Babies and TV: Why Not Have Them Watch?

The American Academy of Pediatrics has again spoken against screen entertainment for children under two. They made their first policy statement about this in 1999, and they haven’t changed their minds. You can see a discussion of their position and thinking at http://www.nytimes.com/2011/10/19/health/19babies.html. When TV first became available, the cautionary joke was that if you watched too much your eyes would become square; the AAP today is seriously cautioning that young children’s mental development can be slowed by exposure to this kind of stimulation.

Is there clear evidence that television, videos, and computer displays do interfere with cognitive development in the first years of life? No, as a matter of fact, the evidence is not very clear, because it’s very difficult to establish. Because the first principle of research on human beings is to do no harm, and because that principle is especially important for the study of the very young, no one is going to do a randomized controlled trial (experimental) study of the effect of screen-watching on intelligence and academic ability. We’re left with nonrandomized studies, in which babies who ordinarily watch screens a great deal are compared with those who watch little or no screen entertainment. But although such evidence should certainly be given some weight, it’s important to remember that it involves confounded variables-- a confusion between the effects of screen-watching itself and other characteristics of families who do or do not expose their young children to screen-watching experiences.

It seems unlikely that chance alone determines the amount of screen exposure young children get, because on the whole they depend on their caregivers to set up a program, turn a device on, etc. Parents do or don’t do these things because of their own beliefs, motives, needs, and understanding of their children’s needs, and those beliefs and so on will also impact other aspects of their caregiving. For instance, parents who are exhausted or overwhelmed by problems may be more likely to want their children to be distracted and to leave the adults alone, but they may also talk to and look at the children less or be more irritable and difficult to communicate with. Parents whose poverty keeps them cooped up in a small apartment with their children, and whose dangerous neighborhood discourages them from going outside, may find screen-watching a lifesaver, but their children’s development may also be influenced by living in a poor and frightening place. When these children with a history of extensive screen-watching do poorly in school, we can’t know which of these factors really caused the problem-- or indeed whether it was caused by all the factors working together.

Nevertheless, all the major thinking of the last century about early mental development has emphasized the idea that children under the age of two are active rather than passive learners. They can learn some things by watching other people, but on the whole their understanding of the world develops through activity and interaction with the environment. They learn, for instance, that an object still exists when it’s hidden from view, and they learn this by crawling, reaching, grabbing, and mouthing objects, not just by observation (and certainly not by instruction).

Jean Piaget, the great Swiss theorist of cognitive development from birth into adulthood, referred to the period from birth to two years as the “sensorimotor” stage. He used this term to describe what he believed was the essential nature of early learning-- that it was based on a combination of information from the senses and from movement. He considered that toward the end of this stage toddlers became capable of symbolic thought and no longer were forced to learn solely through sensorimotor means, but that human beings continue throughout life to have a capacity for sensorimotor learning. Piaget’s theory of early development was based on a small number of direct observations of young children, and more recent work suggests that infants can learn some things by observation much earlier than Piaget believed. Nevertheless, it is a generally accepted idea among developmentalists that combined sensory and motor experience plays the major role in the early learning which forms a foundation for later school success. This view strongly suggests that much exposure to screen-watching will take away time from the needed sensorimotor experience from which young children learn most. The problem is not what screen-watching causes to happen, but what necessary experiences it interferes with.

A more recent thinker, the late Stanley Greenspan, the outstanding child psychiatrist and developmental theorist who founded Floortime/DIR as a treatment for autism and other problems, added an important concept to Piaget’s view of sensorimotor learning. Greenspan saw the senses and movement as essential to early learning, but in addition he emphasized that the most effective learning involved multisensory stimulation. In order to learn efficiently and to be interested, babies need to have a variety of senses stimulated at the same time-- not just vision, but hearing, touch, taste and smell, and movement senses of various kinds. What is most likely to provide excellent multisensory stimulation? It’s interaction with an interested, affectionate, engaged adult. That adult is not planning to give some planned form of instruction or purposely “teach” the baby, but because he or she is attentive and involved, whatever happens next helps the baby learn.

