Dirección Xeral de Saúde Pública Galicia: Digital Media use Recommendations

Abstract: Abstract The current generation of children and adolescents is growing up surrounded by the media, both traditional media and information and communication technologies (ICTs). The effects of media use are multifactorial and depend on type of media, the type of use, the amount and extent of use, and the characteristics of the individual child. In general, healthcare professionals who have contact with families with young children should, whenever possible, use visits to make a series of recommendations regarding digital media use (such as setting access limits, preventing children from having devices connected to the Internet in their rooms, monitoring the content they have access to, and acting as role models).

Keywords: Digital media; conncected devices

INTRODUCTION

The current generation of children and adolescents is growing up surrounded by the media, both traditional media and information and communication technologies (ICTs). Young people combine the consumption of traditional content (such as television or video games), with access to interactive media, such as the Internet, social media, and online video games, in which users can both consume and create content. Interactive media allow information sharing and provide an engaging digital environment that becomes highly personalised (American Academy of Pediatrics, 2016a).

The effects of media use are multifactorial and depend on type of media, the type of use, the amount and extent of use, and the characteristics of the individual child. Children today are growing up in an era of highly personalised media use experiences, so parents must develop personalised media use plans for their children that attend to each child’s age, health, temperament, and developmental stage. These plans must be compatible with the basic needs of that population, as research evidence shows that children and teenagers need adequate sleep, physical activity, and time away from media (American Academy of Pediatrics, 2016a).

In addition, children younger than 2 years need hands-on exploration and social interaction with trusted caregivers to develop their cognitive, language, motor, and social-emotional skills. Because of their cognitive immaturity, infants and toddlers cannot learn from traditional digital media as they do from interactions with caregivers. For this reason, the recommendation, as discussed below, is that the use of these devices should be avoided in children younger than 2 years (American Academy of Pediatrics, 2016b)

GENERAL RECOMMENDATIONS AND ISSUES TO DISCUSS WITH FAMILIES

As a general rule, healthcare professionals who have contact with families with young children should use visits, whenever possible, to make the following general recommendations regarding digital media use:

Establish daily access limits, especially for the younger ones, and encourage them to learn to control the time they spend on these activities and not to neglect their studies and spare time.
Prevent children from having devices (TV, tablet, mobile phone, console, etc.) in their room, and from using them while unattended.
Monitor the games and content accessed by minors. If agitated or aggressive behaviours are observed, they should stop, rest, and engage in other activities.
Participate in the games and access the content together with the children, taking advantage of these situations to instill rules, norms, and values in them.
Act as role models by applying rules that are reasonable and proportionate for adults as well.
Know the PEGI recommendations (https://pegi.info/eres) to choose, together with the children, the games they like, as long as they are in accordance with their interests and their developmental level.
Prevent children from sleeping with their mobile phones or tablets in their bedroom (even if they are turned off).

A think tank from the American Academy of Pediatrics (Brown, Shifrin, & Hill, 2015) produced a document with a series of key messages that should be conveyed to and discussed with families when dealing with issues related to gaming and the use of the Internet and ICTs. These are messages, considerations, or aspects that reinforce the guidelines and recommendations that will be dealt with in the following section:

Media is just another environment. Children do the same things they have always done, only virtually. Like any environment, media can have positive and negative effects. The media content should be consumed in accordance with the values and parenting styles of each family. When media is used reflectively and in an appropriate way, it can improve daily life. But if used thoughtlessly and inappropriately, it might take the place of other activities which are important for the proper development of children and young people.
Parenting has not changed. The same parenting rules apply to your children’s real and virtual environments. Play with them. Set limits; kids need and expect them. Teach kindness. Be involved. Know their friends and where they are going with them.
Don’t use technology as an emotional pacifier. Media can be very effective in keeping kids calm and quiet, but it should not be the only way they learn to calm down. Children need to be taught how to identify and handle strong emotions, come up with activities to manage boredom, or calm down through breathing, talking about ways to solve the problem, and finding other strategies for channelling emotions.
Role modelling is critical. Teach and model kindness and good manners online. And, because children are great mimics, limit your own media use. In fact, you’ll be more available for and connected with your children if you’re interacting, hugging and playing with them rather than simply staring at a screen.
We learn from each other. Young children learn best via two-way communication instead of one-way (like video presentations). For this reason, it is important to aim for interactive activities in which adults are involved.
Content matters. The quality of content is more important than the platform. The content accessed by young children should be reviewed and monitored to ensure that it is appropriate to their age and stage of development. Many apps are as labelled or promoted as educational, but little research validates their quality. An interactive product requires more than “pushing and swiping” to teach. Look to organisations that review age-appropriate apps, games and program.
Co-engagement counts. Family participation with media facilitates social interactions and learning, and strengthens bonds. Play a video game with your kids. It’s a good way to demonstrate good sportsmanship and gaming etiquette. Watch a show with them; you can introduce and share your own life experiences and perspectives—and guidance. Don’t just monitor their time online, but participate with them, so you can find out what they’re doing and be a part of their activities.
Playtime is important. Unstructured playtime away from the media is key to the development of children, especially the very young.
Set limits. Tech use, like all other activities, should have reasonable limits, appropriate to the age of the child.
The use of ICTs is positive. Tech can be a useful tool for learning, having fun and interacting with others. Online relationships are integral to adolescent development. Social media can support identity formation.
Create tech-free zones. Certain family activities should be carried out outside of ICT (family mealtimes, schoolwork, or sleep, among others). This will allow children to develop healthier lifestyles.
Privacy is important. Children should be warned about the importance of privacy and the potential dangers of sexual predators (who often use social networks and online games) and practices such as sexting (sending photos, videos, or messages of a sexual and erotic nature through technological devices, whether using instant messaging applications, social networks, email, or other communication tools) or cyberbullying (or cyberstalking, harassment, or psychological abuse through the Internet). They should be aware that once content is shared with others they cannot delete it or get rid of it completely (including sending text messages with inappropriate images). They also need to be familiar with the privacy settings on their devices.
Kids will be kids. Kids will make mistakes using media. These can be teachable moments if handled with empathy. Certain aberrations, however (such as sexting, bullying, etc.), signal a need to seek additional support.

