The American Academy of Pediatrics also recommends that pediatricians at a minimum ask two questions about media use:
• How much time does the child spend on the Internet or other media per day? (and suggesting less than 2 hours).
• Does the child have a television in the bedroom? (and suggesting getting it out of there)!
Those are good questions for all age groups. But for teens, another critical question is "At what time do you turn off your cell phone at night?" A recent study in Belgium showed that about 20% of teens continued to send and receive texts throughout the night, causing a severe disruption in their already limited sleep.
So what can we as pediatricians do? Well, this is a good time to lean back in your chair and ask questions nonjudgmentally rather then spring to the advice or restrictions you may have imposed on your own children. The process of thinking through a behavior to motivate change rather than simply telling someone what to do, called "motivational interviewing," is much more effective.
After collecting media usage information, you might say, "What are the good things you are getting from your media use?" They’re likely to say, "It’s a great way to stay connected with friends, to know what’s going on, and I have learned a lot. It makes my homework easier. I make friends in other parts of the world now. And it is something fun to do even if I can’t go out of the house." You can honestly salute all of those as good things.
The next part of motivational interviewing is to establish ambivalence! While this sounds like a bad thing, in decision-making it’s really good to realize that there are pros and cons to everything. You might ask, "In what ways has texting or the Internet been a problem for you or made you feel bad?" What I’m hearing from kids is a great deal of upset about feeling left out when they see what looks like a big social gathering on Facebook, even if it was a photo taken at the bus stop. At the very least, they are not getting enough sleep and often not doing a good job on homework. Another response might be, "I said more than I meant to say (or posted a compromising photo) and felt sick about it later." This is certainly to be expected owing to the loose boundaries and impulsivity of teens. But once a message or photo is posted, it’s a permanent part of cyberspace, and something that malicious and impulsive peers may distribute to others in a way that can be quite damaging.
After summarizing what they just said were pluses and minuses to their Internet or cell phone use, you can ask them, "Is this something you feel ready to change?" They may say, "No"; or that they’re thinking about it; or that they’re actually ready to make a change right now because they see that this is bad for them.
If they are just considering change, you might suggest they think about it and send you an e-mail next week. If they’re not ready to change, you might ask permission to bring it up again at a future visit. For those teens (or parents who are having trouble limiting media) who are ready to let some media go, picking and writing down a specific target and time, such as no cell use after lights out, no media until homework is done, or no sexy websites because it makes you have weird thoughts, begins a commitment for change.
Then you can text them to check on their success!
Dr. Howard is an assistant professor of pediatrics at the Johns Hopkins University, Baltimore, and creator of CHADIS (www.CHADIS.com). Dr. Howard’s contribution to this publication was as a paid expert to Elsevier. E-mail her at pdnews@elsevier.com.