Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • NCE Meeting Abstracts
  • AAP Policy
  • Supplements
  • Multimedia
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • NCE Meeting Abstracts
  • AAP Policy
  • Supplements
  • Multimedia
  • Subscribe
  • Alerts
  • Careers
American Academy of Pediatrics
Article

Office-Based Randomized Controlled Trial to Reduce Screen Time in Preschool Children

Catherine S. Birken, Jonathon Maguire, Magda Mekky, Cedric Manlhiot, Carolyn E. Beck, Julie DeGroot, Sheila Jacobson, Michael Peer, Carolyn Taylor, Brian W. McCrindle and Patricia C. Parkin
Pediatrics December 2012, 130 (6) 1110-1115; DOI: https://doi.org/10.1542/peds.2011-3088
Catherine S. Birken
aDivision of Paediatric Medicine and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jonathon Maguire
aDivision of Paediatric Medicine andbThe Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Magda Mekky
aDivision of Paediatric Medicine and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Cedric Manlhiot
cLabatt Family Heart Centre, Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada; and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Carolyn E. Beck
aDivision of Paediatric Medicine and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Julie DeGroot
aDivision of Paediatric Medicine and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sheila Jacobson
aDivision of Paediatric Medicine and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Peer
aDivision of Paediatric Medicine and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Carolyn Taylor
aDivision of Paediatric Medicine and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Brian W. McCrindle
cLabatt Family Heart Centre, Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada; and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Patricia C. Parkin
aDivision of Paediatric Medicine and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • Comments
Loading
Download PDF

Abstract

OBJECTIVE: To determine if an intervention for preschool-aged children in primary care is effective in reducing screen time, meals in front of the television, and BMI.

METHODS: A randomized controlled trial was conducted at a primary care pediatric group practice in Toronto, Canada. Three-year-old children and their parents were randomly assigned to receive a short behavioral counseling intervention on strategies to decrease screen time. The primary outcome 1 year later was parent reported screen time. Secondary outcomes included television in the child’s bedroom, number of meals in front of the television, and BMI.

RESULTS: In the intention-to-treat analysis at 1 year, there were no significant differences in mean total weekday minutes of screen time (60, interquartile range [IQR]: 35–120 vs 65, IQR: 35–120; P = .68) or mean total weekend day minutes of screen time (80, IQR: 45–130 vs 90, IQR: 60–120; P = .33) between the intervention and control group. Adjusting for baseline BMI, there was a reduction in the number of weekday meals in front of the television (1.6 ± 1.0 vs 1.9 ± 1.2; P = .03) but no differences in BMI or number of televisions in the bedroom.

CONCLUSIONS: This pragmatic trial was not effective in reducing screen time or BMI but was effective in reducing meals in front of the screen. Short interventions focused solely on reducing screen time implemented in the primary care practice setting may not be effective in this age group.

KEY WORDS
  • screen time
  • television
  • meal
  • preschool
  • obesity
  • health
  • clinical trial
  • Abbreviations:
    IQR —
    interquartile range
  • What’s Known on This Subject:

    Interventions to reduce screen time in preschool-aged children are promising.

    What This Study Adds:

    A screen time intervention in 3-year-old children implemented in the primary care setting did not reduce screen time or BMI.

    Children are spending an increasing amount of their time engaged in screen time. Screen time, defined as time spent watching television, DVDs, or videos or playing computer or video games, has been associated with important health outcomes in children including delayed language development, aggressive behavior, cigarette smoking,1–3 and obesity.4–10 Interventions aimed at reducing screen time have been a focus of childhood obesity prevention and treatment of the past decade and have yielded varying results.11,12 A recent systematic review of 13 studies examining screen time interventions in children showed that, overall, there were no effects on screen time or BMI.12 A subgroup analysis including the 2 studies performed with preschool-aged children did identify a reduction in screen time.5,13 Neither of these studies were implemented in the primary care practice setting.12 There is compelling evidence that obesity prevention should be focused on preschool-aged children.14,15 This evidence includes the following: overweight begins at a young age and persists,16 parents have control over feeding and activity of their children at this age,17 and children who learn and adopt healthy behaviors are more likely to engage in those practices as adults.18 Primary care physicians are among the only professionals who see nearly all preschool-aged children, and their anticipatory guidance is a powerful source of parenting information for young families.19,20 Thus, primary care physicians are ideally positioned to influence lifestyle behaviors of the family. A review of prevention interventions in primary care practice has identified a substantial gap in the evidence for practice.21 The primary objective of this pragmatic randomized controlled trial was to determine if a simple intervention aimed at preschool-aged children, applied at the annual health maintenance visit, in the primary care setting, would be effective in reducing screen time. The secondary objective was to determine if the intervention was effective in reducing the proportion of children eating meals in front of the television and reducing BMI.

