Category: Education

What should be the chidlren TV watching guidelines?

[start highlight] Limit the total amount of television watching time and/or other media use to less than 1 to 2 hours per day. Avoid exposure to screen media in children younger than 2 years of age. The attitude of parents about TV may influence the TV viewing habits of children.  [end highlight]

Do our children watch too much TV?

It was estimated that American children aged 2 to 18 spend approximately 6,5 hours per day using media, increasing to 8 hours per day if considering the simultaneous use of multiple media; this makes it the leading activity in terms of time consume, with exception for sleep.
It has been estimated that, by the age of 18, a person may have already seen a surprising number of 200.000 acts of violence, on television alone. Sexual, racist and xenophobic contents may also be seen by young children, who cannot discriminate and who can imitate the observed attitudes.

What is the importance of parents’ attitude towards media use by their children?

Not only the television but also the so-called “new media”, which may include cell phones, iPads, and social media, are becoming a dominant force in children’s lives. While using these media, violent, sexual, racist and xenophobic contents may be seen by young children, who cannot discriminate and who can imitate the observed attitudes.

In a study conducted by Valerio D et al., 95% of the parents of a total of 156 children attending nursery school, kindergarten, and the first 2 years of elementary school responded to a questionnaire. The results from this pilot study, which are shown below, suggest that the attitude of parents about TV may influence the TV viewing habits of children, hence the importance that the parents set rules for their children concerning media use.

[mme_databox]

Parental attitude influences the TV viewing habits of children(Italian survey)

• Television viewing time

– 1-3 hour s per day: 50% of children
– >3 hours per day: 9% of children

• Parental attitude

1) Most frequent way of involvement by parents in the use of T.V. by children: prohibition of some programs.

2) Optimistic judgment by parents about the contents  and values of TV programs:
– Significantly associated with greater quantitative exposure, i.e., more T.V. viewing time (p < 0.04)
– Significantly associated with uncritical exposure of children to TV messages (p < 0.05)

3) Severe judgment by parents about the contents and values of TV programs:
– Significantly associated with qualitatively better exposure to TV (p < 0.05)
– Significantly associated with greater selectivity of programs watched by children (p < 0.05)
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Another topic that deserves attention is the presence of television in children’s bedrooms – the numbers presented in the box below explain this concern. It is easy to realize that a child who has a T.V. in the bedroom tends to watch T.V. for more hours and, in addition, it has been studied that not only the risk for violent behavior may be increased, but also increases the risk for obesity by 31% and the risk for smoking doubles. So, it’s recommended not to allow a child to have T.V. in her/his bedroom as a rule.

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T.V. in children’s bedrooms by age (U.S. survey)

• Infants: 19%
• 2 – 3 years: 29%
• 4 – 6 years: 43%
• 8 years and older: 68%

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What rules should parents implement regarding TV/media use?

• Limit the total amount of television watching time and/or other media use to less than 1 to 2 hours per day.
• Avoid exposure to screen media in children younger than 2 years of age.
• Plan your children’s watching time: prefer programs whose contents are specific for your children’s age.
• Avoid putting a television as well as internet connected devices in your child’s bedroom at all costs.
• Monitor the media your children are using, including television, web sites and social media.
• View television and movies with your children and use them as an opportunity to allow your children to pose questions and to discuss important values.
• Establish a plan of use for all media in the house. Give a special reinforcement for a curfew mealtime and bedtime regarding media devices, which may include not only television and computers, but also cell phones.
• Keep in mind that there are many positive messages and examples in movies and television programs, so learn also to take advantage of these during the media use allowed time.

Summary and Recommendations

• Recent surveys have shown that children and adolescents spend too much time in front of television or other screens for media use.
• Parents should restrain that time to a maximum of 1 to 2 hours per day. Screen exposure before 2 years should be avoided.
• The proportion of children who have a television in their room is surprisingly big. Television and media devices should be kept out of children’s rooms.
• Parents should monitor what media their children use and what they see.
• Parents should take advantage of television programs and movies to discuss important values.

[mme_references]
References

• Council on communications and Media. Children, adolescents, and the media. Pediatrics. 2013 Nov; 132(5):958-61.
• Jordan AB, Hersey JC, McDivitt JA, Heitzler CD. Reducingchildren’s television-viewing time: a qualitative study of parents and their children. Pediatrics. 2006 Nov;118(5):e1303-10.
• Valerio M, Amodio P, Dal Zio M et al. The use oftelevision in 2- to 8-year-old children and the attitude of parents about such use. Arch Pediatr Adolesc Med. 1997 Jan;151(1):22-6.
• Council on Communications andMedia. From de American Academy of Pediatrics. Policy statement–Media violence. Pediatrics. 2009 Nov;124(5):1495-503.
• Committee on Public Education. American Academy of Pediatrics. Media Violence. Pediatrics.2001 Nov;108(5):1222-6.

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What if my child enrolls school too late?

[mme_highlight] For children with adequate development, neither delayed nor early entrance into kindergarten has been shown to yield substantial differences regarding academic success after the first few years of school. Nevertheless, some results show that children who enroll kindergarten later may perform slightly better on some tests over time. [/mme_highlight]

Many parents pose a difficult question when the time of school entry comes: should they enroll their children in kindergarten as soon as they become age-eligible or may it be beneficial to academic success to wait an additional year? In fact, chronological age at entrance of kindergarten is many times considered by parents and teachers as a major determinant of future academic success achievement.
However, if a child entries kindergarten later because of poor readiness due to risk factors such as poverty, low maternal education, single parent status or minority status. Age of entry to school is also in the centre of some government policies.
The exact age of enrollment in kindergarten varies around the world. In most European countries, like Switzerland and German, as well as in Australia, Japan and Russia, children enter kindergarten at 6. In Sweden, children enter school at the age of 7 and in England between 4 and 5 years of age. Differently, in New Zealand children begin school on their fifth birthday, rather than on a specific uniform date in September or October.

What is redshirting?

Redshirting refers to a voluntary delay in kindergarten entrance. The term has its roots on a practice used by athletes to prolong their eligibility for another season. About 10% of American parents defer their children’s kindergarten entry.
This occurs more frequently Children whose birthdays are closest to the cutoff, Caucasian children, boys and children from high-income families are most likely to be held back from kindergarten by parents (redshirting).

According to the National Centre for Education Statistics, approximately 9% of kids have a delayed school entrance. In addition, a report from 2007 in the US has shown that this delayed entrance occurs with about 14% of children between 5 and 6 years of age.

