Screen time permeates the lives of toddlers and preschoolers. For many young children, their exposure includes both direct viewing, such as watching a TV show, and indirect viewing, such as when media is on in the background during other daily activities.

As many parents will know, . As scholars who specialize in and , we are particularly interested in the recent finding that too much screen time is associated with less parent-child talk, such as .

As a result, the and suggest limiting screen time for children.

Beyond quantity, they also emphasize the quality of a child鈥檚 engagement with digital media. Used in moderation, certain kinds of media can 鈥� and even contribute to language development.

These tips may help parents structure and manage screen time more effectively.

No. 1: Choose high-quality content

Parents can enhance their children鈥檚 screen-time value by choosing high-quality media 鈥� that is, content with educational benefit. , from 鈥淣ature Cat鈥� to 鈥淪id the Science Kid,鈥� that would qualify as educational.

Two other elements contribute to the quality of screen time.

First, screen content should be age-appropriate 鈥� that is, parents should choose shows, apps and games that are specifically designed for young children. Using a resource such as allows parents to check recommended ages for television shows, movies and apps.

Second, parents can look for shows that use evidence-based educational techniques, such as participatory cues. That鈥檚 when characters in shows break the 鈥渇ourth wall鈥� by directly talking to their young audience to prompt reflection, action or response. that children learn new words better when a show has participatory cues 鈥� perhaps because it encourages active engagement rather than passive viewing.

Many classic, high-quality television shows for young children feature participatory cues, including 鈥�,鈥� 鈥�,鈥� 鈥溾�� and 鈥�.鈥�

No. 2: Join in on screen time

The that whenever possible.

This recommendation is based on the evidence that increased screen media use can reduce parent-child conversation. This, in turn, can affect . Intentionally discussing media content with children increases language exposure during screen time.

Parents may find the following joint media engagement strategies useful:

• Press pause and ask questions.
• Point out basic concepts, such as letters and colors.
• Model more advanced language using a 鈥渢hink aloud鈥� approach, such as, 鈥淭hat surprised me! I wonder what will happen next?鈥�

No. 3: Connect what鈥檚 on screen to real life

because their brains struggle to transfer information and ideas from screens to the real world. Children learn more from screen media, research shows, when the content connects to their real-life experiences.

To maximize the benefits of screen time, parents can help children connect what they are viewing with experiences they鈥檝e had. For example, while watching content together, a parent might say, 鈥淭hey鈥檙e going to the zoo. Do you remember what we saw when we went to the zoo?鈥�

This approach promotes language development and cognitive skills, including . Children learn better with repeated exposure to words, so selecting media that relates to a child鈥檚 real-life experiences can help reinforce new vocabulary.

No. 4: Enjoy screen-free times

Ensuring that a child鈥檚 day is filled with varied experiences, including periods that don鈥檛 involve screens, increases language exposure in children鈥檚 daily routines.

Two ideal screen-free times are mealtimes and bedtime. Mealtimes present opportunities for back-and-forth conversation with children, exposing them to a lot of language. Additionally, bedtime should be screen-free, as using screens near bedtime or having a TV in children鈥檚 bedrooms .

Alternatively, devoting bedtime to reading children鈥檚 books accomplishes the dual goals of helping children wind down and creating a .

Having additional screen-free, one-on-one, parent-child play for at least 10 minutes at some other point in the day is good for young children. Parents can maximize the benefits of one-on-one play by letting .

A parent鈥檚 role here is to follow their child鈥檚 lead, play along, give their child their full attention 鈥� so no phones for mom or dad, either 鈥� and provide language enrichment. They can do this by labeling toys, pointing out shapes, colors and sizes. It can also be done by describing activities 鈥� 鈥淵ou鈥檙e rolling the car across the floor鈥� 鈥� and responding when their child speaks.

Parent-child playtime is also a great opportunity to extend interests from screen time. Including toys of your child鈥檚 favorite characters from the shows or movies they love in playtime transforms that enjoyment from screen time into learning.

This article is republished from under a Creative Commons license. Read the .

The Food and Drug Administration April 29 that it will reserve the dates June 8, 21 and 22 for its vaccine advisory committee to review the emergency use authorization requests of Moderna’s and Pfizer-BioNTech’s coronavirus shots for toddlers. While the dates remain subject to change, they provide an indication of when doses may be available to those under 5, as the FDA typically follows the recommendation of the committee in the weeks following its meeting.