AGE-SPECIFIC RECOMMENDATIONS

The WHO (WHO, 2019) has published a guide on physical activity, sedentary behaviour, and sleep for children under 5. In the section on sedentary time, the guide includes media use and recommends against the use of screens for children under 2 years of age. For those aged 2 years, sedentary screen time should be no more than 1 hour.

The American Academy of Pediatrics has recently produced two documents with recommendations for infants and pre-school children (American Academy of Pediatrics, 2016a) nd school-age children (American Academy of Pediatrics, 2016b) .The following is a brief adaptation of the most relevant guidelines and advice included in these two materials.

These materials are complemented with a website available in Spanish and English and free of charge, where families may find help to create, step by step, their personalised family plan for media use (American Academy of Pediatrics, n.d.).

Other material that may be useful for families when planning media use or for answering questions, is the Guía para padres y educadores sobre el uso seguro de internet, móviles y videojuegos (Labrador Encinas, Requesens Moll, & Helguera Fuentes, 2018).

Recommendations for infants and toddlers

Recommendations for healthcare professionals

Start the conversation early. Ask parents of infants and young children about family media use (TV, tablets, computer, consoles), their children’s use habits, and media use locations.
Help families develop a Family Media Use Plan (www.healthychildren.org/MediaUsePlan), with specific guidelines for each child.
Educate parents about brain development in the early years and the importance of hands-on, unstructured, and social play to build language, cognitive, and social-emotional skills.
For children younger than 18 months, discourage use of screen media other than video-chatting.
For parents of children 18 to 24 months of age who want to introduce media, advise that they choose high-quality programming/apps and use them together with children (Letting children use media by themselves should be avoided).
Guide parents to resources for finding quality products.
In children older than 2 years, limit media to 1 hour or less per day of high-quality programming. Recommend shared use between parent and child to promote enhanced learning, greater interaction, and avoid being passive.
Recommend no screens during meals and for 1 hour before bedtime.
Problem-solve with parents facing challenges when planning media use in the family, especially when setting limits, finding alternate activities, and calming children.

Recommendations for families:

Avoid media use (except video-chatting).
For children ages 18 to 24 months of age, if you want to introduce media, choose high-quality programming and use media together with your child. Avoid solo media use.
Do not feel pressured to introduce technology early; interfaces are so intuitive that children will figure them out quickly once they start using them at home or in school.
For children 2 to 5 years of age, limit screen use to 1 hour per day of high-quality programming, coview with your children, help children understand what they are seeing, and help them apply what they learn to the world around them.
Avoid fast-paced or fast-moving programs, lots of distracting content, and any violent content.
Turn off digital devices when not in use.
Avoid using media as the only way to calm your child. Although there are intermittent times (eg, medical procedures, airplane flights). There is concern that using media as strategy to calm could lead to problems with limit setting or the inability of children to develop their own emotion regulation.
Monitor children’s media content and what apps are used or downloaded. Test apps before the child uses them, play together, and ask the child what he or she thinks about the app.
Keep bedrooms, mealtimes, and parent–child playtimes screen free for children and parents.
No screens 1 hour before bedtime, and remove devices from bedrooms before bed.

Recommendations for school-aged children

Recommendations for healthcare professionals:

Work with families and schools to promote understanding of the benefits and risks of media.
Promote adherence to guidelines for adequate physical activity, sleep, and a correct media use.
Be aware of updated information and guidelines to avoid sexting, cyberbullying, and Internet gaming disorder.

Recommendations for families:

Develop, consistently follow, and routinely revisit a Family Media Use plan:
- Address what type of and how much media are used and what media behaviors are appropriate for each child or teenager, and for parents. Place consistent limits on hours per day of media use.
- Promote that children and adolescents get the recommended amount of daily physical activity and adequate sleep.
- Recommend that children not sleep with devices in their bedrooms, including TVs, computers, smartphones, and similar devices. Avoid exposure to devices or screens for 1 hour before bedtime.
- Discourage entertainment media while doing homework (unless using media is required for it).
- Designate media-free times together (e.g., family dinner) and media-free locations (e.g., bedrooms) in homes. Promote healthy activities, including positive parenting activities, such as reading, teaching, talking, and playing together.
- Communicate guidelines to other caregivers, so that media rules are followed consistently.
Engage in selecting and co-viewing media with your child and guide them, so they can transfer the content to real life, content through which your child can use media to learn and be creative.
Have ongoing communication with children about online citizenship and safety, respect, cyberbullying, or paedophilia.

Actively develop a network of trusted adult who can engage with children through social media and to whom children can turn when they encounter challenges.