What is the balance between benefits and possible harms in a delayed enrollment?

For children with adequate development, neither delayed nor early entrance into kindergarten has been shown to yield substantial differences regarding academic success after the first few years of school.

Nevertheless, data from a study conducted by Rand Corporation in 2005 suggested that children who entered kindergarten one year later scored better in reading tests. However, this conclusion can be biased, because those children had one more year of life experience and may be better prepared because they had an extra year in preschool. In addition, it should be noted that this difference is likely to disappear overtime.

An interesting study conducted by NICHD (Early Child Care Research Network) analyzed data from more than 900 children with the goal of understanding the effect of age of entry to kindergarten on children’s functioning in early elementary school. Children’s academic achievement and socioemotional development were evaluated repeatedly from 54 months of age through 3rd grade.
Results show that age of entry proved to be significantly related to three measures of children’s estimated functioning in the fall of their kindergarten year: Letter-word recognition test, Language and Literacy and Mathematical Thinking scales.

[mme_databox]

Effect of age of entry on the performance on cognitive tests (only statistically significant results shown) Effect size for estimated functioning in the fall of their kindergarten year: –        Letter-word recognition test: 0.09 –        Language and Literacy scale: 0.12 –        Mathematical Thinking scale: 0.14

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Although the effect size is little, age of entry proved also to be significantly related over time to four measures: Letter-word recognition test, applied problems test, Memory for sentences and Picture vocabulary test.

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Effect of age of entry on the performance on cognitive tests (children who began school at an older age evinced greater increases over time; only statistically significant results shown) Effect size for estimated functioning overtime (slope): –        Letter-word recognition test: 0.09 –        Applied problems test:0.13 –        Memory for sentences: 0.07 –        Picture vocabulary test: 0.10

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Summary

• Age of school entry should not be regarded as a major determinant of children’s later academic success.
• Most research findings demonstrated that, in itself, entrance age was not a good predictor of learning or academic risk. Nevertheless, some results show that children who enroll kindergarten later may perform slightly better on some tests over time.
• Empiric evidence supports the enrollment of children in kindergarten at the age-appropriate time (which varies from country to country).
• If there is concern about a child’s school readiness, parents should discuss it with teachers and health care providers.
• The decision of age of enrollment of children in kindergarten must be centered on each child and should balance costs of one more year of childcare and a marginal benefit for those children who have one more year of preschool preparation.
• Keep in mind that a child whose entrance is delayed for one year may eventually be ahead in the class, but probably knows less than children of the same age who are in the next grade.

[mme_references]
References

1. Stephanie Pappas, “More Parents ‘Redshirting’ Kindergartners”,Live Science, 5 September 2010.
2.   Winsler A, Hutchison LA, De Feyter JJ et al. Child, family, and childcare predictors of delayed school entry and kindergarten retention among linguistically and ethnically diverse children. Dev Psychol. 2012 Sep;48(5):1299-314.
3. NICHD Early Child Care Research Network. Age of Entry to Kindergarten and Children’s Academic Achievement and Socioemotional Development. Early Educ Dev 2007; 18:337.
4. Morrison FJ, Griffith EM, Alberts DM. Nature-nurture in the classroom: entrance age, school readiness, and learning in children. Dev Psychol 1997; 33:254.

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What if my child enrolls school too early?

[mme_highlight] For children with adequate development, neither delayed nor early entrance into kindergarten has been shown to yield substantial differences regarding academic success after the first few years of school. When parents believe their child is ahead of peers regarding intellectual, social or creative skills, early entrance may be an option.  [/mme_highlight]

Many parents pose a difficult question when the time of school entry comes: should they enroll their children in kindergarten as soon as they become age-eligible or may it be beneficial to academic success to wait an additional year? Some parents may want to decide for early kindergarten enrollment (at age four years) if their children seem to be ahead of their same-age peers regarding cognitive development and skills.

Should my gifted child enroll school earlier?

Some gifted children may benefit from enrolling earlier in school, as in most cases pre-school does not have nothing new  left to offer to enhance their capabilities. The definition of giftedness used by a govern entity in Australia: “Students who are gifted have the capacity for advanced development relative to their age peers in at least one ability domain (intellectual, physical, creative or social), to a degree that places them at least among the top 10% of their age peers”.
In fact this benefit is more likely among exceptionally gifted children, i.e., the top 2% of the population. For these children, enrolling earlier is an educational intervention that boosts their academic achievement.

What is the balance between benefits and possible harms in an early enrollment?

Although the effect size is very little, according to a study conducted by NICHD (Early Child Care Research Network) which analyzed data from more than 900 children, teacher ratings of academic mastery in second or third grade were slightly higher in children who were older at kindergarten entry. According to this study, there were no differences regarding social functioning.

In addition, a study which collected data from a large community sample revealed that the youngest children in the school year were at an increased risk of being incorrectly identified by teachers as having learning difficulties.

Some adverse effects of early enrollment may become evident as the children progresses to middle and junior high and when physical maturation differences become more obvious. These early enrollees may be more likely to develop socioemotional difficulties. A study revealed that the younger children in a school year are at slightly greater psychiatric risk than older children.

[mme_databox]

Correlation between relative age and mean symptom score on strengths and difficulties questionnaire  Adjusted regression coefficients: –        According to teacher report: 0.51 (CI 0.36 to 0.65, P < 0.0001 ): moderate and statistically significant correlation. –        According to parental report: 0.35 (CI 0.23 to 0.47, P < 0.0001 ): ): weak but statistically significant correlation. Odds Ratio: –        adjusted OR for psychiatric diagnoses for decreasing relative age: OR 1.14 (1.03 to 1.25, P = 0.009) – younger children in a school year have a risk 1.14 times higher to present a psychiatric problem.

CI – confidence interval; OR – odds ratio
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A study from 2011 addressed the impact of the age of starting education on obesity among adolescent girls and showed that early school entry may reduce girls’ likelihood of becoming obese in their adolescence.

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Association between body weight status and early school status among adolescents aged 12–19 years in the National Longitudinal Survey of Youth 1997 (NLSY97) 1)      Within one month of cut-off date –        One additional school year for girls decreased the risk of overweight (OR 0.78) and obesity (OR 0.73) in adolescence by approximately 30%. 2)      Within 6 months of cut-off date –        One additional school year for girls decreased the risk of obesity (OR 0.84) in adolescence by approximately 16%.

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How should I decide concerning early enrollment?

As stated above, for children with adequate development, neither delayed nor early entrance into kindergarten has been shown to yield substantial differences regarding academic success after the first few years of school. Note also that children with normal development who miss the birth date cut off probably would not benefit from early enrollment, because being one of the oldest in their class may actually boost their success.

When parents believe their child is ahead of peers regarding intellectual, social or creative skills, early entrance may be an option. However, to enroll a child early in school should thus be a joint decision, resulting of the views of parents, educators and doctors. There may be an indication to consult a Psychologist of Psychiatrist so that the child is evaluated and can do IQ tests.

Summary

• Age of school entry should not be regarded as a major determinant of children’s later academic success.
• Most research findings demonstrated that, in itself, entrance age was not a good predictor of learning or academic risk.
• Empiric evidence supports the enrollment of children in kindergarten at the age-appropriate time (which varies from country to country).
• For gifted children, early enrollment may not only an option but an educational intervention to boost their academic success.
• Some adverse effects of early enrollment may become evident later, namely some socioemotional disturbances.
• If there is concern about a child’s school readiness, parents should discuss it with teachers and health care providers.

[mme_references]
References

1. NICHD Early Child Care Research Network. Age of Entry to Kindergarten and Children’s Academic Achievement and Socioemotional Development. Early Educ Dev 2007; 18:337.
2. Zhang N, Zhang Q. Does early school entry prevent obesity among adolescent girls? J Adolesc Health. 2011 Jun;48(6):644-6.
3. http://www.education.vic.gov.au/school/teachers/teachingresources/diversity/pages/giftedentry.aspx (accessed 07.12.2013).
4. Frequently Asked Questions about Early Entry to Kindergarten – Cross Sectoral Information for Parents. Department of Education. Tasmania, Australia.
5. Gledhill J, Ford T, Goodman R. Does season of birth matter? The relationship between age within the school year (season of birth) and educational difficulties amongst a representative general population sample of children and adolescents (aged 5-15) in Great Britain.Research in Education 2002;68: 41-7.

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What can I do to enhance my child’s psychosocial skills before entering kindergarten?

[mme_highlight] Psychosocial skills promote peer acceptance and also harmonious relationships with teachers. Parents can contribute everyday to improve their children psychosocial skills in many ways by encouraging their children to express feelings using words, to share and to interact with peers.  [mme_highlight]

Psychosocial skills, such as the capability of understanding emotions and keeping a positive social behavior, promote peer acceptance and also harmonious relationships with teachers. It is a worry for parents when they see that their child shows difficulty in making or keeping close friends or if she/he is teased or even rejected by peers in school. However, parents can also help their children improve such skills with simple and funny activities.

Why are psychosocial skills so important?

At school entry, learning engagement as a whole is reflected the capacity of a child to listen, follow rules and directions, as well as in the determination to do tasks. And this engagement and skills are closely related to social-emotional competence and to positive peer and teacher relationships in the classroom too.
An overall positive learning from the beginning engagement influences dramatically future academic success of a child. Ladd et al. found that higher levels of social participation and learning engagement at the beginning of kindergarten predicted better performance in tests at the end of the school year.
On the opposite, preschool children who tend to show oppositional or aggressive coping behaviors at home often also show such behavior when they enter school, which can lead first to rejection by peers and teachers and then to a negative cycle of social and academic failure.

Some studies have reported that approximately 20% of preschool children in the general population show moderate to clinically significant levels of emotional and behavioral problems. Nevertheless, studies also have found that under optimal circumstances, social skills training has been effective in improving popularity of children who were initially among the lowest regarding peer acceptance in their classroom.

What have social skills training programs proved?

The Head Start REDI study enrolled a total of 356 4-year-old children in an intervention group. Some of the main results are shown below. The investigation of correlations among study variables revealed that growth in emotion understanding and competent social problem solving was significantly associated with growth in positive social behavior.
Of note, growth in emergent literacy skills was significantly associated with growth in emotion understanding and competent social problem solving.

[mme_databox]
Correlations among study variables

• Correlation between emotion understanding and emergent literacy skills: 18; p < 0.001 (statistically significant)
• Correlation between competent social problem solving and emergent literacy skills: 14; p < 0.01 (statistically significant)
• Correlation between competent social problem solving and growth in positive social behavior: 14; p < 0.01 (statistically significant)
• Correlation between emotion understanding and growth in positive social behavior: 14; p < 0.01 (statistically significant)

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A study conducted by Han SS et al. evaluated the post-treatment outcome effects of a classroom-based social skills program for pre-kindergarten children, using a teacher-consultation model. Some of the results are shown below. Teachers rated children in the treatment group as showing significantly greater improvement than children in the control group in terms of their total problems, as well as regarding total social skills, like cooperation, assertion and self-control.

[mme_databox]
Teacher Ratings of Children’s Behavior Problems and Social Skills

	Pre-intervention	Post-intervention
Emotionally reactive	2.80	12.35
Anxious / Depressed	3.83	2.71
Withdrawn	5.06	3.89
Attention problems	6.81	4.88
Aggressive behavior	12.80	11.05
Cooperation	12.95	14.59
Assertion	9.99	12.85
Self-control	12.35	14.13

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What can parents do to improve their child’s psychosocial skills?

• Encourage your child to describe feelings using words.
• Practice turn taking in daily life situations.
• Practice following directions, starting with one step directions (e.g. put your shirt in the wardrobe) and progressing to more complex directions.
• Give a positive reinforcement to your child for sharing belongings with other persons.
• Practice sitting quietly at a table to do some work, trying a gradual increase in the amount of time spent.
• Enroll your child in extracurricular activities, which should help in making new friends.
• Invite friends over to the house for a play afternoon, observe children’s interactions and intervene if appropriate and needed.

Summary and Recommendations

• Social skills are crucial for life and absolutely determinant in the academic achievement of a child.
• Some children may show negative social behaviors and difficulty in making friends, while others may be teased by peers or experience peer rejection. Some children may have behavioral problems or diseases, but many can grow up normally if they benefit from specialized help. If you are worried, consult your doctor.
• Studies have shown that interventions regarding social skills have a positive outcome in improving these.
• Parents can contribute everyday to improve their children psychosocial skills in many ways by encouraging their children to express feelings using words, to share and to interact with peers.

[mme_references]
References

• Robert L. Nix , Karen L. Bierman , Celene E. Domitrovich & Sukhdeep Gill (2013) Promoting Children’s Social-Emotional Skills in Preschool Can Enhance Academic and Behavioral Functioning in Kindergarten: Findings From Head Start REDI, Early Education & Development, 24:7,1000-1019.
• Ladd, G. W., Birch, S. H., & Buhs, E. S. (1999). Children’s social and scholastic lives in kindergarten: Related spheres of influence? Child Development, 70, 1373–1400.
• Patterson, G. R., & Stoolmiller, M. (1991). Replications of a dual failure model for boys’ depressed mood. Journal of Consulting and Clinical Psychology, 59, 491–498.
• Fergusson, D. M., Lynskey, M. T., & Horwood, L. J. (1996). Factors associated with continuity and changes in disruptive behavior patterns between childhood and adolescence. Journal of Abnormal Child Psychology, 24, 533–553.
• Han SS, Catron T, Weiss B, Marciel KK. A teacher-consultation approach to social skills training for pre-kindergarten children: treatment model and short-term outcome effects. J Abnorm Child Psychol. 2005 Dec;33(6):681-93.

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What can I do to enhance my child’s language literacy before entering kindergarten?

[mme_highlight] The ability of a child to use adequately language is a major determinant of her/his future academic achievement and impacts greatly social and economic characteristics of families and communities. The developmental skills for reading and writing are strengthened during the preschool years, which makes these crucial times for children development. [mme_highlight]

The ability of a child to use adequately language is a major determinant of her/his future academic achievement and impacts greatly social and economic characteristics of families and communities. Children learn oral language by listening and talking to adults around them, that is why they should be included and encouraged to take part in conversations since very young age. In fact, the optimal timing to improve language literacy is during preschool and early primary school years.

Why are language and literacy so important?

The International Reading Association (IRA) and the National Association for the Education of Young Children (NAEYC) issued a joint position statement where it is stated that “One of the best predictors of whether a child will function competently in school and go on to contribute actively in our increasingly literate society is the level to which the child progresses in reading and writing”. 
It is now consensual that the developmental skills for reading and writing are strengthened during the preschool years, which makes these crucial times for children development.

What can parents do to improve their child’s language skills?

Reading aloud to your child on a frequent basis is the mainstay to promote early literacy development in children however it is has been estimated that only 58% of children aged 3 to 5 year are read to daily by a family member (Forum on Child and Family Statistics, 2004).

Here are some useful tips to help your child build language:

• Read aloud to your child as much as you can, if possible, on a daily basis. Ask your child to turn the pages.
• Encourage your child to be active participants rather than passive listeners when you are sharing the reading of a book.
• Arrange the bedroom and living room environment so that children have an opportunity to interact with books and other print materials.
• Help your children get familiar with letters of the alphabet and their corresponding sounds.
• Use position words when talking to your child (e.g., Put the box on the lower shelf.
• Use rhyming words and sentences; use sentences with alliteration (similar sounds).
• Learn the nursery rhymes and practice them at home.
• Ask your child to re-tell you the story you have read to her/him.
• Encourage your child to assemble the pieces of a puzzle.
• Ask your child to find shapes in a picture.

The language and literacy promotion scale proposed by Green SD et al. is composed of 23 items and can serve both as a survey method and a set of useful tips to promote these skills. Results from the survey which included the answers of 180 educators using the items of the scale are shown below.

[mme_databox]
Results from a survey with educators using a 23 items Language and Literacy Promotion Scale

	“Often or Always”	“Sometimes"	“Seldom or Never”
Read aloud to children in a group setting	78.3%	16.7%	5.0%
Read aloud to children individually	50.0%	30.6%	19.4%
Set aside special time each day to read to children	75.0%	19.4%	5.6%
Read aloud a variety of books	85.6%	9.4%	5.0%
Re-read favorite books	82.8%	12.8%	4.4%
Talk about books read together	68.9%	20.6%	10.6%
Ask children questions about the books	74.4%	17.8%	7.8%
Provide opportunities for children to look at books and other printed materials on own	82.2%	13.3%	4.4%
Teach children features of a book	58.3%	21.1%	20.6%
Teach children that printed letters and words run from left to right and from top to bottom	63.3%	19.4%	17.2%
Practice saying alphabet with the children	93.3%	5.0%	1.7%
Teach children to recognize letters of alphabet	90.0%	7.8%	2.2%
Teach children to distinguish between uppercase and lowercase letters	69.4%	20.6%	10.0%
Help children learn the sounds each letter can represent	78.9%	12.2%	8.9%
Teach children to write letters of alphabet	71.7%	17.2%	11.1%
Help children to write their names	74.4%	16.1%	9.4%
Help children identify different colors, shapes, and sizes	88.3%	8.3%	3.3%
Help children learn opposites	81.1%	16.1%	2.8%
Help children recognize numbers	87.2%	8.9%	3.9%
Practice counting with the children	88.9%	9.4%	1.7%
Choose books to read aloud that focus on sounds, rhyming, and alliteration	77.2%	16.7%	6.1%
Have children sing or say a familiar nursery rhyme or song	85.6%	12.8%	1.7%
Encourage children to make up new verses of familiar songs or rhymes by changing beginning sounds or words	63.9%	20.6%	15.6%

[/mme_databox]

The same study found that some variables significantly influence early childhood promotion of language and literacy by educators, namely, the availability of books and other print materials adequate for children and the number of children cared for by the educator. The table below shows these correlations.

[mme_databox]
Variables significantly correlated to promotion of language literacy

• Correlation between availability of print materials and promotion of language literacy: β = 0.52; p < 0.001 (statistically significant)
• Correlation between the number of children cared for by each educator and promotion of language literacy: β = 0.17; p < 0.01 (statistically significant)
• Correlation between perceived adequacy of training received by educators and promotion of language literacy: β = 0.36; p < 0.001 (statistically significant)

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Summary and Recommendations

• The ability of a child to use adequately language is a major determinant of her/his future academic achievement and throughout life.
• The optimal timing to improve language literacy is during preschool and early primary school years.
• Parents and educators play a major role in promoting language literacy skills.
• Reading aloud to children on a frequent basis is one of the most consistent ways to promote early literacy development in children. Children should be included in conversations and encouraged to participate actively since very young age.
• If you think your child is not developing language and literacy skills as expected or has lose skills previously acquired, consult a doctor.

[mme_references]
References

• Green SD, Peterson R, Lewis JR. Language and Literacy Promotion in Early Childhood Settings: a survey of center-based practices. Early Childhood Research and Practice. 2006. Vol. 8, N. 1.
• Landry SH. Effective Early Childhood Programs. Children’s Learning Institute. University of Texas.
• Committee of the Prevention of Reading Difficulties in Young Children, Commission on Behavioral and Social Sciences and Education, National Research Council. Preventing Reading Difficulties in Young Children, 4 ed. Snow, C. E., Burns, M. S.; and Griffin, P. Washington DC: National Academy Press, 1998.

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What can I do to enhance my child’s knowledge before entering kindergarten?

[mme_highlight] Poor school readiness predicts increased likelihood of low levels of academic achievement, high levels of retention in grade, special education and ultimately school dropout. Parents can use a wide variety of strategies since early childhood to enhance their child’s knowledge before entering kindergarten, using cultural activities, mathematics exercises and conversations about everyday’s life. [mme_highlight]

Poor school readiness predicts increased likelihood for low levels of academic achievement, high levels of retention in grade, special education and ultimately school dropout. In turn, this raises the risk for unemployment, teen pregnancy, juvenile delinquency, social dependency, and poor parenting practices.
Studies have shown evidence that early childhood learning interventions have positive results throughout life. Parents are one of the foundations to these, and there are many simple interventions they can put into practice to enhance their child’s knowledge even before entering kindergarten.

What have early childhood interventions proven?

The Chicago’s Child-Parent Center (CPC) Preschool Program, which targeted low-income minority children, offered half-day preschool for one to two years, full or part-day kindergarten, as well as a parent educa­tion component.  Results shown in the table below refer to participants when they turned 21 years, having had 1 to 2 years of CPC.
Another important study was the Abecedarian Preschool program, which also targeted low-income children with intensive daycare or center intervention according to age, this program integrated activities that addressed social, emotional, and educational development. The results below refer to participants of the Abecedarian Preschool program when they turned 21, having participated in the program for 5 years.

[mme_databox]

Results from the Chicago’s Child-Parent Center Program

Intervention group vs control group (no participation in the program)

	Intervention group	Control Group
School Dropout	46.7%	49.7%
Number of years of completed education	10.6	10.2
Rates of juvenile arrest	16.9%	25.1%
Rates of high school completion	49.7%	38.5%

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[mme_databox]

Results from the Abecedarian preschool program

Intervention group vs control group (no participation in the program)

	Intervention group	Control Group
Increase in IQ	4.4	4.2
Number of years of completed education	12.2	11.6
Rates of 4 year college/university enrollment	36%	14%
Rates of teenaged parenthood	26%	45%

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Practical tips to enhance your child’s general knowledge before entering kindergarten

Cultural domain

• Each weekend see what’s on in your city concerning cultural activity. Take your child to the theatre, to a ballet or music performance or to an art exhibiton. Talk to her/him about what you are seeing; have no fear of giving too much information. In addition, spare time at afternoon to take her/him to the park and talk about the plants, the animals and the people.
• Example: listen to the “Four Seasons” and talk to your child about it, for instance: “This music was done by a man called Vivaldi. This music makes me think of the Winter…listen, it seems like the wind and the rain drops…”
• Example 2: See that ballerina? She is moving like a swan, look at her arms like wings! She uses special shoes to be on top of her fingers. It hurts a lot, but she does it to move like a feather on the stage.”

Linguistic domain

• Read, read and read with your child! And reread known stories. This one of the most robust evidence as an extremely beneficial early learning experience.
• Talk about everything you see and do together while at home or on the road. “Look at that shop. They sell sockets. We use sockets to warm our feet. These yellow sockets are bigger than the pink ones.”
• Sing songs with your child.
• Give your child complex commands: “take off your gloves and put them on the top of the dinner table.”
• Use open-ended questions: “What do you think about…?”
• Incentive your child to put objects into categories, organizing them by function, color or size.

Mathematics domain

• Teach your child to count to 100.
• Ask your child to identify shapes: circles, triangles, squares.
• Ask your child to make comparisons: more than, less than, same as.

Summary and Recommendations

• School readiness influences the academic success and general well-being of a child throughout life.
• Early intervention programs have consistently shown that intensive and early learning experiences have a considerable impact on parameters like number of years of completed education, criminal behavior and teenaged parenthood.
• Parents can use a wide variety of strategies from early childhood to enhance their child’s knowledge before entering kindergarten, using cultural activities, mathematics exercises and conversations about everyday’s life.
• Reading to and with children is one of the cornerstones for future academic success.

[mme_references]
References

• www.childrenslearninginstitute.org/library/publications/documents/Effective-Early_Childhood-Programs.pdf (accessed 4.11.2013)
• Reynolds, A. J.; Temple, J. A.; Robetson, D. L.; and Mann, E. A. “Age 21 Cost-Benefit Analysis of the Title Chicago Child–Parent Centers.” Educational Evaluation and Policy Analysis 24 (2002): 267-303.
• Reynolds AJ, Temple JA, Robertson DL et al. Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools. JAMA. 2001 May 9;285(18):2339-46.

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Should my child attend music classes?

[mme_highlight] The influence of formal musical training on auditory cognition has been well established. Recent studies have demonstrated a causal link between musical training and actual changes in brain. Research has demonstrated that already at around the age of six months infants have the perceptual and cognitive prerequisites necessary to benefit from musical experiences.[mme_highlight]

At the time of choosing organized activities to enroll their children, many parents wish they can learn to play a music instrument. It is definitely a beautiful art, but does musical training also helps academic achievement? The current evidence suggests so. In fact, music as a part of daily informal activities may improve several cognitive functions; thereby learning music should be encouraged.
For those parents whose children already have other activities or who cannot afford their children attending music classes, keep in mind that the benefits of music for cognitive development can take place even without formal instrumental training – the advice is let your child listen to and play with music.

Can musical training improve academic achievement?

The influence of formal musical training on auditory cognition has been well established. Recent studies with children have demonstrated a causal link between musical training and actual changes in brain structure and function.

Skills like phonological awareness, speech-in-noise perception, rhythm perception, auditory working memory, and sound pattern learning improve with musical training, suggesting that musical training might provide an effective developmental educational strategy for all children, including those with language learning impairments.

In fact, auditory processing has been linked to the development of reading, as reading requires that sounds of spoken language are linked to their written forms.

Banai K. and colleagues followed 184 children to find if musical training (from 1 to 36 months long) could improve literacy linked skills. Their results, as shown in the box below, reveal that general cognitive ability, verbal memory span, frequency and temporal-interval discrimination thresholds were significantly correlated with musical experience.

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Correlation between music training and literacy related skills
(note: results presented for students without previous musical training, after analysis of variance)

• Reading accuracy: r=-0.38 (p<0.05 – statistically significant)
• Memory spans: r=-0.51 (p<0.01 – statistically significant)
• Working memory: r=-0.56 (p<0.001 – statistically significant)
• Phonological awareness: r=-0.42 (p<0.01 – statistically significant)

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A recent meta-analysis by Jaschke AC compiled these thrilling results concerning the benefits of musical training for learning.

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Association between musical training and cognitive skills
(note: results presented fall among the best associations found to date by studies; after a meta-analysis by Jaschke AC et al., 2013)

• Writing: children who received musical training perform approximately 5 times better

(OR=5.223, p=0.002 – statistically significant); Register D, 2001.

• Mathematics: children who received musical training perform approximately 9 times better

(OR=9.429, p=0.000 – statistically significant); Rickard NS et al., 2012.

• Intelligence quotient (IQ): children who received musical training perform approximately 4 times better

(OR=4.032, p=0.001 – statistically significant); Portowitz A et al., 2009.

OR – odds ratio
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Which instrument to choose?

Even if starting by a specific instrument such as piano or violin can seem exciting for parents, music teachers advise it is better to let children try the different instruments and let teachers decide what instrument your child is best at. This will raise the odds of success in musical training for your children, avoiding the loss of motivation and costs that can be implied in changing from one instrument to another.

At which age to begin?

For children, musical experience does not primarily consist of adult-guided training on a musical instrument. Remember your young children engage in everyday musical activities such as singing, dancing and musical play and this should certainly be as encouraged as possible. However, as the research results prove, children benefit from attending music classes.

Research has demonstrated that already at around the age of six months infants have the perceptual and cognitive prerequisites necessary to benefit from musical experiences. Apparently, infants encode melodies in terms of relative pitch and duration, surprisingly showing long-term memory for musical pieces. Skills like neural discrimination of different intervals, sound grouping and detecting the beat of rhythmic sounds may be present already before the age of six months or even at birth.

These findings definitely reinforce that everyday musical activities are a rich source of experiences with potential to enhance skill development.

In addition, some clinical studies have reported that musical activities may play a role in the the recovery of hearing in children with cochlear implants.

Early childhood, while the brain has still plasticity, may therefore be the best for infants and children to take advantage of musical activities.

Summary and Recommendations

• Musical training induces changes in brain.
• Musical training improves cognitive skills, like reading, writing, mathematics and overall intelligence. Aesthetical sensitivity and general culture also benefit from experiences with music.
• From birth to 6 months, babies already have the capacity to benefit from musical experiences, which therefore should be promoted as early as possible.
• Children who can enroll in music classes may benefit in artistic and cognitive levels, but also regarding sensitivity, self-esteem, confidence and creativity.

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References

• PutkinenV, Saarikivi K, Tervaniemi M. Do informal musical activities shape auditory skill development in preschool-age children? Front Psychol. 2013 Aug 29;4:572.
• Banai K, Ahissar M. Musicalexperience, auditory perception and reading-related skills in children. PLoS One. 2013 Sep 24;8(9):e75876.
• Jaschke AC, Eggermont LH, Honing H, Scherder EJ. Music education and its effect on intellectual abilities in children: a systematic review. Rev Neurosci. 2013;24(6):665-75.
• Plantinga, J.,andTrainor,L.J.(2005). Memoryformelody:infantsusea relativepitchcode. Cognition 98, 1–11.

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Should my child attend ballet classes?

[mme_highlight] Ballet helps develop fine motor skills, coordination, flexibility, expression, posture and body self-awareness. Ballet enhances memory, attention and concentration, which may help better academic achievement. Ballet makes children contact with music, rhythms and traditional dances from an early age. Ballet gives a sense of confidence and self-esteem and develops the capacity to work in group.[mme_highlight]

When enrolling your child in ballet classes, the main goal of parents and teachers is to help children build their personality and strengthen ways of self-expression and confidence. This must be done taking the most out of a child’s capacities and posing new challenges always with a training and set of goals adjusted for every child’s profile. Ballet is beneficial in many ways as it teaches posture, musicality, rhythm, and may also improve bone and cardiovascular health.

Mr. Carr set the goals for dance education in 1984:

• to develop capacities and techniques;
• to teach traditions through traditional forms of dance;
• to teach certain series of movements;
• to promote independency;
• to develop imagination;
• to learn to critically judge one’s own achievements.

What is the relationship between pursuing ballet and personality?

62 young dancers were given self-esteem questionnaires which inquired about empathy, creativity and other personality factors as well as a list of interests. The results can be found in the box below and suggest that in comparison to the control group, ballet dancers had a significantly higher interest in music, singing, acting, writing, drawing and handwork, showing less interest in technology.

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Frequency of hobbies in young ballet dancers vs. control group (Helsinki students)

	Young Ballet Dancers			Control Group
	Often	Seldom	Very seldom	Often	Seldom	Very seldom
Playing an instrument	33%	13%	54%	31%	5%	65%
Singing	39%	11%	50%	24%	4%	72%
Acting	24%	12%	64%	5%	2%	92%
Writing	55%	17%	28%	28%	13%	59%
Painting	58%	12%	30%	30%	16%	53%
Handwork	52%	14%	34%	24%	26%	61%
Engines	3%	5%	92%	13%	7%	80%
Nature activities	18%	23%	59%	14%	13%	72%
Photography	3%	8%	89%	4%	12%	84%
Collecting	15%	20%	65%	24%	16%	60%

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Ballet dancers may better develop since young age better capacity of expression, improved self-esteem and confidence, sensitivity and empathy.

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Empathy levels in young ballet dancers vs. control group (Helsinki students)

	Ballet Dancers	Control Group
Female	79.8 +/-6.6	71.0 +/-6.8
Male	72.0 +/-8.9	64.7 +/-7.0
Total	77.2 +/-8.2	67.3 +/-7.6

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Self-esteem levels in young ballet dancers vs. control group (young baseball players)

	Ballet Dancers	Control Group
Female	24.2 +/-3.4	18.9 +/-4.3
Male	22.5 +/-3.8	19.7 +/-4.1
Total	23.4 +/-3.5	19.7 +/-4.1

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What can be the physical implications / benefits of ballet?

Aside from artistic intentions, ballet training implies also physical activity, which has been shown to have health benefits and therefore is likely to benefit children who participate, irrespective of whether they will continue into a professional career. Most skills needed to ballet are not inborn, but, on the contrary, demand training. One of the most prominent physical features is the hip external rotation (ER), which is fundamental to the turned out position characteristic of the art.
Every child van benefit from attending ballet classes, but teachers should define an individualized training program to help children improve as much as possible and to cope with possible physical limitations with positive reinforcement. Thus, a dancer with limited turnout may still benefit enormously from doing ballet.

Bennell K and colleagues  compared bone mineral of 78 pre- and early-pubertal novice female ballet dancers with controls and found that dancers had 4.5% greater total hip bone mineral density (BMD) and 4.9% greater femoral neck BMD (both p <.01). These findings suggest that the mechanical loading of dance training may benefit the bone mineral density, which may prevent fractures and later onset of osteoporosis.

Most of injuries associated with ballet training in children are overuse injuries, caused by errors in technique and abrupt changes in training. Forcing turn-out is the most common technique error. Ballet teachers should be able to prevent such injuries from happening.

Summary and Recommendations

• Ballet is one of the most physically and artistic demanding dance styles.
• Parents may enroll their children in ballet academy since young age (baby ballet classes accept 3-year-olds). The desirable initial training focus primarily in the motor and expressive skills than on classical ballet technique itself.
• For young children, ballet is a good option irrespective of sex. However, plan carefully your child’s weekly schedule not to overload it – remember kids benefit a lot from free playing time.
• Ballet helps develop fine motor skills, coordination, flexibility, expression, posture and body self-awareness.
• Ballet enhances memory, attention and concentration, which may help better academic achievement. Ballet can also be beneficial for hyperactive children.
• Ballet makes children contact with music, rhythms and traditional dances from an early age.
• Ballet gives a sense of confidence and self-esteem and develops the capacity to work in group.

[mme_references]
References

• Kalliopuska M. Empathy, self-esteem and creativity among junior ballet dancers. Percept Mot Skills. 1989 Dec;69(3 Pt 2):1227-34.
• Bennell K, Khan K, Matthews B et al. Activity-Associated Differences in Bone Mineral Are Evident Before Puberty: A Cross-Sectional Study of 130 Female Novice Dancers and Controls. Pediatric Exercise Science, 2000,12, 371 -381.

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Should I offer my child a pet?

[mme_highlight] Owning a pet may help the acquisition of a sense of responsibility, as well as the development of self-confidence, a sense of social membership and security. Some of the potential health risks associated with pet ownership include aggression and bites, allergies and zoonosis. [mme_highlight]

Pets have been shown to influence human development and evidence seems to support the hypothesis that the children’s relationships with their pets are more important than the presence pets in their homes per se. In fact, many educators, parents and researchers see domesticated pets, particularly dogs, as objects of instruction and assistants in the education of children, defending they may help the development of children in socio-emotional and cognitive levels.

What are the most important features of pet ownership by children?

Till now, little is known about cultural and socioeconomic differences regarding childhood pet ownership. The box below illustrates the overall proportion of pet ownership as well as the proportion per type of pet.

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Prevalence of pet ownership
(results from a survey of 1021 9–10 year old primary school children in Liverpool, U.K.)

• Any pet: 66.8%
• Dog: 37.1%
• Cat: 16.6%
• Rabbit: 9.1%
• Rodent: 14.6
• Horse: 2.1%
• Other: 36.1%

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According to Westgarth C et al. and as the box below shows, in general, girls were more likely to own most pet types, except for rabbits; however no difference was found concerning children’s attachment to their favorite pet. Children of white ethnicity were more likely to own dogs, rodents and other pets but again no differences were found regarding attachment. Youngest children and those with no siblings showed greater attachment to their pets. “Pit Bull or cross” and “Bull Breed” dogs were more likely to be owned by children in more deprived areas than other dog types.

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Factors associated with pet ownership
(Results from a survey of 1021 9–10 year old primary school children in Liverpool, U.K.)

• Girls were 2 times more likely to own most pet types (OR 2.00, CI 95% 1.44-2.79; p<0.001).
• Children of non-white ethnicity were almost 80% less likely to own dogs, rodents and other pets (OR 0.23, CI 95% 0.15-0.35; p<0.001).

OR – odds ratio; CI – confidence interval.
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What may be the positive impact of pet ownership by children?

The core of this subject is not in the pet ownership itself, but in the relationship it makes arise. Hence, owning a pet may help the acquisition of a sense of responsibility, as well as the development of self-confidence, a sense of social membership and security. A child who has a pet may be more prone to demonstrate some positive character traits such as frankness, broad mindedness, and sympathetic understanding. Parents should keep a supporting role, which includes assuring optimal pet keeping conditions to prevent harm to the children.

In a study conducted by Kidd AH et al. 700 parents completed a Melson Parent Questionnaire which assesses children’s activities with, interest in, and responsibility for pets, and completed either the Wilson Attitude Inventory for Pet Owners or for Nonpet Owners. Among the results it is interesting to highlight that children of strongly attached adults and in pet-owning homes scored higher on “Activities and Interest” than children of weakly attached adults and in nonpet-owning homes and also that girls scored higher than boys on “Interest” and, in pet-owning homes, also on “Responsibility” .

Another study, by Triebenbacher SL et al., emphasized the children’s use of pets as transitional objects. Their sample included 94 boys and 80 girls in preschool through Grade 5, among which 70% were current pet owners and 30% were not pet owners.
The answers to the interview designed to assess perceptions about the role of friendships between animals and humans have shown that children perceive their pets as special friends, important family members and providers of social interactions, affection, and emotional support.

What may be the negative impact of pet ownership by children?

Some of the potential health risks associated with pet ownership include aggression and bites, allergies and zoonosis.

However the association between early exposure to pets in childhood and subsequent development of sensitization and asthma remains controversial. Some studies have found a higher prevalence of allergic sensitization and respiratory illness in children owning a cat or dog at home, but other studies did not. In fact, it was observed that children living on a farm with animals may be less prone to allergic disease than those living in urban settings.

According to an article by Medjo B et al., pet owning is not significantly associated with increased risk for asthma. Apparently, only owning a cat during the first year of a child’s life increases the risk of sensitization to cat allergen; this association was not found past the first year, as shown in the box below.

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Pet ownership, asthma and allergic sensitization

• Early pet ownership was not significantly associated with asthma: 0.94; 95% CI 0.44–2.01.
• Past pet ownership was not significantly associated with asthma: OR, 1.083; 95% CI 0.57–2.06.
• Current pet ownership was not significantly associated with asthma: OR, 0.866; 95% CI 0.45–1.66.
• Early cat ownership was significantly associated with sensitization to cat allergen: adjusted OR, 51.59; 95%CI 2.28–1167.07.

