PIAGETTHEORY

3.5.1 Cognitive Theory of Development

Swiss psychologist Jean Piaget is well known for his theory which describes how
humans gather and organize information and how this process changes developmentally.
Piaget used a clinical-description method to collect his research data. The method
involved asking children carefully selected questions and recording their response along
with meticulous observation of children’s behavior. Although he frequently observed
small numbers of children his observation were longitudinal in nature that is, following
the development of these same children over a period of years. While much of his early
work was based on systematic observation of his own three children, a large part of his
later work was based on statistical friendship.
Basic Cognitive Concepts
Piaget indentified four concepts, which he used to explain how and why cognitive
development occurs. These include schema, assimilation, accommodation and
equilibration.
(i) Schema: Piaget used the term scheme to refer to the cognitive structures by
which individuals intellectually adapt to and organize their environment.
Based on his interests in biology. Piaget postulated that the mind has mental
structures or schemata, just as the body has physical structures. Piaget
suggested that when an organism encounters stimulation or a new experience,
and relies on its structures to assist in that adaptation. Thus, just as the human
body is “organized’ into various structures such as the stomach, kidneys etc.,
which assist in ongoing adaptation, so too does the mind have structures or
ways of organized experiences, which facilitate adaptation to the experiences.
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(ii) Assimilation: This process of integrating new perceptual, motor or conceptual
material or experiences into existing schemata is termed assimilation.
Teachers often facilitate the student’s use of assimilation by connecting the
new material to the student’s existing knowledge. Thus, often watching a
nature film, a child may discover new animals to add to existing groups of
animals she has already stored in memory.
(iii) Accommodation: When this process of assimilation is not possible because
there are no schemata into which to fit new data or the characteristics of an
available schema, a new schema will have to be developed in order to adopt to
these new and unique experience. This process of creating a new schema
Piaget termed accommodation.
(iv) Equilibration: Piaget hypothesized that a self-regulatory process called
equilibration operated in all children and adults. This equilibrium is a state of
balance between assimilation and accommodation. Piaget believed that one of
the most effective methods for motivating a child was to set up a state of
cognitive disequilibrium in which the child is thrown into “cognitive conflict”
when he expects something to happen a certain way and it does not.
Piaget’s Stages to Cognitive Development
According to Piaget, cognitive development unfolds as the child passes through
four district and qualitatively different stages: the sensorimotor, pre-operational, concrete
operation, concrete operation and formal operational stages:
Table 3.5 the four periods of intellectual development--------------------------------

cognitive periods appropriate stages

The Sensorimotor pd (birth to 18-24 months)
The Pre-operational period (2 to 7 years)
The Concrete operational period (7 to 11 years)
The Formal operational period (over 11 years)
(I) The Sensorimotor Period
Piaget’s first stage of intellectual development, in which the child moves from the
reflective activities of reaching, grasping and sucking to more highly organized forms of
activity. The infant begins to understand that there is a difference between him/herself
and the rest of the world and that the sensory experiences received are in fact suggestive
of the existence to some form of “objects” or “events” that exist outside of themselves.

This development of object permanence expands the infant’s view of the world
beyond that which is immediately and directly experienced. Thus, the infant may begin to
search for objects that are out of sight. During the period, the infant develops object
permanence, the realization that objects exist even if they are out of sight.
Another milestone of the sensory-motor period is the development of the
beginnings of problem-solving ability. While at first this is based largely on trial and
error, by the end of the period, approaches to problem solving are planned.
(II) The Pre-operational period
The stage is Piaget’s theory of cognitive development, in which the lack of logical
operations forces children to make decisions based on their perceptions. The major

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development during the pre-operational period is the ability to represent object and events
or to use symbolic functions. You will recall that towards the end of the sensorimotor
period, children become capable of engaging in activities that involve mental
representation such as pretending.
Between the ages of two and seven, the mental abilities come to unfold fullyas
advances in language development and imagination enable the child think and play in
new ways. In addition to symbolic functions the pre-operational period is characterized
by several unique features.
Egocentrism
Piaget described the pre-operational children’s thinking as egocentric. That is,
pre-operational children cannot put themselves in other stages or someone else’s
perspective. Consider the four year old who can label own right hand and left hand, but
cannot identify the right and left hands of a friend. Piaget emphasized that egocentrism
has nothing to do with selfishness, but merely reflects the qualitative limitations in
thinking apparent during the pre-operational stage. As the child gets older, egocentrism
vanes. By age six, children exhibit, less egocentrism than at age three.
Centration
Another characteristic of pre-operational thought is centration or concentration as
only one aspect of an object or activity, usually the aspect that is perceptually dominant.
For instance, a child of four or five is presented with two rows of objects in which one
row contains nine objects and a second but longer row, contain seven objects. The preoperational
child will typically select the longer row as having more objects even though
the child knows that nine is more than seven.

Inability to reverse operation

A third feature of pre-operational thought is inability to reverse one’s thinking.
Understanding subtraction is a prime example of this feature. Pre-schoolers may have
learned that 1+1=2 but cannot comprehend that 2-1=1 or ponder the case of the preoperational
child who is presented with two identical glasses, both short and fat in shape.
Then water from one of the glasses is poured into a tall thin glass. The child is then asked
if the glasses contain the same amount of water. In order to answer correctly, the child
would have to be mentally able to reverse the operation of pouring the water from the
original short, fat glass into the tall this one. But pre-operational children typically
respond that the tall, thin glass contain more water.
The later illustration shown that pre-operational children are not yet ready to
engage in conservation or to conceptualize that the quantity or amount of matter stays the
same despite changes in an irrelevant dimension.

Animism
A fourth feature of the pre-operational child is animism. An animistic thinker
attributed human characteristics to inanimate objects. For instance, consider that preoperational
child who is asked the question where do boats go at night”? and responds “to
bed” or ponder the drawings of a pre-operational child, which feature a face drawn on a
sun or a moon. Piaget believed that this tendency decreased by age six or seven as the
child became more cognizant of his or her own personality.

Transductive reasoning
Finally, the pre-operational child exhibits fifth characteristics known as
transductive reasoning. That is, he or she reasons neither deductively nor inductively.
Deduction is reasoning from general to specific. If we acknowledge that all men are
mortal and Socrates was a man, then Socrates has to be mortal. Inductive reasoning in
contrast involves establishing generalization from specific instances. However, according
to Piaget, the thinking of pre-operational children is somewhere in between moving from
particular without touching on the general.

