Parenting & TED: Key Parenting Takeaways From the TED2017 Conference

Originally posted on my US News & World Report parenting blog (May 5, 2017)

AS ONE OF ONLY A FEW pediatricians at last week’s TED2017 conference in Vancouver, British Columbia, I want to let you in on a little secret I’m fairly sure most parents and conference attendees don’t know: The TED conference is actually a parentingconference.

Sure, influential people from around the globe gather to hear thought-provoking talks delivered on “the world’s largest stage.” But when you get right down to it, the 90-plus carefully curated talks collectively paint a picture of the world in which our children will live.

It is this glimpse into what the future holds for our kids that makes TED especially relevant to parents. Whether you’re the world’s greatest female athlete sharing thoughts on becoming a parent (as Serena Williams did), or a parent on the go, what unites us is our shared hopes and dreams for our children. The legacy we leave will depend on how well we prepare our children to live healthy, meaningful and productive lives in a rapidly changing, complex world. This makes parents the people most in need of knowing the direction in which the world is headed. Ironically, we are also the least likely to have enough spare time to watch a 15-minute video online. That’s why I’m so compelled to share a handful of key parenting takeaways from TED2017…


Parenting News Flash: TV Under 2 isn’t exactly educational

Recent advice from the country’s largest advocacy group for children leaves me concerned that what I’m about to write is going to be met with poor reception. Following extensive review of more than 50 research studies, the American Academy of Pediatrics released its October 2011 Policy Statement: Media Use by Children Younger Than 2 Years. I would like to think that all parents of young children tuned in, but for those of you who missed it – here are some of the highlights.

First, let’s start with a few facts about the current state of our children’s media diet. A full 90 percent of parents report (admit?) that their children under the age of 2 watch some form of electronic media – on average consuming 1 to 2 hours of television a day. For 1 in 7 of these young children, we’re talking 2 or more hours a day of media. By age 3, nearly one-third of our nation’s youngest have televisions in their own bedrooms. While these numbers may not be entirely surprising, given the ubiquitous nature of ipads, iphones, ipods, computers, laptops and TVs, they should nevertheless be disturbing given what we know about the potential effects of screen time for babies and toddlers.

There are several important questions we all should now be asking before taking even one more baby step towards the TV set.

  • Are infant- and toddler-directed programs educational?
  • Is there any harm in letting babies and toddlers watch TV (and other screens)?
  • What is “secondhand TV” and why should I care?

Let’s start with the question of educational value. In the words of my pediatric colleague (and the lead author of the policy statement) Dr. Ari Brown, the phrase “educational TV/videos for children under two” is an oxymoron. That’s because in order for anything to be educational, children need to “get it.” This inherently involves understanding both the content and the context. Given that young children have been shown to fundamentally lack the ability to distinguish between programs shown backwards from those shown forwards, one would be hard pressed to suggest educational benefit from watching. Sure these TV-viewing infants and toddlers laughed at viewings in both directions – suggesting some entertainment value – but entertainment does not equal education.

That’s not to say that there’s no such thing as educational television, or that educational television can’t be entertaining. Studies have actually shown proven educational benefit for children over the age of two from quality shows such as Sesame Street. It’s just that if you happen to be one of the majority of parents who have been led to believe (most likely by extensive explicit and/or implicit marketing) that TV programs and/or videos are going to enhance your baby or toddler’s intellect, you need to tune into the fact that it’s simply not.

Okay, so screen time isn’t the answer to making your baby smarter. What about those parents who readily admit they use the TV (and various other screens) as a sure-fire reprieve from entertaining their babies/toddlers just long enough to make dinner, take a shower, make a phone call….you know – all those things that just about all parents of young children struggle to find time to do in the day. I get that, and readily admit that TV did, on occasion, get used as a babysitter in my own household.

But the fact of the matter is that there are several key concerns regarding the time toddler and infants spend in front of screens, not the least of which involve language development. We already see expressive language delays in the short term. And the fact that we don’t yet know for sure about screen time’s long-term effects on language should not rule it out. In the meantime, there is a valid concern that screen time interferes with “talk time” – especially given findings such as the fact that 84 percent of parents talk less when the TV is on, and 74 percent use fewer new words. This is huge, considering that we’re talking about the most crucial time for language development.

There’s also reason to worry about the quality of sleep our children are getting. While most studies thus far have looked at media effects on older children, we know that healthy sleep habits impact just about every other aspect of all children’s health. Remember that a reported 30 percent of kids under 3 have TVs in their bedrooms. We clearly need to tune in to the possibility that their sleep may be suffering as a result.

