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

Michael Rich, MD, MPH

Q:So far I’ve only allowed my 5-year-old to watch DVDs that I’ve selected. Should I introduce some quality educational TV programs, or should I stick to my guns and keep her away from TV—and the commercials that come with it—for as long as I can?

-Tepid about TV, USA

A: Dear Tepid,

Your question raises some good points. First, there’s no reason your child has to watch TV. There are many different ways she can learn the same lessons…like books, creative play, and time outside in nature.

If and when you do decide to incorporate TV into her media diet, there are a few things to consider. First, choose the programs carefully. There are high-quality educational TV shows that she could really enjoy (in limited quantities). Which ones work best for her depends on both who she is as an individual and her developmental stage. Refer to child-friendly reviews of children’s TV to help you decide whether the content is developmentally appropriate for her. 

Second, you are right to be concerned about exposing your daughter to commercials. Research shows that young children are especially susceptible to advertisements. Our own research has indicated that attention to food commercials on TV may be the driver of the relationship between screen media and obesity. If you do let your daughter watch a show on TV, use the same media-smart approach as you’ve been using for DVDs—by recording and pre-viewing each program yourself. Then, you can not only skip the commercials but also make sure that the show is appropriate for your child. Many educational shows are also available on commercial-free DVDs or can be watched live on PBS (which has no commercials but does include sponsorships).

Finally, even if she isn’t watching TV at home, commercials will eventually start making their way into her consciousness. Therefore, it’s important for her to start learning about how media messages are created, by whom, and for what purpose. When she does see or talk about ads, use the opportunity teach her media literacy skills, which will help her question and evaluate ads (and other media) on her own. That way, as she grows, she has the tools and strategies to think about it for herself.

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 stopped our 17-year-old daughter from using Facebook a number of times due to angry and inappropriate postings. We put unrecognizable passwords in, but she keeps creating or restarting Facebook pages. I believe she has one now, and I can’t find it. She has probably blocked me. Is there any way of totally blocking Facebook from our home? She is unable to control her reactions and what she says. We are at a loss.

-          Facebook Frazzled in Acton, MA

A: Dear Frazzled,

Frankly, it is difficult, if not impossible, to block Facebook from her (remember, in the days of smartphones and free wifi sites, blocking from your home is not enough). However, it sounds as if keeping your daughter off of Facebook—even if you did manage it—wouldn’t solve the problem. Her angry posts probably reflect what she’s feeling in real life, and it sounds like she’s looking for an outlet for those feelings.

It is important to remember where your daughter is developmentally as a teenager. At this stage, it is normal for your daughter to be exercising her independence and expressing how she feels. Social media sites serve these developmental needs well because they can be crafted by each user. The best way to address your daughter’s postings is by opening the doors of communication and engaging her in a conversation about them.

It may be helpful to start the conversation by asking her general questions or just having her share what’s going on in her life. This will help you understand your daughter’s point of view, and may even lead you to understanding the reasons behind her angry postings. As both a parent and pediatrician, I’ve seen many kids acting out because they have been victims of others’ hurtful actions or were exposed to inappropriate talk or behavior. Finding the source of your daughter’s anger can allow you to help her deal with her emotions and experiences in a developmentally healthy way.

Once you’ve talked it through and are both in a calm state, you may also want to remind your daughter that what she puts online reflects back on her and that inappropriate or angry content may have negative and long-lasting repercussions. Suggest some alternative means of expressing herself, such as talking with her friends, keeping a private journal or blog, or confiding in another trusted adult (or even a therapist) whom she feels respects her. Be sure to let her know that you are always there as a resource and that you support her in her efforts to deal with whatever she may be going through.

For more information on internet safety, please see:

• CMCH Internet Safety
• Facebook Safety Center

Enjoy your media and use them wisely,
The Mediatrician®

Children are using iPads earlier and earlier. Is it affecting development? flickr/remcovandermeer

Apple’s iPhone and iPad technology has revolutionized communication. The way millions of Americans interact with media, personal contacts and the Internet is now largely funneled through an Apple shaped logo. But are these machines so influential they could shape the mental and emotional development of young users?

Because these devices are so new, there’s not enough hard scientific data to know for sure. But the fact that more than half of the young children in the United States now have access to an iPad, iPhone or similar touch-screen device means the time to ask these questions is now.

So that’s exactly what Wall Street Journal reporter Ben Worthen did. Worthen spoke with many childhood development experts, including Michael Rich, MD, MPH, director of Boston Children’s Center on Media and Child Health, to find out how touch-screen technology is affecting the development of millions of young users. Here’s a brief video describing what he learned.

Until more data is collected, the scientific community remains split on how touch-screen technology affects kids. But there is one thing that they all agree on: parents know their children best and should be the final decision-maker on if and when this type of technology is appropriate in their house.

Does your child use an iPad, iPhone or tablet? If so, are you pleased or worried about her reaction to its interactive nature? Let us know in the comment section or our Facebook wall.