(III) The Concrete operational Period

In contrast to pre-operation, the child in concrete operation now engages in logical
thought to solve concrete problems. At this stage of development a child’s logic is
directed by cognitive activity rather than dominated by immediate experience, as was the
case both pre-operational thought.
(i) Decentering
A child in the concrete operational stage is able not only to imagine things
independent of their immediate experience, but now is capable of employing all of the
perceptual features of an experience (decenter) in order to derive logical solutions to
concrete problems.
(ii) Reversibility
Piaget proposed that the most important of these was reversibility. A concrete
operational child understands that a model of an airplane, which had formerly been a
ball of clay, can be changed back into a ball of clay.
(iii) Conservation

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The fact that the child in the concrete operational stage of development is able to
decenter and to reverse operational facilities the ability to develop conservation skills. A
child is able to solve conservation of number problems around the age six, area and mass
problem around seven or eight, and volume problem by eleven or twelve.
(iv) Classification
Other significant changes in problem-solving ability can be seen in the concrete
operational child’s ability to engage in classification. Before the age of seven children
typically form classifications of objects along one dimension. That is, children can
classify according to color or shape. Thus, presented with a group of white and black
circles, squares and triangles, a child may classify them into two groups, all the while and
all the black designs together.
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(v) Seriation
Seriation is the ability to mentally arrange a series of elements according to
increasing or decreasing size, volume, weight or some other dimensions. A child in the
concrete operational stage begin to employ strategies such as searching for the smallest
stick, then the next etc to develop the solution or seriation problems.
(IV) The Formal operational stage
With the onset of Piaget’s fourth stage of cognitive development, formal
operation, comes the ability to solve abstract problems. The development of formal
operation proves the ability to reason and construct logic useful for all classes of
problems. During this stage of development, thinking has a number of unique structural
properties, those of being hypothetical, analogical and deductive.
(i) Hypothetical reasoning
Hypothetical reasoning transcends perception and memory and deals with things
not in the realm of direct experience. For instance, if a logical argument is prefixed by the
statement” suppose coal is white” a concrete operational child will invariably say that is
not possible and therefore the question cannot be answered. However, a formal
operational child will readily accept the assumptions of the argument and goon to reason
about its logic.
(ii) Analogical reasoning
Analogical reasoning in which children can fully explain why an analogy works
and how each pair of the analogy is connected to the other, also emerges in formal
operations.
(iii) Deductive reasoning
Deductive reasoning is reasoning from generalities to specifics. The type of
reasoning contained in a syllogism is deductive reasoning. Consider the child who
correctly responds to the following complex if- then statement. If all animals have four
legs and if this table has four legs then is this table an animal? The child who correctly
responds reason that although both tables and animals have four legs, a table cannot be an
animal because it is not a living creature.
(iv) Reflective abilities
In addition to the above described abilities, formal operational thinkers possess a
sophisticated set of reflective abilities. For instance, they are able to systematically
generate all possible solutions to a problem or engage in combinational reasoning

ERIKSON THEORY

3.5.2 Psycho- Social Theory of Development (Erikson)

Erik Erickson, the famous psychoanalyst is considered with developing the theory
of psycho-social development which covers normal development over the entire life span
of human beings. Erikson postulated that the development of an individual is the result of
his interaction with his social environment. Right from his book, his social development
puts him under specific pressures or conflicts by making specific demands at different
ages or developmental stages of his life.
Erickson discovered eight such issues or crisis of life arising at different ages or
periods of one’s development and linked them with the eight stages of one’s psychosocial
development covering one’s entire life span.
Table 3.6 Age span for the stages of psycho-social development
Stage of psycho-social development Specific age or period
Trust Vs mistrust Birth to One year
Autonomy Vs shame & Doubt One to Three Years
Initiative Vs Guilt Three to Five years
Industry Vs Inferiority Five to Eleven years
Identity Vs Role Confusion Eleven to Eighteen Years
Intimacy Vs Isolation Eighteen to Thirty Five Years
Generativity Vs Stagnation Thirty Five to Sixty Five Years
Integrity Vs Despair Over Sixty Five Years

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Stage I: Period of Trust Vs Mistrust (Birth to 1 year)
In the first one year of life, the infant is confronted with the crisis termed trust Vs
mistrust. During the period the baby is completely dependent upon its mother or caretaker
for the satisfaction of its needs. The sense of trust or mistrust with regard to the
environment gained in this way at this stage of development may then be carried over to
the stage of development to follow and consequently reflected in the developing
personality.
Stage II: The Period of Autonomy Vs Shame and Doubt (1 to 3 years)
Having gained a primary sense of trust and security with regard to his
environment in the second and third years of his life, the child now passes through the
second stage of psycho-social development. With the newly developed motor or physical
skills and language ability, the child now engages in exploring his environment and
experimenting with his strength and limitations for achieving a sense of autonomy and
independence.
Children who are denied the opportunity to develop a sense of independence by
over-protective, harsh or restricted parents begin to doubt their ability and ultimately
begin to feel embarrassment or ashamed in the presence of others.
Stage III: The Period of Initiative Vs Guilt (3 to 5 years)
The third stage of psycho-social development between three to five years of age is
characterized by the crisis of initiative versus guilt. Equipped with the sense of trust and
autonomy the child now begins to take initiative in interacting with his environment. In the case the child is discouraged from taking
the initiative by his parents and
guardians not having faith in him or is pulled down by unhealthy criticism, punished or
rebuke for minor failures, the child is sure to develop a sense of guilt leading to
hesitation, indecision and lack of initiative in planning and carrying out life activities.
Stage IV: Period of Industry Vs Inferiority (5 years to 11 years)
The teachers and school environment thus play a very significant role in helping
the child out of the industry versus inferiority crisis, for the child. The school becomes
the place where success and failure are defined. Therefore, it is the duty of the teachers
and school authorities to structure their classroom and school environment in such a way
as to help the students to maintain a positive attitude and view themselves as capable and
valuable individuals.
Stage V: Period of Identity Vs Role Confusion (11 Years to 18 Years)
This stage, beginning with the advent of puberty, is marked with the crisis of
identity vs role confusion. Equipped with the sense of trust, autonomy, initiative and
industry, adolescents begin to search for their own personal identity. The sudden changes
in the bodies and mental functioning and the altered demands of society compel then to
ask and questions of themselves like, who am I?.
Teachers and parents can play a very constructive role in helping, adolescents
through this identity versus confusion crisis. The adolescents craving for identity must be
fully recognized and it should be clearly understood that adolescents want to be identified
as adults and must, therefore be treated as such and not as children as many teachers and
parents tend to do.
Stage VI: The Period of Intimacy Vs Isolation (18 years to 35 years)
This is the sixth stage of psycho-social development the span of years of early
adulthood. During this stage the individual tends to develop a sense of intimacy or
commitment to a close relationship with another person. Thus, during this stage the
individual seeks to form close personal attachments by merging his identity with that of
another person. The relationships develop into such a close involvement that he tends to
risk even the loss of his ego or image as is evidenced in the harmonious relationship
between husband and wife and intimate friends, and is the ideal relationship between a
teacher and his pupil.
The opposite of intimacy is isolation. When one fails to develop an adequate
sense of intimacy by merging one’s identity with that of another person or when relations
deteriorate for one reason or another one tends to develop a sense of isolation.
Stage VII : The Period of Creativity Vs Stagnation (35 years to 65 years)
An individual’s life up to this stage is taken up with trying to establish himself in
a professional career. Now, he needs to satisfy his need for generativity, a concern to
establish and guide the new generation.
As opposed to the some of generativity, there is a tendancy on the part of the
individual to become egoistic and selfish. This leads to stagnation and personal
impoverishment.
Stage VIII :The Period of Ego-Integrity Vs Despair (Over Sixty Five Years)
This stage of psycho-social development is associated with later adulthood or old
age. During this last stage of psycho-social development one is confronted with the final
crisis of one’s life span, termed ego-integrity Vs despair. Ego integrity refers to the
integration or culmination of the successful resolution of all the seven previous crisis
provides a sense of fulfillment and satisfaction to one’s ego.
When one reflects on one’s past and feel satisfied over what could have been or
for what should have been done differently. On the other hand, person who have not been

