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.

Toddler Meltdown, the Ever-Popular Thanksgiving Side Dish

Got a toddler or preschooler? Planning to celebrate Thanksgiving tomorrow? Be prepared for your little person to lack all aplomb as he or she encounters the feast that even grown-ups often dread.

The best you can hope for is that your child copes pretty well, cries only a little bit, eats a bite or two from the carefully-prepared menu, and delays tantrums until late in the day. Like some other major holidays, Thanksgiving contains many of the elements most disturbing to young children, and its family focus ensures that there will be plenty of adults and older kids who try awkwardly to cheer the little guys up, or scold them for their crankiness. This combination easily produces tears, resistance, clinginess, the biting of cousins, loud statements that the stuffing is yucky, and everything else that exhausts and humiliates parents.

What is it, anyway, that makes toddlers and holidays like Thanksgiving such a lethal mixture? Here’s a list of reasons:

1. Toddlers are creatures of habit. They eat when it’s the time they usually eat. If it’s too early or too late to eat, they don’t want to eat-- and of course we usually have the Thanksgiving meal later than lunch time and earlier than supper time, so what do we expect?

2. More habit, plus neophobia: Toddlers eat what they’re used to eating. They don’t eat new things until they’ve become familiar with them by seeing them a number of times. Even if their own family eats green beans and turkey, toddlers will instantly detect that what someone else cooked is not the right kind; it doesn’t look exactly the same and it doesn’t taste exactly the same, so the fact that it’s a green bean cuts no ice with the two-year-old. Even a turkey cooked at the toddler’s own house may not be acceptable, because Mom and Dad have done their best to make it interesting and appetizing for older people, i.e., different from what the child is used to. This problem, plus the timing of the meal, may mean that the child is hungry but can’t manage to eat.

3. Toddlers don’t manage well when they’re tired, and a holiday like Thanksgiving usually makes them tired. They may have been up late the night before while Mom and Dad were rushing around trying to get organized. In the morning, they may have had a long drive (in the course of which they fell asleep, messing up their usual sleep schedule), or there may have been a lot of commotion at their own house as someone tried to put a turkey in the oven while keeping the child from touching the hot oven door. Either at home or elsewhere, nap time was probably disrupted.

4. There are too many people to cope with. Toddlers are disorganized by large groups of large people, many of whom may be talking and laughing loudly, or alternatively starting to yell at each other. Just imagine yourself in a roomful of rambunctious 12-foot-tall people, if you want to see what the toddler experience may be like.

5. Ordinarily, toddlers depend on contact with familiar caregivers to get them through difficult situations. They make eye contact, or call out, or hold onto a parental leg until they calm down. But holidays like Thanksgiving make this difficult. There may be too much of a crowd for ordinary contact to be easy to make, and what’s more parents are likely to be distracted with cooking or with the demands of other adults for attention.

6. Toddlers pick up their parents’ feelings and are distressed when the parents are distressed. (This doesn’t mean that the child will behave differently in order to keep from upsetting a parent, though!) Parents often have reason to be anxious about family-focused holidays, and they are especially vulnerable to criticism or disapproval of their children’s behavior. This produces a vicious circle in which the fussy child draws criticism that disturbs the parent, who then becomes increasingly distressed, disturbing the child and becoming less capable of handling the disturbance. Scolding or spanking do no good at all when everyone is already in a tailspin.


All of these problems together pretty well insure that toddlers are going to behave less well on a day like Thanksgiving than they usually do. Unfortunately, most of these items are part and parcel of the holiday. It might be possible to get the dinner scheduled at something closer to toddler mealtimes, or to bring familiar food from home, and those changes might help a bit. But you won’t be able to change most of what happens.

Nothing is going to change a toddler into an adult for the day, but adults may be able to plan ahead and make sure that they themselves are as adult-like as possible. It would be an especially good idea for parents of toddlers to remind themselves that the child does not exist to make them, the parents, look good. Indirect criticism of the parents, by way of disapproval of the child, is uncomfortable to feel, but can be ignored, for the day at least.

Yes, this too shall pass. Just remind yourself that 20 years from now that toddler is going to ask why you can’t make the stuffing the way Grandma or Aunt Carol always did, completely forgetting how he used to shriek when coaxed to eat it!