Members of Congress sent a to the U.S. Food and Drug Administration Monday asking whether the agency intended to delay reviewing Moderna鈥檚 coronavirus vaccine for children 5 years old and younger and for 鈥渢he scientific basis and any other rationale鈥� for such an action.

The move comes after White House officials told last week that young kids, the last age group not yet eligible for coronavirus vaccines, will likely have to wait until the summer for immunizations 鈥� a longer timeline than previously expected.

Although Moderna completed the trial for its toddler vaccine in late March and submitted a on Thursday, Anthony Fauci said that the FDA is considering reviewing the pharmaceutical company鈥檚 application at the same time as Pfizer-BioNTech鈥檚, which has not yet been submitted.

“[The] two products 鈥� are similar but not identical, particularly with regard to the dose. And what the FDA wants to do is to get it so that we don’t confuse people to say, ‘this is the dose. This is the dose regimen for children within that age group of 6 months to 5 years,'” President Biden鈥檚 chief medical advisor on Thursday.

鈥淪uch a decision could delay the potential authorization and administration of the Moderna vaccine by several weeks,鈥� points out Rep. James Clyburn, chair of the House Subcommittee on the Coronavirus Crisis, in its letter to the FDA. The committee asked for a staff briefing on the subject by May 9.

In early February, Pfizer-BioNTech submitted data on a two-dose vaccine series for children under 5 to the FDA, but in a highly unusual move withdrew their application just 10 days later. The two shots, which are 10 times less potent than the companies鈥� adult doses, were safe for all age groups, but did not provide enough protection against the Omicron variant for 3- and 4-year-olds. Pfizer-BioNTech now plans to request that the FDA authorize a three-dose regimen for children under 5, the companies have said.

The Moderna series currently submitted for review includes two shots that are each one-quarter the dose adults received. Trial data showed shots to be 44% and 38% effective in preventing illness among children 6 months to 2 years old and 2 years to under 6 years old, respectively.

But despite the relatively low efficacy, many parents of young children are anxious for a base level of protection for their kids, especially as mask mandates and social distancing requirements continue to fall across the country. 

For some, the idea that the FDA would delay the Moderna shots on parents鈥� behalf 鈥� ostensibly to avoid confusion 鈥� struck the wrong chord.

鈥淚f I sign a waiver saying 鈥業 don鈥檛 find this confusing at all,鈥� can I go ahead and get the vaccine for my four-year-old?鈥� parent and New York Times writer Whet Moser .

Meanwhile, a Tuesday report from the Centers for Disease Control and Prevention revealed that more than half of Americans have been infected by the coronavirus, including . Rates of prior infection nearly doubled over the course of the Omicron surge, the agency found.

Jennifer Shu, an Atlanta-based pediatrician, agrees that if doses are ready for emergency use authorization, Washington should not delay the rollout. After all, vaccines from separate companies were approved at different times for other age groups, she pointed out.

鈥淚f it’s ready to go, if the science has proven that the vaccine is safe and effective, then why not let the parents educate themselves on it?鈥� she told 蜜桃影视, adding that health professionals like herself can help families make an informed choice.

Parents of kids under 5 may feel they鈥檙e being 鈥渢hrown under the bus鈥� as pandemic precautions dwindle and the BA.2 Omicron subvariant threatens, said Shu.

But despite thousands of families eager to vaccinate their toddlers, still more are likely to pass on the opportunity when it becomes available. 

Immunization rates remain relatively low for older kids and teens with 28% of 5- to 11-year-olds and 58% of 12- to 17-years-old fully vaccinated as of April 20, according to the . New immunizations have slowed nearly to a halt, with vaccine coverage having increased only 1 percentage point in each age group since mid-March.

Even as vaccination rates are flatlining, Pfizer-BioNTech is planning to seek authorization for a third booster shot for kids 5- to 11-years old after trials found that it offers added protection against the Omicron variant.

According to by the Centers for Disease Control and Prevention, body mass index (a common measure of weight relative to height) in a sample of 430,000 children increased between March and November 2020 at nearly double the rate that it did before the pandemic began. The changes were especially prevalent among elementary-aged children, as well as those who were already overweight or obese.