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to successfully resolve the previous crisis of the developmental stages are sure to feel
differently. They look back on their lives both despair and feel dissatisfied with the way
they have lived their lives.

KOHLBERG THEORY

3.5.3 Theory of Moral Development (Kohlberg)

Lawrence Kohlberg a Psychologist belonging to the university of Harvard is
known for putting forward a theory of the development of moral judgment in the
individual right from the years of early childhood .He has based his theory of moral
development on the findings of his studies conducted on hundreds of children from
different cultures.
He differs from the popular view that children imbibe the sense and methods of
moral judgment from their parents and elders by way of learning. According to him as
soon as we talk with children about morality, we find that they have many ways of
making judgments which are not internalized from the outside and which do not come in
any direct and obvious way from parents teachers and even peers (Kohlberg, 1968).
Going further he clarified that internal or cognitive processes like thinking and reasoning
also play a major role in one’s moral development i.e the way children make moral
judgment depends on their level of intellectual development as well as on their
upbringing and learning experience.
For studying the process of moral development in human beings, kohlberg first
defined moral development as the development of an individual’s sense of justice.
Table 3.7 Kohlberg’s six stages of Moral Development
Level I Pre- moral (age 4 to 10 years)
Stage 1: The stage of obedience for avoiding punishment
Stage 2 : The stage of conforming to obtain rewards and favours in return.

Level II Conventional Morality (Age 10 to 13 years)

Stage 3: The stage of maintaining mutual relations and approval of others
Stage 4: The stage of obedience for avoiding censure by higher authority or social systems.

Level III Self – accepted moral principles (Age 13 or not until middle or later adulthood)
Stage 5: Stage of conforming to the democratically accepted law and mores of community welfare
Stage 6: Stage of conforming to the universal ethical principles and the call of one’s conscience.

Pre-Moral Level ( 4 to 10 years)

The child begin to make judgments about what is right or wrong, good or bad.
However, the standards by which he measures the morality are those of others. He is
persuaded to take such judgment either to avoid punishment or to earn rewards.
Development of morality at this level usually follows the following two stages.
Stage 1 In the beginning the child’s morality is controlled by the fear of punishment. He
tries to obey his parent s and elders purely to avoid reproof & punishment.
Stage 2 In the second stage of the pre-moral stage, children’s moral judgment is based on
self-interest and considerations of what others can do for them in return. Here they value
a thing because it has some practical utility for them.
Conventional Morality Level (10 to 13 years)
At this stage also, children moral judgment is controlled by the likes and dislike
of others -the conventions, rules and regulations and the law and order system maintained
within society. Staling or mercy killing would thus be judged wrong because it is
considered wrong by the society at large by the legal system. In this way, the
conventional level of morality may be regarded as the level where the child identifies
with authority. It is characterized by the following stages.
Stage 3 In the early years of the second level of moral development, the child’s moral
judgment is based on the desire to obtain approval of others and avoid being declared a
good boy or a good girl. For this purpose he begins to judge the intention and likes and
dislikes of other to act accordingly.
Stage 4 In the later years of conventional morality level, children’s moral judgment are
governed by convention as well as the law and mores of social system.
Self Accepted Moral Principles (Age 13 or Later Childhood)
This marks the highest level of attainment of true morality as the centering force
for making judgments now rests with the individual himself. He does not value a thing or
conform to a idea merely because of consideration of the views of others, conventions or
the law and order system of society but because into the frame work of the frame work
of the self-accepted moral principles. This level is also characterized by two separate
stages.
Stage 5 At this stage the individuals moral judgment are internalized in such a form what
he responds positively to authority only if he agrees with the principles upon which the
demands of authority are based.

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Stage 6 At this stage the controlling forces for making moral judgments are highly
internalized. The decision of the individual are now based upon his conscience and the
belief in universal principles of respect, justice and equality. He does what he, as an
individual thinks regardless of legal restrictions or the opinion of others. Thus at this
stage people act according to the inner voice of their conscience and lead a life that they
can without self-condemnation or feeling of guilt or shame.

PLAY

Play is a child’s first education experience. It is the way they connect to others and learn about themselves. Play teaches children
important skills and prepares them for life skills they will use throughout their childhood and adult lives. Play is children’s work.
Through play, children learn academic skills like math, science, reading, language and literacy. They learn social skills like effective
communication, conflict resolution, problem solving and cooperation. Maybe most importantly, they learn about themselves – they
get to know their personalities including their likes and dislikes, strengths and interests. Through play, children learn where they fit in
in the world.In order to support learning through play for young children, it is first important to understand the different types of play
and why they are beneficial for children.

following types of play and why they are important to development.

