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How to provide evidence-based pediatric care for the digital age :

April 20, 2017

Is my son’s video gaming making him anxious? Is my daughter addicted to social media? Is it OK for my toddler to play with a tablet?

Increasingly, we are hearing these questions at well-child visits, questions for which our pediatric training did not prepare us.

The Academy has long been a leader in recognizing that the media children use and how they use them affect physical, mental and social health. But implementing anticipatory guidance and interventions on health problems arising from children’s media immersion as the standard of clinical care has not been easy. Given growing demands on ever-shorter patient visits, many pediatricians have struggled to integrate realities of the digital age into their practices.

Fortunately, evidence-based clinical tools and strategies are now available.

The majority of children’s schoolwork, entertainment, interpersonal communications and relationships are conducted on screens. Adolescents are averaging nearly nine hours of media use every day and multitasking one-third of the time, according to studies from the Kaiser Family Foundation and Common Sense Media. Ninety-two percent are online daily, and 24% say they are almost constantly connected, according to the Pew Research Center.

Our traditional advice to limit screen time and restrict content is no longer relevant and often is unheard by families. In 1974, when there was only one screen of concern, “America’s pediatrician” T. Berry Brazelton, M.D., FAAP, presciently advised, “I am certainly not suggesting that we eliminate television altogether… Active participation on the part of the parent, as well as the child, may begin to make television the valuable experience it should be.”

We must meet and treat children where they are, using scientific evidence to guide them to use media mindfully, in ways that promote their health, safety and productivity.

Historically, concern for the influence of media on children has been values-based, warning about “bad” or “too much” media consumption — and has been stymied by opposing concerns for freedom of expression and the interests of the entertainment industry.

The Center on Media and Child Health (CMCH) based at Boston Children’s Hospital (BCH) is a resource for clinicians who need to be aware of the ways media use can affect child and adolescent health and implement that awareness in clinical practice. CMCH’s mission is to build on research from around the world to educate and empower children and their caregivers to create and consume media in ways that optimize health and development.

CMCH and BCH are being referred increasing numbers of adolescents struggling with problematic interactive media use, colloquially called “internet addiction” and non-specifically termed “internet gaming disorder” by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Although there are not yet enough empirical data to support standardized diagnosis or treatment, BCH pediatricians, psychiatrists and psychologists treat these young people using clinical judgment and strategies established for related conditions. The resulting interventions and outcomes are evaluated and shared with fellow clinicians, building the evidence base necessary to develop formal diagnostic and treatment guidelines.

Respecting that families have different and deeply held values, CMCH reframes media exposure as a public health issue, providing descriptions rather than prescriptions. The center has aggregated science from around the world and more than a dozen disciplines to understand positive and negative media influences on the health and development of children and adolescents.

Building on this balanced, values-neutral evidence, pediatricians can offer goals toward which parents can aspire while adhering to their family’s values and choices, just as we advise parents and children on nutrition and injury prevention.

Dr. Rich is a member of the AAP Council on Communications and Media. He also is director of the Center on Media and Child Health.

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