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Dietician Michelle Demeule-Hayes, the director of at Baltimore鈥檚 Mt. Washington Pediatric Hospital, called the trends 鈥渟taggering.鈥�

鈥淚t鈥檚 never been this bad,鈥� she added. 鈥淪o the research is definitely accurate.鈥�

The CDC鈥檚 findings echo those of other research released in the past few months. by the Journal of the American Medical Association (JAMA) showed that rates of overweight and obesity have soared among children measured in California between the ages of 5 and 17. Two others 鈥� one and appearing in the journal Pediatrics 鈥� found that the weight gain was greater for certain demographic subgroups, including Hispanic, African American, publicly insured, and low-income children.

The spate of publications suggests a national spike in pediatric weight gain as kids have been restricted in their movements outside the home.

Corinna Koebnick, a nutrition scientist at Kaiser Permanente Southern California and a co-author of the JAMA paper, wrote in an email that it was 鈥渟afe to say鈥� that children have gained weight during the pandemic, and that it was unclear whether opening schools to in-person learning will be enough to reverse the trends that have taken hold.

鈥淭he increase in obesity over the 11 months [we] analyzed compares to the increase seen in national data over almost the last two decades,鈥� Koebnick said. 鈥淐hildren who have social and financial disadvantages, who live in school districts with less money or…less access to parks and meal programs may have additional challenges returning to healthy weights.鈥�

Koebnick鈥檚 study used Kaiser Permanente electronic health records for over 190,000 children whose body-mass index (BMI) was measured during a medical visit both before and during the pandemic. Researchers divided patients into three age groups (those between the ages of 5 and 11, 12 and 15, and 16 and 17) and studied their tendency to be overweight (at or above the 85th percentile of BMI for age) or obese (at or above the 95th percentile.)

Children in all three age groups gained more weight during the pandemic than they did before. But elementary-aged kids saw the biggest relative gains, with an average increase of BMI of 1.57, compared with an increase of 0.91 for the next-youngest group and 0.48 for the oldest. Adjusted for height and translated into actual weight, those figures indicate average gains of 5.07 pounds, 5.09 pounds, and 2.27 pounds for the respective groups.

Overall, the portion of 5-11-year-olds who are classified as overweight or obese is now 45.7 percent, up from 36.2 percent before the pandemic. The same figures rose by 5.2 percent among 12-15-year olds and 3.1 percent among 16- and 17-year-olds.

Demeule-Hayes, said that the wave of research on pandemic-related weight gain reflected the reality she and her colleagues face every day. Some patients referred to her, none older than 17, weigh as much as 400 pounds, and it has become typical to treat children diagnosed with what are typically seen as adult ailments, such as hypertension, high cholesterol, diabetes, and osteoarthritis.

Several papers already showcased the rising prevalence of type-2 diabetes. In both Washington, D.C., and Baton Rouge, Louisiana, researchers discovered that pediatric diagnoses of the dangerous and chronic condition approximately doubled in the year after school closures began. Among children diagnosed during that period, one study found that 60 percent required hospitalization for complications like severe hyperglycemia, compared with just 36 percent in the year before COVID emerged.

But Demeule-Hayes said that another common health complication of obesity, obstructive sleep apnea, poses particular risks for K-12 students.

鈥淭here are a whole lot of sleep disturbances with these kids because they’re tired, they’re not getting good-quality REM sleep,鈥� Demeule-Hayes said. 鈥淪o they’re coming home and taking naps, which just perpetuates that sleep-disturbance cycle 鈥� they can’t get to sleep later because they’ve taken a three-hour nap after school.鈥�

Experts are still investigating how the coronavirus changed the lifestyles of both children and adults. have shown that sales of packaged and processed foods shot up in the early months of the pandemic, and suggests that consumption of fresh foods declined. Demeule-Hayes pointed to the monthslong stillness that followed school closures, during which she watched her own young children learn from inside the house.

“Having them be on a computer literally all day, not having any of the recess or the steps outside or even just walking up and down the halls 鈥� they’ve been so, so sedentary,鈥� she lamented. 鈥淧re-pandemic, even if they were getting driven to school, they were still at least walking around the school and walking up one or two flights of stairs to classrooms.