The affectionate caregiver provides the baby with two essential conditions for good learning. One is a combination of sensory experiences-- the warmth of touch, the rhythms of movement, the visual interest of facial expressions and eye positions, and speech or other sounds like humming and tongue-clicking. These are combined with each other into patterns that are more than the sum of their parts, as voice sounds follow the same rhythm as facial expressions and touch changes together with the movement of the adult body. These patterns offer powerful forms of sensory stimulation which draw the intense interest of the baby. In addition, the adult’s movements, speech, and gaze can all be instantly modulated in response to what the baby responds to-- what Greenspan, in talking about slightly older children, called “following the child’s lead”. The interested, caring adult provides multisensory stimulation that engages the baby’s interest and maintains it in ways impossible for any screen that offers entertainment to the passive baby. When babies spend much of their time in screen-watching, the opportunities for multisensory stimulation are limited.

There are other issues about screen entertainment or similar stimulation. One is that infants and toddlers have not yet achieved good control over attention (most of us are never perfect on this point). Where there is a great deal of noise or activity, young children find it difficult to focus mentally on everyday things they would otherwise learn about the world. The National Association for the Education of Young Children makes a point of this in their standards for early childhood education, in which they suggest that early childhood classrooms need to have low noise levels most of the time so that children can pay attention to speech or other sounds. Young children have trouble ignoring loud or distracting stimulation, which may draw them away from important sensory experiences. I recall visiting a foster home where a two-year-old boy was completely distracted by a television set and some music playing simultaneously. He stood between the two sounds and rocked back and forth from one foot to the other, and didn’t respond to his name being spoken. He was totally engaged with a sensory experience that was not meaningful in terms of the learning he needed to be doing--- in strong contrast to what he might have experienced if sitting on someone’s lap looking at a picture book.

The American Academy of Pediatrics and other interested groups are not concerned about what screen-watching does to children, but about what it prevents them from accomplishing. Because of the special nature of early childhood learning, watching passively does not give infants and toddlers the learning experiences that older human beings can achieve through observation. This is true no matter how carefully programming is claimed to have been designed for the very young.

Infant and Toddler Overnights: A Focus of Divorce Disagreements

When couples have children of infant and toddler age, the breakdown of marriage is often followed by intense and bitter argument over allowing the child to have an overnight visit and sleep away from the familiar home. In most cases, the mother is the custodial parent and continues to live in the marital home, while the father is more likely to be the one who moves out, lives elsewhere, and does the “visiting”.

Mothers are very likely to resist overnight visits for young children. They are concerned that the father is unaware of the child’s bedtime rituals or needs, that the child may be distressed by the experience, or even that a father who has behaved violently in the past may lose his temper if the child cries or fusses in the unfamiliar night-time setting. Fathers, on the other hand, may be concerned that the child spends less time with them than with the mothers and may therefore be less attached to the fathers. They may also believe that if the child does not form a strong attachment to the father in the first couple of years, no real relationship will ever be possible.

However the estranged couple work things out, this problem will pass (and of course will be replaced by different issues). The child will get older and reasons to resist overnight visits will gradually disappear. At the beginning, though, the overnight issue seems to be of overwhelming importance. In a recent special issue of the journal Family Court Review (2011, Vol. 49), the issue editor noted that when she surveyed readers to ask what they wanted to know about attachment and child custody, 60% of them asked what to do about overnights.

Several well-known psychiatrists and psychologists who contributed to the issue made a point of commenting on the overnight question. And all of them said about the same thing: overnight visits are problematic for about the first two years of the child’s life. Depending on the child, it may be best to wait as late as age 4 before beginning overnights (George, Solomon & McIntosh [2011]. Divorce in the nursery: On infants and overnight care. Family Court Review, 49, 521-528). The reasoning behind this advice is that children have real individual differences in temperament (for instance, the ease with which they accept a new situation) and in language development (which allows them to understand what they are told about the length of a visit). Children who are easily distressed, who have little concept of time, and who are still immature in their understanding of language may interpret an overnight visit as permanent abandonment by the custodial parent and may not be able to communicate their fears to the other parent-- who may have no wish to hear of the child’s longing for the divorced spouse. When children have handicapping conditions that affect communication and cognition, their level of development may be much more important than their chronological age.

