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Sign up for Insight Alerts highlighting editor-chosen studies with the greatest impact on clinical care. Exposure to violence in media, including television, movies, music, and video games, represents a significant risk to the health of children and adolescents.
Extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed. Pediatricians should assess their patients' level of media exposure and intervene on media-related health risks. Pediatricians and other child health care 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.
Office counseling has been shown to be effective. Although shootings in schools around the world periodically prompt politicians and the general public to focus their attention on the influence of media violence, the medical community has been concerned with this issue since the s.
Therefore, pediatricians and parents need to take action. In , the US Surgeon General issued a special report on the public health effects of media violence that was based on a growing and nearly unanimous body of evidence.
American children between 8 and 18 years of age spend an average of 6 hours and 21 minutes each day using entertainment media television, commercial or self-recorded video, movies, video games, print, radio, recorded music, computers, and the Internet.
Children with a television in their bedroom increase their television-viewing time by approximately 1 hour per day. By 18 years of age, the average young person will have viewed an estimated acts of violence on television alone. Prolonged exposure to such media portrayals results in increased acceptance of violence as an appropriate means of solving problems and achieving one's goals. After the tragic shootings at Columbine High School in , the Federal Trade Commission FTC investigated whether the motion picture, music, and video-game industries specifically advertised and marketed violent material to children and adolescents.
Studies have revealed that children and adolescents can and do easily access violent media that are deemed inappropriate for them by the various rating systems and parents. They are age based, which assumes that all parents agree with the raters about what is appropriate content for children of specific ages.
Furthermore, different rating systems for each medium television, movies, music, and video games make the ratings confusing, because they have little similarity or relationship to one another. The AAP offers an informational brochure that pediatricians can offer to parents and children to help them use the various rating systems to guide better media choices.
Research has associated exposure to media violence with a variety of physical and mental health problems for children and adolescents, including aggressive and violent behavior, bullying, desensitization to violence, fear, depression, nightmares, and sleep disturbances. Consistent and significant associations between media exposure and increases in aggression and violence have been found in American and cross-cultural studies; in field experiments, laboratory experiments, cross-sectional studies, and longitudinal studies; and with children, adolescents, and young adults.
Children are influenced by media—they learn by observing, imitating, and adopting behaviors. Some research has indicated that the context in which media violence is portrayed and consumed can make the difference between learning about violence and learning to be violent.
In this context, with helpful adult guidance on the real costs and consequences of violence, appropriately mature adolescent viewers can learn the danger and harm of violence by vicariously experiencing its outcomes. Unfortunately, most entertainment violence is used for immediate visceral thrills without portraying any human cost and is consumed by adolescents or children without adult guidance or discussion.
Furthermore, even if realistic portrayals of harmful consequences of violence reduce the typical immediate short-term aggression-enhancement effect, there still exists the potential long-term harm of emotional desensitization to violent images.
Interactive media, such as video games and the Internet, are relatively new media forms with even greater potential for positive and negative effects on children's physical and mental health. Exposure online to violent scenes has been associated with increased aggressive behavior. Three recent studies directly compared the effects of interactive video games and passive television and movies media violence on aggression and violence; in all 3 cases, the new interactive-media-violence effect was larger.
Children learn best by observing a behavior and then trying it. The consequences of their behavioral attempts influence whether they repeat the behavior. All violent media can teach specific violent behaviors, the circumstances when such behaviors seem appropriate and useful, and attitudes and beliefs about such behavior.
In this way, behavioral scripts are learned and stored in memory. Rather than merely observing only part of a violent interaction such as occurs in television violence , video games allow the player to rehearse an entire behavioral script, from provocation, to choosing to respond violently, to resolution of the conflict.
Repetition increases their effect. In addition, some youth demonstrate pathologic patterns of video-game play, similar to addictions, in which game play disrupts healthy functioning. Several studies have linked media-violence exposure to decreases in prefrontal cortex activity associated with executive control over impulsive behavior.
Interpersonal violence, for victims and perpetrators, is now a more prevalent health risk than infectious disease, cancer, or congenital disorders for children, adolescents, and young adults. Homicide, suicide, and trauma are leading causes of mortality in the pediatric population. In , unintentional injuries claimed lives, homicides claimed lives, and suicide claimed lives among 5- to year-olds.