Physical play

Physical play is any play that involves physical or motor skills. Whenever children engage in running, jumping, spinning, chasing or
roughhousing, they are working on physical play. Children develop strong bodies and become coordinated, and physical play allows
them to express the undeniable energy of childhood.

Physical play can also help children develop a physical sense of self, boundaries and impulse control. When children have physical
control over their bodies, they begin to form the brain connections that allow them to control those movements, both on a motor level
and on a cognitive level. A child is more prepared to control their hands in interactions with others if they have a sense of mastery of
their motor skills.

Language play

Beginning around two months, children start to play with language by making repetitive cooing sounds. As they continue to develop,
children use their voices, sounds and eventually words for entertainment purposes beyond basic communication. Older children
may invent new words, practice rhymes or suddenly become miniature comedians and respond to everything with a knock-knock
joke.

Children play with phrases, puns, rhymes, alliterations and alternative grammar. Language play involves children manipulating play
in order to entertain themselves, or they may use language as a tool in their other play, such as speaking directions to another child
during fantasy play.

Exploratory play

This type of play involves, you guessed it, exploring something new or unfamiliar. The world is big and sometimes overwhelming
(even for adults). When children engage in exploratory play, they gain not only the skills they need to explore, but also the desire to
understand or learn about new things.

Exploratory play might look as simply as a toddler walking through a climber at the park, figuring out what new and exciting
opportunities for play it offers. Exploration play promotes understanding and a child’s internal drive to learn.

Constructive play

When children build something or work to produce some structure they have created in their mind, they are engaging in constructive
play. Children who engage in constructive play have the opportunity to enhance their cognitive development by practicing. Not only
do children practice cognitive skills, but they also work on fine motor skills, hand-eye coordination and basic engineering skills.
Constructive play also allows children the opportunity to be creative, express themselves and often extend other play, like fantasy
play.

Fantasy play

Children use their imagination in fantasy or pretend play, which gives them opportunities to figure out how the world works and then
create their own world. Pretend play allows children to explore different roles and relationships. When children take on a role during

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their play, like “Mommy,” “Grandpa,” “Doctor,” or “Giant flying dragon,” they get to explore how each character operates in the real
world. What is their job? How do they speak? What do they care about?

The wonderful thing about fantasy play is children not only get to practice these roles and relationships, but they learn to think
outside the box through the ability to question rules and norms and explore multiple possibilities and challenge the logical processes
of the world. Along with the important skill-building capacity of fantasy play, it also presents an opportunity for children to escape
and have fun. Just like adults might dive into a book or movie to temporarily escape the stress and responsibilities of normal life,
children can benefit from the opportunity to escape to a world of their own making.

Social play

Social play is incredibly important for young children’s development. When children engage in social play they are required to
practice important social and life skills like communication, compromise, cooperation, problem-solving, turn-taking and self-
expression. Children practice roles, learn acceptable behavior and practice important life skills like negotiation.

These types of play are not separate entities – children can be engaged in several of these types of play all at the same time. This
speaks to the wonderful power of play. In playing, children have the opportunity to practice skills, learn and grow from even the most
basic play experiences. You can help your child reach their potential by simply helping them play.

Characteristics of play(2018 ques)

In Aistear: the Early Childhood Curriculum Framework’s “Learning and developing through play,” 10 characteristics of play are
defined:

1. Active. During active play, children use their bodies and minds in play by interacting with the environment, materials and
other people.
2. Adventurous and risky. This type of play involves children exploring unknown or new concepts. When children engage
in adventurous or risky pretend play, they are able to safety explore these concepts within the confines of a safety net.
3. Communicative. Play presents a natural opportunity for children to share information and knowledge. Children can
communicate verbally, using words or their bodies, postures and other non-verbal cues and these messages can be
simple or more complicated.
4. Enjoyable. Simply put, play is fun! When children play they should be enjoying themselves and they can often find
excitement and humor in or through their play. If they aren’t having fun, it probably isn’t play. Instead of playing to win,
children should be playing to play and have fun!
5. Involved. Remember that play is a child’s work, and just like adults need to concentrate while working, children should
concentrate during their play also. Children might become very involved while playing as they are actively thinking about
what they are doing.
6. Meaningful. Play provides opportunities for children to make sense of their world. Through play, children process the
things they have seen and heard, what they know and what they don’t yet know. These experiences help children build
upon their current knowledge, test out new theories and roles and grow their knowledge, understanding and skills.
7. Sociable and interactive. While it is healthy and necessary for children to play independently, at least some of the time,
play presents a unique and formative opportunity for children to engage in social interactions and build relationships with
other children and adults.
8. Symbolic. Children are able to test out roles, feelings, behaviors and relationships, replay things that have already
happened in order to make sense of them. Symbolic play may just look like pretending, but it is actually laying the
foundation for understanding of themselves and the larger world.
9. Therapeutic. When play is fun, engaging and meaningful, it can be very therapeutic for children. Play can be a natural
way for children to relieve stress and work through different emotions and experiences.
10. Voluntary. Play is a self-chosen, spontaneous pursuit that children can change, alter and manipulate freely. Children
should and will change the story, characters, materials, events, locations and purpose of their play at will.

Categories of play
Categories of play are not mutually exclusive; different forms or categories of play may overlap. Having choices is important since
an action that appeals to one child may be of no interest to another, and the child's interest is likely to change throughout the play
period. An understanding of play in many forms can help parents understand its importance for children of all ages. Some specific
categories of play are as follows.

 Physical play. When children run, jump, and play games such as chase, hide-and-seek, and tag, they engage in physical
play. This play has a social nature because it involves other children. It also provides exercise , which is essential for
normal development.