According to tech firm SuperAwesome, the time children spent on screens each day after COVID-related closures began; 40 percent of kids aged 3-9 said they spent 鈥渕uch more鈥� time on screens. Respondents to of Canadian youth reported lower levels of physical activity, less time spent outside, more sedentary behaviors, and more sleep than before the pandemic.

As school districts around the country reopened for full-time, in-person learning, educators have welcomed back students whose lives were meaningfully 鈥� and perhaps permanently 鈥� altered by COVID. The extent of the academic damage is thought to be extensive, and hospital records suggest that many children may have suffered prolonged abuse while separated from their schools. On top of those severe setbacks, the bodily changes that some have undergone may prove long-lasting: Obese children and adolescents are as adults.

Koebnick recommended that parents limit screen time and encourage their kids to exercise and drink lots of water. Demeule-Hayes said that she recognized that some parents might still be leery of outdoor play given the dangers of the Delta variant. Still, she said, there was much that families and educators could do to combat further weight gain.

鈥淎s much as teachers and administrators can work [movement] into school time, they should. For parents, it’s taking walks as a family, after dinner, whenever you can work it in. Our message is always to make changes as a family so there’s not a stigma around a child’s ‘weight issue’; it’s really about making healthy changes for the family.鈥�

They are, however, little sponges, rapidly soaking up the attitudes and emotional responses they encounter. By the time they are toddling and talking, they have begun to form opinions and responses of their own 鈥� again, before they even have words to articulate their thoughts. By the time they are 2, they have begun to internalize racial bias.

鈥淩acial attitudes are formed not only by what children hear, but by actions and reactions of those around them,鈥� Doug茅 says. 鈥淵ou may never say to your child, 鈥業 think such-and-such about race,鈥� but your child will absorb what you think and feel.鈥�

As health services director of Maryland鈥檚 Howard County Health Department, Doug茅 coauthored a policy statement for the American Academy of Pediatrics (AAP) journal Pediatrics on the . Although progress has been made in the U.S. toward racial equality and equity, she writes, racism鈥檚 ongoing negative impact on the health and well-being of the nation鈥檚 children is clear. Failure to address racism will continue to undermine health equity for all of our children and families. The good news, she says, is that this moment represents an unprecedented opportunity to shape the future in powerful ways, for our children and for ourselves.

Just as we vaccinate our children early in their lives against polio and other devastating diseases, so we can inoculate our children against racial bias and provide them with lifelong tools to effectively address the biases they encounter. In the process, we can enrich our own lives.

As with all cultural change, the starting place is with ourselves, Doug茅 says. Confronting our biases and fears, examining our attitudes and consciously creating a wide, culturally diverse social network can provide the first steps toward profound social change. Make some new friends and take your babies with you. Your interest, kindness and compassion will model how you want your children to respond to people鈥檚 differences without your ever saying a word.

According to two , there鈥檚 even more to it than that. According to professor Kang Lee, these studies show that babies begin to show racial preferences by the time they 6 to 9 months old in favor or members of their own race and against those of other races. The cause, he says, appears to be a lack of exposure to other races. Prior studies from other labs indicate that more than 90% of infants only interact with people of their own race, which provides little to no experience with other-race individuals. Early exposure may help hard-wire awareness of 鈥渙therness鈥� in positive ways.

When it鈥檚 time to talk about race, Doug茅 wants you to know it鈥檚 OK. It isn鈥檛 racist to address the issue or answer and anticipate questions your child may have 鈥� particularly in this time when every media source is insistently broadcasting stories of race. When your child notices differences, there鈥檚 no need to self-consciously shush them: consider it a teaching moment, and one in which similarities as well as differences can be underscored. If you don鈥檛 talk to them about race, they could begin to fill in the blanks with the biases of the world outside your home.

鈥淚t鈥檚 important that you have these conversations in ways that are developmentally appropriate,鈥� she says. 鈥淲hen you teach your kids the importance of washing hands to prevent the spread of disease, you don鈥檛 go into the whole epidemiologic, scientific background. It鈥檚 the same way with race. There is nothing wrong with acknowledging that people have different hair colors, eye colors and skin colors, and doing that when children are very young.鈥�

鈥淭here鈥檚 no shame to noticing. You don鈥檛 want to shame anyone 鈥� we just want to start from very young being conscious of how we create the narrative about how people are and how they can be.鈥�

One tip Doug茅 and Dr. Ashaunta Anderson, who cowrote 鈥溾�� as an AAP resource for parents, offer is when your preschooler notices and points out differences in the people around you in the grocery store or park, hold your arm against theirs to show the differences in skin tone even within your own family. Comparing and commenting about how our wonderful differences are will go much farther than trying to distract or shush a child who has noticed that people don鈥檛 all look the same. Or, if they say something biased, ask how they know that and gently correct the mistaken belief.