    Methods

    This study was a pragmatic, parallel group, randomized controlled trial. Pragmatic trials are designed and conducted to answer important questions facing patients, clinicians, and policy makers. They compare ≥2 interventions that are directly relevant to clinical care or health care delivery and strive to assess those interventions’ effectiveness in real-world practice.22

    Participants

    Three-year-old children and their parents were recruited at their 3-year health maintenance visit from a 3-physician (SJ, MP, CT), community-based, primary care pediatric group practice located in Toronto, Canada. This practice is participating in TARGet Kids! (Toronto Applied Research Group), a university-affiliated, practice-based, primary care research network. Children were excluded if they had limitations in vision or hearing, ambulation, or cognitive delay because this could affect their screen time use and their ability to implement the intervention.

    Intervention

    The intervention was modeled around previously published screen-time interventions23,24 and used embedded concepts of goal setting, positive reinforcement, monitoring, and cognitive restructuring.25 Parents in the intervention group received a 10-minute behavioral counseling intervention by trained study personnel directly after the health maintenance visit, which included information on the health impact of screen time in children and provided strategies to decrease screen time. These strategies included suggestions such as removing the television from the child’s bedroom, encouraging meals to be eaten without the television on, and budgeting of the child’s screen time. Families were encouraged to try a 1-week television turn off, in which children were encouraged to spend time without the television and were provided with a calendar and stickers to reward the children for days without the television. Contingency planning for time spent not watching television was promoted. Activities for the child, during this session, included providing a story to parents about television viewing (The Berenstain Bears and Too Much TV) and creating a list of non-television-related activities. The intervention group also received a Canadian Pediatric Society handout titled “Promoting Good Television Habits.”26 Parents of children in both the intervention and control groups received standardized counseling from trained study personnel on safe media use, which included information on television rating systems, Internet safety, and limiting exposure to violent programming. They both received a previously published Canadian Pediatric Society parent handout titled “Managing Media in the Home.”

    The study personnel who delivered the intervention had graduate-level training in dietetics and were trained by the research team by using scripts and role-playing during a half-day training session before initiation of the trial. The research assistant had monthly meetings with the research team to discuss progress with the trial and address issues related to the intervention. The research assistant had content knowledge on screen time and healthy eating behaviors. There was no additional observation of the research assistant performing the intervention or the follow-up assessment.

    Outcomes

    The primary outcome was parent-reported screen time defined as total time in minutes the child was in a room with the television or video/DVD on or playing video games or using the Internet during the previous weekday and the previous weekend day. Secondary outcomes included intermediate measures identified from the literature to be associated with screen time, including presence of the television in the child’s bedroom and parent report of the number of meals the child ate in front of the television on the last weekday and weekend day,27,28 as well as adiposity measures including BMI. Outcomes were measured at 1-year follow-up during the 4-year-old scheduled health maintenance visit. Survey data (at baseline and at 1-year follow-up) were collected at the health maintenance visit, by using a standardized, parent-completed, data collection form adapted from the Canadian Community Health Survey and the literature on screen time.29

    Sample Size

    Based on NHANES data, preschool-aged children view on average 14 hours per week of screen time.30 In a trial by Dennison et al, children in the intervention group watched 5 hours less television per week, compared with the control group. To detect a minimally important difference of 5 hours per week and maintain a power of 80% and 2-sided α of .05, the sample size required was estimated to be 70 children per group. To account for a 15% dropout rate, we randomly assigned 80 children to each group.