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  Expressive play. Certain forms of play give children opportunities to express feelings by engaging with materials.
Materials used in expressive play include tempera paints, fingerpaints, watercolors, crayons, colored pencils and markers,
and drawing paper; clay, water, and sponges; beanbags, pounding benches, punching bags, and rhythm instruments; and
shaving cream, pudding, and gelatin. Parents can take an active role in expressive play by using the materials alongside
the child.
 Manipulative play. Children control or master their environment through manipulative play. They manipulate the
environment and other people as much as possible. Manipulative play starts in infancy. Infants play with their parents; for
example, they drop a toy, wait for the parent to pick it up, clean it, and return it, and then they drop it again. This
interaction brings the infant and parent together in a game. Children move objects such as puzzle pieces and gadgets to
better understand how they work.
 Symbolic play. Certain games can symbolically express a child's problems. Because there are no rules in symbolic play,
the child can use this play to reinforce, learn about, and imaginatively alter painful experiences. The child who is in an
abusive family may pretend to be a mother who loves and cuddles her child rather than one who verbally or physically
abuses her child. Or in play this same child might act out abusive experience by hitting or screaming at a doll that
symbolizes the child. Parents can be surprised by their child's perception of family issues. Children mimic their parents in
certain play; in other games they may pretend they are the heroes they read about in books or see on television. At
certain developmental stages children believe they can fly or disappear. Symbolic play may be used by children to cope
with fear of separation when they go to school or to the hospital.
 Dramatic play. Children act out situations they suspect may happen to them, that they are fearful will happen, or that they
have witnessed. Dramatic play can be either spontaneous or guided and may be therapeutic for children in the hospital.
 Familiarization play. Children handle materials and explore experiences in reassuring, enjoyable ways. Familiarization
prepares children for potentially fearful and painful experiences, such as surgery or parental separation.
 Games. Some video and card games are played by one child alone. Games with rules are rarely played by children
younger than four years of age. Board games, card games, and sports are enjoyed typically by school-age children. In
these games children learn to play by the rules and to take turns. Older children enjoy games with specific rules; however,
younger children tend to like games that allow them to change the rules.
 Surrogate play. For children who are too ill or incapacitated to play, another child or a parent may serve as surrogate.
Watching the surrogate who plays on behalf of the sick child is stimulating to the sick child. When parents engage in
expressive art by painting or redecorating a room while the physically challenged child watches, they stimulate the child.

Functions of play(v v i)
Play reinforces the child's growth and development. Some of the more common functions of play are to facilitate physical, emotional,
cognitive, social, and moral development .
PHYSICAL DEVELOPMENT Play aids in developing both fine and gross motor skills . Children repeat certain body movements
purely for pleasure, and these movements develop body control. For example, an infant will first hit at a toy, then will try to grasp it,
and eventually will be able to pick it up. Next, the infant will shake the rattle or perhaps bring it to the mouth. In these ways, the
infant moves from simple to more complex gestures.
EMOTIONAL DEVELOPMENT Children who are anxious may be helped by role playing. Role playing is a way of coping with
emotional conflict. Children may escape through play into a fantasy world in order to make sense out of the real one. Also, a
child's self-awareness deepens as he explores an event through role-playing or symbolic play.
When a parent or sibling plays a board game with a child, shares a bike ride, plays baseball, or reads a story, the child learns self-
importance. The child's self-esteem gets a boost. Parents send positive messages to their child when they communicate pleasure
in providing him or her with daily care. From these early interactions, children develop a vision of the world and gain a sense of their
place in it.
COGNITIVE DEVELOPMENT Children gain knowledge through their play. They exercise their abilities to think, remember, and
solve problems. They develop cognitively as they have a chance to test their beliefs about the world.
Children increase their problem-solving abilities through games and puzzles. Children involved in make-believe play can stimulate
several types of learning. Language is strengthened as the children model others and organize their thoughts to communicate.
Children playing house create elaborate narratives concerning their roles and the nature of daily living.
Children also increase their understanding of size, shape, and texture through play. They begin to understand relationships as they
try to put a square object in a round opening or a large object in a small space. Books, videos, and educational toys that show
pictures and matching words also increase a child's vocabulary while increasing the child's concept of the world.
SOCIAL DEVELOPMENT A newborn cannot distinguish itself from others and is completely self-absorbed. As the infant begins to
play with others and with objects, a realization of self as separate from others begins to develop. The infant begins to experience joy
from contact with others and engages in behavior that involves others. The infant discovers that when he coos or laughs, mother
coos back. The child soon expects this response and repeats it for fun, playing with his mother.
As children grow, they enjoy playful interaction with other children. Children learn about boundaries, taking turns, teamwork, and
competition. Children also learn to negotiate with different personalities and the feelings associated with winning and losing. They
learn to share, wait, and be patient.
MORAL DEVELOPMENT When children engage in play with their peers and families, they begin to learn some behaviors are
acceptable while others are unacceptable. Parents start these lessons early in the child's life by teaching the child to
control aggressive behavior . Parents can develop morals while reading to children by stressing the moral implications in stories.
Children can identify with the moral fictional characters without assuming their roles. With peers they quickly learn that taking turns

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is rewarding and cheating is not. Group play helps the child appreciate teamwork and share and respect others' feelings. The child
learns how to be kind and charitable to others.

Play Types and Development(v v I )

When your child plays, he's having fun, but he also is engaging in a complex process of learning and development. The Montana
State University Extension office lists 11 types of play, including unoccupied, solitary, onlooker, motor-physical, constructive and
fantasy, which occur along a continuum as children grow and develop the skills and capabilities required. For instance, infants are
engaged in unoccupied play when they focus on random movements. From ages 3 months to 3 years, children progress through
several types of play from watching other children play to playing with other children. Play helps your child move through the
developmental milestones along the road to adulthood.

Cognitive

Children learn from doing, which gives play a cognitive function. Play develops cognitive skills when children have to think and
remember processes and rules. Children develop language skills and learn about the world and how it works. During play, children
learn about sizes, shapes, colors and textures. Peek-a-boo teaches infants that unseen objects still exist. Counting games teach
numbers. Play encourages children to explore creativity and imagination. As children solve problems during play, they learn to
reason and develop their decision-making skills.

Physical

The physical function of play helps children develop strong muscles, bones and stamina. Play helps develop the brain as children
interact with people and the world around them. Playing with an infant while she is on her stomach helps strengthen her neck
muscles. Children learn to crawl, walk, run and jump as they learn to use large muscle groups in gross motor development. Fine
motor skills are developed when children pick up toys, hold a crayon, use building blocks and sing songs that teach hand gestures
or other movements. Play helps children develop balance, speed and coordination.

