POLICY STATEMENT Organizational Principles to Guide and Define the Child HealthCare System and/or Improve the Health of all Children

Media Use in School-Aged
Children and Adolescents
COUNCIL ON COMMUNICATIONS AND MEDIAThis policy statement focuses on children and adolescents 5 through 18
years of age. Research suggests both benefits and risks of media use forthe health of children and teenagers. Benefits include exposure to new
ideas and knowledge acquisition, increased opportunities for social contact
and support, and new opportunities to access health-promotion messages
and information. Risks include negative health effects on weight and sleep;
exposure to inaccurate, inappropriate, or unsafe content and contacts;
and compromised privacy and confidentiality. Parents face challenges
in monitoring their children’s and their own media use and in serving as
positive role models. In this new era, evidence regarding healthy media use
does not support a one-size-fits-all approach. Parents and pediatricians canwork together to develop a Family Media Use Plan (www.healthychildren.
org/MediaUsePlan) that considers their children’s developmental stages toindividualize an appropriate balance for media time and consistent rules
about media use, to mentor their children, to set boundaries for accessing
content and displaying personal information, and to implement open family
communication about media.

abstract

This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors have
filed conflict of interest statements with the American Academyof Pediatrics. Any conflicts have been resolved through a process
approved by the Board of Directors. The American Academy of
Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.
Policy statements from the American Academy of Pediatrics benefit
from expertise and resources of liaisons and internal (AAP) andexternal reviewers. However, policy statements from the American
Academy of Pediatrics may not reflect the views of the liaisons or theorganizations or government agencies that they represent.
The guidance in this statement does not indicate an exclusive courseof treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.
All policy statements from the American Academy of Pediatrics
automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.
DOI: 10.1542/peds.2016-2592

INTRODUCTIONPEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Today’s generation of children and adolescents are growing up immersed
in media, including broadcast and social media. Broadcast media include
television and movies. Interactive media include social media and 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 personalized.

Media Use Patterns

The most common broadcast medium continues to be TV. A recent study
found that TV hours among school-aged children have decreased in thepast decade for children younger than 8 years.1 However, among children
aged 8 years and older, average daily TV time remains over 2 hours per

Copyright © 2016 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: The authors have indicated they do
not have a financial relationship relevant to this article todisclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors haveindicated they have no potential conflicts of interest to
disclose.
To cite: AAP COUNCIL ON COMMUNICATIONS AND MEDIA.
Media Use in School-Aged Children and Adolescents. Pediatrics. 2016;138(5):e20162592

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PEDIATRICS Volume 138, number 5, November 2016:e20162592

FROM THE AMERICAN ACADEMY OF PEDIATRICS

day.2 TV viewing also has changed
over the past decade, with content
available via streaming or social
media sites, such as YouTube andNetflix.

Overall media use among adolescentshas continued to grow over the
past decade, aided by the recent
increase in mobile phone use among
teenagers. Approximately threequarters of teenagers today own asmartphone,3 which allows access to
the Internet, streaming TV/videos,
and interactive “apps.” Approximately
one-quarter of teenagers describe
themselves as “constantly connected”
to the Internet.3

Social media sites and mobile apps
provide platforms for users to create
an online identity, communicate withothers, and build social networks.
At present, 76% of teenagers use atleast 1 social media site.3 Although
Facebook remains the most popularsocial media site,3 teenagers do not
typically commit to just 1 social
media platform; more than 70%
maintain a “social media portfolio”
of several selected sites, including
Facebook, Twitter, and Instagram.3
Mobile apps provide a breadth offunctions, such as photo sharing,games, and video-chatting.
Video games remain very popularamong families; 4 of 5 households
own a device used to play video
games.4 Boys are the most avid video
game players, with 91% of boys
reporting having access to a game
console and 84% reporting playing
video games online or on a cell
phone.3

Benefits of Media

Both traditional and social media canprovide exposure to new ideas andinformation, raising awareness ofcurrent events and issues. Interactive
media also can provide opportunities
for the promotion of community
participation and civic engagement.
Students can collaborate with otherson assignments and projects on
2

many online media platforms. The
use of social media helps families
and friends who are separated
geographically communicate acrossthe miles.