Read the entire Wall Street Journal on toddlers and iPads. Dr. Rich participated a live chat on the topic with parents on The Wall Street Journal’s website. Follow the conversation here: Should Your Toddler Use a Tablet?

You may also enjoy these stories on how touch-screen technology has shaped the lives of some of our patients and their families:

Are kids benefiting from all these electronics?

The new digital reality: why parents and pediatricians may need to rethink their messaging

Can the new iPad take therapy apps to the next level?

Mobile Mamas: Parenting in the smartphone age

Touchscreen technology helps kids with cerebral palsy

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 son is 15 and displays symptoms of video game addiction, including lying and sneaking to try to gain access. He has Asperger’s and ADHD, and regardless of what medication regimen we try, the gaming obsession remains. I recently asked the psychiatrist to hospitalize him and treat him as they would other addicts, but they just changed his meds. Anyway, even if he were treated, he needs the computer for school. Do you have any advice for me?
-Dealing with Addiction, Orlando, FL

A: Dear Dealing with Addiction,

Unfortunately, more and more families share your story. Whether through sleep deprivation, anxiety, or social isolation, teens struggling with problematic video game or internet use are suffering, and their families are disrupted. And research shows that young people with ADHD may actually be more susceptible to problematic video game or internet use.

Part of why it’s so hard to find good treatment is that these symptoms have yet to be recognized as a formal psychiatric diagnosis in the U.S. (unlike in South Korea and China, where clinics, hospitals, and “detox” centers treat Internet Addiction Disorder). Still, there are steps you can take to help your son:

1. Keep working with mental health professionals. Make sure that his providers recognize and respect these particular problems.
2. Optimize his treatment. Just as youth with ADHD learn more effectively in the controlled computer environment than in the chaos of a classroom, they are also at higher risk for problematic internet behaviors. Similarly, the social awkwardness of Asperger’s syndrome feels more manageable online. That may be why there’s some evidence that problematic behaviors may decrease or disappear underlying issues are addressed in therapy and any medication is optimized.
3. Move his computer and internet access into common space. Your presence will help you help him regulate his computer behaviors. Be aware that smartphones and many portable digital players are wireless internet-capable, so treat them similarly.
4. Find diverse activities that fill his needs. Look for pursuits that have clear rules, and achievable goals, and that allow him to move at his own pace. Rock climbing or a martial art like tae kwan do or karate would build his mindfulness and self-discipline, while also providing exercise and positive social interaction.
5. Get him outside. Being immersed in nature has a calming and focusing effect. It can also be an effective context for treatment—wilderness therapy has worked wonders for some of my patients and could be a good option for your son.

Remember, too, that when used in moderation, computers and video games can help young people with ADHD and Asperger’s learn, grow, and thrive in ways that they cannot in more traditional educational and social contexts. For more information and resources, take a look at this website.

Enjoy your media and use them wisely,
The Mediatrician®

By Kristelle Lavallee, staff member at Boston Children’s Hospital’s Center on Media and Child Health

Are you looking to take the family to a movie but aren’t sure whether your child should see The Hunger Games (PG-13) or Bully (unrated)? If you base the decision on the Motion Picture Association of American (MPAA) ratings, the answer seems pretty cut and dry—“maybe” to Hunger Games, and “no” to Bully. But are the movie ratings the best guide to making healthy media choices for your children?

Based on the best-selling novel, The Hunger Games is a fantasy story where teenagers are pitted against each other in a battle to the death broadcast on live TV. In contrast, Bully is a “slice of life” documentary about peer-on-peer bullying in American schools.

Both movies center on children and teenagers, but the fictional Hunger Games, portraying “intense violent thematic material and disturbing images” (MPAA’s description) was given a PG-13 rating, while the documentary Bully with “some language” (MPAA again) was rated R. The producers of Bully knew that accepting an R rating would greatly limit the film’s impact as an educational tool for young viewers, so they chose to release it unrated. But when a film is released without an MPAA rating, it comes at a price: Fewer theaters are willing to show it, and those that do will treat it the same way they treat films unrated for extreme violence or sex.

Clearly the MPAA has a lot of power in terms of how many people will be able to see a film, but who really applies these standards, and what criteria do they use?

The MPAA is made up of six major American movie studios and serves as the “voice and advocate” for the film and television industry. That means the MPAA is the tool that media producers use to govern themselves and represent their interests to the government and public. Since 1968, the MPAA has assigned movie ratings, which it claims “exists to give parents clear, concise information about a film’s content, in order to help them determine whether a movie is suitable for their children.”

Movie poster for the film Bully

Sounds like a useful tool. But it is important to remember that the primary goals of the MPAA studios are to protect their movies from external restrictions and to attract as many ticket buyers as possible. The MPAA decides the criteria on which ratings decisions are made, chooses the members of the ratings board, and administers the ratings in partnership with the National Association of Theater Owners, many of whom will not show any film that is unrated.

So who does the MPAA employ to make these decisions? Parents. Film ratings are not assigned by child psychologists, educators, pediatricians, or anyone with child development credentials, but by a full-time board of eight to 13 parents whose only qualifying credential is that they have at least one child between the age of 5 and 17. (And even that is loosely applied—for an in-depth look at the ratings process, see the documentary This Film is Not Yet Rated.)

According to the MPAA, the job of the ratings board is to “reflect what they believe would be the majority view of their fellow American parents in assigning a rating to a film.” In short, our film ratings are determined by the opinions of a few parents on what their peers will find socially acceptable.

But research has shown that this system has been inconsistent. For example, one study found that the amount of violent content allowed in PG-13 rated films significantly increased from the late 1980s until the mid 2000s, resulting in a shift of one full rating level every 11 years. Both this and other studies concluded that child development and health care professionals should participate in assigning ratings, so the decision-making can combine parental opinions with research-based guidance.

Since each child will interpret and react to on-screen action differently, parental input about what is and isn’t best for children to see is still essential. A film like Bully may be considered R material by the MPAA, but can be accepted, even embraced by parents who understand the film’s important message. At the same time, despite the MPAA’s reassurance that viewing does not require adult supervision, The Hunger Games story of children being forced to kill other children may be too potent for young viewers, even those that have read the book. These nuances aren’t captured by ratings.

For that reason, the ratings system can be used, at best, as a starting point—and then parents can take into account the individual child, media content and expert advice to help them choose what to share with their children.

Update added after original publishing:

On April 5^th, The Weinstein Company announced that the documentary, Bully, will be released with a PG-13 rating. The announcement follows an agreement that Weinstein Co. made with the MPAA to re-cut the film. As a result, Bully editors removed the audio on three obscenities, however, the controversial school bus scene that features three F-words (uttered by children) remained untouched. The new cut of Bully makes the film an exception to the MPAA’S standard of giving an R rating to any film that features the F-word more than twice.

The new PG-13 rated version of Bully allows all children to see the film without an adult. The rated version will also be shown in most major theater chains, which typically have policies against showing unrated movies.  Bully opens nationwide on April 13^th.

For other helpful resources on making these choices, please visit the Center on Media and Child Health at: http://www.cmch.tv/

You can also ask Children’s Hospital Boston’s own ‘Mediatrician’ at: www.askthemediatrician.org

For useful parent-friendly film reviews, try: http://www.commonsensemedia.org/movie-reviews/

Scene from The Hunger Games movie

The movie The Hunger Games opens today, and record tickets sales are expected to make the grisly, post-apocalyptic, survival tale one of the spring’s biggest blockbusters. Like the Harry Potter and Twilight series before it, The Hunger Games film is based on a book written for young adults that has captured the imaginations of readers of all ages.

Considering the ultraviolent nature of The Hunger Games’ plot line—24 teenage protagonists are pitted against each other in a fight to the death—is all this hype a good thing for young, would-be fans? The intended age for young adult novels is 12 to 17, but the books’ popularity has piqued the interest of much younger readers. Not wanting to sully their younger children’s budding interest in reading, many parents across the country have allowed them to read the story.

But just because your child has read The Hunger Game books, does that mean she’s ready to watch it’s bloody action unfold on the big screen? The answer will vary from child to child, but it’s a question parents of younger Hunger Game fans need to ask.

Michael Rich, MD, MPH

“[Reading about violence] is a gut experience as opposed to a head experience,’’ said Michael Rich, MD, MPH, director of Children’s Hospital Boston’s Center on Media and Child Health, in a recent Boston Globe story. “A movie is very direct. You are seeing it, you are hearing it, as compared with translating it from black ink on a page into something in your own mind.’’

It may seem counter intuitive that a child who is ready for a book might not be ready for the movie version of the same story. But, as mentioned in one of Rich’s past Ask the Mediatrician posts, books and movies have very different ways of creating worlds. When we read a book, our minds generate the details that are described there—and young readers will imagine only what their brains are ready for. But movies provide all those details for them, which means that a child watching a movie may be exposed to images and sounds for which they are not prepared.

In addition, reading allows children to set their own pace with the story. If it becomes too intense, they can take breaks or even skip over sections. In a movie—especially in a theater—it’s hard to get space from the intensity. The scary parts may be scarier on the big screen, especially because it’s harder to escape them.

If you’re unsure about whether your child is prepared to see The Hunger Games, watch it without her first, and see what you think. As a parent, you know your child best: If you think it will be too intense for her, have her wait to see it.

Are you letting your pre teen see The Hunger Games this weekend? Why or why not? We’d love to hear your thoughts on how appropriate the movie is for younger viewers. Let us know via twitter: @ThrivingKids or on our Facebook page.

For more information about how media affects children, please visit Boston’s Center on Media and Child Health. If you have a media related question you’d like to ask Dr. Rich, send an email to cmch@childrens.harvard.edu or click here.

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®