Michael Rich, MD, MPH

Michael Rich, MD, MPH, is Children’s Hospital Boston’s media expert and director of Children’s Center on Media and Child Health. Take a look at his blog archive or follow him on Twitter @CMCH_Boston

Q: I have an son who’s 11 and a daughter who’s 9½, and for many years, they have sat close to the TV when watching. I have asked them to sit farther away, and they do move back maybe a foot…but they always go back to viewing the show close up, even if the screen is a 40” color flat screen. Any studies that show why? Any concerns? My wife and I sit 8 to 10 feet from the TV.
-Up Close and Personal, in Rochester Hills, MI

A: Dear Up Close,

Concern about sitting close to TV screens, like concern about reading in low light, is founded more on what our parents told us when we were little than on research. The worries about sitting close dates from the (not so long ago) time when TVs were actually “tubes”—cathode ray tubes, that is—and people were uncertain about how the cathode radiation emitted might affect a viewer’s eyes. Today’s TVs flatscreens only emit the light you see, which removes that concern. And there’s no evidence that sitting close to either kind of screen hurts your eyes.

That said, the fact that your children sit so close to the TV may be a sign that they are near-sighted and that this distance is where they best resolve the pixels of color, light, and darkness into a coherent image. Bring them in for an eye exam to see whether they need glasses.

If their eyes are fine, then they probably sit close because they like having the screen fill their peripheral vision. That shouldn’t cause any problems. Just make sure that they aren’t staring at screens all the time—that can cause eye strain and, of course, will take time away from all of the other activities they need to accomplish in a day to be happy and healthy.

Enjoy your media and use them wisely,
The Mediatrician®

Q: My seven-year-old daughter loves movies, and there are many 3D movies geared toward kids this holiday season—Arthur Christmas, Happy Feet 2, Hugo, Puss in Boots, and The Muppets. But when my friend took her to see Puss in Boots, which opens with snow falling, the 3-D snow really freaked my daughter out, and she refused to put the glasses back on the remainder of the film. Is this something she will grow out of? What should I do?
-Multidimensional in Atlanta, GA

A: Dear Multidimensional,

These movies can be exciting and fun—for some viewers. The 3D effect that is so engaging demands that our eyes and brains combine two artificially created 2D images into a single 3D image. This is much harder for the brain to do than it is to visually process objects that actually have three dimensions, like snow falling in real life. This processing uses parts of the brain that do not fully develop until the mid-20s (although even adults can develop eyestrain, headaches, and even nausea from watching 3D movies).

Michael Rich, MD, MPH

Because her brain is not fully mature, doing this work may be really uncomfortable for your daughter. It may also feel overwhelming to be “surrounded” by the movie, especially when it gets loud or scary. That’s part of what a lot of people like about 3D, but it isn’t enjoyable for everyone.

The fact that she took off the glasses and refused to put them back on actually sounds like a good thing: She’s taking care of herself. She’s determining for herself what feels good, and adjusting what she can to make herself comfortable. Those are good skills for a seven year old—or anyone—to have.

So even though your daughter may grow out of any physical discomfort with 3D, follow her lead. It’s not important for her to feel comfortable with or even like 3D. If you want to bring her to a movie, take a look at some reviews to make sure the content is right for her, and then watch it in 2D (which you can usually do in the same cineplex where it’s showing in 3D). After all, if she’s not enjoying the movie, her time—and yours—is definitely better spent elsewhere.

Enjoy your media and use them wisely,
The Mediatrician®

Michael Rich, MD, MPH

Michael Rich, MD, MPH, is Children’s Hospital Boston’s media expert and director of Children’s Center on Media and Child Health. Take a look at his blog archive or follow him on Twitter @CMCH_Boston

Q: We have a 16-year-old daughter and a 14-year-old son who are at the same school. They have voluntarily given up Facebook because of the time drain it can be, and both have fairly heavy academic loads. They are interested in starting a blog together. What are the pros and cons?
-Benefits of Blogging in Roseville, CA

A: Dear Benefits,

What a great way for adolescent siblings to connect and use their creativity together! This kind of self-expression that can be incredibly powerful—even therapeutic—for teens pursuing the developmental tasks of finding themselves and connecting with their peers. But it can also be as much of a time sink as Facebook. To help them focus their efforts and make the time they spend on this project rewarding and positive, ask your teens these questions:

“What is the mission of your blog?” Do they want their blog to focus on sports, or music, or issues in their school, or what it’s like to be a teenager? Maybe they want to offer their different age, grade level, and gender perspectives on issues that interest them both. Having a vision and mission will help them focus their blog, limit the time they spend updating it, and create a unique niche in the blogosphere that will draw readers.

“Who is your audience?” Knowing who they’d like to have read and respond to their blog will help them focus their posts. They should choose what they write with an understanding that the blog will be accessible and interesting to many people—like teachers, coaches, grandparents, friends, and crushes—and not just to their intended audience.

“How will you handle comments?” Blog comments can lead to productive, exciting conversation, but they can also be a breeding ground for gossip and attacks. If your teens want to allow comments on their blog, encourage them make themselves moderators of the comments, so that no comment actually posts without their approval. That can help them create a space for thoughtful, responsible, useful communication—and prevent the bullying behaviors that could occur there.

Enjoy your media and use them wisely,
The Mediatrician®

Michael Rich, MD, MPH

Michael Rich, MD, MPH, is Children’s Hospital Boston’s media expert and director of Children’s Center on Media and Child Health. Take a look at his blog archive or follow him on Twitter @CMCH_Boston

Q:My father-in-law bonds with my 4-year-old son by playing video games. Recently, he bought a LEGO pirates game, rated for 10 year olds, and the two play it for about an hour every time they see each other. I love that they spend time together, but since they started playing this game, my son has become more violent. My father-in-law doesn’t see the problem, even though I’ve tried talking with him about it. Is there research that might help convince him to choose other bonding activities?

-Baffled over bonding in Palo Alto, CA

A: Dear Baffled,

You know your child better than anyone else, so you are most sensitive to a change in his behavior—and you are in the best position to guide him toward the person you want him to become.

Research agrees with your observations, showing that video games are excellent tools for teaching whatever they focus on. They can teach players to build a city—or to see violent acts as okay, as may be true in your son’s case. The fact that these games are such good teachers might help explain why research has linked playing violent ones with increased aggressive behavior, increased attention problems, and decreased helping behaviors.

Thus, there are good reasons to help your father-in-law shift how he connects with your son. First, point out the important role he plays in your son’s life—because he is a trusted and loved role model, your son will see anything he brings as something he endorses. So if he wants to connect through video games, encourage him to choose games that offer information and skills that he wants his grandson to have. And don’t rely on the age recommendations on the labels—researchshows that games are often rated by the industry ratings as less violent than they actually are. Instead, look at parent-oriented reviews  for ideas.

Finally, encourage your father-in-law to connect with his grandson through creative, hands-on activities like playing with real building blocks and developing stories about them together. Such imaginative, open-ended play is a great way to build your 4 year old’s brain, and it’s a great way for him to connect with his grandfather.

Enjoy your media and use them wisely,
The Mediatrician®

Michael Rich, MD, MPH

Michael Rich, MD, MPH, is Children’s Hospital Boston’s media expert and director of Children’s Center on Media and Child Health. Take a look at his blog archive or follow him on Twitter @CMCH_Boston

On Monday, the American Academy of Pediatrics came out with a revised policy on media for kids two and younger. The recommendations for this age group are much the same as they were in 1999—that it is best for their developing brains and bodies to avoid both screen use (such as placing a toddler in front of a TV or video) and background media (such as leaving the TV on in the same room where a baby is playing)—but there is new scientific evidence to support these recommendations. An infant’s brain triples in volume in the first two years of life and research suggests that brain development during that time can benefit the most from:

We already knew that newborn brains develop in response to whatever is in their environment. New research from the past 12 years suggests that interacting with people, exploring the physical world (like stacking blocks or “reading” board books), and playing in open-ended ways are great for that development. And no matter how “educational” their content, screen media can’t provide that kind of environment.

