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September 18, 2000
Pediatricians Give Media Exams
Has television become a health issue?
By Rebecca Chastenet de Géry

Illustration: Media Exams

On a typical Saturday morning this summer, my 6-year-old nephew Jean-Baptiste was watching cartoons. I sat with him as Wile E. Coyote, in the middle of a two-dimensional desert highway, was flattened by a passing truck. Of course, he got up, popped himself back into shape, and continued his timeless pursuit of the Roadrunner. We both laughed. Even at 6, Jean-Baptiste understands the difference between cartoons and real life. Still, when he's old enough to read a magazine, will Jean-Baptiste understand that smoking cigarettes will turn his lungs black? After he plays a shoot-'em-up computer game, will he understand the consequences of gun violence?

Media messages are everywhere -- we see and hear them when we turn on the TV, when we click on the computer, when we listen to music or read the paper, even when we walk down the street. As reasonable adults, we're supposed to understand how to decipher them and apply them to our personal lives in an appropriate way. Adults, we assume, can distinguish between fact and fiction in the media, but children and adolescents may find this difficult. Because their reasoning skills aren't fully developed, youths can be particularly susceptible to harm from the messages the media delivers.

The American Academy of Pediatrics (AAP) has believed this for more than a decade. In 1997 the AAP launched "Media Matters," a public education campaign to encourage awareness of the influence that television, the Internet, advertising, and popular music and games have on children's health. Now, in addition to providing guidelines surrounding media use and perception for parents, this organization of 55,000 pediatricians and related specialists is recommending that doctors play a role in their patients' "media health" as well as their physical health.

In a policy statement released in August 1999, the AAP's Committee on Public Education recommended that pediatricians support media education by discussing the health risks of media exposure with parents and children during office visits. They are encouraging pediatricians to carry the message beyond their office walls by distributing relevant public-education materials and speaking publicly about the dangers of childhood media exposure.

"The impact of television and television advertising in particular is so pervasive," says Stacey Ludlow, M.D., a general pediatrician and mother of two preschool-age boys in Tulsa, Oklahoma. "I think that the AAP's recommendation is a good one. In my office we've made questions about television exposure a part of regular well-child exams for the past two years. We haven't incorporated questions about exposure to other forms of media yet, but I think it's a good idea," she says.

While the AAP recognizes the positive role media can play in children's lives, it also notes that the media can have harmful effects, including the following:

  • Promoting aggressive behavior and desensitizing children to violence
  • Normalizing and/or glamorizing the use of alcohol and drugs
  • Influencing sexual behavior and/or encouraging sexual exploitation
  • Contributing to obesity
  • Contributing to decreased school achievement

"When preschool-age kids start watching too much television or spend hours playing video or computer games instead of playing with blocks or puzzles, they miss out on the development of a lot of spatial relationships they need to build on in years to come," explains Ludlow. "As for teens, the negative impact the media can have on them has been well documented again and again," she adds.

According to the AAP, research conducted over the last decade has shown that media education can help reduce the negative aspects of media exposure and promote critical thinking. The AAP defines a media-educated person as one who understands that all media messages are constructed, that media messages shape our perception of the world, that media messages have powerful economic implications, and that media messages are interpreted differently by different individuals.

Since children and adolescents receive a majority of media messages while at home, the AAP has created guidelines to help parents educate their children about the effects of the media. They strongly discourage television viewing for children under the age of 2, saying that research on early brain development shows that babies and toddlers need direct interactions with parents and other caregivers in order to develop appropriate social, emotional, and cognitive skills. For children aged 2 and up, the AAP suggests that parents:

  • Carefully select programs for their children
  • View media with their children and adolescents and discuss its content
  • Teach critical viewing skills
  • Limit and focus the time spent using media
  • Be good "media role models" by selectively using media
  • Emphasize alternative activities
  • Create an electronic-media-free environment in children's rooms
  • Avoid using media as an "electronic baby sitter"

In order to help pediatricians determine their patients' media health, the AAP has published guidelines regarding media education in the practice setting. The AAP is also developing a "media history form" that would travel with a child's medical chart.

It's going to take a joint effort to help our kids limit their media use and understand the political, social, economic, and emotional implications of the images and sounds they are bombarded with every day. If the APP has its way, the Nielsen ratings may be just as important to your pediatrician as your child's vaccination record.