Social

Children develop social skills through play when they learn about taking turns and sharing, rules, negotiation, cooperation and
conflict resolution. Your child will learn which behaviors are inappropriate, such as hitting, and how to apologize and make amends.
Children need the social skills learned during play to enter the adult world. While playing with others, children begin to develop
characteristics such as kindness, empathy and self-control. Children begin to develop morals and to understand more about
consequences.

Emotional

The emotional function of play in child development begins with parental bonding. When you play with your child, he learns he is
loved, his self-esteem is enhanced and he learns how to build healthy relationships, according to the website Zero to Three. Your
child learns to succeed through play, but he also learns how to react to disappointment. As he masters his world, he develops new
skills, acquires more knowledge and builds his confidence and resiliency. Play gives your child opportunities to develop his self and
discover his interests and strengths.

PARENTAL STYLE

The parenting style construct commonly used in psychology today is based on the work of Diana Baumrind, a developmental psychologist.

Baumrind noticed that preschoolers exhibited three different types of behavior. Each type of behavior was highly correlated to a specific kind of
parenting. Based on extensive observation, interviews and analyses, Baumrind identified three initial parenting styles: authoritative parenting,
authoritarian parenting and permissive parenting (1967).

Maccoby and Martin (1983) expanded this parenting style model using a two-dimensional framework. They made further distinction by
expanding Baumrind’s permissive parenting into two different types: permissive parenting (also known as indulgent parenting) and neglectful
parenting (also known as uninvolved parenting).

These four parenting styles are sometimes called the Baumrind parenting styles or Maccoby and Martin parenting styles.

Definition Of The 4 Parenting Styles

Parenting styles are categorized based on two dimensions of parenting behavior:

Demandingness refers to the extent parents control their children’s behavior or demand their maturity.

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Responsiveness refers to the degree parents are accepting and sensitive to their children’s emotional and developmental
needs.

Here is the 4 types of parenting styles chart:

1. Authoritarian Parenting
Authoritarian parents believe kids should follow the rules without exception.

Authoritarian parents are famous for saying, "Because I said so," when a child questions the reasons behind a rule. They are not interested in
negotiating and their focus is on obedience.

They also don't allow kids to get involved in problem-solving challenges or obstacles. Instead, they make the rules and enforce the consequences
with little regard for a child's opinion.

Authoritarian parents may use punishments instead of discipline. So rather than teach a child how to make better choices, they're invested in
making kids feel sorry for their mistakes.

Children who grow up with strict authoritarian parents tend to follow rules much of the time. But, their obedience comes at a price.

Children of authoritarian parents are at a higher risk of development self-esteem problems because their opinions aren't valued.

They may also become hostile or aggressive. Rather than think about how to do things better in the future, they often focus on the anger they feel
toward their parents. Since authoritarian parents are often strict, their children may grow to become good liars in an effort to avoid punishment.

2. Authoritative Parenting

Authoritative parents have rules and they use consequences, but they also take their children's opinions into account. They validate their
children's feelings, while also making it clear that the adults are ultimately in charge.

Authoritative parents invest time and energy into preventing behavior problems before they start. They also use positive discipline strategies to
reinforce good behavior, like praise and reward systems.

Researchers have found kids who have authoritative parents are most likely to become responsible adults who feel comfortable expressing their
opinions.

Children raised with authoritative discipline tend to be happy and successful. They're also more likely to be good at making decisions and
evaluating safety risks on their own.

2. Permissive Parenting
Permissive parents are lenient. They often only step in when there's a serious problem.

They're quite forgiving and they adopt an attitude of "kids will be kids." When they do use consequences, they may not make those consequences
stick. They might give privileges back if a child begs or they may allow a child to get out of time-out early if he promises to be good.

Permissive parents usually take on more of a friend role than a parent role. They often encourage their children to talk with them about their
problems, but they usually don't put much effort into discouraging poor choices or bad behavior.

Kids who grow up with permissive parents are more likely to struggle academically. They may exhibit more behavioral problems as they don't
appreciate authority and rules. They often have low self-esteem and may report a lot of sadness.

They're also at a higher risk for health problems, like obesity, because permissive parents struggle to limit junk food intake. They are even more
likely to have dental cavities because permissive parents often don't enforce good habits, like ensuring a child brushes his teeth.

4. Uninvolved Parenting

Uninvolved parents tend to have little knowledge of what their children are doing.

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 There tend to be few rules. Children may not receive much guidance, nurturing, and parental attention.

Uninvolved parents expect children to raise themselves. They don't devote much time or energy into meeting children's basic needs.

Uninvolved parents may be neglectful but it's not always intentional. A parent with mental health issues or substance abuse problems, for
example, may not be able to care for a child's physical or emotional needs on a consistent basis.

At other times, uninvolved parents lack knowledge about child development. And sometimes, they're simply overwhelmed with other problems,
like work, paying bills, and managing a household.

Children with uninvolved parents are likely to struggle with self-esteem issues. They tend to perform poorly in school. They also exhibit frequent
behavior problems and rank low in happiness.

Using social media Web sites is among the most common activity of today's children and adolescents. Any Web site that allows social interaction is considered a social media site, including social networking sites
such as Facebook, MySpace, and Twitter; gaming sites and virtual worlds such as Club Penguin, Second Life, and the Sims; video sites such as YouTube; and blogs. Such sites offer today's
youth a portal for entertainment and communication and have grown exponentially in recent years. For this reason, it is important that parents become aware of the nature of social media sites,
given that not all of them are healthy environments for children and adolescents. Pediatricians are in a unique position to help families understand these sites and to encourage healthy use and
urge parents to monitor for potential problems with cyberbullying, “Facebook depression,” sexting, and exposure to inappropriate content.

