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Pediatricians criticize use of TVs in hospital

Children's Hospital Boston, which runs a center that is an authority on the effects of television on children, has TVs throughout the building, some of which show programs to infants.

Cartoons, educational programs, and other shows are shown to children as young as 2 months old; the Globe observed two babies on their backs with screens playing cartoons a foot from their faces. A hospital spokeswoman said the TVs provide a necessary distraction from treatment, but the practice is drawing criticism.

``This is eyebrow-raising," said Don Shifrin , a pediatrician in Seattle and chairman of the American Academy of Pediatrics' Committee on Communication, when told that infants were watching TV. The academy issued a policy in 1999 setting guidelines for TV viewing for children of all ages -- including no television for children 2 or younger -- and reaffirmed it in 2001.

Susan Shaw , a Children's Hospital spokeswoman and director of clinical operations, defended the use of TVs. ``These kids [in cardiac care] are very, very sick," she said. ``They need whatever distraction possible from their pain and boredom." The same room in the cardiac intensive care unit, she said, could be occupied by a 16-year-old or a 6-week-old.

``We are a family-focused place. We have to engage our families," Shaw said. ``And yes, even an infant needs the distraction from pain that television can give."

Before installing the televisions in the new cardiac unit last year, she said, the hospital sought input from patients' families and found overwhelming interest in having television. The parents wanted them not just as a distraction for the children but also as entertainment for parents who are there for long stretches, including times when a child is sleeping. Shaw said the hospital is ``aware of and, to the extent possible, respectful" of the pediatrics academy guideline. There are no televisions in the neonatal intensive care unit, for instance.

But the televisions have stirred controversy even within Children's Hospital .

Michael Rich, a pediatrician and head of the Center on Media and Children's Health at Children's Hospital, helped write the American Academy of Pediatrics policy on TV viewing. He said infants don't know they are watching television. ``From what we know about the way babies perceive an electronic screen, they will focus on anything that is bright, loud, or moving within their range, which is limited to what's right in front of the face," Rich said. ``That's part of a strong alert instinct. They would respond to anything unknown in the same way. They need to figure it out for survival."

Shifrin said it's a stretch to argue that TV is a distraction for a baby.

``They don't know from TV. It's not like they are asking for it to be turned on. An adult is making that decision," he said. ``In a hospital setting, particularly a premier hospital such as Children's, this is not something the academy would like to see as precedent." Babies can see only about a foot in front of themselves, he said, which is why the screens are so close.

An ad hoc committee of hospital employees that formed two years ago set limits on which programs patients see, and the TVs get only those channels that have been approved by hospital staff. ``We don't want them watching `Jerry Springer,' " said Fred Mirliani , director of multimedia services and a member of the committee. ``We pulled in age-appropriate programming; ``Animal Planet," sports programs, Nickelodeon," as well as in-house programming. Parents in the rooms can change the channel or shut the TVs off .

But the committee was unable to get the hospital to agree with American Academy of Pediatrics standards and prohibit television viewing by children under 2, according to Rich. He said he is disappointed by that decision.

``We need to set an example to parents and the community as to what is best for children," he said. ``This is as important as the food they eat. That's our failure, those of us who know the research, to not get the information out there in ways that enable parents and other clinicians to make wise choices around media use."

The pediatrics academy policy cautioning against viewing for babies and toddlers evolved from research that shows that the brain undergoes rapid growth during the first two years , including a natural selection process that prunes away unnecessary neural connections. Because watching television is a two- rather than three-dimensional experience, exposure tends to prune away the neurons responsible for social interaction and deductive reasoning. This could affect academic success.

The pediatrics academy policy has come under fire by those who say it fails to recognize that television is a fact of life in American families. According to a 2003 study by the Kaiser Family Foundation, two-thirds of the nation's children under 6, including those as young as 6 months old, spend an average of two hours a day in front of a TV, computer, or video screen. The pediatrics academy is in the process of deciding whether to rewrite the recommendation to include a nod to that reality. But, Shifrin predicted, ``in no way are we easing up."



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