    Randomization

    Patients were consented to the trial then assigned randomly by using a computerized, random-number generator. Assignment was concealed through the use of sequentially numbered, opaque, identical, sealed envelopes. The assignment sequence was generated by the study epidemiologist (MM), and then a research assistant enrolled participants and assigned participants to their groups. Baseline characteristics were collected after randomization and group assignment.

    Blinding

    Attending pediatricians and study personnel who conducted the 1-year outcome assessments were blinded to the group assignments. Although blinding of parents to the educational intervention was not possible, parents were not informed of the group assignment, the main outcome measures, or the study hypothesis, except that it was a study on preschool media use. Parents in the 2 groups were asked not to discuss the study with parents of other children.

    Statistical Analyses

    An intention-to-treat (intervention group versus control group) analysis was performed. Differences between continuous variables were analyzed by using the Student t test, and differences between categorical variables were analyzed by using the Fisher exact χ2. Screen time was log transformed because of skewed distribution. Adjustments for outcome baseline values, zBMI, by using World Health Organization normal values at baseline and follow-up, were accomplished through linear regression modeling (maximum likelihood estimates for parameters determination), with weekday screen time (minutes) and weekend day screen time (minutes) at 1 year as the outcome variables and group assignment as the exposure variable. Secondary analyses were conducted by using the same methods but with number of meals in front of the screen, television in the bedroom, and zBMI as outcomes. All data were analyzed by using SAS 9.2 (SAS Institute, Cary, NC).

    Ethics Approval

    Parents provided written informed consent. This study was approved by the research ethics board of the Hospital for Sick Children, and the study protocol was registered with clinicaltrials.gov (trial # NCT00959309).

    Results

    Over the study period, 351 children were scheduled to attend a 3-year-old visit in the practice; 187 of these children were assessed for eligibility and approached for consent to participate in the study. One hundred sixty families were assigned randomly to intervention or control groups, with 79% and 86% follow-up in the intervention and control groups, respectively (see Fig 1). There were no baseline differences between the intervention and control group for age, gender, maternal education and employment, television ownership, total weekday and weekend day screen time, meals in front of the screen, television in the bedroom, parent screen time, or maternal BMI. The intervention group had a clinically significantly higher BMI z score at baseline, compared with the control group (0.66 ± 1.18 vs 0.30 ± 0.83; see Table 1).

    FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Participant flow through the trial.

    View this table:
    • View inline
    • View popup
    TABLE 1

    Baseline Characteristics

    Intention-to-Treat Analysis

    In the intention-to-treat analysis at 1 year, there were no significant differences in mean total weekday minutes of screen time (60 minutes, interquartile range [IQR]: 35–120 vs 65 minutes, IQR: 35–120; P = .68), or mean total weekend day minutes of screen time (80 minutes, IQR: 45–130 vs 90 minutes, IQR: 60–120, P = .33), between the intervention and control groups (see Table 2). After adjusting for the baseline BMI group imbalance, there was a reduction in the number of weekday meals in front of the television (1.6 ± 1.0 vs 1.9 ± 1.2; P = .03), but no differences were seen in BMI or number of television sets in the bedroom (see Table 2). At 1-year follow-up, subjects in the intervention group compared with the control group reported they were more likely to recommend this counseling session to others (89% vs 63%; P = .002).

    View this table:
    • View inline
    • View popup
    TABLE 2

    Mean Between Groups Difference in Outcomes From Baseline to 1-Year Follow-up

    Discussion

    This pragmatic, randomized controlled trial of a brief behavioral intervention administered to parents and 3-year-old children during a health maintenance visit did not result in a reduction in the primary outcome measure of reported screen time or a secondary outcome measure of BMI. There was a statistically significant reduction in meals in front of the screen, a secondary outcome measure, by >2 screen meals per week.

