Toddlers’ media use goes way beyond TV

Children no older than 4 years in an urban, low-income, minority population almost universally use various mobile media devices, a survey of their parents showed. Investigators conducted the survey in 350 parents of children aged from 6 months to 4 years who were patients at a pediatric practice at an academic medical center. The 20-question, self-administered paper survey addressed types of media available to the child and when, how often, and how much the youngsters were exposed to these media.

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Almost all households (97%) had televisions, and most had tablets (83%) and smartphones (77%). More than half (56%) had video consoles, such as Xbox, PlayStation, and Nintendo, and Internet access (59%). By age 4 years, one-half of the children had their own television and nearly three-fourths their own mobile device, most often a tablet.

Overall, 338 children (96.6%) had used a mobile device, usually before they were aged 1 year. Parents gave children their devices to play with so they could do household chores (70%), run errands (58%), keep the child calm in public places (65%), or to put the child to sleep (28%). Most children, whatever their age, watched television every day, and by the time they were aged 2 years about three-quarters of the children used a mobile device daily to play games, watch a video, or use apps. Parents downloaded educational, entertainment, and content delivery apps across all age groups.

Although television screen time remained constant across all age groups, mobile device screen time increased with age. On average, youngsters spent 45 minutes a day watching television; 27 minutes watching television shows or videos on a mobile device; 22 minutes using apps on a mobile device; and 15 minutes playing games on a video console. YouTube was the most popular application among children through age 2 years. Netflix use was first reported for 2-year-olds and was the most used app for 3- and 4-year-olds. About one-third of 3- and 4-year-olds engaged in media multitasking (Kabali HK, et al. Pediatrics. 2015;136[6]:1044-1050).

Commentary: This is an amazing study, full of remarkable data on the very widespread use of media devices even in very young children in resource-constrained households. Previous American Academy of Pediatrics (AAP) recommendations suggested no screen time for children aged younger than 2 years, less than 2 hours per day of screen time for older children. These guidelines may no longer be realistic. It may be time for a change in direction, focusing less on amount of time spent with these devices and instead looking carefully at how electronics are used. Can we encourage parents to sit with their child while they access media and to carefully choose videos and games? Perhaps we can put an AAP stamp of approval on certain apps or video games. The reality is that our patients are living in a media-laden world. Our advice needs to reflect that reality. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.