But what if there are no overnights? Does this mean that the child’s relationship to the noncustodial parent is negated from the beginning? Charles Zeanah, the well-known attachment researcher, commented about this: “it’s not necessary for both parents to have attachment relationships with the child in the early years. That can happen later, when the child has more sophisticated abilities to sustain attachment relationships over time and place. Where it is possible, it does make sense for the child to keep contact at the level of comfort and familiarity until they are ready for more” (Lieberman, Zeanah, & McIntosh [2011]. Attachment perspectives on domestic violence and the law. Family Court Review,49, 529-538). Alan Sroufe, another leading attachment researcher, said, “I think that if parents, judges, lawyers, and so on took the view that attachment is a gradual building process, and that each relationship is built on its own terms, there would be less paranoia about this… even if they had no overnights for the first 2 years” (Sroufe & McIntosh [2011]. Divorce and attachment relationships: The longitudinal journey. Family Court Review, 49, 464-473).

These commentators are stressing the best interests of the child, a vague standard indeed, but one which we can clearly distinguish from an emphasis on parents’ rights. They seem to agree that it’s in the child’s best interest to have as calm an infancy and toddlerhood as possible and not to be asked to adjust to unnecessary changes and transitions. They also agree that two caring parents-- even if separated-- are better than one, but that there is no natural process that demands that both sets of relationships must develop simultaneously and early on. The fact that no “window of attachment” closes at age 2 means that it’s possible both to preserve family connections and to support a child’s early needs for a peaceful life.

Separated parents with very young children would do well to take these cautions to heart, but at the same time they may want to consider whether they want to try out visits with an eye to overnights. A gradual approach, including nap-time at the noncustodial residence, may give them an idea whether a child is ready to take the step to an overnight stay. If the child copes well with one overnight visit, it is wise to wait a while for the next one rather than rushing to a new schedule of frequent changes and risking overwhelming him or her. But none of this will work well unless the parents are able to concentrate on the child’s needs and reactions rather than hurrying to blame each other for any distress the child shows.

When overnight visits begin, one point that can be difficult for separated parents to deal with is co-sleeping. Plenty of parents let infants and toddlers sleep with them part or all of the time (and I am far from criticizing this practice). In addition, if a father leaves the household, the mother is likely to respond to the child’s distress and her own by letting the child sleep in her bed. What happens, then, if the child stays overnight with the father? Can the co-sleeping mother deal with having the child share a bed with the father, or will this trigger concerns about sexual behavior? How does the father comfort the child who is accustomed to sharing a bed, except by co-sleeping? This highly emotional situation is one in which straightforward discussion with neutral parties is essential in order to avoid distress, fears, and accusations that are in the great majority of cases completely unrealistic.

P.S. The comments of Alan Sroufe about attachment as a gradual building process are also highly relevant to adoption issues.

P.P. S. The issue of Family Court Review I'm referring to is available for free on line. Google the journal name and you'll see how to get to the articles.

Ages and Stages of Baby Emotion: A Natural History

In a recent query apparently directed to another reader, one reader of this blog asked, “when do babies start to feel grief and other emotions?” This is a question that can be talked about a lot. Whether it can be completely answered, or even what the reader meant exactly, is not so certain. I’m going to make some efforts at the “talking about” part.

There are some real difficulties about knowing the answer to this apparently simple question. One is that we can’t really know what any other person feels, in the sense that we can know what we feel ourselves. Even if someone can tell us in words, we can’t be sure that the feelings they experience are connected with the words in the same way that our own feelings would connect with those words. This is a basic problem of the human condition and one reason why most of us experience times of feeling isolated even though we are with other people. Babies, of course, can’t even tell us in words what they feel, so we are in especially deep waters when we try to know something like when they begin to have certain feelings. We have to use things like facial expressions, crying or other vocalizing, posture and gestures to guide us to some idea of the baby’s emotions. Even then, what we’re usually doing is asking ourselves, “all right, if I made that face or sound, what would I be feeling like?” Then we take our own feelings as a best guess about what is going on inside the baby.

