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Although it is known that parents of infants and toddlers with difficult behavior disproportionately use television and videos as calming tools,1 there are no published data regarding to what degree mobile technologies (such as cell phones and tablets) are used for this purpose. Previous qualitative work with parents has suggested that parental perceived control, defined as feelings of control over children’s behavior and development, may determine how parents set limits around screen media use2 and respond to difficult child behavior.3 We therefore sought to further explore this observation by examining associations between the social-emotional development of toddlers and mobile media use in a sample of parent-toddler dyads, and to determine whether potential associations are modified by parental perceived control.
The study was deemed exempt by the Boston University Medical Center institutional review board. We surveyed 144 English- or Spanish-speaking parents of healthy children 15 to 36 months of age who were recruited from an urban primary care clinic and 3 Women, Infants, and Children nutrition centers. Survey instructions, questions, and answer choices were read to participants by research assistants. After collecting demographic information, we assessed social-emotional development using the validated Baby or Preschool Pediatric Symptom Checklist.4,5 Mobile technology use by children was queried using 6 questions adapted from prior surveys6 asking about the likelihood of allowing smartphone or tablet use by children during different situations, including to calm them down, keep them quiet, while eating, in public, to get chores done, or at bedtime. Six items from the Parent Opinion Survey7 assessed parental perceived control regarding their child’s development, social relationships, and behavior. Using multivariable logistic regression, we modeled the odds of being somewhat/very likely to allow a child to use mobile technology in different situations, using the child’s social-emotional score on the Baby or Preschool Pediatric Symptom Checklist as the primary predictor, controlling for all covariates whose removal from the model changed odds ratios by more than 10%. We then stratified analyses by parental perceived control, which was split at the median value. Owing to sample size limitations, tests for interactions were not performed.
Caregivers were primarily mothers (81.3%) of nonwhite race (78.7%) and foreign-born (64.0%), with a mean (SD) age of 31.6 (7.2) years (Table 1). Compared with children without social-emotional difficulties, children with social-emotional difficulties (Baby or Preschool Pediatric Symptom Checklist score ≥9; 58 of 144 children [40.3%]) had a higher prevalence of being given mobile technology as a calming tool when they were upset (61.8% vs 38.1%; P = .01) and to keep peace and quiet in the house (69.6% vs 51.2%; P = .03); however, there were no differences during other situations such as eating, being in public, doing chores, or at bedtime. After adjustment for potential confounders, associations between social-emotional difficulties and mobile technology use persisted (Table 2). Such associations were stronger among parents with low vs high perceived control for calming down (adjusted odds ratio [AOR], 7.63 [95% CI, 2.07-28.1] vs AOR, 1.52 [95% CI, 0.45-5.13]) and for keeping peace and quiet in the house (AOR, 6.48 [95% CI, 1.52-27.7] vs AOR, 2.90 [95% CI, 0.75-11.2]).
This cross-sectional analysis showed significant associations between increased social-emotional difficulties in toddlers and the tendency of low-income parents to use mobile technology to calm their children or keep them quiet, particularly parents who expressed lower perceived control over their children’s behavior and development. While reverse causation can also explain this finding (ie, the exposure to technology affecting social-emotional development), we intentionally stratified analyses by perceived control in order to explore the hypothesis that frustration with the child’s behavior would lead to use of digital media as a coping strategy. However, we recognize that these results are exploratory and are from a modest-sized low-income sample, so they may not be generalizable. Longitudinal studies are needed to understand the transactional relationship between the use of digital technology and the developmental trajectories of children.
Corresponding Author: Jenny S. Radesky, MD, Division of Developmental Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, 300 N Ingalls St, Ste 1107, Ann Arbor, MI 48108 (firstname.lastname@example.org).
Published Online: February 29, 2016. doi:10.1001/jamapediatrics.2015.4260.
Author Contributions: Drs Radesky and Peacock-Chambers had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Radesky.
Critical revision of the manuscript for important intellectual content: Peacock-Chambers, Zuckerman, Silverstein.
Statistical analysis: Radesky, Peacock-Chambers, Silverstein.
Obtained funding: Peacock-Chambers.
Administrative, technical, or material support: Silverstein.
Study supervision: Zuckerman, Silverstein.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was funded by the Academic Pediatric Association Maternal and Child Health Bureau Bright Futures Young Investigator Award U04MC07853 (Dr Peacock-Chambers).
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Radesky JS, Peacock-Chambers E, Zuckerman B, Silverstein M. Use of Mobile Technology to Calm Upset ChildrenAssociations With Social-Emotional Development. JAMA Pediatr. 2016;170(4):397–399. doi:10.1001/jamapediatrics.2015.4260
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