Parents of preschoolers: expert media recommendations and ratings knowledge, media-effects beliefs, and monitoring practices

Primary Care Counseling of Parents Regarding Childhood Screen Media Use

Parental beliefs and motivation are instrumental in improving childhood digital media use (DMU). Parents (n = 611) completed questionnaires about childhood DMU assessing knowledge, interest in counseling, motivation to change, self-efficacy, and beliefs. Less than a third correctly recognized screen time limits. Twenty-seven percent received childhood DMU information from a doctor, while 46% stated they would like such information. Only 2% had a doctor-recommended DMU plan. Interest in DMU topics, motivation to improve, and management self-efficacy were moderate. Top negative beliefs were addiction to DMU (52%), sleep problems (39%), obesity (33%), social skills (33%), and inappropriate content (32%). Differences between age categories existed for social (48%, P = .01) and language (14%, P = .01) concerns (highest for toddlers), attention concerns (27%, P = .02; highest in preschoolers), and depression (13%, P < .001) and low self-esteem (8%, P = .04; highest in teens). Findings support further development of approaches to address DMU, tailored by age-specific common parental views.

A Survey of Screen Media Access and Use in Primary School Children's Households

Our primary aim was to gain a better understanding of current technology availability and use in the homes of primary school children. The online-accessible questionnaire was made available for families with a child enrolled at primary school, with over 300 families participating. The results suggest that it is common for children to be introduced to screen media early in life and that they watch a wide range of content. While many families have rules regarding their children's technology use, screen media is a significant part of their lives, with many children exceeding the recommended two hours of viewing per day. Future research could investigate whether media access and use differ between ethnic and socio-demographic groups, and whether changes have occurred as a result of the coronavirus pandemic.

Explaining Adherence to American Academy of Pediatrics Screen Time Recommendations With Caregiver Awareness and Parental Motivation Factors: Mixed Methods Study

BACKGROUND

With the increasing integration of technology into society, it is advisable that researchers explore the effects of repeated digital media exposure on our most vulnerable population-infants. Excessive screen time during infancy has been linked to delays in language, literacy, and self-regulation.

OBJECTIVE

This study explores the awareness of and adherence to the American Academy of Pediatrics' (AAP) recommendations related to avoiding screen time for infants younger than 2 years and the motivational factors associated with screen time exposure.

METHODS

A mixed methods survey design was used to gather responses from 178 mothers of infants younger than 2 years. The measures included infant screen time use and duration, maternal awareness of screen time use recommendations, and motivations related to screen time exposure. A variety of statistical procedures were used to explore associations between caregiver awareness of and adherence to AAP guidelines for screen time exposure, motivations related to screen time for infants, and the duration of infant screen time exposure.

RESULTS

The results indicated that 62.2% (111/178) of mothers were aware of the AAP screen time recommendations, but only 46.1% (82/178) could cite them accurately, and most mothers learned of them via the internet or from a medical professional. Mothers who were aware of the guidelines allowed significantly less screen time for infants than those who were unaware (P=.03). In addition, parents who adhered to the AAP guidelines reported significantly less infant screen time per day than those who did not adhere (P<.001). Among mothers who reported not adhering to the guidelines, the greatest motivation for allowing screen time was perceived educational benefits. Less educated mothers rated an infant's relaxation as a motivational factor in allowing screen time significantly higher than more highly educated mothers (P=.048). The regression analysis indicated that none of the parental motivation factors predicted daily infant screen time.

CONCLUSIONS

These results indicate 2 key approaches to improving adherence to screen time recommendations. First, the awareness of the AAP recommendations needs to be increased, which tends to improve adherence. Second, the myth that screen time can be educational for infants needs to be dispelled.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Touchscreen generation: children's current media use, parental supervision methods and attitudes towards contemporary media

AIM

To explore media preferences and use among young children, as well as to obtain information about parental supervision methods and beliefs about media.

METHOD

Ninety parents of three- to six-year-olds, recruited from a relatively economically advantaged area in the United Kingdom, completed a media opinion survey.

RESULTS

Although traditional television remains the favourite type of media platform among young children, touchscreen devices are gaining in popularity, and may promote simultaneous multi-screen use. Moreover, parents believe that the effects of media on developmental outcomes are generally positive. However, they do monitor the content of traditional and new media their children are exposed to.

CONCLUSION

This study shows an emerging evidence of concurrent multi-screen use among very young children. More detailed examination of early media multitasking, and its relationship to cognitive and behavioural outcomes, is necessary.

Family Socioeconomic Status Moderates Associations Between Television Viewing and School Readiness Skills

OBJECTIVE

We examined whether the negative relation between television viewing that exceeds the recommendations of the American Academy of Pediatrics (AAP) and school readiness varied by family income.

METHODS

Data were collected from 807 children from diverse backgrounds. Parents reported hours of television viewing, as well as family income. Children were assessed using measures of math, knowledge of letters and words, and executive function (EF).

RESULTS

Television viewing was negatively associated with math and EF but not with letter and word knowledge. An interaction between television viewing and family income indicated that the effect of television viewing in excess of the AAP recommended maximum had negative associations with math and EF that increased as a linear function of family income. Furthermore, EF partially mediated the relation between television viewing and math.

CONCLUSION

Television viewing is negatively associated with children's school readiness skills, and this association increased as family income decreased. Active efforts to reinforce AAP guidelines to limit the amount of television children watch should be made, especially for children from middle- to lower-income families.

Prospective associations between televiewing at toddlerhood and later self-reported social impairment at middle school in a Canadian longitudinal cohort born in 1997/1998

BACKGROUND

Using a large Canadian population-based sample, this study aimed to verify whether televiewing in toddlerhood is prospectively associated with self-reported social impairment in middle school.

METHOD

Participants are from a prospective-longitudinal birth cohort of 991 girls and 1006 boys from the Quebec Longitudinal Study of Child Development. Child self-reported ratings of relational difficulties at age 13 years were linearly regressed on parent-reported televiewing at age 2 years while adjusting for potential confounders.

RESULTS

Every additional 1 h of early childhood television exposure corresponded to an 11% s.d. unit increase in self-reported peer victimization [unstandardized β = 0.03, 95% confidence interval (CI) 0.02-0.04], a 10% s.d. unit increase in self-reported social isolation (unstandardized β = 0.04, 95% CI 0.03-0.05), a 9% s.d. unit increase in self-reported proactive aggression (unstandardized β = 0.02, 95% CI 0.01-0.03) and a 6% s.d. unit increase in self-reported antisocial behavior (unstandardized β = 0.01, 95% CI 0.01-0.01) at age 13 years. These results are above and beyond pre-existing individual and family factors.

CONCLUSIONS

Televiewing in toddlerhood was prospectively associated with experiencing victimization and social withdrawal from fellow students and engaging in antisocial behavior and proactive aggression toward fellow students at age 13 years. Adolescents who experience relational difficulties are at risk of long-term health problems (like depression and cardiometabolic disease) and socio-economic problems (like underachievement and unemployment). These relationships, observed more than a decade later, and independent of key potential confounders, suggest a need for better parental awareness of how young children invest their limited waking hours.

Revisiting the Association Between Television Viewing in Adolescence and Contact With the Criminal Justice System in Adulthood

A substantial number of previous studies have reported significant associations between television viewing habits and a host of detrimental outcomes including increased contact with the criminal justice system. However, it remains unclear whether the results flowing from this literature are generalizable to other samples and whether previously observed associations are confounded due to uncontrolled genetic influences. The current study addresses these limitations using the National Longitudinal Study of Adolescent to Adult Health (Add Health). The results of the preliminary models, which do not include controls for genetic influences, produced a pattern of results similar to those previously reported in the extant literature. The results of the genetically informed models revealed that the associations between television viewing and antisocial outcomes are not causal, but rather are driven by uncontrolled genetic influences. Further replication is required, but these findings suggest that results drawn from the extant literature may not be trustworthy.

Too Much Television? Prospective Associations Between Early Childhood Televiewing and Later Self-reports of Victimization by Sixth Grade Classmates

BACKGROUND

Using a birth cohort, this study aimed to verify whether televiewing at 29 months, a common early childhood pastime, is prospectively associated with self-reported victimization at age 12.

METHODS

Participants are 991 girls and 1006 boys from the Quebec Longitudinal Study of Child Development. The main predictor comprised parent-reported daily televiewing by their children at 29 months. In the sixth grade, children reported how often they experienced victimization by classmates in the past year. The authors conducted multivariate linear regression, in which child self-reports of victimization were linearly regressed on early televiewing and potential confounders.

RESULTS

Every SD unit increase (0.88 hours) in daily televiewing at 29 months predicted an 11% SD unit increase in self-reported peer victimization by sixth grade classmates (unstandardized B = .031, p < .001, 95% confidence interval = 0.014-0.042). This relationship was adjusted for child characteristics (gender, preexisting externalizing behaviors, baseline cognitive abilities, and televiewing at age 12) and family characteristics (family configuration, income, and functioning, and maternal education).