The homicide rate for black males is 2. Some research has suggested that interventions of the types discussed below can reduce media-violence consumption and its effects on children and adolescents. Pediatricians must become cognizant of the pervasive influence that the wide and expanding variety of entertainment media have on the physical and mental health of children and adolescents.
Pediatricians should ask at least 2 media-related questions at each well-child visit: Pediatricians should encourage parents to adhere to the AAP media recommendations 11 , Make thoughtful media choices and coview them with children. Coviewing should include discussing the inappropriateness of the violent solutions offered in the specific television show, movie, or video game and helping the child to generate nonviolent alternatives.
Parents tend to limit sexual content more than violent content, 38 yet research has indicated that the latter is potentially more unhealthy. Limit screen time including television, videos, computer and video games to 1 to 2 hours per day, using the V-chip, and avoiding violent video games defined as games that include intentional harm to other game characters, including cartoonish or unrealistic violence as well as realistic or gory violence.
Counseling about limiting screen time has been shown to be effective in office settings. Avoid screen media for infants or toddlers younger than 2 years. Pediatricians and other child health professionals should ensure that only nonviolent media choices be provided to patients in outpatient waiting rooms and inpatient settings. On a local level, pediatricians should encourage parents, schools, and communities to educate children to be media literate as a means of protecting them against deleterious health effects of media exposure.
On state and national levels, pediatricians should work with the AAP and their AAP chapters and districts to collaborate with other health care organizations, educators, government, and research-funding sources to keep media violence on the public health agenda. Media violence is often characterized in the public domain as a values issue rather than what it truly is: A recent revealed found that two thirds of parents actually favor increased governmental oversight of the media when children and teenagers are concerned.
Pediatricians should advocate for more child-positive media. Pediatricians should support and collaborate with media producers, applying our expertise in child health and development toward creating child-friendly and truthful media.
The AAP makes the following recommendations to the entertainment industry:. Avoid the glamorization of weapon-carrying and the normalization of violence as an acceptable means of resolving conflict.
Eliminate the use of violence in a comic or sexual context or in any other situation in which the violence is amusing, titillating, or trivialized. Eliminate gratuitous portrayals of interpersonal violence and hateful, racist, misogynistic, or homophobic language or situations unless explicitly portraying how destructive such words and actions can be.
Even so, violence does not belong in media developed for very young children. If violence is used, it should be used thoughtfully as serious drama, always showing the pain and loss suffered by victims and perpetrators.
Music lyrics should be made easily available to parents so they can be read before deciding whether to purchase the recording. Video games should not use human or other living targets or award points for killing, because this teaches children to associate pleasure and success with their ability to cause pain and suffering to others. Play of violent video games should be restricted to age-limited areas of gaming arcades; the distribution of videos and video games and the exhibition of movies should be limited to appropriate age groups.
Pediatricians should advocate for a simplified, universal, content-based media-rating system to help parents guide their children to make healthy media choices. Content should be rated on the basis of research about what types of media depictions are likely to be harmful to children, rather than simply on what adults find offensive. Just as it is important that parents know the ingredients in food they may feed to their children, they should be fully informed about the content of the media their children may use.
This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.
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Abstract Exposure to violence in media, including television, movies, music, and video games, represents a significant risk to the health of children and adolescents. EXPOSURE American children between 8 and 18 years of age spend an average of 6 hours and 21 minutes each day using entertainment media television, commercial or self-recorded video, movies, video games, print, radio, recorded music, computers, and the Internet.
IMPACT Research has associated exposure to media violence with a variety of physical and mental health problems for children and adolescents, including aggressive and violent behavior, bullying, desensitization to violence, fear, depression, nightmares, and sleep disturbances.
AAP ACTION Interpersonal violence, for victims and perpetrators, is now a more prevalent health risk than infectious disease, cancer, or congenital disorders for children, adolescents, and young adults. Remove televisions, Internet connections, and video games from children's bedrooms. The AAP makes the following recommendations to the entertainment industry: Nelson, MD Gwenn S.
Milteer, MD Donald L. Influence of TV crime programs on children's health. J Am Med Assoc. Adolescents and media violence: Children, Adolescents, and the Media.
Go ahead punk, make my day: Television and Growing Up: National Institute of Mental Health; Joint statement on the impact of entertainment violence on children: Congressional public health summit—July 26, Accessed January 26, A Threat Assessment Perspective.