    One of the major strengths of our study was the pragmatic nature of the intervention. We chose to test the intervention at the 3-year-old visit, when no routine vaccinations are scheduled. The intervention itself targeted behaviors shown in the literature to be associated with increased screen time, such as eating in front of the screen,27 and television in the bedroom,5 and factors associated with reducing screen time such as the presence of a family rule about screen time.27 A study from Quebec, Canada, showed that nearly 25% of children reported eating at least twice daily in front of the television, and those who ate snacks while watching TV had increased risk for other poor dietary practices such as soft drink consumption.28 Meals in front of the screen in school-aged children have also been shown to be associated with increased caloric intake, alterations in satiety signals, and place children at risk for direct food advertising.31–33

    A recently published meta-analysis of screen-time interventions showed overall no effect of screen-time interventions on BMI or screen time. Our study confirms these findings in preschool-aged children. A secondary analysis of these studies in a recent meta-analysis on screen time interventions showed that the 2 included studies in preschool-aged children were effective in reducing screen time, with a point estimate of –3.72 hours (95% confidence interval –7.23 to 0.20) per week of screen time.6 Differences in our study, compared with these 2 studies, may include the lower “dose” and the pragmatic “setting” of the intervention itself; for example, the trial by Dennison et al5 included seven 1-hour sessions for children in a preschool setting and multiple parent handouts over an 18-month time period. Of note, all 13 studies in the meta-analysis were implemented in a single setting (school, home, or nutrition clinic), and none included the primary care practice setting. There may be certain interventions that are more amenable to implement in the primary care setting. A recently published pragmatic trial from the TARGet Kids! team19 examined the outcomes of an educational intervention for parents of 9-month-old children to transition from bottle use to cup. We hypothesize that this new behavior (cup use) was successfully maintained over the follow-up period, because parents are unlikely to transition back to bottle use after cup use is established. Complex behavior change such as reducing overall screen time may require repeated reinforcement, and flexible, developmentally appropriate approaches that change with age. Limitations of the study include potential for contamination among intervention and control families; a cluster randomized controlled trial design by practice site may be more effective. The lack of a standardized method of measuring and reporting screen time in preschool-aged children is an important limitation in this field of research. We used parent report of child screen time.2,4,24,29 There is evidence that parent report of child screen time provides accurate estimates of television viewing times, compared with videotaped observation; r = .70.34 The education levels of mothers in our cohort are high, but similar to education levels of women in this age group in Toronto.35

    We may have diluted the effective difference between control and intervention group screen time by using a screen-time based counseling session for the control group (selection of screen time programs and Internet safety). The fidelity of the intervention was not monitored, and the intervention was delivered by a single trained study staff member, by using a standardized protocol. This would not, however, be expected to alter the effective difference between control and intervention group. The outcome was measured after 12 months; it is possible there was a significant reduction in reported screen time after the intervention that did not persist.

    Preventive care interventions in early childhood have potential for improving health outcomes. A recent randomized controlled trial in the primary care setting was effective in selective lifestyle behavior changes.36 In addition, there have been no cost-effectiveness analyses of primary care interventions for health promotion in children published. Studies on physical activity promotion and cessation in adults were shown to be cost-effective for interventions that focused on individual behavior change and were implemented in practice.37,38 The health benefits associated with reduced screen time during meals have not been established in young children, and, if implemented as an additional counseling service at the primary care visit, would be a significant cost. For example, if we calculate direct costs for physician counseling for all children in Ontario attending a primary care practice and use an existing fee code for smoking cessation counseling in Ontario,39 the cost would be >C$2 million annually.

    Conclusions

    This pragmatic trial of a brief intervention in the primary care setting was not effective in reducing screen time or BMI in 3-year-old children. In addressing screen time and obesity prevention interventions in primary care, identifying which behaviors to target, how best to format and deliver the intervention, integration of interventions across settings, and an assessment of cost-effectiveness should be a focus for future research.

