Dissecting the AAP’s new guidelines for child media use: Advice from The Mediatrician


Children are exposed to screens earlier in life and for longer periods than ever before. Mobile technology has pervaded our society to the point where doctors and parents alike are asking: what effect is this having on young minds? On brain development? On socialization?

How much “screen time” is too much? How young is too young? And, of course, the follow-up question of our time: are all apps created equal?

Michael Rich, MD, director of the Center on Media and Child Health at Boston Children’s Hospital, has a crystal-clear message. “This is a critical part of parenting in the 21st century,” he says. “It is no longer a fringe issue. The first thing we have to do with pediatricians, he says, is get them to talk about it.

Rich, also known as “The Mediatrician,” conducted research that helped inform the American Academy of Pediatrics’ latest recommendations for children’s media use.

The recommendations emphasize that different ages and circumstances need different approaches. For example, older children may need to use computers and/ or the internet to complete homework assignments. This kind of screen time shouldn’t be conflated with watching TV or YouTube videos.

“What’s tough with guidelines is the press will only take certain things from it,” says Rich. “What they took this time was: “no more screen time limits. But it’s more nuanced than that – we’re recommending less entertainment screen time: one hour per day!”

The best tool for the ‘job’

Rich suggests a helpful framework for approaching entertainment media: think about devices as tools that serve specific functions. Then, “Ask yourself: is this app doing anything a book can’t do? Is it really an improvement? You can use an i-pad to drive a nail, but a hammer works better.”

“We have to be mindful and purposeful in our use of these devices,” he says. “We need to encourage our children to practice critical thinking. What we should be aiming for is a rich and diverse menu of experience for our kids; this can include technology, but it should also include a variety of other activities.”

“We need to treat media like we treat food,” he advises, “by seeking out what is nutritious and staying away from what is junk.”

Dr. Michael Rich, aka "The Mediatrician"
Dr. Michael Rich, aka “The Mediatrician”

Are there any ‘good’ apps or educational software out there?

Rich doesn’t endorse any specific products or apps, but concedes that some may be better than others. Anything that promotes human interaction — for example, an app that asks a parent to read a story, then ask a question to assess comprehension — is better than a video. Still, Rich recommends using a smart phone, tablet or computer only when a lower-tech option will not suffice.

“Media are so wall-to-wall in our kids’ lives these days,” says Rich. “When you’re constantly bombarded, you begin to lose agency. You’re reacting to stimulus from the outside, not acting from within, and it’s a reflexive reaction.”

What matters most, says Rich, are content and context.

“What are you watching and who are you watching it with? If you watch a show with your kid, content that may have fueled immature remarks among peers can instead lead to teachable moments.”

Can you really be addicted to the internet?

Video games, mobile apps, social media — they’re all are designed to get you hooked and keep you hooked.

Yet Rich recoils at the word “addiction.”

“The problem with that word is,” he says, “it connotes a physiological component, and there is none in this case. It’s also quite stigmatizing, and that isn’t helpful either.”

We need to treat media like we treat food,” Rich advises, “by seeking out what is nutritious and staying away from what is junk.”

Rich says he is seeing more and more children and adolescents come to his clinic with severe difficulties pulling away from technology and social media.

In the same way that America’s poorest families struggle more with obesity– a problem of excess –than their wealthy neighbors, the lower socio-economic classes are also more likely to spend too much time with electronic media.

“Yes: iPads are expensive,” says Rich. “But they’re not as expensive as things like hockey practice, dance class, or trombone lessons, which are the types of things more affluent kids are doing after school.”

“Also, it’s common for kids to choose media as a diversion if they spend most after-school hours home alone. This is a true health risk disparity and should be addressed as such.”

Lead by example

“Kids hear 1% of what we say and 100% of what we do,” says Rich. He points to research conducted by Jenny Radesky, MD, on parental use of media and its influence on children.

Did you know that 73 percent of parents use mobile devices at dinner? And that when parents are on their phones, the interactions they have with children are more likely to be harsh and punitive?

“Another study focused on playgrounds,” says Rich. “30 percent of parents present were distracted by using a mobile device. During that distracted time, kids were three times more likely to take dangerous risks.”

“I have a slightly extreme proposal for parents who really want to cut down on their family’s media use,” says Rich. “Take a digital Sabbath.”

The whole idea of a Sabbath, he explains, is to put aside daily worries and focus on yourself and the ones you love.

We do it already when we go hiking, or when we go on vacation; but we’re not doing it mindfully, he says. “A lot of the leaders in the tech world actually put strict limits on their children’s use of technology.”

Has he heard of the trend where when you’re out to dinner with a group, everyone puts their phones in the middle of the table, and the first one to reach for theirs pays the bill?

“Phone stacking?,” asks Rich. “I highly recommend it.”

Visit the Center for Media and Child Health to learn more.