Television can be really bad for children. That is what study after study tells us. Watching too much television makes kids more likely to be overweight.1–4 It interferes with executive function5 and increases the risk of attentional problems.6,7 If they watch programming that contains sex, it can make them have sex earlier.8,9 It can make them more aggressive.10–12 And, in this issue, a study from New Zealand states that the more television you watch as a child, the more likely you are to have a criminal conviction, a diagnosis of antisocial personality disorder, or more aggressive personality traits as an adult.13 In the study, every extra hour of television watched by children on a weeknight increased by 30% the risk of having a criminal conviction by age 26.
Clearly, it would be better for the physical and mental health of our children, not to mention their future prospects, if they listened to the recommendations of the American Academy of Pediatrics and watched ≤1 to 2 hours a day.14
The problem is, they are not listening. For years the American Academy of Pediatrics has been giving this recommendation, and for years families have been largely ignoring it. Christakis et al15 reported that the mean total screen time (television, video games, and computers) for children <11 years old was >3 hours; as children enter adolescence, that number goes up. With our society of smart phones and YouTube and video streaming, screen time is becoming more a part of daily life, not less. People have all sorts of reasons for ignoring us; having it on works for them, and shutting it off does not.
In thinking about this, I can’t help thinking about Einstein’s definition of insanity: doing the same thing over and over again and expecting a different result. For years, we have been steadfastly telling people to limit screen time. We talk a bit about types of programming, but the cornerstone of our messaging has been turn it off. We keep saying it and saying it, as if saying it repeatedly or more firmly is all we need to do to make people change their behavior—in the face of overwhelming evidence that the behavior is not changing. I am pretty sure that qualifies as insane.
It is time to change our approach. In another study in this issue,16 Christakis et al provide an example of how we can do this. He and his team were concerned about the evidence that watching violent programming can cause aggressive behavior in children and wondered in particular about the effect on preschool-aged children. They also were curious about how watching prosocial programs might help the behavior of preschool-aged children. Therefore, they educated families of preschool-aged children about the risks of violent programming and the benefits of prosocial programming and gave them practical ways to decrease their child’s exposure to the former and increase their exposure to the latter. They did not talk to them about how long they should watch; they talked to them about what they should watch.
It worked. The children did not watch any less television, but they watched less violent and inappropriate content and more prosocial content. More importantly, their social competence and behavior scores improved.
We need to switch our emphasis to outcomes and not screen time, because it is outcomes that matter. We want children to be physically and mentally healthy; although screen time may affect this outcome, screen time itself is not the outcome. In fact, as Christakis et al point out in their paper, “Although television is frequently implicated as a cause of many problems in children, our research indicates that it may also be part of the solution.”
I am not saying we should say it is fine to watch television all day. We should still be encouraging people to shut it off and go outside and play. But this cannot be all we do.
We are already working on content in our efforts to decrease cigarette smoking in movies and ads for junk food during children’s shows, in our work with the ratings on video games and movies, and in our efforts to educate parents about the effects of different kinds of programming. However, there is so much more we can do when it comes to helping creators not just take things out, but put things in. With some creativity and a change of focus, we could help create video content that improves health and behavior.
It is a variation on the “if you can’t beat ‘em, join ‘em” idea. If the screens are going to be on, let’s concentrate on the content, and how we can make it work for children.
- Accepted December 19, 2012.
- Address correspondence to Claire McCarthy, MD, General Pediatrics, Boston Children’s Hospital, Boston, MA. E-mail:
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.
This was a solicited commentary. Dr McCarthy conceptualized and wrote it, without other contributions.
FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
- Jackson DM,
- Djafarian K,
- Stewart J,
- Speakman JR
- Dennison BA,
- Erb TA,
- Jenkins PL
- Lillard AS,
- Peterson J
- Swing EL,
- Gentile DA,
- Anderson CA,
- Walsh DA
- Christakis DA,
- Zimmerman FJ
- Robertson L,
- McAnally H,
- Hancox B
- ↵American Academy of Pediatrics. Committee on Public Education. American Academy of Pediatrics: children, adolescents, and television. Pediatrics. 2001;107(2):423–426
- Christakis D,
- Garrison M,
- Herrenkohl T,
- Haggerty K,
- Zhou C,
- Liekweg K
- Copyright © 2013 by the American Academy of Pediatrics