    Footnotes

      • Accepted August 14, 2012.
    • Address correspondence to Catherine Birken, MD, MSc, FRCPC, Division of Paediatric Medicine, The Hospital for Sick Children, Assistant Professor, Department of Paediatrics and Department of Health Policy Management & Evaluation, Faculty of Medicine, University of Toronto, 555 University Ave, Toronto, Ontario, M5G 1X8 Canada. E-mail: catherine.birken{at}sickkids.ca
    • Dr Birken contributed to study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis, and obtaining funding; Drs Maguire, Beck, and McCrindle contributed to critical revision of the manuscript for important intellectual content; Dr Mekky contributed to acquisition of data and administrative, technical, and material support; Dr Manlhiot contributed to statistical analysis; Dr DeGroot contributed to analysis and interpretation of data and administrative, technical, and material support; Drs Jacobson, Peer, and Taylor contributed to acquisition of data; and Dr Parkin contributed to study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, obtaining funding, and administrative, technical, and material support.

    • This trial has been registered at www.clinicaltrials.gov (identifier NCT00959309).

    • FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

    • FUNDING: Supported in part by a Paediatric Consultants Research Grant, Hospital for Sick Children, Toronto. The Paediatric Outcomes Research Team is supported by a grant from the Hospital for Sick Children Foundation. The funding organizations were not involved in any of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