Social media can enhance accessto valuable support networks,
which may be particularly helpful
for patients with ongoing illnesses,
conditions, or disabilities.5 In 1 study,
young adults described the benefitsof seeking health information
online and through social media,
and recognized these channels as
useful supplementary sources of
information to health care visits.6
Research also supports the use ofsocial media to foster social inclusion
among users who may feel excluded7
or who are seeking a welcoming
community: for example, those
identifying as lesbian, gay, bisexual,
transgender, questioning, or intersex.
Finally, social media may be used
to enhance wellness and promotehealthy behaviors, such as smoking
cessation and balanced nutrition.8

Risks of MediaA first area of health concern ismedia use and obesity, and moststudies have focused on TV. One
study found that the odds of being
overweight were almost 5 times
greater for adolescents who watch
more than 5 hours of TV per daycompared with those who watch 0
to 2 hours.9 This study’s findings
contributed to recommendations by
the American Academy of Pediatrics
that children have 2 hours or less ofsedentary screen time daily. Morerecent studies have provided new
evidence that watching TV for morethan 1.5 hours daily was a risk factor
for obesity, but only for children 4through 9 years of age.10 Increased
caloric intake via snacking while
watching TV has been shown to be arisk factor for obesity, as is exposure
to advertising for high-calorie foods
and snacks.11,12 Having a TV in the
bedroom continues to be associatedwith the risk of obesity.13
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Evidence suggests that media use
can negatively affect sleep.14 Studies
show that those with higher social
media use15 or who sleep withmobile devices in their rooms16 wereat greater risk of sleep disturbances.
Exposure to light (particularly blue
light) and activity from screens
before bed affects melatonin levels
and can delay or disrupt sleep.17
Media use around or after bedtime
can disrupt sleep and negatively
affect school performance.13
Children who overuse online
media are at risk of problematicInternet use,18 and heavy users ofvideo games are at risk of Internet
gaming disorder.19 The Diagnostic
and Statistical Manual of Mental
Disorders, Fifth Edition,20
lists both as conditions in needof further research. Symptoms
can include a preoccupation withthe activity, decreased interest in
offline or “real life” relationships,
unsuccessful attempts to decreaseuse, and withdrawal symptoms. The
prevalence of problematic Internet
use among children and adolescentsis between 4% and 8%,21,22 and up
to 8.5% of US youth 8 to 18 years ofage meet criteria for Internet gaming
disorder.23
At home, many children andteenagers use entertainment
media at the same time that they
are engaged in other tasks, such as
homework.24 A growing body ofevidence suggests that the use of
media while engaged in academic
tasks has negative consequences onlearning.25,26

Media Influence

Evidence gathered over decades
supports links between media
exposure and health behaviors
among teenagers.27 The exposure ofadolescents through media to
alcohol,28,29 tobacco use,30,31 orsexual behaviors32 is associated withearlier initiation of these behaviors.
Adolescents’ displays on social
media frequently include portrayal

FROM THE AMERICAN ACADEMY OF PEDIATRICS

of health risk behaviors, such as
substance use, sexual behaviors,
self-injury, or disordered eating.33–36
Peer viewers of such content may
see these behaviors as normativeand desirable.37,38 Research fromboth the United States and the United
Kingdom indicates that the major
alcohol brands maintain a strong
presence on Facebook, Twitter, andYouTube.29,39

Cyberbullying, Sexting, and Online
Solicitation

Cyberbullying and traditional
bullying overlap,40 although online
bullying presents unique challenges.
These challenges include thatperpetrators can be anonymousand bully at any time of day, that
information can spread online
rapidly,41 and that perpetrator andtarget roles can be quite fluid in
the online world. Cyberbullying
can lead to short- and long-term
negative social, academic, andhealth consequences for boththe perpetrator and the target.42
Fortunately, newer studies suggestthat interventions that target bullying
may reduce cyberbullying.43“Sexting” is commonly defined as theelectronic transmission of nude or
seminude images as well as sexually
explicit text messages. It is estimatedthat ∼12% of youth aged 10 to 19
years have ever sent a sexual photo
to someone else.44 The Internet
also has created opportunities forthe exploitation of children by sex
offenders through social networking,chat rooms, e-mail, and online
games.45

Social Media and Mental HealthResearch studies have identified
both benefits and concerns regarding
mental health and social media
use. Benefits from the use of social
media in moderation include
the opportunity for enhancedsocial support and connection.
Research has suggested a U-shaped
relationship between Internet use
PEDIATRICS Volume 138, number 5, November 2016

and depression, with increased risksof depression at both the high andlow ends of Internet use.46,47 One
study found that older adolescents
who used social media passively (eg,viewing others’ photos) reported
declines in life satisfaction, whereas
those who interacted with others andposted content did not experience
these declines.48 Thus, in addition to
the number of hours an individual
spends on social media, a key factor
is how social media is used.

Social Media and Privacy

Content that an adolescent chooses
to post is shared with others,
and the removal of such content
once posted may be difficult or
impossible. Adolescents vary in theirunderstanding of privacy practices49;
even those who know how to set
privacy settings often don’t believe
they will work.50 Despite efforts bysome social media sites to protect
privacy or to delete content after
it is viewed, privacy violations andunwelcome distribution are always
risks.51,52

Parent Media Use and Child HealthSocial media can provide positivesocial experiences, such asopportunities for parents toconnect with children via videochat services. Unfortunately, someparents can be distracted by media
and miss important opportunities
for emotional connections that are
known to improve child health.53,54
One research study found thatwhen a parent turned his or her
attention to a mobile device whilewith a young child, the parent wasless likely to talk with the child.55
Parental engagement is critical in thedevelopment of children’s emotionaland social development, and these
distractions may have short- andlong-term negative effects.

