Infants, Toddlers and TV: The Sky is Falling!

The front page headline of the Boston Globe on 5/27/07 screamed: "Heavy TV viewing under 2 is found. Ignoring risks, parents cite 'educational' value." Article subtext: Don't these misguided, irresponsible parents know that TV viewing is toxic to their infant's and toddler's brain?

The study of 1009 parents found that 40% of 3-month-olds and 90% of 24-month-olds were watching TV, DVDs, or videos. The average TV viewing time/day was 1 hour in 12 month olds and 1.5 hours in 24 month olds. This despite the recommendation of the American Academy of Pediatrics to avoid any TV viewing until after 2 years of age!

The researchers warn: "Such exposure to [TV] screens can have a negative impact on an infant's rapidly developing brain and put children at a higher risk for attention problems, diminished reading comprehension, and obesity."

Oh, really?

Alas, like many newspaper articles, the Boston Globe was content to uncritically quote these gurus, rather than examining the primary scientific sources for their assertions. If they had, they would have found the research to be weak / non-existent that proves early TV viewing will lead to hyperactive, learning disabled, violent, obese, couch tater-tots.

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If that is the case, why did this issue cop a lead, front-page headline? I've come up with the following trifecta:

1. It advanced the current bias that TV is a uniformly evil influence on child development.
2. It served to reinforce the popular (albeit hopelessly misleading) belief in "infant determinism" (experiences in the first years alter brain development forevermore or, as Rob Reiner famously opined, "After 3, you're toast."). The dubious premise is that the very act of watching a flickering screen in the first years will cause the brain to wire itself - irrevocably - in nasty ways.
3. Appearances aside - it's a "feel-good" story. The world is a mess. Wouldn't it be great if simply turning off the TV in the first two years of life would allow for a generation of smart and non-violent and physically fit kids who, unlike our flawed selves, will be exempt from human folly?

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Look, I'm hardly a champion of kids watching TV. There's no question excessive viewing in childhood is associated with obesity and a distorted understanding of the world and its dangers. Baby Einstein is a lucrative crock. TV viewing is a passive and non-creative experience which substitutes for time that would be much better spent reading and actively playing and interacting with fellow humans. The less TV for kids in general, the better.

But mandating an absolute prohibition is a bad idea. Aside from not being justified by the current scientific evidence, it leads to haranguing and guilt-tripping already anxious parents who are sensibly ignoring the gurus and allowing their young kids to spend a little time in front of the tube.

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Article cited:
Television and DVD/Video Viewing in Children Younger Than 2 Years
Zimmerman F, Christakis D, Meltzoff A
Archives of Pediatric and Adolescent Medicine. May, 2007

Related Topics:

• Study: Most Tots Watching TV
• TV for Tots? Pros and Cons

Technorati Tags: child development, parenting, TV, television, Baby Einstein, health and wellness

Should You Test Your Child's Cholesterol Level?

Photo Credit: Enrico Strocchi

A new trend in pediatrics is afoot: testing children's cholesterol levels. At first blush it makes sense, especially since we know that:

• High levels of cholesterol (>200) and their protein convoys in the blood ("low density lipoproteins" or LDL >130) are related to the formation of fatty plaques ("atherosclerosis") in the blood vessels. These blockages can one day lead to heart attacks and strokes.
• High cholesterol /LDL levels in children are caused by heredity, dietary intake of saturated fats and cholesterol, and obesity. Each of these risks is higher in U.S children, compared to other industrialized countries. You can guess why.
• Fatty plaques in blood vessels have already been found in the autopsies of adolescent (and even younger) children. This suggests that the process of atherosclerosis can begin in childhood.

So it seems reasonable to test cholesterol/LDL in childhood and to treat high levels sooner rather than later. After all, an ounce of prevention is worth a pound of cure.

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But is cholesterol testing kids really a slam dunk? I vote no. Here's why:

• Nearly half of children with high cholesterol levels will have normal levels as adults.
• The most effective treatment for high levels is medication ("statins") and these have never been tested, nor are they recommended, for use in childhood.
• It's not known if early treatment in childhood makes any long term difference in a process that takes decades for trouble to appear.
• Focusing solely on a number is rarely a good idea. I'm concerned that the testing will imply to some parents that their obese child with a normal cholesterol level should not be a concern and, alternatively, others will become unduly overwrought about their perfectly healthy child with a high number. Seems to me a set-up for both unwarranted reassurance and needless anxiety.

Finally, I'm worried about the ongoing erosion of an oblivious childhood. The time of childhood innocence seems to be ever more ephemeral. At increasingly earlier ages, kids are exposed to sexual content, to violence, to drugs, to world-wide catastrophes.

And, in the interests of "scaring them healthy," they are asked to envision what no child should: a future full of illness and woe. What does it mean to an eight year old to be constantly reminded that his "bad habits" could some day lead to a heart attack? What is lost when the glorious taste of a hot fudge sundae is confounded with the worry that it is causing blood vessel sludge?