SOCIAL MEDIA USE BY TWEENS AND TEENs

Engaging in various forms of social media is a routine activity that research has shown to benefit children and adolescents by enhancing communication, social connection, and even technical
skills.1 Social media sites such as Facebook and MySpace offer multiple daily opportunities for connecting with friends, classmates, and people with shared interests. During the last 5 years, the
number of preadolescents and adolescents using such sites has increased dramatically. According to a recent poll, 22% of teenagers log on to their favorite social media site more than 10 times a
day, and more than half of adolescents log on to a social media site more than once a day. 2 Seventy-five percent of teenagers now own cell phones, and 25% use them for social media, 54% use
them for texting, and 24% use them for instant messaging. 3 Thus, a large part of this generation's social and emotional development is occurring while on the Internet and on cell phones.
Because of their limited capacity for self-regulation and susceptibility to peer pressure, children and adolescents are at some risk as they navigate and experiment with social media. Recent
research indicates that there are frequent online expressions of offline behaviors, such as bullying, clique-forming, and sexual experimentation,4 that have introduced problems such as
cyberbullying,5 privacy issues, and “sexting.”6 Other problems that merit awareness include Internet addiction and concurrent sleep deprivation. 7
Many parents today use technology incredibly well and feel comfortable and capable with the programs and online venues that their children and adolescents are using. Nevertheless, some
parents may find it difficult to relate to their digitally savvy youngsters online for several reasons. Such parents may lack a basic understanding of these new forms of socialization, which are
integral to their children's lives.8 They frequently do not have the technical abilities or time needed to keep pace with their children in the ever-changing Internet landscape.8 In addition, these
parents often lack a basic understanding that kids' online lives are an extension of their offline lives. The end result is often a knowledge and technical skill gap between parents and youth, which
creates a disconnect in how these parents and youth participate in the online world together.9

BENEFITS OF CHILDREN AND ADOLESCENTS USING SOCIAL MEDIA

Socialization and Communication

Social media sites allow teens to accomplish online many of the tasks that are important to them offline: staying connected with friends and family, making new friends, sharing pictures, and
exchanging ideas. Social media participation also can offer adolescents deeper benefits that extend into their view of self, community, and the world, including1,10:

1. opportunities for community engagement through raising money for charity and volunteering for local events, including political and philanthropic events;

2. enhancement of individual and collective creativity through development and sharing of artistic and musical endeavors;

3. growth of ideas from the creation of blogs, podcasts, videos, and gaming sites;

4. expansion of one's online connections through shared interests to include others from more diverse backgrounds (such communication is an important step for all adolescents and affords the

opportunity for respect, tolerance, and increased discourse about personal and global issues); and

5. fostering of one's individual identity and unique social skills. 11

Enhanced Learning Opportunities

Middle and high school students are using social media to connect with one another on homework and group projects. 11 For example, Facebook and similar social media programs allow students
to gather outside of class to collaborate and exchange ideas about assignments. Some schools successfully use blogs as teaching tools,12 which has the benefit of reinforcing skills in English,
written expression, and creativity.

Accessing Health Information

Adolescents are finding that they can access online information about their health concerns easily and anonymously. Excellent health resources are increasingly available to youth on a variety of
topics of interest to this population, such as sexually transmitted infections, stress reduction, and signs of depression. Adolescents with chronic illnesses can access Web sites through which they
can develop supportive networks of people with similar conditions. 13 The mobile technologies that teens use daily, namely cell phones, instant messaging, and text messaging, have already
produced multiple improvements in their health care, such as increased medication adherence, better disease understanding, and fewer missed appointments.14 Given that the new social media
venues all have mobile applications, teenagers will have enhanced opportunities to learn about their health issues and communicate with their doctors. However, because of their young age,

11
 adolescents can encounter inaccuracies during these searches and require parental involvement to be sure they are using reliable online resources, interpreting the information correctly, and not
becoming overwhelmed by the information they are reading. Encouraging parents to ask about their children's and adolescents' online searches can help facilitate not only discovery of this
information but discussion on these topics.

RISKS OF YOUTH USING SOCIAL MEDIA

Using social media becomes a risk to adolescents more often than most adults realize. Most risks fall into the following categories: peer-to-peer; inappropriate content; lack of understanding of
online privacy issues; and outside influences of third-party advertising groups.

Cyberbullying and Online Harassment

Cyberbullying is deliberately using digital media to communicate false, embarrassing, or hostile information about another person. It is the most common online risk for all teens and is a peer-to-
peer risk.

Although “online harassment” is often used interchangeably with the term “cyberbullying,” it is actually a different entity. Current data suggest that online harassment is not as common as offline
harassment,15 and participation in social networking sites does not put most children at risk of online harassment. 16 On the other hand, cyberbullying is quite common, can occur to any young
person online, and can cause profound psychosocial outcomes including depression, anxiety, severe isolation, and, tragically, suicide. 17

Sexting

Sexting can be defined as “sending, receiving, or forwarding sexually explicit messages, photographs, or images via cell phone, computer, or other digital devices.” 18 Many of these images
become distributed rapidly via cell phones or the Internet. This phenomenon does occur among the teen population; a recent survey revealed that 20% of teens have sent or posted nude or
seminude photographs or videos of themselves.19 Some teens who have engaged in sexting have been threatened or charged with felony child pornography charges, although some states have
started characterizing such behaviors as juvenile-law misdemeanors.20,21 Additional consequences include school suspension for perpetrators and emotional distress with accompanying mental
health conditions for victims. In many circumstances, however, the sexting incident is not shared beyond a small peer group or a couple and is not found to be distressing at all. 4

Facebook Depression

Researchers have proposed a new phenomenon called “Facebook depression,” defined as depression that develops when preteens and teens spend a great deal of time on social media sites, such
as Facebook, and then begin to exhibit classic symptoms of depression. 22,–,27 Acceptance by and contact with peers is an important element of adolescent life. The intensity of the online world is
thought to be a factor that may trigger depression in some adolescents. As with offline depression, preadolescents and adolescents who suffer from Facebook depression are at risk for social
isolation and sometimes turn to risky Internet sites and blogs for “help” that may promote substance abuse, unsafe sexual practices, or aggressive or self-destructive behaviors.

PRIVACY CONCERNS AND THE DIGITAL FOOTPRINT

The main risk to preadolescents and adolescents online today are risks from each other, risks of improper use of technology, lack of privacy, sharing too much information, or posting false
information about themselves or others.28 These types of behavior put their privacy at risk.
When Internet users visit various Web sites, they can leave behind evidence of which sites they have visited. This collective, ongoing record of one's Web activity is called the “digital footprint.”
One of the biggest threats to young people on social media sites is to their digital footprint and future reputations. Preadolescents and adolescents who lack an awareness of privacy issues often
post inappropriate messages, pictures, and videos without understanding that “what goes online stays online.” 8 As a result, future jobs and college acceptance may be put into jeopardy by
inexperienced and rash clicks of the mouse. Indiscriminate Internet activity also can make children and teenagers easier for marketers and fraudsters to target.