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Summary and Recommendations

• Pets are proposed to confer both physiological and psychological health benefits, but more scientific evidence is needed to prove such assumption.
• Owning a pet may help the cognitive and social development of a child, particularly the acquisition of a sense of responsibility, as well as the development of self-confidence, a sense of social membership and security
• There are also potential health risks associated with pet ownership including aggression and bites, allergies and zoonosis.
• More studies to provide solid evidence are needed, but it seems that owning a pet is not associated with an increase in asthma risk, but may be associated with sensitization to allergens.
• Parental supervision to assure a secure setting for the development of a relationship between their children and pets is essential.

[mme_references]
References

• Kidd AH, Kidd RM. Factors in children’s attitudes toward pets. Psychol Rep. 1990 Jun;66(3 Pt 1):775-86.
• Triebenbacher SL. Pets as transitional objects: their role in children’s emotional development. Psychol Rep. 1998 Feb;82(1):191-200.
• Westgarth C, Boddy LM, Stratton G et al. A cross-sectional study of frequency and factors associated with dog walking in 9-10 year old children in Liverpool, UK. BMC Public Health. 2013 Sep 10;13:822.
• Medjo B, Atanaskovic-Markovic M, Nikolic D et al. Association between pet-keeping and asthma in school children. Pediatr Int. 2013 Apr;55(2):133-7.

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Is there a relationship between watching violence and violent behavior?

[mme_highlight] The American Academy of Pediatrics recognizes exposure to violence in media (television, video games and others) as a significant risk to children’s health. Results from studies have shown that exposure to media violence is associated with problems such as aggressive behavior, desensitization to violence, fear, depression, nightmares, as well as sleep disturbances. [mme_highlight]

The American Academy of Pediatrics recognizes exposure to violence in media (television, video games and others) as a significant risk to children’s health. Research results join consensus indicating that media violence can contribute to aggressive behavior, nightmares and fears in children.

Why is media violence a public health issue?

It was estimated that American children aged 2 to 18 spend approximately 6,5 hours per day using media, increasing to 8 hours per day if considering the simultaneous use of multiple media; this makes it the leading activity in terms of time consume, with exception for sleep. Of course, during such a great amount of time, violent scenes are viewed.
It has been estimated that, by the age of 18, a person may have already seen a surprising number of 200.000 acts of violence, on television alone. The box below presents a surprisingly negative idea of the numbers of media violence.

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Media Violence in Numbers

• Average time spent by children using media: 6.5 hours per day
• Average screen time spent by children <2 years: 2 hours per day
• Number of violence scenes viewed during childhood: 200.000
• Average % of violence in broadcast programming: 66%
• % of animated movies showing violence (1937-1999): 100%

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It also shocking to note that most of violence presented in media is perpetrated by handsome characters, establishing a wrong belief in children’s minds in which violence is a act heroes use as an acceptable way to solve problems.

How can children be affected by watching media violence?

Previous exposure to violence is the main factor to increase the risk for violent behavior. Remember that children learn by observing and they will try to imitate the attractive hero who solves problems with a gun. Also keep in mind the fact that a child younger than 8 years cannot discriminate between fantasy and reality so they may feel tempted to adopt what they watch in media as reality.

Another topic that deserves attention is the presence of television in children’s bedrooms. In fact, it was estimated that 19% of infants, 29% of 2 to 3-year-olds, 43% of 4 to 6-year-olds, and 68% of children aged 8 years or older have got a television in the bedroom. It is easy to realize that a child who has a T.V. in the bedroom tends to watch T.V. for more hours and, in addition, it has been studied that not only the risk for violent behavior may be increased, but also increases the risk for obesity by 31% and the risk for smoking doubles.

However, even in light of strong evidence from studies that media violence has a negative impact on children, it appears that the public, politicians, and parents all have been reluctant to accept these findings and take action.

Do studies support the association between viewing violence and violent behavior?

Yes, undoubtedly. Results from studies have shown that exposure to media violence is associated with problems such as aggressive behavior, desensitization to violence, fear, depression, nightmares, as well as sleep disturbances.

A study by Christakis DA and Zimmerman FJ was conducted with the goal to find if exposure to violent programming during the preschool period would be associated with subsequent aggressive behavior.

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Association between violent television programming and antisocial behavior

• Increased risk for antisocial behavior with violent programming
• Overall: 2.2 times more likely (OR: 2.20; 95% CI: 1.35–3.60).
• Boys: 4 times more likely (OR: 4.10; 95% CI: 2.09–8.02)
• Girls: no association found: (OR:0.39; 95% CI: 0.04–3.74)
• Educational programming – no association with increased risk found
• Boys: no association found (OR: 0.41; 95% CI: 0.09–1.86)
• Girls: no association found (0.63; 95% CI: 0.11–3.73)

OR – odds ratio; CI – confidence interval
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Summary and Recommendations

• The American Academy of Pediatrics recognizes exposure to violence in media (television, video games and others) as a significant risk to children’s health.
• There is a substantial body of evidence indicating that exposure to media violence is associated with aggressive behavior, fear, depression, nightmares and sleep disturbances.
• Children pass an alarming number of hours in front of television and other media and most of programming contains violent scenes.
• Young children cannot discriminate fiction from reality and tend to imitate the heroes they see on the screen and who frequently use violence.
• Children should not have a television in their bedroom as this will increase the number of hours watching T.V., raising the odds for obesity and smoking.

[mme_references]
References

• Council on Communications andMedia. From de American Academy of Pediatrics. Policy statement–Media violence. Pediatrics. 2009 Nov;124(5):1495-503.
• Committee on Public Education. American Academy of Pediatrics. Media Violence. Pediatrics.2001 Nov;108(5):1222-6.
• Roberts DF. Media and youth: access, exposure, and privatization. J Adolesc Health. 2000;27(suppl):8–14.
• University of California, Center for Communication and Social Policy.National Television Violence Study, I-III Thousand Oaks, CA: Sage Publications; 1996-98.
• Christakis DA, Zimmerman FJ. Violent television viewing during preschool is associated with antisocial behavior during school age. Pediatrics 2007; 120:993.
• Dennison BA, Erb TA, Jenkins PL. Television viewing and television in bedroom associated with overweight risk among low-income preschool children. 2002;109(6): 1028–1035.
• Jackson C, Brown JD, L’Engle KL. R-rated movies, bedroom televisions, and initiation of smoking by white and black adolescents. Arch Pediatr Adolesc Med. 2007;161(3): 260–268.

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