1. Beal, Judy A. DNSc, RN, FNAP, FAAN

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The "App Generation" of children or the first generation to use handheld technology from birth has raised an important issue for parents and pediatric providers. How much screen time is good...or bad? The easy answer is that we still don't really know for sure. In 2011, the American Academy of Pediatrics (AAP) issued a statement recommending screen time be discouraged in children under the age of 2 and limited to 2 hours a day in children 2 years and older (Christakis, 2014). Although published in 2011, the report was written before the first iPad sold. On September 28, 2015, AAP convened a symposium, Only Growing Up Digital where scientists gathered to evaluate the research so they could provide parents and providers with practical advice (Brown, Shifrin, & Hill, 2015). What became clear is that there is a dearth of research on the effects of these new interactive media devices on young children.


According to a Nielson study (2012), 70% of households with tablets report that their children under the age of 12 regularly use them. Tablet activities include downloading games and educational programming, watching TV shows or movies, communicating with friends and family, and entertainment while traveling or at restaurants. Very little is known about the effect of these mobile devices on the development and behavior of children (Radesky, Schumacher, & Zuckerman, 2015). Use of tablets, mobile devices, and other interactive screen media has increased rapidly since the first iPad debuted in 2010. Mobile media differs significantly from television in its multiple modalities. Visual design, sound effects, and touchscreen interface of interactive media can either engage young children or distract them from educational content (Radesky et al.). In the United States, more than 30% of children first play with a mobile device while they are in diapers (Brown et al., 2015).


Other concerns related to the use of interactive media in young children focus on how its use to distract children during common daily routines such as car rides, eating out, or running errands, may actually be detrimental to the child learning how to self-regulate (Radesky et al., 2014). Moreover, overuse of mobile media may in fact displace other sensory-motor, social-emotional, and physical activities. The increased use of this media by parents in turn may displace parent-child interaction. On the flip side, if used at the appropriate age, with parents and teachers may promote learning and social engagement by modeling effective teaching strategies.


What should pediatric nurses recommend to parents of young children? As Radesky et al. (2015) suggest, use of mobile devices during the well-child visit presents a teachable moment. Until further research is conducted on appropriate age, content, and enhancements at different developmental stages, parents should be encouraged to: 1) limit the use of mobile media in children under 2 years; 2) actively engage with their child in all screen time; 3) role model limited use themselves; and 4) participate in the more traditional activities for family fun such as concerts, playgrounds/parks, fairs/festivals, and reading paper books. Consider a tech-free hiatus for the household. Until the AAP issues formal recommendations, refer to the proceedings of the 2015 symposium at




Brown A., Shifrin D., Hill D. L. (2015). Beyond 'turn it off': How to advise families on media use. AAP News, 36(10), 1-3. Retrieved from Accessed October 31, 2015. [Context Link]


Christakis D. A. (2014). Interactive media use at younger than the age of 2 years: Time to rethink the American Academy of Pediatrics guideline? JAMA Pediatrics, 168(5), 399-400. doi:10.1001/jamapediatrics.2013.5081 [Context Link]


Nielson. (2012). American families see tablets as playmate, teacher, and babysitter. Retrieved from[Context Link]


Radesky J. S., Kistin C. J., Zuckerman B., Nitzberg K., Gross J., Kaplan-Sanoff M., ..., Silverstein M. (2014). Patterns of mobile device use by caregivers and children during meals in fast food restaurants. Pediatrics, 133(4), e843-e849. doi:10.1542/peds.2013-3703 [Context Link]


Radesky J. S., Schumacher J., Zuckerman B. (2015). Mobile and interactive media use by young children: The good, the bad, and the unknown. Pediatrics, 135(1), 1-3. doi:10.1542/peds.2014-2251 [Context Link]