Even during our children’s waking hours, the time that babies and toddlers spend in front of screens may simply not be time well spent. Not if it ends up displacing reading, playing, and entertaining oneself. We know that free play is hugely important for young children’s development, as are 3-dimensional, real world interactions with parents and other caregivers.

I would imagine with all of that, many of you may now be tempted to adjust your child’s media diet just a bit – and that’s great. But before you simply commit to eliminating an episode or two of toddler TV from your child’s daily viewing schedule or limit how often your baby watches his admittedly captivating video, don’t forget to take into account your own viewing schedule. That’s right – the evidence presented by the AAP is equally worthy of your attention when it comes to having your own shows on in the background. In other words, as parents we also need to take into account what is now being referred to as “secondhand TV” – an unintended exposure that is occurring in an estimated 40 to 60 percent of households across America. While parents may report “the TV is on but no-one is watching,” the fact of the matter is that someone is watching. Someone, as in our children. One study found that young children playing in a room shifted their gaze to the television that was left on in the background three times every minute!

So with that news flash, what’s a parent to do? Pediatricians fully understand that screens are everywhere, and it is entirely unrealistic to avoid exposing young children 100% of the time. But it is well worth your time to acknowledge that in many instances, there are better things for them to do to help them learn and develop. The AAP recommends the following strategies for making this happen.

  • Set media limits for children under two, bearing in mind that the AAP discourages media use for this age child.
  • Opt for supervised independent play rather than screen time to occupy your child when you aren’t able to sit down and actively engage in play. A simple set of nesting plastic cups on the floor can work wonders for engaging toddlers while their parents prepare dinner.
  • Keep TVs out of all children’s bedrooms
  • Recognize that your own media use can have a negative effect on your children. Help your child avoid secondhand TV exposure.

Originally posted on Omaha World Herald’s Live Well Nebraska

Helping Children Live Their Lives in a Post 9/11 World

As we near the tenth anniversary of the September 11th attacks, I find myself, like so many others, reflecting on where I was at the time of the attacks and vividly recalling how feelings ranging from disbelief and overwhelming sadness to anger, fear and unity all but overwhelmed our country in the subsequent days, weeks, and months that followed.

In the hours immediately following the attacks, I have a particularly clear memory of exactly what I was thinking and feeling, if for no other reason than I hurriedly but carefully wrote down my thoughts and any words of parental support I could come up with in an article that was distributed around the country entitled Helping Your Children Cope with the News of Reported Terrorist Attacks. In the years since, I have repeatedly been asked about (and struck by) what I wrote that morning, not only because I too was feeling an overwhelming sense of loss, but because the steps I outlined for parents to take in order to comfort their children and help them make some sense of the tragedy apply as much today as they did back then.

At the time, I wrote that no matter how upset we are by the grim reality that our country is not as safe as we would like to believe it to be, we have to offer our children some semblance of security in their world. The fact of the matter is that I believe this is what we, as parents, should always strive to do. To that end, I wanted to share with you what I wrote so you can continue to offer your children a sense of security each and every day.

  • Immediate reassurance. In the event of any tragedy, start by emphasizing your child’s personal safety and the safety of loved ones. Let your child see, hear, and tangibly feel a sense of security that comes from knowing that he/she is safely surrounded by adults who care about him/her. At the time I wrote this, I recommended letting children talk to relatives on the phone or reach out by email. Ten years later and I firmly believe it shouldn’t take a national or even a personal family tragedy for us to remember how important our family and loved ones are to us and reach out, whether by phone, email, text, Skype, Facebook, or the good old fashioned way…in person.
  • A sense of structure. Even before the events of September 11th,  I was one of a vast majority of pediatricians, including Dr. Benjamin Spock himself, who expressed concern about the inappropriate and potentially harmful violent images children were being exposed to – from prime time television to Saturday morning cartoons and the evening news. Perhaps one of the most vivid memories I have of the morning of September 11th, 2001 is that of watching the televised coverage of people in the World Trade Center Towers jumping to their deaths. While these horrifying images may well have been permanently emblazoned in my mind had I only witness them once, the fact that they, along with all of the equally tragic and impossible-to-comprehend events of the day were repeated over and over and over again in the twenty-four-hour a day newscasts and on the internet made it impossible for me, as an adult, to escape. I certainly understood (and still recognize) the feeling of needing to leave the television set on and watch events unfold. But my cautionary advice to parents was and is that children (and all people, for that matter) are more able to handle shocking news when it is not immediate in time and when it is presented in print, rather than on television. Now think about where we are today. The next couple of days are sure to be filled with a lot of re-living of the events of that day ten years ago. And while I agree that we should never forget, and that we should honor those whose lives were lost, it’s as important today as it was ten years ago to protect our children from having to repeatedly witness and re-live the horrors of the day. Let me also just say that I believe that the world would be a better place if we all made a concerted effort to limit the amount of violence, so often disguised as entertainment, that our children are exposed to each of the other 364 days of the year as well.
  • Showing emotions and patience. Regardless of the circumstances and even if they are too young to fully understand, from a very early age children are acutely aware of the emotional state of their parents and loved ones. My advice to parents now is the same as it was then: It’s fine to let children know that you are upset and sad, but make sure to make it clear that you’re not upset with them. Also, as with any tragedy, loss, or change in routing, don’t be surprised if children show signs of distress. Whether in the form of fussiness, fear, nightmares, or tantrums, all of these reactions are normal and are best handled with patience.
  • Mutual support. When our country was telling from the attacks on the World Trade Center and the Pentagon, it only made sense to focus on our national unity and resolve and encourage parents to seek the support and solace they needed in order to be able to be calm and confident with their children. The fact of the matter is that raising our children to be happy, healthy, and safe and with a sense of belonging to a bigger community is what we should all be striving for. While raising a child may not technically require a village, having a community of support sure can help. It is my sincere hope that we all look for ways to teach tolerance, come together, and support each other.

