Music, movies, television, and video games can have adverse effects on the behavior of children and teens, so pediatricians should find out what their patients watch and listen to, according to two policy statements from the American Academy of Pediatrics.
Music plays an important role in the socialization of children and adolescents, members of the AAP council on communications and media concluded in one statement.
Meanwhile, an increasing number of studies are showing that violence in music, movies, television, and video games is affecting young people's behavior, they said in another statement.
"Pediatricians and other child healthcare providers can advocate for a safer media environment for children by encouraging media literacy, more thoughtful and proactive use of media by children and their parents, more responsible portrayal of violence by media producers, and more useful and effective media ratings," the authors said.
The policy statements appeared in the November issue of Pediatrics.
Studies have suggested that children and teens spend more time listening to music than watching TV each day.
This can be an issue because parents are often unaware of the lyrics of the music to which their kids are listening, especially when they're downloading music online and listening with headphones.
Lyrics have become more explicit in references to sex, drugs, alcohol, tobacco, and violence, the authors said.
Studies have linked a preference for certain types of music to specific behaviors.
For example, the kind of electronic music played at raves has been associated with use of drugs and alcohol, while heavy metal and rap have been associated with reckless behavior and below-average academic performance, the authors said.
Heavy metal and some rock music have also been associated with an increased risk of suicide, depression, delinquency risk behavior, smoking, and conduct problems.
"With the evidence portrayed in these studies, it is essential for pediatricians and parents to take a stand regarding music lyrics," the authors said.
Music videos have also been shown to have an influence on the behaviors and attitudes of children and teens.
For instance, watching music videos has been associated with the development of false stereotypes and an increased concern about appearance and weight among adolescent girls.
Taking these findings into consideration, the authors recommended that pediatricians do the following:
- Become familiar with the role of music in the lives of children and adolescents and identify music preferences that could be clues to emotional conflict or problems.
- Become familiar with the literature linking music to behavioral problems.
- Explore with patients and parents the type of music to which they listen.
- Encourage parents to take an active role in monitoring their youngsters' music and music video watching.
- Encourage parents and caregivers to become media literate.
- Help raise public awareness of these issues by participating in local and national coalitions to discuss the effects of music on children.
The group also made the following recommendations:
- Parents and public should be aware of and use the music industry's parental advisory warning of explicit content.
- Performers should serve as positive role models for children and teens.
- The music video industry should produce more videos with more positive themes about relationships, racial harmony, drug avoidance, nonviolent conflict resolution, sexual abstinence, pregnancy prevention, and avoidance of promiscuity.
The AAP council on communications and media focused on violence in various media -- including TV, music, movies, and video games -- in particular.
The authors reviewed numerous studies that found associations between media violence and aggressive behavior, bullying, desensitization to violence, nightmares, depression, sleep disturbances, and a fear of being harmed that could result in a teen carrying a weapon or acting more aggressively.
The strength of these relationships is greater than more widely accepted medical associations, such as those between calcium intake and bone mass, lead ingestion and lower IQ, and condom nonuse and sexually acquired HIV infection, the authors asserted.
In fact, they wrote, the media associations are nearly as strong as the association between cigarette smoking and lung cancer.
"The evidence is now clear and convincing: media violence is one of the causal factors of real-life violence and aggression," the authors said.
Although pediatricians have accepted this as fact, they said, the American public, politicians, and parents have been slow to respond, and violent media remains easily accessible.
"Although exposure to media violence is not the sole factor contributing to aggression, antisocial attitudes, and violence among children and adolescents, it is an important health risk factor on which we, as pediatricians and members of a compassionate society, can intervene," the authors said.
They made the following recommendations for pediatricians:
- Ask at least two media-related questions at each well-child visit: how much TV is the child watching, and is there a TV or Internet connection in the bedroom?
- Suggest alternatives to media, such as sports, interactive play, and reading.
- When heavy media usage is detected, evaluate the child for aggressive behaviors, fears, or sleep disturbances.
- Encourage parents to follow the AAP recommendations on media use, including prohibiting media in bedrooms, making thoughtful media choices and co-viewing with kids, limiting screen time to one to two hours a day, and providing no screen media at all for infants and toddlers under two years old.
- Ensure than only nonviolent media choices are present in waiting rooms and inpatient settings.
- Advocate at the local levels for the education of children in media literacy.
- Advocate on state and national levels to keep media violence in the public consciousness.
- Advocate for more child-positive media.
- Advocate for a universal media rating system based on content.
The authors also called on the entertainment industry to adhere to the following guidance:
- Do not glamorize weapon carrying.
- Eliminate the use of violence in a comic or sexual context.
- Eliminate gratuitous portrayals of interpersonal violence.
- The pain and loss suffered by victims should be shown if violence must be used.
- Music lyrics should be made easily available to parents so they can read them before purchasing music.
- Video games should not use humans or other living targets, and points should not be awarded for killing.
- Violent video games should be limited to age-restricted areas of arcades.
The authors made no financial disclosures.
Zalman S. Agus, MD Emeritus Professor
University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner