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Original Investigation
September 30, 2019

Parent-Toddler Social Reciprocity During Reading From Electronic Tablets vs Print Books

Author Affiliations
  • 1Department of Pediatrics, University of Michigan Medical School, Ann Arbor
  • 2Center for Human Growth and Development, University of Michigan, Ann Arbor
  • 3Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
  • 4Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor
  • 5Department of Biostatistics, University of Michigan, Ann Arbor
JAMA Pediatr. 2019;173(11):1076-1083. doi:10.1001/jamapediatrics.2019.3480
Key Points

Question  How does parent-toddler social reciprocity differ when engaging in tablet-based reading compared with print book reading?

Findings  In this counterbalanced, laboratory-based, within-participants study of 37 parent-toddler dyads, parents and toddlers showed lower social reciprocity with tablet-based books compared with print books as evidenced by greater frequency of solitary body posture, social control, and intrusive behaviors occurring during the reading of tablet-based books.

Meaning  These findings suggest that parents and toddlers may find engaging in shared tablet-based experiences to be challenging.


Importance  Although the American Academy of Pediatrics recommends parent-child joint engagement with digital media, recent evidence suggests this may be challenging when tablets contain interactive enhancements.

Objective  To examine parent-toddler social reciprocity while reading enhanced (eg, with sound effects, animation) and basic tablet-based books compared with print books.

Design, Setting, and Participants  This within-participants comparison included 37 parent-toddler dyads in a counterbalanced crossover, video-recorded laboratory design at the University of Michigan from May 31 to November 7, 2017. The volunteer sample was recruited from an online research registry and community sites. Dyads included children aged 24 to 36 months with no developmental delay or serious medical condition, parents who were the legal guardians and read English sufficiently for consent, and parents and children without uncorrected hearing or vision impairments. Data were analyzed from October 18, 2017, through April 30, 2018.

Exposures  Reading an enhanced tablet-based book, a basic tablet-based book, and a print book in counterbalanced order for 5 minutes each.

Main Outcomes and Measures  Video recordings were coded continuously for nonverbal aspects of parent-toddler social reciprocity, including body position (child body posture limiting parental book access coded in 10-second intervals), control behaviors (child closing the book, child grabbing the book or tablet, parent or child pivoting their body away from the other), and intrusive behaviors (parent or child pushing the other’s hand away). Coding intracorrelation coefficients were greater than 0.75. Poisson regression was used to compare each outcome by book format.

Results  Among the 37 parent-child dyads, mean (SD) parent age was 33.5 (4.0) years; 30 (81%) were mothers, and 28 (76%) had a 4-year college degree or greater educational attainment. Mean (SD) age of children was 29.2 (4.2) months, 20 (54%) were boys, 21 (57%) were white non-Hispanic, and 6 (16%) were black non-Hispanic. Compared with print books, greater frequency of child body posture limiting parental book access (mean [SD], 7.9 [1.9; P = .01] for enhanced; 8.4 [1.8; P = .006] for basic), child closing the book (mean [SD], 1.2 [0.4; P = .007] for enhanced; 1.2 [0.5; P < .001] for basic), parent pivoting (mean [SD], 0.4 [0.2; P = .05] for enhanced; 0.9 [0.4; P = .004] for basic), child pushing parent’s hand (mean [SD], 0.6 [0.2; P < .001] for enhanced; 0.4 [0.2; P = .002] for basic), and parent pushing child’s hand (mean [SD], 1.7 [0.3; P < .001] for enhanced; 2.4 [0.5; P < .001] for basic) occurred while reading enhanced and basic tablet-based books. Child pivots occurred more frequently while reading basic tablet-based books than print (mean [SD], 1.0 [0.3] vs 0.3 [0.1]; P = .005).

Conclusions and Relevance  In this study, toddlers and parents engaged in more frequent social control behaviors and less social reciprocity when reading tablet-based vs print books. These findings suggest that toddlers may have difficulty engaging in shared tablet experiences with their parents.

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