Television and Your Child's Health

Monika Pis, PhD, CPNP

 The average American child spends approximately 26 hours a week watching television, and 26% of children reported watching 4 or more hours of television per day (Andersen, Crespo, Bartlett, Cheskin, & Pratt, 1998). In 1961, the average age children started to watch television was 2.8 years; today, it is 9 months! (Zimmerman, Christakis, & Meltzoff, 2007). 

The first two years of children’s lives represent a critical window for neurological development. Studies show that viewing television before age 3 has been associated with attention and cognitive problems at school age (Christakis, Zimmerman, Giuseppe, et al., 2004; Zimerman, & Christakis, 2005). Even programs like Sesame Street can delay language acquisition when watched by children who are too young (Linebarger, & Walker, 2005).

The American Academy of Pediatrics recommends that children younger than 2 years of age watch no television, and those over the age of 2 years spend no more than 1-2 hours a day in front of the TV. These recommendations are based on the research findings showing that television has a strong influence on health. In addition, television viewing is a sedentary activity, thus contributes to less energy expenditure by children, and the rate of overweight and obesity among children and adolescents in the United States has already doubled in the last two decades.

Increased Snacking
Children watching TV are subjected to a multitude of ads promoting unhealthy foods that are high in fat and sugar. Research showed that television viewing of more than one hour of TV per day was associated with a much higher consumption of fast food, sweets, chips, and pizza than fruits and vegetables (Muller, Koertzinger, Mast, Langnase, & Grund, 1999).

Nationally representative data showed that the prevalence of snacking increased in all age groups over the past 20 years (Jahns, Siega-Riz, & Popkin, 2001), and although the average size of snacks and energy per snack remained relatively constant, the number of snacking occasions increased significantly; therefore, increasing the average daily energy intake. Could watching many hours of television have anything to do with the obesity epidemic in the U.S.?

Obesity
Television viewing is sedentary, and children who are not physically active are at a higher risk for becoming overweight. Countless studies show a relationship between watching television and weight gain. Sedentary TV viewing displaces physical activity, decreases metabolic rate, and increases caloric intake leading to excessive weight (see Increased Snacking above).

Physical Health Problems
Overweight in childhood has been associated with a number of physical health problems, some of them immediate, and some presenting as long-term consequences and emerging in adulthood. Some of the health problems that have been contributed to obesity in childhood are high blood pressure, heart and gallbladder disease, and diabetes (Troiano et al., 1995). In addition, studies show association between obesity and severity of asthma, abnormal liver enzymes resulting from fat accumulation around the liver, and sleep apnea.

Poor Manual Dexterity
Preschool children watching television might develop inadequate manual dexterity due to the lack of activities such as playing with play dough, using plastic scissors, finger painting, playing a toy piano, etc.

Self-Esteem
Overweight affects the mental health of children and adolescents. Overweight children report negative assumptions made about them by others, including being lazy, strong, tougher than others, not having feelings, and being unclean (American Obesity Association, 1999). Because of the negative connotations of obesity, obese children are at risk to develop negative self-image that might persist into adulthood.

Aggression
Observational and experimental studies reveal that television violence induces real-life aggression in children in three ways. First, repeated exposure to violence on television may desensitize children to violence. Second, watching favorite TV superheroes acting violently, may sand a message that such behaviors are acceptable, justified, and desirable. Lastly, TV violence may send a message that the world is a scary place and aggression is a form of survival.

ADHD
A few decades ago, a theory was born that the rapid changes of images and sound on television may overwhelm the neurological systems of young children and lead to problems with attention later in life. Recent scientific findings reported that television viewing at age 1-3 years is associated with ADHD at age 7 years (Christakis, Zimmerman, Giuseppe, et al., 2004). Researchers found that watching 5 hours of TV per day at age 1 year was associated with a 28% increase in the likelihood of having ADHD at age 7 year.

Risk-Taking Behaviors
Television portrays many risky behaviors. Countless movies are filled with images of drinking, cigarette smoking, and obscene language. Ads marketing beer are prominent and send a message that “cool people” drink alcohol, thus influencing pre-teens’ and teens’ attitudes toward drinking. Several studies showed that the more exposure teens had to alcohol and cigarettes on television, the more likely they were to engage in drinking and/or smoking.

Intimate relationships shown on television often portray sex as an inconsequential behavior, or a game. Rarely, shows mention the need for protection, or discuss the meaning of responsible sex in a context of a serious relationship.

A Note to Parents
There is no doubt television is an integral part of the 21st century life. However, it should never be taken for granted. The effects of television on children are real. Parents can use television as a tool in teaching children about various aspects of life. The key is that they exercise control of what is watched and how much time their children spend in front of the TV.

Suggestions for Healthy TV Viewing
 Have TV in a central location (not your child’s bedroom), so you can monitor the quantity and quality of programs watched
 Do not allow snacking while watching TV (or allow only fruits and vegetables)
 Watch TV together. You’ll be available to discuss what’s going on on the screen
 Teach your children to watch TV critically (TV has a point of view!)
 Reinforce positive messages of television programs, and discuss the negative ones. Television may serve as a spring board for a good family discussion and teach your children right from wrong



References
American Obesity Association (1999). The facts about obesity in youth [online]. Available:www.obesity.org/Obesity_Youth.htm (9-23-00).
Andersen, R., Crespo, C., Bartlett, S., Cheskin, L., & Pratt, M. (1998). Relationship of physical activity and television watching with body weight and level of fatness among children: Results from the Third National Health and Nutrition examination Survey. JAMA, 279, 938-942.
Christakis, D., Zimmerman, F., Giuseppe, D.,et al. (2004). Early television exposure and subsequent attentional problems in children. Pediatrics, 113(4), 708-713.
Jahns, L., Siega-Riz, A., & Popkin, B. (2001). The increased prevalence of snacking among US children from 1977 to 1996. The Journal of Pediatrics, 134(4), 493-498.
Linebarger, D., & Walker, D. (2005). Infant’s and toddler’s television viewing and language outcomes. American Behavioral Scientist, 48(5), 624-645.
Muller, M., Koertzinger, I., Mast, M., Langnase, K., & Grund, A. (1999). Physical activity and diet in 5 to 7 years old children. Public Health Nutrition, 2, 443-444.
Troiano, R., Flegal, K., Kuczmarski, R., Campbell, S. & Johnson, C. (1995). Overweight prevalence and trends for children and adolescents: The National Health and Nutrition Examination Survey, 1963-1991. Archives of Pediatrics and Adolescent Medicine, 149.
Zimmerman, F., Christakis, D., & Meltzoff, A. (2007). Media viewing by children under 2 years old. Archives of Pediatric and Adolescent Medicine, 161. Available online at: http://ilabs.washington.edu:16080/news/UW_I-Labs_infant_TV_viewing.pdr.pdf.
Zimerman, F., & Christakis, D. (2005). Children’s television viewing and language outcomes: A longitudinal analysis of national data. Archives of Pediatric and Adolescent Medicine, 159(7), 619-625.