Raise parent's awareness of risks, benefits of cyberspace

ARTICLE REPRINT • From the February 2003 AAP News, the official news magazine of the American Academy of Pediatrics

Kids don't need to leave the house to find trouble. Put them in front of a computer, and trouble is at their fingertips. Kids are one click away from:

• viewing frightening depictions of sexuality;
• downloading games in which they "shoot" people, sniper-style; or
• meeting adults looking for sex.

All while their parents think they're upstairs doing homework. "When (children) go online, they're not really in your house anymore," said Kathy Free of the National Center for Missing and Exploited Children. "They're out there."

Because unsafe and unhealthy situations may arise, pediatricians should talk with patients about computer use, said Daniel D. Broughton, M.D., FAAP, an advocate for missing children. "It's part of anticipatory guidance," he said. "Like alcohol, tobacco, drugs and nutrition, this is one of the (topics) that needs to be included."

How much is too much?

Perhaps one of the first questions that should be addressed is the amount of time spent on the computer. Dr. Broughton said children should be exposed to no more than two hours of media a day. That includes TV, videos, music and computers.

Too much time at the computer, Dr. Broughton said, could interfere with a child's ability to learn skills needed to succeed in life. Computers may impede interaction with other people and dampen imagination, he said.

Unfortunately, said S. Andrew Spooner, M.D., FAAP, many parents don't see it that way. "There's a false sense that looking at a computer has a higher value than looking at the TV," said Dr. Spooner, chair of the AAP Steering Committee on Clinical Information Technology. "Parents may think (if their) child spends five to six hours on the computer, he's learning important job skills."

In reality, he said, children are playing computer games, checking e-mail and idling away hours in chat rooms. None of that makes for marketable skills and too much online activity hampers social development. Staring at a screen, Dr. Spooner said, is no substitute for enjoying family life and developing friendships.

David W. Kaplan, M.D., FAAP, chair of the AAP Committee on Adolescence, said he believes kids can become "addicted" to the computer, although perhaps not in the sense that they would suffer withdrawal symptoms if the machine were unplugged. Still, he said, the amount of time these kids spend on the computer - five or six hours a day - would indicate a problem. Many times, such kids stay up until the wee hours of the morning talking in chat rooms and playing games.

"I haven't found many kids that are addicted to it because they're working on a science project," Dr. Kaplan said. "They're spending a lot of time on the computer when they should be doing homework or sleeping. A lot of these kids are sleep-deprived." In extreme cases, the pediatricians said, an adolescent's computer activities take priority over the rest of his life. He drops off the swim team, for example, or no longer comes down for dinner.

Both Drs. Broughton and Spooner said the pediatrician's job here is to assess whether the patient is developing normal social skills. Can he maintain friendships? Do peers accept him? Does he get any exercise?

Physicians need to consider whether such adolescents are depressed or suffering from anxiety disorder. Even if they're not, Dr. Spooner said, pediatricians should work with parents to get the kids plugged into other social activities.

Content also a concern

Monitoring how the computer is used is just as important as monitoring the amount of time spent on it. Marilyn J. Bull, M.D., FAAP, chair of the AAP Committee on Injury, Violence and Poison Prevention, said she's concerned about the games kids play on the computer. She noted that video games in which players shoot people are used as part of military training to desensitize soldiers to killing. Kids, she said, have no business playing similar games.

"There's no sense of the pain (of being shot), and children don't begin to comprehend the finality of death until they're at least 7 or 8," she said. "Even adolescents don't fully comprehend the picking up of a gun and bang, you're dead."

Studies linking television to violent behavior can be extrapolated to computer use, Drs. Bull and Spooner said. Furthermore, the violence depicted on television "pales in comparison to the horrible content on the Internet," Dr. Spooner said. On their computer screens, children can watch as women are beaten as part of sex or as people engage in unnatural acts with animals. Such images can frighten, disgust and confuse kids, Dr. Spooner said.

While some adolescents may seek out pornography, 25% of youngsters who use the Internet report being subjected involuntarily to such material, according to a national survey done by the University of New Hampshire Crimes Against Children Research Center (www.unh.edu/ccrc/pdf/Victimization_Online_Survey.pdf).

In addition, the Internet plays host to a broad range of ideas that parents may not want their children exposed to, such as racism or social injustice.

While an adult may watch a movie that depicts racism or violence and understand how it fits into the sweep of history, a child doesn't have that skill. "We know from child development (research) that kids don't operate that way. They can't see things in context," Dr. Spooner said. At least with television, he said, parents can control what children watch and discuss programs with them. But, he said, when kids sit down at the computer, "the content is totally unpredictable."

Danger online

Also unpredictable is who a child might meet online. The University of New Hampshire survey also found that 20% of kids who use the Internet regularly have been solicited sexually while online. In 15% of these incidents, the solicitor attempted to contact the youth in person, over the phone or by mail. Meeting youngsters online is easy for predatory adults because kids often reveal too much information about themselves in chat rooms, or create member profiles for themselves when they register with their service providers, Free said.

Predators then use information from the member profiles to approach kids as "friends." For example, an adult may masquerade as another kid and upon finding out that his correspondent is going on vacation say, "My father will be at that same hotel for a convention. Why don't you meet him?" "A few kids have been killed," Dr. Broughton said.

Advice for patients, parents

In addition to talking to patients and parents about computer use, physicians also can provide brochures on computer safety, Dr. Broughton suggested. Such material is available from the National Center for Missing and Exploited Children (www.missingkids.org).

Pediatricians, Dr. Broughton and Free said, should advise parents to do the following:

• Learn about computers. Too often, kids know more than their parents and therefore can conceal their activities.
• Limit use of media (including computers) to no more than two hours a day.
• Set up the computer in a public area of the house where parents can monitor activities.
• Instruct children not to provide personal information, including pictures, addresses or telephone numbers.
• Tell children that they should not respond to messages that upset them.
  

Reprinted with permission. American Academy of Pediatrics, AAP News, February 2003.