The Screen Time Flip-Flop

November 10, 2015

When I moved from Chapel Hill to coastal Wilmington, NC, I couldn’t help noticing people’s feet. Where in Chapel Hill shoes ran the gamut from open-toed Birkenstocks to closed-toe Birkenstocks, the official footwear of Wilmington was the sandal. There were the cheap plastic kind tourists grabbed at Walgreens, the Brazilian kind that looked just like those but cost 10 times as much, and, for weddings and business presentations, leather Rainbows, although some iconoclasts chose Reefs with their sole-mounted it’s-5:00-somewhere bottle-openers. Winter saw the emergence of shearling-lined flip-flops, a shoe that dared the uninitiated to ask, “Why?”

People are now calling my attention to a different kind of “flip-flop,” the American Academy of Pediatrics’s (AAP’s) reconsideration of our media use guidelines, a process we kicked off this September with a commentary that I co-authored for AAP News. Reaction came swiftly and was all over the map, from a Forbes article asserting that we had finally learned to stop worrying and love the media to a well-balanced piece in the Wall Street Journal to a critical blog post in PLOS accusing us of turning our backs on decades of solid science.

As the chair of the AAP’s Council on Communications and Media, I was not surprised at the range of reactions to our statement, but I do think that it’s important to explain what we are and are not doing. First, the commentary — “Beyond Turn It Off: How to Advise Families on Media Use” — this article was no more and no less than the summary of what we learned at an AAP-sponsored academic meeting, the Growing Up Digital Media Research Symposium held in May of this year. We invited pediatricians, psychologists, educators, activists, and industry executives to meet with AAP leadership and discuss what we do and do not know about the health effects of media on infants, children, and adolescents. Our report from that meeting does provide a perspective on our current thinking, but it does not supplant any official AAP policy or guidelines.

Technology is Here to Stay

We convened the symposium out of an acute awareness that mobile and interactive technology is both novel and ubiquitous in our children’s lives. The evidence base that informs our policy rests overwhelmingly on studies of television and movies; most of our data were generated when video calls were confined to The Jetsons (a show that also foretold the ascendance of the treadmill desk). We know that these technologies are here to stay and that our advice to parents has to acknowledge their presence. So what should that advice be?

The answer, pitched as revolutionary by many, was in truth evolutionary. Media platforms may be changing rapidly, but human nature is not. For example, kids still get together to study, to hang out with friends, and to do good for society; social media catalyze these activities in unprecedented ways. These same platforms, however, also mediate bullying, sexting, and self-harm behaviors. We are handing our children a powerful set of tools; parenting involves helping kids learn to use them responsibly.

Unchanging Facts

When the AAP first recommended that kids limit their media time to 2 hours a day, it was because viewing television beyond that threshold was strongly associated with increased rates of overweight and obesity. Newer data suggest that this effect still holds, but it does not seem to translate to computer, telephone, or video game use, except to the extent that these devices are still often being used to watch television. Is two hours the magic limit for other deleterious effects of media use? We don’t know, but I’m going to guess that the answer depends very much on the activity.

Another fact has not changed, at least not yet: young children learn best from other people or, as my friend and colleague Dimitri Christakis recently told the New York Times, “Children need laps more than apps.” While overwhelming data support a language deficit attributable to excessive television exposure in young children, the data that favor screen-based learning in children under age two remain preliminary and underwhelming and are limited to real-time screen-based interactions with other people. Will we continue to discourage screen time for children under age two? My guess is the answer will be the same: it depends what they’re doing with it: does that time foster interpersonal interaction or displace it?

Future Changes for Kids and Media Use

Our next step is to revise the official AAP policy on media use and children, a process that we have already initiated and hope to complete less than a year from now. The new policy will appear as two statements, one regarding media and children under age 5 and another regarding school-aged children and adolescents. Accompanying these statements will be a technical report detailing the literature and rationale informing our advice. All three documents will undergo review and approval by the AAP Board as well as by multiple other councils, committees, and sections of the AAP. Our charge is not to make flip-flops (or Birkenstocks) but to craft something both flexible and sturdy, fit for children of all sizes.

Dr. David Hill, Chair, American Academy of Pediatrics Council on Communications and Media, will be discussing screen time with The Family Online Safety Institute CEO Stephen Balkam, at the 2015 FOSI Annual Conference. Register to attend.

Photos courtesy of Flicker.

Written by

David Hill

David L. Hill, MD, FAAP is the chair of the AAP Council on Communications and Media, a member of the AAP Children, Adolescents, and Media Leadership Working Group, and a scientific advisory board member of the Institute of Digital Media and Child Development as well as a board member of the North Carolina Pediatric Society. An adjunct assistant professor of pediatrics at UNC School of Medicine, he served as the 2014 Media Visiting Professor at Duke University.
Dr. Hill is also the author of Dad to Dad: Parenting Like a Pro (AAP Publishing, 2012) and has appeared in Hank Azaria’s Fatherhood online series for Disney, AOL, and David has been a commentator for National Public Radio’s All Things Considered and a regular contributor to NPR member stations WUNC and WHQR as well as RadioMD’s “Healthy Children Radio.” He appears regularly on news stations WECT and WWAY and has been featured on CNN Headline News as well as in numerous online videos about pediatrics and parenting. A humorist and (very) occasional standup comedian, David maintained a regular humor blog (“Needles”) for Pediatric News from 2011 to 2014. Dr. Hill has worked as a medical content advisor for, Sharecare, Inc., and Pediacare Brands. Dr. Hill graduated from Rice University and attended medical school at the University of Texas Houston before completing a combined internal medicine/pediatrics residency at the UNC School of Medicine. He practices at Coastal Pediatric Associates in Wilmington, NC, where he lives with his wife, three children, and two step-children. For fun he runs and practices Tae Kwon Do with his children.