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5 C’s framework provides new approach for discussing media use with families

April 30, 2024

Pediatric providers need quick, simple ways to discuss digital media with families during busy office visits. Many use the “two-hour rule” as their main bit of advice, but that recommendation no longer reflects the nuance in new research about kids and media.

The AAP Center of Excellence on Social Media and Youth Mental Health has developed an updated approach to help parents navigate digital media that focuses on “the 5 C’s”: Child, Content, Calm, Crowding out and Communication. The 5 C’s include ties to family relational health, social-emotional development and mental health. The approach is based on recent research and the 3 C’s advice about kids and screens developed years ago by journalist and author Lisa Guernsey.

The center has developed handouts that explain what happens during each developmental stage from infancy through the older teen years, provide questions parents can ask regarding each of the 5 C’s and suggest healthy media habits to strive for at each stage.

Pediatricians are not being asked to recite all 5 C’s at each visit. Instead, the goal is to give media guidance in a smarter way that connects to the conversations they already are having with families.

Following are examples of how pediatricians can use the 5 C’s.  

Child: When talking about a toddler’s tantrums, a child’s attention-deficit/hyperactivity disorder or a teen’s anxiety, discuss how media impact the unique ways the child experiences the world. Do they seek out age-inappropriate thrills on YouTube, or do media help support an artistic or musical gift they have? Is social media drama feeding social anxiety, or does the teen have a supportive friend group online?

Content: Research shows that the quality of content shapes whether kids have positive or negative relationships with media. Ask parents and kids what games they play and videos they watch. Help them think about media with too much violence, rude role-modeling, unrealistic beauty standards or commercialism. Although content may trend on social media, it may not have a positive influence on kids’ emotions and behavior. Common Sense Media ( is a resource for age-appropriate videos and games.

Calm: When talking about how kids manage strong emotions or fall asleep at night, ask about media. If it seems that media use is their only coping strategy, offer other ways to calm down brains and bodies such as snuggling, listening to soft music, taking a walk or deep breathing.

Crowding out: Instead of asking how many hours a day kids use media, ask whether time spent on media crowds out other activities. Families may be motivated to reduce media use if they think about what else they could be doing such as spending quality time together, playing outdoors or sleeping more. Help families recognize that digital media have a lot of “hooks” that keep us online longer than we planned, so it helps to be intentional about when and where media are used every day.

Communication: When families talk about media, kids build digital literacy skills, and caregivers can identify when their child or teen is struggling. However, families find this topic stressful. Therefore, encourage them to take a deep breath, try to be open-minded and ask questions. This helps reduce guilt and encourages problem-solving.

The 5 C’s are designed to meet kids and parents where they are, build insight and communication skills, and motivate healthy behavior change. Pediatric providers are encouraged to give the handouts to families at well-child visits. They also can consider putting links to the Center of Excellence website, the AAP Family Media Plan and the Common Sense Media website in the after-visit summary.

 Dr. Radesky is co-chair of the AAP Center of Excellence on Social Media and Youth Mental Health and chair of the AAP Council on Communications and Media.



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