though few parents listen

New York Time Parents Urged Again to Limit TV for Youngest

New York Times Comments to Parents Urged Again to Limit TV for Youngest

Boston Globe Trying to Gauge the Impact of Growing Up Digital

Huffington Post David Kleeman Children and Media: Pediatricians’ Monolithic Myth 

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Intro to Childcare

Guest Blog Post

by Beth Meloy

Often, as a Child Care Researcher, I get questions from friends, family members, and sometimes even total strangers about the benefits of childcare for their children and how to pick a childcare arrangement.  The truth is, as with most parenting decisions, there isn’t one correct answer.  Luckily there is plenty of research on the topic, and we do know a couple of things that can help guide parents as they make this important decision.

What are the benefits of childcare for your child?  The answer to this question largely depends on the alternatives. We know that child care, especially preschool/ pre-Kindergarten programs boost cognitive test scores, increase school readiness, and can even impact long-term outcomes (visit these sites for findings from a few high profile studies: The Carolina Abecedarian Project, High Scope Perry Preschool Study, Gormley, Phillips, Gayer, 2008. However, most of this research is derived from samples of low-income children, and when studies compare children by family income, they find that more disadvantaged children derive greater benefits from childcare and pre-K.

When you are making a decision for your own child, it is important to consider the alternatives.  Childcare can be beneficial for children if it places them in a more stimulating, sensitive, and/or secure environment.  That said, if your child is very young (under 3) and the alternative is staying home with you—the sensitive and instructive primary caregiver- then there is no rush to put your child into childcare.

The most important factor is the quality of the experience for your child (See Burchinal, 1999).  For young children, the highest quality experience may be staying at home with a parent.  For older children, it may be a preschool program.  And for parents who work, cannot stay home, or want their child to enter childcare, the goal should be to find the highest quality arrangement, and the best fit for their child.

Not sure how to find a “high quality” child care arrangement or preschool program?  Here are some helpful guidelines and tips:

(1)  Research. Currently, twenty-three states have implemented Childcare Rating and Improvement Systems (QRIS).  Like the rating systems for hotels or restaurants, QRIS assesses childcare settings based on program standards. A full list of states that have these systems and their websites is available here.   For example, if you live in Illinois and are considering childcare for your child you can go here and click on Licensed Child Care Centers & School-Age Programs and it will give you a 10 page pdf document listing all of the centers by county.

In addition, several states have public pre-K programs.  Find out if your state has one, and how they measure-up by visiting the National Institute for Early Education Research.  If your state isn’t on either of these sites, a simple google search, asking other parents, and looking at local parenting websites for advice is always a good place to start!  Another great resources is Child Care Aware which provides information about locating high-quality child care, parent information, helpful tools, resources, and newsletters.

When you find a center that you are interested in, you should also ask to tour the facilities and meet the prospective caregivers.  Again, trust your gut, if something feels off when the facility ought to be putting its best foot forward (to get your business), you could be picking up on something important that you don’t want to expose your child to.

(2) Child’s Age. Your child’s age may be particularly important when making the decision of where to place your child.  For young children, informal arrangements, such as those with relative caregivers, nanny care, or home-based childcare may be best.  Lower adult to child ratios are associated with higher quality care for infants and toddlers (NICHD ECCRN, 2007).  As your child gets older, it becomes more important to help them get used to school-like settings.  Childcare centers, and especially high quality preschool programs may be a good way to do this.   Think about it this way—you wouldn’t throw your child in the deep end of a pool without first teaching them to swim.  Kindergarten is a scary place with lots of rules and expectations.  High quality center care and/or preschool programs, like swimming lessons, will help teach your child the skills they need to succeed in school  (See Pre-K Now).

(3) Center Care vs Home-Based Care. Both center-based and home-based child care offer benefits and disadvantages. Home-based care may be more flexible with your work hours and are more likely to mix age groups (more sibling interaction).  However, center-based childcare is usually higher quality than family day care.  Childcare centers also tend to be more educationally focused… they are geared more towards learning and preparing children for school, so they are particularly beneficial for older children when compared to home-based day care options (Loeb, Fuller, Lynn, & Carrol, 2004). That said, parents can usually trust their gut on these things, not all childcare centers are better than all family care centers, and most importantly, not all child care centers are high quality (Love et al., 2003, Fuller. Kagen, Loeb, & Chang, 2004).

(4) Stability.  Find a childcare arrangement that works for you and stick with it.  From the childcare research we know that stability matters!  Stability in childcare can be defined in terms of stability of the childcare center (the physical building) and stability of the caregiver.  Ideally, the arrangement you choose for your child will be stable for both. Each arrangement has different expectations (rules and routines) and entering a new arrangement involves navigating new relationships (with the caregiver and with peers).  Switching up the game too often will be stressful for your child.  When you are choosing a childcare program, it is important to find a good fit, so that you are less likely to move your child mid-year.  Consider the center’s policies.  If your child will age out of the center after a few months, or even a year, you may want to look for a different arrangement. Read all about childcare stability and its potential impacts on your child’s development by going here.

So, what is the take home message?  Choosing childcare is all about considering the alternatives, finding a high-quality program—and one that is a good fit for you—and sticking with it.  There are tools out there to help guide your decision, but in the end it’s all about knowing yourself, knowing your child, and going with your gut.

About the Author:

Beth Meloy is a fifth-year student in the Dual MPP/PhD program working with Deborah Phillips at Georgetown University. Her research interests include the effects of early education (child care) programs on subsequent cognitive development (particularly for minority and low-income children), as well as the effect
of involvement with the child welfare system on child development. Her current research focuses on the effects of type, stability, and quality of childcare on young children with special needs and young children in foster care. She received her BA in Psychology from the University of North Carolina at Chapel Hill in 2005 and her MPP from the Georgetown Public Policy Institute in 2008. Email Beth at mec87@georgetown.edu

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Filed under Infants, News and Other Resources, Preschoolers, Toddlers