And that leads me to one of the most important things we need to remember and teach our children as we reflect on the past ten years, and that’s the importance of teaching respect for differences and tolerance. I was recently reminded of the fact that in the period following 9/11, there was a disturbing backlash agains Muslims that sadly does not seem to have fully subsided. Despite the fact that the religion of Islam preaches peace, justice, and tolerance, and those who follow the religion of Islam are estimated to make up more than one-fifth of the world’s population, there are still many Americans who continue to direct their post-9/11 anger and distrust towards all Muslims. Even here in Omaha, a close friend recently told me that her own daughter was no longer allowed to be in contact with another family’s son, simply because her father was an “Arab Muslim.” In response to this sadly racist statement, I suggest that in remembering what were the most tragic attacks to ever occur on American soil, we also remind ourselves and our children that these attacks were carried out by extremists and not representatives of any certain color, religion or race.

Originally posted on Omaha World Herald’s Live Well Nebraska

Toying with our Children’s Health: Happy Meals, Public Health & the Obesity Epidemic

Like a great many other pediatricians and parents, I have increasingly focused my attention in recent years on the topic of children and nutrition. With an ever-increasing number of children now deemed overweight or obese, quite frankly it’s a topic that’s all but impossible to ignore. Poor nutrition and less than ideal dietary habits are posing an ever-expanding threat to our children’s (and in many cases, our own) overall health and well-being – a threat that we simply can not take lightly. As Iowa Senator Tom Harkin put it, “The childhood obesity epidemic isn’t just a catch phrase. It’s a real public health crisis.”

I, for one, don’t take it lightly. As a pediatrician and parent of three, I hope I’m not alone in considering it my parental duty to pay attention to what my children eat – not only at home, but at school and elsewhere. Sure, I strongly believe in teaching them to become independent and make wise choices, but the fact of the matter is they still need nutritional guidance. After all, I am painfully aware that when it comes to making wise food choices, they’re up against some powerful forces.

Michael O’Connor’s January 30th Omaha World Herald article, Toying with kid’s health, brings to the front page one such force. The article addresses a proposed bill (Nebraska’s Legislative bill 126) that would “prevent fast-food outlets and other restaurants from including Barbie and other prizes in kids meals unless the food meets nutrition requirements.” My concern is that people will come to the same, nutritionally dangerous conclusion as the parent whose closing argument in the article was that “fast food is supposed to be fun and entertainment.” Believe it or not, I do understand this argument. I too have found myself pressed for time at the end of a long work day, driving children around from one scheduled activity to another, and faced with pleas for the “fun and entertainment” that fast food promises to deliver. But that doesn’t change what we know about fast food and all of the other outside forces that threaten our children’s nutritional fortitude.

It probably won’t come as news to anyone when I point out that here in the United States, unhealthy foods are marketed to even the youngest of children. But the magnitude is staggering and the extent to which our children are being influenced may surprise you. I hope the following information will help you better recognize just what we are up against.

Food Fact #1: Children are not only witness to literally thousands of television food ads every year, but an overwhelming majority are for foods significantly lacking in nutritional value. With the exception of a recent (and much heralded) carrot campaign, the vast majority of ads (on the order of nearly 98% for 2 to 11 year olds and ~90% for adolescents) tout energy dense, sugary, salty and/or fatty foods.