CONCLUSIONS

Daily televiewing time at 29 months was associated with a subsequent increased risk of victimization by classmates at the end of sixth grade, a period which represents a critical developmental transition to middle school. Youth who experience peer victimization are at an increased risk of long-term mental health issues, such as depression, underachievement, and low self-esteem. This prospective association, across a 10-year period, suggests the need for better parental awareness, acknowledgement, and compliance with existing recommendations put forth by the American Academy of Pediatrics.

The Early Childhood Obesity Prevention Program (ECHO): an ecologically-based intervention delivered by home visitors for newborns and their mothers

BACKGROUND

Obesity is a major problem in the United States, particularly among socio-economically disadvantaged Latino and Black children. Effective interventions that can be disseminated to large numbers of at-risk children and their families are needed. The goals of the Early Childhood Obesity Prevention Program (ECHO) are to examine the 12-month efficacy of a primary obesity prevention program targeting the first year of life that is delivered by home visitors and that engages mothers as agents of change to modify their own behavior and their infant's behavior through education and skill-building around nutrition, physical activity, and wellness, and then "echoes" her training with linkages to neighborhood programs and resources.

METHODS/DESIGN

Six family centers located in low-income neighborhoods in Hartford, CT were randomized into control and intervention neighborhoods. Fifty-seven mothers were recruited either prenatally or shortly after delivery into the Nurturing Families Network home visitation program; 27 lived in a control neighborhood and received the standard home visitation program and 30 lived in an intervention neighborhood and received both the standard home visitation program and the ECHO intervention. The intervention increases maternal skills in goal-setting, stimulus control and problem-solving, engages family members to support changes, links mothers to neighborhood resources and is embedded in the standard home visitation program. ECHO targets include breastfeeding, solids, juice and sugar-sweetened beverages, routines for sleep and responding to infant cues, television/screen time, and maternal diet and physical activity. We hypothesize that infants in ECHO will have been breastfed longer and exclusively, will have delayed introduction of solids and juice, have longer sleep duration, decreased television/screen time and a lower weight for length z-score at 12 months, and their mothers will have greater fruit and vegetable consumption and higher levels of physical activity.

DISCUSSION

ECHO will provide important information about whether an enhanced behavior change curriculum integrated into an existing home visitation program, focused on the mother as the agent of change and linked to neighborhood resources is effective in changing energy balance behaviors in the infant and in the mother. If effective, the intervention could be widely disseminated to prevent obesity in young children.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02052518 January 30, 2014.

Early childhood television viewing and kindergarten entry readiness

BACKGROUND

Using a large population-based sample, this study aims to verify whether televiewing at 29 mo, a common early childhood pastime, is prospectively associated with school readiness at 65 mo.

METHODS

Participants are a prospective longitudinal cohort of 991 girls and 1,006 boys from the Quebec Longitudinal Study of Child Development with parent-reported data on weekly hours of televiewing at 29 mo of age. We conducted a series of ordinary least-squares regressions in which children's scores on direct child assessments of vocabulary, mathematical knowledge, and motor skills, as well as kindergarten teacher reports of socioemotional functioning, were linearly regressed on early televiewing.

RESULTS

Every SD increase (1.2 h) in daily televiewing at 29 mo predicted decreases in receptive vocabulary, number knowledge scores, classroom engagement, and gross motor locomotion scores, as well as increases in the frequency of victimization by classmates.

CONCLUSION

Increases in total time watching television at 29 mo were associated with subsequent decreases in vocabulary and math skills, classroom engagement (which is largely determined by attention skills), victimization by classmates, and physical prowess at kindergarten. These prospective associations, independent of key potential confounders, suggest the need for better parental awareness and compliance with existing viewing recommendations put forth by the American Academy of Pediatrics (AAP).

Conceptual understanding of screen media parenting: report of a working group

Screen media (television, computers, and videogames) use has been linked to multiple child outcomes, including obesity. Parents can be an important influence on children's screen use. There has been an increase in the number of instruments available to assess parenting in feeding and physical activity contexts, however few measures are available to assess parenting practices regarding children's screen media use. A working group of screen media and parenting researchers convened at the preconference workshop to the 2012 International Society for Behavioral Nutrition and Physical Activity (ISBNPA) annual meeting, "Parenting Measurement: Current Status and Consensus Reports," to identify and prioritize issues in assessing screen media parenting practices. The group identified that screen media use can pose different risks for children, depending on their age and developmental stage, across physiologic, psychosocial, and development outcomes. With that in mind, a conceptual framework of how parents may influence their child's screen-viewing behaviors was proposed to include the screen media content, context of viewing, and amount viewed. A research agenda was proposed to prioritize a validation of the framework and enhance the ability of researchers to best assess parenting influences across the three domains of content, context and amount of children's screen media use.