For most of our children, day care and school are the two places second to family where racial attitudes are learned. Though the coronavirus pandemic has limited many children鈥檚 exposure to other children, we won鈥檛 all be staying at home forever and Brug茅 says it鈥檚 extremely important for parents and caregivers to be conscious, aware and involved when it comes to what鈥檚 happening in their school and group situations.

According to a , racial profiling of our children begins almost as soon as children enter preschool. Black children represent 18% of preschool enrollment but 48% of children receiving more than one out-of-school suspension. We are talking about 4-year-olds.

鈥淭here鈥檚 a role for parents to play in terms of making sure that the environment is supportive of all kids and reaching out to teachers, the board of education, whomever they need to get involved,鈥� she says. 鈥淏eginning from an early age, parents can educate their children to speak up about things they see that are unfair or wrong. Depending on the age of the child, a parent might need to step in and say, 鈥榃hat you said there is probably not the nicest thing to say,鈥� when they observe stereotyping or bias. Again, this models effective behavior even starting at a very young age.

鈥淭here are always opportunities to teach our children to not just stand by but to actually help to make a difference when they can. If they鈥檙e too young or uncomfortable to intervene themselves, we can teach them to tell their teacher or another adult.鈥�

Doug茅 says she is encouraged by the massive energy and awareness behind the Black Lives Matter protests that continue to take place throughout the country and particularly the participation of people who previously might not have thought that racism directly affected them.

鈥淭his is really an 鈥榓ll-and-everyone鈥� situation now,鈥� she says. 鈥淚t鈥檚 not like, 鈥極h, the Black people have it,鈥� because that鈥檚 not how change happens. Look at the Civil Rights Movement. Yes, we have the historical figure, Martin Luther King, Jr., and all the other Black people in that movement. But if you look at the March on Washington, many of the individuals were not Black. They were white Americans. There鈥檚 been a long history of white Americans taking up the cause of justice. And when we鈥檙e talking about women鈥檚 rights and suffrage, men also took part in that cause.鈥�

鈥淭o move this country forward, it isn鈥檛 just the marginalized people who make that change. It鈥檚 all of us working together and coming in to help,鈥� she says. 鈥淚 know confronting all of this is uncomfortable, but it鈥檚 time to have these conversations and do this work.鈥�

Starting with our babies and our own circle of connections.

RESOURCES

• Online module: (Institute for Learning and Brain Sciences)
• : The American Academy of Pediatrics Parenting Website
• 鈥�,鈥� by Peggy McIntosh (Peace and Freedom Magazine, July/August, 1989).聽
• (TEDEd)
• (NPR)

Mount Sinai鈥檚 pediatric residency program takes on 22 new doctors per year. Recently, this highly regarded program has undertaken a revolutionary new approach to training, which may be destined to transform pediatric education all over the country.

The Keystones of Development curriculum, an online, self-directed platform, currently is being piloted at eight residency programs across the country. Preliminary results are encouraging, with significant shifts in pediatricians鈥� knowledge, behavior and confidence. The modules are winning praise from residents. One used all caps in her concise review: 鈥淚 LOVE THEM.鈥� Another commented 鈥淚t鈥檚 something that I started using the very next day with a lot of my parents.鈥�

This week, Keystones of Development is taking the next step on its journey to scale, with a workshop at the annual gathering of the in New Orleans. The goal is to get this curriculum into every pediatric residency program in the country.

To understand this breakthrough, think about how preventive medicine 鈥� for example, immunizations and antibiotics 鈥� has changed medicine in recent decades. Children are surviving diseases that were once considered death sentences. At the same time, pediatricians are seeing an increase in behavioral and developmental issues and are fielding questions from parents regarding tantrums and timeouts.