    References

    1. ↵
      1. Christakis DA,
      2. Gilkerson J,
      3. Richards JA,
      4. et al
      . Audible television and decreased adult words, infant vocalizations, and conversational turns: a population-based study. Arch Pediatr Adolesc Med. 2009;163(6):554–558pmid:19487612
      OpenUrlCrossRefPubMed
    2. ↵
      1. Wake M,
      2. Hesketh K,
      3. Waters E
      . Television, computer use and body mass index in Australian primary school children. J Paediatr Child Health. 2003;39(2):130–134pmid:12603802
      OpenUrlCrossRefPubMed
    3. ↵
      1. Gidwani PP,
      2. Sobol A,
      3. DeJong W,
      4. Perrin JM,
      5. Gortmaker SL
      . Television viewing and initiation of smoking among youth. Pediatrics. 2002;110(3):505–508pmid:12205251
      OpenUrlAbstract/FREE Full Text
    4. ↵
      1. Christakis DA,
      2. Ebel BE,
      3. Rivara FP,
      4. Zimmerman FJ
      . Television, video, and computer game usage in children under 11 years of age. J Pediatr. 2004;145(5):652–656pmid:15520768
      OpenUrlCrossRefPubMed
    5. ↵
      1. Dennison BA,
      2. Erb TA,
      3. Jenkins PL
      . Television viewing and television in bedroom associated with overweight risk among low-income preschool children. Pediatrics. 2002;109(6):1028–1035pmid:12042539
      OpenUrlAbstract/FREE Full Text
    6. ↵
      1. Gortmaker SL,
      2. Must A,
      3. Sobol AM,
      4. Peterson K,
      5. Colditz GA,
      6. Dietz WH
      . Television viewing as a cause of increasing obesity among children in the United States, 1986–1990. Arch Pediatr Adolesc Med. 1996;150(4):356–362pmid:8634729
      OpenUrlCrossRefPubMed
      1. Dietz WH Jr,
      2. Gortmaker SL
      . Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics. 1985;75(5):807–812pmid:3873060
      OpenUrlAbstract/FREE Full Text
      1. Hancox RJ,
      2. Milne BJ,
      3. Poulton R
      . Association between child and adolescent television viewing and adult health: a longitudinal birth cohort study. Lancet. 2004;364(9430):257–262pmid:15262103
      OpenUrlCrossRefPubMed
      1. Jago R,
      2. Baranowski T,
      3. Baranowski JC,
      4. Thompson D,
      5. Greaves KA
      . BMI from 3–6 y of age is predicted by TV viewing and physical activity, not diet. Int J Obes (Lond). 2005;29(6):557–564pmid:15889113
      OpenUrlCrossRefPubMed
    7. ↵
      1. Crespo CJ,
      2. Smit E,
      3. Troiano RP,
      4. Bartlett SJ,
      5. Macera CA,
      6. Andersen RE
      . Television watching, energy intake, and obesity in US children: results from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med. 2001;155(3):360–365pmid:11231802
      OpenUrlCrossRefPubMed
    8. ↵
      1. Maniccia DM,
      2. Davison KK,
      3. Marshall SJ,
      4. Manganello JA,
      5. Dennison BA
      . A meta-analysis of interventions that target children’s screen time for reduction. Pediatrics. 2011;128(1). Available at: www.pediatrics.org/cgi/content/full/128/1/e193pmid:21708797
      OpenUrlAbstract/FREE Full Text
    9. ↵
      1. Wahi G,
      2. Parkin PC,
      3. Beyene J,
      4. Uleryk EM,
      5. Birken CS
      . Effectiveness of interventions aimed at reducing screen time in children: a systematic review and meta-analysis of randomized controlled trials. Arch Pediatr Adolesc Med. 2011;165(11):979–986pmid:21727260
      OpenUrlCrossRefPubMed
    10. ↵
      1. Epstein LH,
      2. Roemmich JN,
      3. Robinson JL,
      4. et al
      . A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. 2008;162(3):239–245pmid:18316661
      OpenUrlCrossRefPubMed
    11. ↵
      1. Mangione-Smith R,
      2. DeCristofaro AH,
      3. Setodji CM,
      4. et al
      . The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007;357(15):1515–1523pmid:17928599
      OpenUrlCrossRefPubMed
    12. ↵
      1. Perrin EM,
      2. Finkle JP,
      3. Benjamin JT
      . Obesity prevention and the primary care pediatrician’s office. Curr Opin Pediatr. 2007;19(3):354–361pmid:17505200
      OpenUrlCrossRefPubMed
    13. ↵
      1. Nader PR,
      2. O’Brien M,
      3. Houts R,
      4. et al.,
      5. National Institute of Child Health and Human Development Early Child Care Research Network
      . Identifying risk for obesity in early childhood. Pediatrics. 2006;118(3). Available at: www.pediatrics.org/cgi/content/full/118/3/e594pmid:16950951
      OpenUrlAbstract/FREE Full Text
    14. ↵
      1. Wardle J,
      2. Carnell S,
      3. Cooke L
      . Parental control over feeding and children’s fruit and vegetable intake: how are they related? J Am Diet Assoc. 2005;105(2):227–232pmid:15668680
      OpenUrlCrossRefPubMed
    15. ↵
      1. Mikkilä V,
      2. Räsänen L,
      3. Raitakari OT,
      4. Pietinen P,
      5. Viikari J
      . Consistent dietary patterns identified from childhood to adulthood: the cardiovascular risk in Young Finns Study. Br J Nutr. 2005;93(6):923–931pmid:16022763
      OpenUrlCrossRefPubMed
    16. ↵
      1. Maguire JL,