That said, screen media aren’t toxic for babies—they’re just not really what they need. And other kinds of media, like music and books, can be great for kids of this age group. The updated AAP policy statement also recognizes that there are good screen media options for preschoolers, whose brains have developed to the point where they can learn from electronic screens.

The reality, of course, is that sometimes you just need get the laundry done or get dinner on the table, so you need a way to occupy your baby or toddler. While you’re taking care of the business of life, try some of these non-screen activities that can occupy and optimize their brain development:

• When you need to make dinner, hand your toddler a box of uncooked macaroni and a big serving spoon. He’ll have a grand old time moving the noodles from one pot to the other (and even sorting out the shapes, if you put in different ones).
• When you need to pay the bills, sit at the kitchen table with him and give him some playdough or a coloring book.
• When you need to take a shower, place a dishtub of water on a towel on the bathroom floor and have your child wash a baby doll.
• When you need to fold laundry, have her help by picking out all the socks and put them in a pile, or “fold” washcloths.

As your child grows older and becomes ready to benefit from screen media, here are some ideas on ways to manage it wisely.

Enjoy your media and use them wisely, The Mediatrician®

We recently ran a post on whether or not it’s OK for parents to monitor their teenagers’ Facebook page if they suspect the child is engaging in risky behaviors like drinking or drug use. In this blog by Children’s media expert Michael Rich, MD, MPH, a parent asks for advice on how to balance her desire to respect her son’s online privacy while still setting limits on much time he spends on the computer.

Q: My 16-year-old son uses the computer constantly at home in his room and almost always claims he is doing homework. He doesn’t want me to look over his shoulder and see what he is doing when I come into his room, and frankly, I want to allow him his privacy when he is on the computer, as well as in other areas of his life. I believe that he spends too much time on the computer, to the detriment of other activities such as time with family, reading, extracurricular activities, etc., but he disagrees and doesn’t want to be controlled by his parents. Any suggestions?
-Computer confused mom, NY, NY

A: Dear Computer confused,

I applaud your instincts to give your son the freedom to practice using the computer responsibly, as well as your concern that he may not be doing so. Giving him privacy can help him establish who he is, independent of you. But this privacy is not the given that many adolescents assume it is: It is, rather, a privilege of his impending adulthood that he must earn.

Physically, he is approaching adulthood fast, but his brain won’t catch up until his mid to late 20s—particularly the pre-frontal cortex, which is the part responsible for future thinking and understanding consequences. Developmentally, he is no more in a position to effectively control how much time he spends on the computer, or to understand the physical, psychological, and academic consequences of failing to do so, than he was to walk at 6 months old. That may be part of why you’re uneasy about how much time he spends on the computer. Indeed, recent research shows that the average American 8- to 18-year-old does do homework on the computer—for an average of 16 minutes a day. That’s out of 1 hour 29 minutes total computer time, which includes 22 minutes of social networking and 17 minutes of playing games.

Michael Rich, MD, MPH

Parenting him online as you do offline can give you a way to teach him to balance these different activities. As you would do when he is learning to drive, start with more supervision, and then allow him increasing freedom as he demonstrates the maturity to handle it. The first step is to move his (and possibly everyone’s) computer use into public family space. Explain that you are making this shift because you know that he wants to be a fully engaged member of the household. Part of that is bringing media use out of the bedroom, which lets him demonstrate for you that he knows how to manage it himself (which means coming to dinner when dinner is ready, finishing his homework, etc.).

In addition, bringing the computer into public space allows you to use that media with him. Ask him to teach you about something he does online, like Facebook or a game he loves. Your willingness to learn from him shows that you respect what he knows and who he is becoming—and can help lay the groundwork for future conversations about managing his media use.

Enjoy your media and use them wisely,
The Mediatrician®

Michael Rich, MD, MPH, is Children’s Hospital Boston’s media expert and director of Children’s Center on Media and Child Health. Take a look at his blog archive or follow him on Twitter @CMCH_Boston

The following was written by Lauren Rubenzahl, EdM, program coordinator at Children’s Center on Media and Child Health (CMCH) and David Bickham, PhD, CMCH staff scientist.

Last week, the FDA released new requirements for labels on cigarette packaging, which will take effect next September. The nine new health warning labels portray the health effects of smoking through text and full-color graphics, like one that compares a healthy set of lungs with a diseased set of lungs and reads, “Cigarettes cause fatal lung disease.” According to the FDA, these labels are intended to “increase awareness of the specific health risks associated with smoking”, “encourage smokers to quit”, and “empower youth to say no to tobacco.”

These warnings could have positive results. By placing graphic health warnings so prominently in cigarette advertisements (they must take up 20% of the ad) and packaging (they must take up 50% of the front and back), the changes will reduce kids’ exposure to actual cigarette advertising, which influences their decision to use tobacco.

The images were selected based on research into what would be most effective for youth, young adults, and adults. This research focused on how well the images conveyed the intended message and on whether they encouraged viewers to stop smoking. The hope is that they will do both of those things. But will these grisly pictures affect kids in the way they are intended to?

It’s hard to say for sure because fear can be a double-edged sword.

Campaigns like this, which rely largely on fear to encourage personal behavior change, can certainly be effective, and the FDA seems to have done substantial research in an attempt to ensure that this campaign will fall into that camp. Shocking images are a fairly direct and memorable way to stimulate intense emotional response. And in the case of smoking, such a portrayal is easy because the outcomes are already scary.

But when not handled carefully, these types of campaigns can backfire: If smoking is already seen as rebellious and cool, then warnings and scary pictures may only serve to reinforce that image. Likewise, training teens to say no doesn’t address the reasons they say yes, which is likely part of why the DARE program wasn’t found to be effective.

If fear campaigns are to leverage the power of the visceral response in the ways they intend to, then they need to do the following.

1. Stay relevant to the target audience. The teen brain has not yet developed the ability to really understand long-term consequences. Thus, arguing that they shouldn’t smoke because it could give them lung cancer years from now is less effective than pointing out immediate side effects—like saying that it stains your teeth yellow or causes acne. For most teenagers, their current social image is MUCH more important than what might happen to them when they’re older.
2. Empower the target audience. Once they’ve grabbed your attention, fear campaigns must follow through by telling you what to do and provide a tool with which to do it. The new FDA warning labels succeed in this regard because they provide a hotline to call if you’re a smoker who would like to quit. Operators can connect callers with a list of resources in your area and free nicotine patches if you don’t have health insurance.

But inspiring fear isn’t the only way to grab a viewer’s attention. Campaigns that target social norms, like the Truth campaign, can be effective in a different way and may have a broader impact. Public health campaigns like the FDA’s new cigarette ads target individuals; while others, like the Truth campaign, target social norms, which can may a broader impact.

Instead of arguing that smoking is dangerous, Truth empowers young people with information and new ways of understanding tobacco. They show teens the ways in which they’re being manipulated by tobacco companies—and offer ways of fighting back. In addition, this campaign appeals to teens’ general mistrust of corporations that market heavily to them and heightens their awareness in a way that may make them less vulnerable to the messages in advertising.

An approach that attempts to shift social norms in this way can lead to huge successes in reducing smoking. Today, you can’t smoke in bars, restaurants, or, in some cities, even in public parks. And that’s a broader scale shift that work alongside an approach that targets individuals.

These changes will likely inspire tobacco companies to change their approach to marketing tobacco products and as a result we may see less advertising and more product placement in other media. This could potentially be the first of an effective two-prong approach: getting smokers to quit and preventing non-smokers from becoming smokers. In the meantime, however, when working to ensure that youth and young adults don’t start smoking at all, the arguments will be most effective if they focus on what’s important to teens. Even though some of the new warnings don’t seem to do that, parents, teachers and (most importantly) other youth can. For ideas on explaining the dangers of tobacco use to young people, take a look at the Truth campaign, or send a question to the Mediatrician at www.askthemediatrician.org.