A second complication is that all emotions may not begin at the same point in development. We can’t just assume that a display of one emotion means that all other emotions are possible for a baby at that same age. Different emotions may (and in fact apparently do) have different “natural histories”. Some are present at birth, it seems, but others may not come into play until 12 to 15 months of age.

A third complication is that there are probably big differences between a baby’s own experience of feeling and its responses to an adult’s emotions. Babies can have emotional responses to adult facial expressions that do not necessarily involve the same emotion as the one the adult shows. Edward Tronick, the leading infancy researcher, recently published an article showing a picture of a mother playing with her 4-month-old by tickling the baby with her hair. The baby grabbed the hair and gave it a good yank, and the mother tried to pull away, with a brief expression of pain and anger on her face-- whereupon the baby flung up its hands to cover its face and avoid seeing that expression.

What emotional behaviors does the baby have at birth? Just about the only thing that seems to be an expression of emotion is crying. Not surprisingly, newborn babies cry with hunger and with pain (and with different cry patterns in the two situations), but they also cry with anger or frustration, for instance when their arms are held down in dressing or bathing. They may also smile, but it doesn’t seem to matter to them whether they’re looking at a person or at the wall-- the smile is not really an indication of social pleasure at this point. Babies in the first few days also have a suprising ability to imitate the facial expressions of people whose faces are very near them, and will open their mouths, put out their tongues, and mimic happy, sad, or surprised expressions.

By about 4 months, babies become quite sociable, smile at people (including strangers), and will chuckle when tickled lightly. They get angry when frustrated. They are already beginning to be disturbed by an unresponsive face staring at them without responding to their sounds or expressions-- they turn away or even begin to cry within a short time after they begin to see this “still face”. What they don’t show at this age is fear. They are not afraid of strangers, separation, the dark, big dogs, snakes, or loud noises (although they might begin to cry when startled by a noise).

At 6 or 7 months, babies become wary about strange people. Rather than smiling at once, they look suspicious and give a new person the “once-over”, gradually warming up to them. Between 7 and 10 months, fear develops and becomes a major and dramatic feature of the baby’s life . An approaching stranger, no matter how friendly; a brief loss of balance; the noise of the garbage truck that has come once a week for the baby’s whole life-- these may all trigger a fearful expression, wailing, and clutching at a familiar caregiver. Now the baby shows a new interest in facial expressions, and when in a new situation carefully checks out the expression of a familiar adult. If that person looks frightened, the baby looks serious and does not move to explore new things or people; if the adult looks happy, the baby will gradually start to explore.

The new capacity for anxiety and fear are associated with attachment behavior. The baby is able to feel calm and comforted when in contact with a familiar caregiver; alone in a new situation (or with a stranger), he or she may be overwhelmed by the fear of the unfamiliar. Some people suggest that there would be a great evolutionary advantage to this, because most babies crawl or start to walk by this point and could easily move into danger if not “tied” by their fearfulness.

It’s when attachment and fearfulness have emerged that babies begin to have intense grief reactions to separation and loss of familiar people. An abrupt and long-term separation leads to many months of withdrawal, sadness, crying, difficulties in sleeping and eating, even weakened immunity, and there is only a little that unfamiliar people can do to help with this. Eventually, though, given good circumstances, separated babies can recover and be comfortable with new caregivers when they have become familiar.

It’s not until between 12 and 15 months that babies seem to develop the social emotions-- strong feelings that are based on what we expect other people to feel about us. These include shame, embarrassment, and pride. It seems that the baby has to be able to recognize himself or herself in the mirror before embarrassment is possible. (How do you know a child recognizes herself? Put a dab of lipstick on her nose and put her in front of the mirror. One who doesn’t recognize herself just looks at “that person” for a minute and walks away; one who does recognize immediately puts her hand to her nose.)