CONCLUSIONSThe effects of media use are
multifactorial and depend on the
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type of media, the type of use, theamount and extent of use, and thecharacteristics of the individual child.
Children today are growing up in an
era of highly personalized media use
experiences, so parents must develop
personalized media use plans fortheir children that attend to eachchild’s age, health, temperament,
and developmental stage. Research
evidence shows that children andteenagers need adequate sleep,
physical activity, and time awayfrom media. Pediatricians can help
families develop a Family Media Use
Plan (www.HealthyChildren.org/
MediaUsePlan) that prioritizes theseand other health goals.

RECOMMENDATIONS
Pediatricians• Work with families and schools
to promote understanding of thebenefits and risks of media.

• Promote adherence to guidelines
for adequate physical activity
and sleep via a Family Media Use
Plan (www.HealthyChildren.org/
MediaUsePlan).

• Advocate for and promote
information and training in media
literacy.

• Be aware of tools to screen for
sexting, cyberbullying, problematicInternet use, and Internet gaming
disorder.
Families• Develop, consistently follow, androutinely revisit a Family MediaUse plan (see the plan from theAmerican Academy of Pediatrics
at www.HealthyChildren.org/
MediaUsePlan).

⚬ Address what type of and how
much media are used and what
media behaviors are appropriate
for each child or teenager, andfor parents. Place consistent
limits on hours per day of media
3use as well as types of media
used.

⚬ Promote that children
and adolescents get therecommended amount of daily
physical activity (1 hour) andadequate sleep (8–12 hours,
depending on age).
⚬ Recommend that children not
sleep with devices in their
bedrooms, including TVs,
computers, and smartphones.
Avoid exposure to devices
or screens for 1 hour before
bedtime.

⚬ Discourage entertainment media
while doing homework.
⚬ Designate media-free times
together (eg, family dinner)and media-free locations (eg,bedrooms) in homes. Promote
activities that are likely tofacilitate development andhealth, including positiveparenting activities, such as
reading, teaching, talking, andplaying together.

⚬ Communicate guidelines to othercaregivers, such as babysittersor grandparents, so that media
rules are followed consistently.

• Engage in selecting and co-viewing
media with your child, throughwhich your child can use media tolearn and be creative, and sharethese experiences with your family
and your community.

• Have ongoing communication withchildren about online citizenshipand safety, including treating otherswith respect online and offline,
avoiding cyberbullying and sexting,
being wary of online solicitation,
and avoiding communications thatcan compromise personal privacy
and safety.
• Actively develop a network oftrusted adults (eg, aunts, uncles,
coaches, etc) who can engage withchildren through social media andto whom children can turn when
they encounter challenges.
4

Researchers, Governmental
Organizations, and Industry• Continue research into the risks
and benefits of media.

⚬ Prioritize longitudinal androbust study designs, including
new methodologies forunderstanding media exposureand use.

⚬ Prioritize interventions including
reducing harmful media use
and preventing and addressing
harmful media experiences.

• Inform educators and legislators
about research findings so they candevelop updated guidelines for safeand productive media use.
LEAD AUTHORS

Megan Moreno, MD, MEd, MP, FAAP
Yolanda (Linda) Reid Chassiakos, MD, FAAP
Corinn Cross, MD, FAAP

COUNCIL ON COMMUNICATIONS AND MEDIAEXECUTIVE COMMITTEE, 2016–2017
David Hill, MD, FAAP, Chairperson
Nusheen Ameenuddin, MD, MPH, FAAP
Yolanda (Linda) Reid Chassiakos, MD, FAAP
Corinn Cross, MD, FAAP
Jenny Radesky, MD, FAAP
Jeffrey Hutchinson, MD, FAAP
Rhea Boyd, MD, FAAP
Robert Mendelson, MD, FAAP
Megan Moreno, MD, MSEd, MPH, FAAP
Justin Smith, MD, FAAP
Wendy Sue Swanson, MD, MBE, FAAPLIAISONS
Kristopher Kaliebe, MD – American Academy ofChild and Adolescent Psychiatry
Jennifer Pomeranz, JD, MPH – American Public
Health Association
Brian Wilcox, PhD – American Psychological
Association

STAFF
Thomas McPheron

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DOI: 10.1542/peds.2016-2592
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publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
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Media Use in School-Aged Children and Adolescents
COUNCIL ON COMMUNICATIONS AND MEDIA
Pediatrics; originally published online October 21, 2016;
DOI: 10.1542/peds.2016-2592

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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2016 by the American Academyof Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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