Noticing these trends, Dr. Blair Hammond, 2010 winner of the Mount Sinai Excellence in Teaching Award, found herself frequently seeking the advice of her friend, Dr. Aliza Pressman, a developmental psychologist. The Division Chief of Developmental Pediatrics at Mount Sinai, Dr. Eyal Shemesh, was enthusiastic about inviting Dr. Pressman to teach about the everyday questions that parents have regarding their children鈥檚 behavior and emotional development, with a focus on promoting optimal development.

Eventually, this partnership gave rise to the Mount Sinai Parenting Center, with Dr. Carrie Quinn coming on as executive director. Another member of the interdisciplinary team was social worker Mariel Benjamin, from the department of maternal child health. The Mount Sinai Parenting Center鈥檚 first big undertaking: the reinvention of how pediatric residents are trained.

All pediatricians must complete at least a three-year residency. They learn about how to care for premature babies, how to diagnose meningitis and which vaccine to give. They study the treatment for pneumonia and the signs of autism. Historically, however, they鈥檝e been missing one huge piece of the puzzle 鈥� the developing mind.

鈥淲e have people who are new to being doctors,鈥� Hammond says, 鈥渕eeting with people who are new to being parents.鈥� On both sides, there鈥檚 a feeling of inadequacy, and in between them is the child鈥攚ho鈥檚 new at being a person.

One of the first resources that the team turned to was Ellen Galinsky鈥檚 Mind in the Making, a groundbreaking and highly readable synthesis of research on mental development. Galinsky summarizes recent experiments illuminating the elasticity of baby鈥檚 brains. 鈥淵es, babies鈥� capacities are truly amazing,鈥� she writes. 鈥淏ut even more amazing is that we now know how to take advantage of these capacities to help babies, and their older sisters and brothers, develop the essential life skills that will serve them throughout their lives.鈥�

Although the text was considered too deep a dive for Sinai鈥檚 residents, the center continues to use it for social workers, child life specialists and other professionals. For pediatric residents, finding time for educational initiatives can be difficult. Eighty-hour weeks and the stress of being thrust into new situations contribute to fatigue and anxiety.

One thing became clear: residents wanted not only foundational knowledge but also tips on what to say in the exam room with patients and families. How could new doctors learn to fit this script into their brief 15-minute well visits with children? That was the challenge.

鈥淚t鈥檚 about fitting teachable moments into care,鈥� says Pressman. 鈥淓veryday health care moments become opportunities to impart broader parenting skills.鈥� Take a routine vaccination, for example. The program reminds residents to notice how parents comfort their children and how powerful that connection can be in helping their child get through a difficult challenge. Another tip for the new doctors is giving young patients the option: Do you want me to examine your ears first, or your eyes? And then turning to the parent and observing that being able to make choices increases a child鈥檚 sense of agency.

Knowing the audience is a key to the curriculum鈥檚 philosophy. , 70% of pediatric residents are women. Hammond notes that 60% are graduates of U.S. medical schools, with the remainder coming from foreign medical schools and from institutions like St. George鈥檚 University School of Medicine on the Caribbean island of Grenada, which specializes in training American students. They are mostly in their mid- to late- twenties, and most don鈥檛 have children of their own.

Keystones of Development is free, quick and even accessible on a smartphone鈥攊n other words, it鈥檚 made for millennials. Each of the twelve modules focuses on a small number of concrete skills for building vital parent-child connections.

For Pressman, Sinai鈥檚 program embodies the principle that every health care encounter is an opportunity to foster supporting parents and families. She notes that 99% of children are born in a hospital. 鈥淭hat鈥檚 an opportunity,鈥� she maintains, 鈥渢o meet parents where they are and provide them with tools and support from the beginning.鈥� These opportunities continue throughout the first five years, with an average of 15 well-child visits and numerous sick visits.

In many instances, the pediatrician is a parent鈥檚 only trustworthy source of information and encouragement. The Mount Sinai Parenting Center is making sure these doctors are equipped to model and support behavior that promotes development. Something as simple as how parents speak to their infants can make significant differences in the their language development. 鈥淚t takes 30 seconds, and it truly matters,鈥� Pressman says.

As she prepared for the New Orleans conference, Hammond reflected on the magnitude of their undertaking: 鈥淲e鈥檙e trying to change the whole culture of pediatrics.鈥