      2. Birken CS,
      3. Jacobson S,
      4. et al
      . Office-based intervention to reduce bottle use among toddlers: TARGet Kids! Pragmatic, randomized trial. Pediatrics. 2010;126(2). Available at: www.pediatrics.org/cgi/content/full/126/2/e343pmid:20624802
      OpenUrlAbstract/FREE Full Text
    17. ↵
      American Academy of Pediatrics. Bright Futures. Elk Grove Village, IL: American Academy of Pediatrics. Available at: http://brightfutures.aap.org/about.html. Accessed October 10, 2012
    18. ↵
      1. Moyer VA,
      2. Butler M
      . Gaps in the evidence for well-child care: a challenge to our profession. Pediatrics. 2004;114(6):1511–1521pmid:15574609
      OpenUrlAbstract/FREE Full Text
    19. ↵
      1. Ware JH,
      2. Hamel MB
      . Pragmatic trials—guides to better patient care? N Engl J Med. 2011;364(18):1685–1687pmid:21542739
      OpenUrlCrossRefPubMed
    20. ↵
      1. Robinson TN
      . Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282(16):1561–1567pmid:10546696
      OpenUrlCrossRefPubMed
    21. ↵
      1. Dennison BA,
      2. Russo TJ,
      3. Burdick PA,
      4. Jenkins PL
      . An intervention to reduce television viewing by preschool children. Arch Pediatr Adolesc Med. 2004;158(2):170–176pmid:14757609
      OpenUrlCrossRefPubMed
    22. ↵
      1. Bandura A
      . A Social Foundation of Thought and Action. Englewood Cliffs, NJ: Prentice-Hall; 1986
    23. ↵
      Canadian Pediatric Society. Caring for Kids: how to promote good television habits. October 2008. Available at: www.caringforkids.cps.ca/growinglearning/GoodTelevision.htm. Accessed October 10, 2012
    24. ↵
      1. Birken CS,
      2. Maguire J,
      3. Mekky M,
      4. et al
      . Parental factors associated with screen time in pre-school children in primary-care practice: a TARGet Kids! study. Public Health Nutr. 2011;14(12):2134–2138
      OpenUrlCrossRefPubMed
    25. ↵
      1. Dubois L,
      2. Farmer A,
      3. Girard M,
      4. Peterson K
      . Social factors and television use during meals and snacks is associated with higher BMI among pre-school children. Public Health Nutr. 2008;11(12):1267–1279pmid:18547454
      OpenUrlCrossRefPubMed
    26. ↵
      Canadian Community Health Survey, Cycle 4.1. Ottawa, Ontario; Statistics Canada. Health Statistics Division: 2009
    27. ↵
      1. Lumeng JC,
      2. Rahnama S,
      3. Appugliese D,
      4. Kaciroti N,
      5. Bradley RH
      . Television exposure and overweight risk in preschoolers. Arch Pediatr Adolesc Med. 2006;160(4):417–422pmid:16585488
      OpenUrlCrossRefPubMed
    28. ↵
      1. Kotz K,
      2. Story M
      . Food advertisements during children’s Saturday morning television programming: are they consistent with dietary recommendations? J Am Diet Assoc. 1994;94(11):1296–1300pmid:7963175
      OpenUrlCrossRefPubMed
      1. Matheson DM,
      2. Killen JD,
      3. Wang Y,
      4. Varady A,
      5. Robinson TN
      . Children’s food consumption during television viewing. Am J Clin Nutr. 2004;79(6):1088–1094pmid:15159240
      OpenUrlAbstract/FREE Full Text
    29. ↵
      1. Bellissimo N,
      2. Pencharz PB,
      3. Thomas SG,
      4. Anderson GH
      . Effect of television viewing at mealtime on food intake after a glucose preload in boys. Pediatr Res. 2007;61(6):745–749pmid:17426650
      OpenUrlCrossRefPubMed
    30. ↵
      1. Anderson DR,
      2. Field DE,
      3. Collins PA,
      4. Lorch EP,
      5. Nathan JG
      . Estimates of young children’s time with television: a methodological comparison of parent reports with time-lapse video home observation. Child Dev. 1985;56(5):1345–1357pmid:4053746
      OpenUrlPubMed
    31. ↵
      2006 Census of Population. Statistics Canada catalogue no. 97-557-XCB2006006 (Ontario, Code35). Ottawa, Canada: Statistics Canada
    32. ↵
      1. Taveras EM,
      2. Gortmaker SL,
      3. Hohman KH,
      4. et al
      . Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study. Arch Pediatr Adolesc Med. 2011;165(8):714–722pmid:21464376
      OpenUrlCrossRefPubMed
    33. ↵
      1. Rigotti NA,
      2. Bitton A,
      3. Kelley JK,
      4. Hoeppner BB,
      5. Levy DE,
      6. Mort E
      . Offering population-based tobacco treatment in a healthcare setting: a randomized controlled trial. Am J Prev Med. 2011;41(5):498–503pmid:22011421
      OpenUrlCrossRefPubMed
    34. ↵
      1. Müller-Riemenschneider F,
      2. Reinhold T,
      3. Willich SN
      . Cost-effectiveness of interventions promoting physical activity. Br J Sports Med. 2009;43(1):70–76pmid:18971249
      OpenUrlAbstract/FREE Full Text
    35. ↵
      Ministry of Health & Longterm Care. Billing and payment guide for blended salary model physicians family health teams, primary health care. Available at: www.health.gov.ca/transformation/fht_bsm_physicians.en.pdf. Accessed October 10, 2012
    • Copyright © 2012 by the American Academy of Pediatrics
    View Abstract
    PreviousNext
    Back to top