Food Fact #2: Exposure to food-related television advertisements increases consumption. In a study that looked at the impact of television ads on children’s eating behavior, exposure to food-related ads served as powerful enough cues to increase subsequent food intake in all children studied.

Food Fact #3: Fast-food companies use toys to market their children’s meals. This fact alone isn’t a big surprise, but now remind yourself that fast food meals typically take the cake when it comes to placing at the very top of the nutritionally dangerous list. Next consider that of the reported $520 million that fast-food companies spent on marketing children’s meals in 2006, toys accounted for nearly three-quarters of this spending. In other words, the marketing of unhealthy foods to children isn’t just limited to television ads. Like it or not, it’s in your Happy Meals and comes in the form of a toy.

While I’d like to agree with the parent interviewed in Mr. O’Connor’s article, I can’t. Reality tells me that even with the best of nutritional intentions, parents are up against a lot. While it is absolutely true that parents can and should try to steer clear of fast-food, teach children to opt for healthier options when purchasing children’s meals, limit children’s television time (and with it, exposure to unhealthy food ads), and encourage daily physical activity along with plenty of fruits and vegetables, I’m not sure that parental interventions alone are going to be enough to overcome the childhood obesity epidemic that is looming large.

Originally posted on Omaha World Herald’s Live Well Nebraska

Katy Perry, Elmo & Sesame Street: An Important Discussion about the Sexualization of Girls

For anyone who may have missed the recent parenting news of the day, pop superstar Katy Perry recently taped a guest appearance on Sesame Street in which she was filmed running from Elmo in a short little low-cut dress and veil. Her yet-to-officially-air frolic with Elmo and friends quickly made its way to You-Tube, triggering a virtual firestorm of national media attention and the subsequent cancellation of the episode’s airing. The fundamental question being raised? Whether Perry’s revealing attire was inappropriate for children’s television.

After listening to one too many national commentators conclude that we’ve all become too prudish as parents and asking, “what’s the big deal?” I feel compelled to stop everything else I’m doing to help parents raise happy, healthy children and answer this admittedly rhetorical question. The fact of the matter is that while it may be superficially amusing to deem this “Cleavagegate” and laugh at the resulting Saturday Night Live skit of Perry donning a breast-emphasizing Elmo t-shirt, there’s something very, very fundamentally wrong about our culture’s acceptance of a scantily-clad 20-something year old female flaunting her highly sexualized assets on what is arguably America’s last bastion of wholesome children’s television.

While I’ve just outed myself as what some would call a prudish parent, I guarantee you I’m not alone in my beliefs. As parents, I strongly believe we need to avoid being lulled into complacency while our children are being steadily fed a media diet of increasingly sexualized images. While sexual well-being is an unquestionably important part of healthy development, a 2007 national report from the American Psychological Association’s Task Force on the Sexualization of Girls concluded that sexualization of girls and women is both pervasive and has wide-ranging negative effects.

So what’s a parent to do? First and foremost, don’t trivialize all of the messages our youngest girls are getting – all of which repeatedly and cumulatively teach them that what really matters is how “hot” they look. You can also take the following steps, adapted from the APA Task Force Report, to teach girls from a very young age to value themselves for who they are, rather than how they look.

  • Tune in and talk to your children. Pay attention to what they’re seeing on TV, in magazines and in the world around them. Discuss what they see in such a way that they learn that looks aren’t the most important quality.
  • Question choices. Don’t hesitate to discuss clothing choices with your daughters so they understand why too short, too revealing, and/or too tight just isn’t appropriate.
  • Speak up. Commit to noticing disturbing images and influences, and then speak up and discuss them with your children. Don’t be afraid to say no to your children, or to any products, campaigns or companies that send the wrong message(s).
  • Educate. Many parents simply aren’t comfortable talking about sexuality with their children, but it’s important. I suggest checking out So Sexy So Soon  and From Diapers to Dating to get yourself started.

While I wish that this was all there was to be said on the subject, the sexualization of girls will inevitably continue to be a force to be reckoned with. And it seems that Katy Perry and her wardrobe choices are here to stay – now reportedly being given a warm welcome by The Simpsons.

While that may be true, we simply don’t have to sit back and allow our children to watch! As parents, we really do have the power to raise our children with respect and a healthy body image, so long as we start by acknowledging that it really is a “big deal”!

Originally posted on Omaha World Herald’s Live Well Nebraska