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My advice is to forget about obtaining your kids' cholesterol level. More importantly, don't burden them with an explanation of the genesis of adult diseases, like atherosclerosis and its discontents. All a kid needs to know is that some things are "healthy" and some are not.

Fortunately, most healthy behaviors aren't all that much of a sacrifice. Exercise is fun! It's not a hardship to use low-fat milk and milk products (especially when that is all you have ever had). Cutting down on animal fat and fried food and dietary cholesterol and trans fats is not a big deal. More fruits and veggies, and moderation in eating junk foods and desserts, is a good habit for all to cultivate. Life without a lot of sugary drinks is still worth living (OK, some of you may argue that point).

My point is that all kids - really, all members of your family - should be instilled with the elements of a healthy life style, not just those with a high cholesterol level. And while we are at it, let's not unintentionally create a generation of hypochondriacs - children for whom the future ominously looms as a time not of joy but of calamity.

So here's to an oblivious and healthy childhood (as long as you can manage to make it last)!

Related Topics:

• WebMD Video: Tips for Parents to Help Their Kids Eat Right
• WebMD Video: Raising Kids to be Active for Life

Technorati Tags: cholesterol, medicine, pediatrics, health and wellness, future

Children Who Witness Violence

It was 1991. In my office, Terry's mom was concerned.

Shortly after his 4th birthday party, he had developed a host of baffling new symptoms and behaviors: he cried to stay home instead of going to his previously beloved child care, he had nightmares and insisted on sleeping with his parents, he complained of stomachaches, he was aggressive towards other kids, he overate compulsively, and he threw major league tantrums with little provocation.

"Hmm..." I said. (Easily stumped, I say 'hmm...' a lot). His physical exam was OK. I could find no apparent medical cause.

"What about stress?" I asked his mom. "Anything going on that could be upsetting him?"

"Not really," she replied. "Everything is pretty much the same at home and at day care."

"Hmm..." I mused sagely, and probed no further. "I'm not sure what is going on. I think he's OK, however. Let's just see how it goes."

I didn't see Terry's mom for another year, at which time she disclosed that she and her husband were estranged. "We weren't getting along for a long time and our relationship got really bad. We were fighting all the time and it could get pretty nasty."

"Hmm..." the light slowly dawning. "Do you think that could have been what has been stressing out Terry all this time?"

"No way," she said emphatically. "He's always been asleep or in another room during our worst fights. I don't think he's at all aware of how bad things have gotten. After all, he's just a baby."

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Fifteen years ago, a social worker named Betsy Groves was working in an inner-city Boston health clinic. She took note of the increasing numbers of kids coming in with complaints much like Terry's. It took a while, but one day Betsy had a revelation: many of these young kids had witnessed violence - usually domestic, occasionally in the community. Contrary to the common wisdom that little ones couldn't show a post-traumatic stress response to such experiences, she was convinced that was exactly what she was seeing.

At the time it was a revolutionary notion. In retrospect it seems obvious. Of course witnessing violence, especially to your mother, is a major stressor for a child of any age. Of course children, in their own developmentally consistent way, would demonstrate all kinds of "post-traumatic stress" symptoms - physical, emotional, behavioral - following such an episode. Of course we adults didn't want to believe that these innocent creatures were affected by the chaos around them (much like when we in the medical profession used to say that infants could not feel pain).

Because they bore no physical scars and because we clinicians were largely unaware of their existence, Betsy dubbed these kids "silent victims."

Next week, the Child Witness to Violence Project, which Betsy founded at Boston Medical Center, celebrates its 15th anniversary. This wonderful program offers parental counseling, child psychotherapy, and parent-child relationship support to help these young children heal before these traumatic experiences become engrained in their souls: so that the child doesn't come to identify with the aggressor and one day become violent herself; so that the parent can learn how to help their children feel safe and find shelter from the storm; so that the child can play out and express her fears and hopes.

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What a privilege it has been for me to watch this program flourish and help so many kids! How lucky am I to have been schooled by Betsy and her wonderful group of clinicians to recognize and ask (as I did not, much to my shame, in 1996) about children's experiences with witnessing violence.

And for those of you out there experiencing relationship violence, know that your child definitely is aware of and responding to what is going on. Know that healing can occur for both you and your little one. The only shame is in not asking for help, not just for your sake, but for the little silent victim cowering in the corner.

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Of course, I've just scratched the surface of this issue.
For more info, read Betsy's book:

Children Who See Too Much:
Lessons from the Child Witness to Violence Project

Beacon Press: Boston, 2002.

or go to their website: www.childwitnesstoviolence.org

Related Topics:

• Child Witness to Violence Project: For Caregivers
• Children and Post-traumatic Stress Disorder

Technorati Tags: pediatrics, domestic violence, post traumatic stress disorder, PTSD, health and wellness