Baby videos

1. Baby videos

2. Ethics and baby videos • A unique ethical issue • Videos are not a medical treatment • They are marketed directly to parents • No FDA oversight • No apparent risks to children • Is there any role for pediatricians?

3. Parents may ask their doctor • Psychologists have studied the videos, trying to measure their effectiveness

4. Do they make children smarter?

7. Controversial history • DVDs for babies have been marketed since the mid 1990s • They are now a multibillion dollar market • President George Bush praised their creator, Julie Aigner-Clark, in his 2007 State of the Union address, as "represent[ing] the great enterprising spirit of America"

8. Controversial history • In the early days, marketers made unsupported claims about the value of the videos: • “According to cognitive research, dedicated neurons in the brain's auditory cortex are formed by repeated exposure to phonemes, the unique sounds of language. Studies show that if these neurons are not used, they may die. Through exposure to phonemes in seven languages, Baby Einstein contributes to increase brain capacity.“ • From an early Baby Einstein website, now unavailable http://www.newsweek.com/blogs/nurture-shock/2009/10/26/baby-einstein-is-dead-long-live-baby-einstein.html(accessed June 11, 2010)

9. Child advocates are skeptical • 1999 – American Academy of Pediatrics recommends no television before age 2 • 2005 - Kaiser Foundation calls for research on the effects of media exposure on children • 2009 – Campaign for Commercial Free Childhood: “No credible evidence that screen media is educational for babies”

10. In response to criticism, companies change their claims • By 2007, Baby Einstein was not making claims about cognitive development or brain capacity. Instead, the videos were dubbed "a rich and interactive learning experience.“ • In 2009, Disney (which acquired Baby Einstein in 2001) offered rebates for any purchasers who were not satisfied with the product. http://blogs.wsj.com/juggle/2009/10/26/baby-einstein-refund-and-the-allure-of-the-digital-babysitter/ http://www.nytimes.com/2009/10/24/education/24baby.html?_r=2&em

11. Parents are ambivalent. They like videos – but think books are better. Kaiser Family Foundation. 2003.

12. But children watch baby DVDs and videos Zimmerman FJ, et al. Arch Pediatr Adolesc Med. 2007.

13. And they start young Zimmerman FJ, et al. Arch Pediatr Adolesc Med. 2007.

14. Should pediatricians recommend or discourage baby DVDs?

15. Little scientific evidence of benefit • Researchers have investigated how well infants respond to particular baby videos now on the market • The findings largely have been the same: up to the age of about 22 months, infants derive little educational benefit from video

16. Do infants learn language from instruction delivered from a screen?

17. Comparison of live instructor, audio, and audiovisual material Different groups of nine-month old babies: - 16 assigned to live Mandarin exposure group - 16 assigned to live English exposure group. - 16 assigned to audio only - 16 assigned to audiovisual only Outcome measure: recognition of Mandarin sounds Kuhl et al. Proc Natl Acad Sci USA. 2003

18. Exposure to live learning, but not to tapes, led to better speech recognition Kuhl et al. Proc Natl Acad Sci USA.2003.

19. Conclusion “Between 9 and 10 months of age, infants show phonetic learning from live, but not prerecorded, exposure to a foreign language, suggesting a learning process that….is enhanced by social interaction.” Kuhl et al. Proc Natl Acad Sci USA.2003.

20. Tests of baby videos Commercially-available baby videos, whether evaluated epidemiologically or in a laboratory setting, have not fared well

21. Videos may impair language development • Survey of 1,008 parents of children 2-24 months old • Questions about parent-child interactions and media use • Outcome: MacArthur-Bates Communicative Development Inventory (CDI) • Score compared to history of media exposure and interactions with parents Zimmerman et al. J Pediatr. 2007.

22. More DVD use, lower language scores Zimmerman et al. J Pediatr. 2007.

23. Results Among children 8-16 months of age: • Daily reading improved performance by about 7 points • 1 hr/d of baby DVDs  17 point drop in language scores Note: differences not present in children 17-24 months Zimmerman et al. J Pediatr. 2007.

24. Why the lower score? • Families that use videos do not engage in activities that enhance language? • Parents show videos to kids whose language is already delayed? • The videos cause language delays?

25. Do babies learn vocabulary from a DVD designed for that purpose?

26. Baby Wordsworth underwhelms • 45 children, 12-15 months old • Half got Baby Wordsworth DVD. Half didn’t. • Parents instructed to show it 15 times over six weeks • Every two weeks, parents rated how many of the 30 words on the DVD their child understood or could speak • Outcome measures: number of words understood or said of the 30 words on DVD Robb et al. Br J Dev Psychol. 2009.

27. DVD makes little difference Robb et al. Br J Dev Psychol. 2009.

28. Reading aloud to infants is best “After controlling for age, gender, cognitive developmental level, income and parent education, the most significant predictor of vocabulary comprehension and production scores was the amount of time children were read to.” Robb et al. Br J Dev Psychol. 2009.

29. DVDs don’t teach vocabulary 96 infants 12-25 months old randomly assigned Baby Wordsworth or no DVD Parents decided whether to watch with child Parents recorded viewing in a diary Richert et al. Arch Pediatr Adolesc Med. 2010.

30. Study design (cont’d) Outcome measures: • Parent report and observational measures of vocabulary acquisition related to words highlighted in the DVD • Parent report of general language development • Parent report of children's media use Richert et al. Arch Pediatr Adolesc Med. 2010.

31. Results Overall communication scores not significantly related to: • How often watched DVDs in general • How often watched Baby Einstein DVDs • Age of first viewing of DVD No differences between the two groups regarding: • Words understood • Words said • Picture identification Richert et al. Arch Pediatr Adolesc Med. 2010.

32. Points that pediatricians might make with parents • Most children under age two get nothing from a video • Children learn best and fastest from a human being • Children gain more from television and videos if an adult watches with them and talks about it • For older children, or for specific tasks, video or television can be useful

33. Resources Center on Media and Child Health. Children’s Hospital Boston. Christakis DA. The effects of infant media usage: what do we know and what should we learn? Acta Paediatrica. 2008;98(1):8-16. DeLoache JS, Chiong C. Babies and Baby Media. Am Behav Sci. 2009;52(8):1115-1135. Garrison MM, Christakis DA. A Teacher in the Living Room? Educational Media for Babies, Toddlers and Preschoolers. Henry J. Kaiser Family Foundation. Dec 2005. Richert RA, Robb MB, Fender JG, Wartella E. Word Learning From Baby Videos. Arch Pediatr Adolesc Med. 2010 May;164(5):432-7. Wartella E, Richert RA, Robb MB. Babies, television and videos: how did we get here? Dev Rev. 2010 Jun;30(2): 116-127.