As you can see, emotions don’t all develop or appear at the same time, as far as we can tell. Some abilities, like imitating a facial expression, are surprisingly early in the schedule; others, like fear, are surprisingly late. It just goes to show that we can only understand infant development by looking carefully at infants rather than trying to work backward from adult characteristics.

Rats and Mice and Such Small Deer: Can They Help Us Learn About Human Infants?

Over at http://marginalperspectives.blogspot.com there’s a discussion going on about research on other species. Reference has been made to a research article: Graham,Y.P., Heim, C., Goodman,S.H., Miller, A.H., & Nemeroff,C.B. (1999). The effects of neonatal stress on brain development: Implications for psychopathology. Development and Psychopathology, 11, 545-565. (And yes, if that name rings a bell, this is the same Nemeroff who had to leave Emory because of failure to report his income from a drug company--- http://www.emorywheel.com/detail.php?n=27732). At marginalperspectives, people are talking about whether information obtained by observing rats can be generalized to human infants. They’re most concerned about the effects of separation from the mother, as evidenced by rat experiments (I mean experiments using rats as subjects, not experiments performed by rats).

The Graham et al paper reports, among many other things, that undesirable brain changes occur in young rats who are separated from their mothers, even though in one situation somewhat older pups could see the mothers through a transparent burrow. The marginalperspectives group suggest that this means that similar effects occur in human babies who are separated from their mothers, as, for example, in a hospital nursery, or of course in adoption.

The Graham group notes the large developmental differences between the central nervous system maturity of newborn rats and humans, noting that a human at 24 weeks gestational age (still 16 weeks preterm) is equivalent in maturity to a newborn rat pup. This in itself points up for us differences between the species. In addition, though, we need to look at differences in rat and human experience of separation. When rat pups are experimentally removed from their mothers in this kind of study, they are NOT given substitute maternal care. Separation from the mother means separation from care. When human infants are separated from their birthmothers in medical situations or in adoption and fostering, they are given substitute care. The only parallel involving substitute care for rats lies in the situation described by Graham et al, in which additional handling by human beings is beneficial for rat pups’ brain and behavioral development.

The Graham article does not allow easy generalization of these points from rat pups to human infants. To try to do this is to confound the variables of maternal-like care and of the mother herself. We can’t logically jump from the experiences of rat pups in experimental separation to those of human infants who are fostered or adopted, nannied, nursed, baby-sat, or picked up by their daddies or big brothers or sisters.

Let me point out, by the way, that not only are humans developmentally and neurologically different from rats, and that rat pups are more mature than humans at birth-- rat mothers also behave differently from human mothers. As an old-fashioned psychologist, dating back to the days when every psych student worked with pigeons or rats or both as part of their studies, I know a lot about this (including how to pick the little guys up without getting bitten).

Rat mothers have much different jobs from human mothers/caregivers. It doesn’t matter if they’re depressed or anxious, because they needn’t talk or communicate with gestures like eye movement. They don’t need to pick up a baby and help it latch on to the nipple, or to maintain their marital relationships during the trying first months of motherhood. Here’s what they do: if a baby gets out of the nest, they retrieve it and put it back in so it doesn’t get cold. They lick the babies all over, thus stimulating urination and defecation, and you guessed it, they lick that up too. If a baby is very sick or dies, they eat it (and of course they started their maternal care by eating off the amniotic sacs and placenta, occasionally eating a baby while they were at it). When the babies start to grow fur, the mother gets a lot less interested. (By the way, the pups at birth are just pink bare skin, so transparent that you can actually see the milk in their stomachs after they nurse-- a sight that would probably be comforting to worried nursing mothers if humans had it too!)

Studying other species can give us some good ideas about how humans might develop, but until we test the ideas in humans themselves, we can’t safely conclude that the facts about one species tell us the facts about another. Does anyone remember Thalidomide, the tranquilizer that caused severe birth defects in Europe? It was thoroughly tested with animal models. It wasn’t teratogenic in those cases. But it surely was in humans. It was a bad idea to generalize too quickly across species about that drug, and that should tell us something about generalizing across species about social and emotional development.