    Advertising Disclaimer »

    In this issue

    Pediatrics
    Vol. 130, Issue 6
    1 Dec 2012
    • Table of Contents
    • Index by author
    View this article with LENS
    PreviousNext
    Email Article

    Thank you for your interest in spreading the word on American Academy of Pediatrics.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Office-Based Randomized Controlled Trial to Reduce Screen Time in Preschool Children
    (Your Name) has sent you a message from American Academy of Pediatrics
    (Your Name) thought you would like to see the American Academy of Pediatrics web site.
    Request Permissions
    Article Alerts
    Sign In to Email Alerts with your Email Address
    Citation Tools
    Office-Based Randomized Controlled Trial to Reduce Screen Time in Preschool Children
    Catherine S. Birken, Jonathon Maguire, Magda Mekky, Cedric Manlhiot, Carolyn E. Beck, Julie DeGroot, Sheila Jacobson, Michael Peer, Carolyn Taylor, Brian W. McCrindle, Patricia C. Parkin
    Pediatrics Dec 2012, 130 (6) 1110-1115; DOI: 10.1542/peds.2011-3088

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Share
    Office-Based Randomized Controlled Trial to Reduce Screen Time in Preschool Children
    Catherine S. Birken, Jonathon Maguire, Magda Mekky, Cedric Manlhiot, Carolyn E. Beck, Julie DeGroot, Sheila Jacobson, Michael Peer, Carolyn Taylor, Brian W. McCrindle, Patricia C. Parkin
    Pediatrics Dec 2012, 130 (6) 1110-1115; DOI: 10.1542/peds.2011-3088
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    Print
    Download PDF
    Insight Alerts
    • Table of Contents

    Jump to section

    • Article
      • Abstract
      • Methods
      • Results
      • Discussion
      • Conclusions
      • Footnotes
      • References
    • Figures & Data
    • Info & Metrics
    • Comments

    Related Articles

    • No related articles found.
    • Scopus
    • PubMed
    • Google Scholar

    Cited By...

    • Adapting the ToyBox obesity prevention intervention for use in Scottish preschools: protocol for a feasibility cluster randomised controlled trial
    • Interventions to reduce sedentary behaviour in 0-5-year-olds: a systematic review and meta-analysis of randomised controlled trials
    • Iron status of young children from immigrant families
    • Scopus (24)
    • Google Scholar

    More in this TOC Section

    • Diagnostic Performance of C6 Enzyme Immunoassay for Lyme Arthritis
    • Trends in Trampoline Fractures: 2008–2017
    • Global Health Experience and Interest: Results From the AAP Periodic Survey
    Show more Article

    Similar Articles

    Subjects

    • Media
      • Screen Time
      • Media

    Keywords

    • screen time
    • television
    • meal
    • preschool
    • obesity
    • health
    • clinical trial
    • Journal Info
    • Editorial Board
    • Editorial Policies
    • Overview
    • Licensing Information
    • Authors/Reviewers
    • Author Guidelines
    • Submit My Manuscript
    • Open Access
    • Reviewer Guidelines
    • Librarians
    • Institutional Subscriptions
    • Usage Stats
    • Support
    • Contact Us
    • Subscribe
    • Resources
    • Media Kit
    • About
    • International Access
    • Terms of Use
    • Privacy Statement
    • FAQ
    • AAP.org
    • shopAAP
    • Follow American Academy of Pediatrics on Instagram
    • Visit American Academy of Pediatrics on Facebook
    • Follow American Academy of Pediatrics on Twitter
    • Follow American Academy of Pediatrics on Youtube
    • RSS
    American Academy of Pediatrics

    © 2019 American Academy of Pediatrics