INFLUENCE OF ADVERTISEMENTS ON BUYING

Many social media sites display multiple advertisements such as banner ads, behavior ads (ads that target people on the basis of their Web-browsing behavior), and demographic-based ads (ads
that target people on the basis of a specific factor such as age, gender, education, marital status, etc) that influence not only the buying tendencies of preadolescents and adolescents but also their
views of what is normal. It is particularly important for parents to be aware of the behavioral ads, because they are common on social media sites and operate by gathering information on the
person using a site and then targeting that person's profile to influence purchasing decisions. Such powerful influences start as soon as children begin to go online and post. 29 Many online venues
are now prohibiting ads on sites where children and adolescents are participating. It is important to educate parents, children, and adolescents about this practice so that children can develop into
media-literate consumers and understand how advertisements can easily manipulate them.

ON TOO YOUNG: MIXED MESSAGES FROM PARENTS AND THE LAW

Many parents are aware that 13 years is the minimum age for most social media sites but do not understand why. There are 2 major reasons. First, 13 years is the age set by Congress in the
Children's Online Privacy Protection Act (COPPA), which prohibits Web sites from collecting information on children younger than 13 years without parental permission. Second, the official
terms of service for many popular sites now mirror the COPPA regulations and state that 13 years is the minimum age to sign up and have a profile. This is the minimum age to sign on to sites
such as Facebook and MySpace. There are many sites for preadolescents and younger children that do not have such an age restriction, such as Disney sites, Club Penguin, and others.

It is important that parents evaluate the sites on which their child wishes to participate to be sure that the site is appropriate for that child's age. For sites without age stipulations, however, there is
room for negotiation, and parents should evaluate the situation via active conversation with their preadolescents and adolescents.

In general, if a Web site specifies a minimum age for use in its terms of service, the American Academy of Pediatrics (AAP) encourages that age to be respected. Falsifying age has become
common practice by some preadolescents and some parents. Parents must be thoughtful about this practice to be sure that they are not sending mixed messages about lying and that online safety
is always the main message being emphasized.

THE ROLE OF PEDIATRICIANS

Pediatricians are in a unique position to educate families about both the complexities of the digital world and the challenging social and health issues that online youth experience by encouraging
families to face the core issues of bullying, popularity and status, depression and social anxiety, risk-taking, and sexual development. Pediatricians can help parents understand that what is
happening online is an extension of these underlying issues and that parents can be most helpful if they understand the core issues and have strategies for dealing with them whether they take
place online, offline, or, increasingly, both.

Some specific ways in which pediatricians can assist parents include:

1. Advise parents to talk to their children and adolescents about their online use and the specific issues that today's online kids face.

2. Advise parents to work on their own participation gap in their homes by becoming better educated about the many technologies their youngsters are using.

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3. Discuss with families the need for a family online-use plan that involves regular family meetings to discuss online topics and checks of privacy settings and online profiles for inappropriate posts.

The emphasis should be on citizenship and healthy behavior and not punitive action, unless truly warranted.

4. Discuss with parents the importance of supervising online activities via active participation and communication, as opposed to remote monitoring with a “net-nanny” program (software used to

monitor the Internet in the absence of parents).

5. Impact of media in the aldoscent

The influence of the media on the psychosocial development of children is profound. Thus, it is important for physicians to discuss with parents their child’s exposure to media and
to provide guidance on age-appropriate use of all media, including television, radio, music, video games and the Internet.

The objectives of this statement are to explore the beneficial and harmful effects of media on children’s mental and physical health, and to identify how physicians can counsel
patients and their families and promote the healthy use of the media in their communities.

Go to:

TELEVISION

Television has the potential to generate both positive and negative effects, and many studies have looked at the impact of television on society, particularly on children and
adolescents (1,2). An individual child’s developmental level is a critical factor in determining whether the medium will have positive or negative effects. Not all television
programs are bad, but data showing the negative effects of exposure to violence, inappropriate sexuality and offensive language are convincing (3). Still, physicians need to
advocate continued research into the negative and positive effects of media on children and adolescents.

Current literature suggests the following:

 Physicians can change and improve children’s television viewing habits (4).

 Canadian children watch excessive amounts of television (5,6).

 There is a relationship between watching violent television programming and an increase in violent behaviour by children (2,7).

 Excessive television watching contributes to the increased incidence of childhood obesity (8,9).

 Excessive television watching may have a deleterious effect on learning and academic performance (10).

 Watching certain programs may encourage irresponsible sexual behaviour (11).

 Television is an effective way of advertising products to children of various ages (12).

The average Canadian child watches nearly 14 h of television each week (13). By his/her high school graduation, the average teen will have spent more time watching television
than in the classroom (2). Studies show how time spent watching television varies between different age groups and cultures (1,13). This is especially relevant when studying the
effects of excessive television exposure on disadvantaged populations.

The amount of time that younger North American children currently spend watching television has not decreased significantly (14). A substantial number of children begin
watching television at an earlier age and in greater amounts than what experts recommend (15). Evidence suggests that television’s influence on children and adolescents is related
to how much time they spend watching television (1,2,16). As a result, with prolonged viewing, the world shown on television becomes the real world (1,2).

Television viewing frequently limits children’s time for vital activities such as playing, reading, learning to talk, spending time with peers and family, storytelling, participating in
regular exercise, and developing other necessary physical, mental and social skills (9). In addition to the amount of time spent in front of the television, other factors that influence
the medium’s effect on children include the child’s developmental level, individual susceptibility and whether children watch television alone or with their parents.

Learning

Television can be a powerful teacher (17). Watching Sesame Street is an example of how toddlers can learn valuable lessons about racial harmony, cooperation, kindness, simple
arithmetic and the alphabet through an educational television format. Some public television programs stimulate visits to the zoo, libraries, bookstores, museums and other active
recreational settings, and educational videos can certainly serve as powerful prosocial teaching devices. The educational value of Sesame Street, has been shown to improve the
reading and learning skills of its viewers (18). In some disadvantaged settings, healthy television habits may actually be a beneficial teaching tool (17).

Still, watching television takes time away from reading and schoolwork. More recent and well-controlled studies show that even 1 h to 2 h of daily unsupervised television viewing
by school-aged children has a significant deleterious effect on academic performance, especially reading (10,19).

Violence

The amount of violence on television is on the rise (20). The average child sees 12,000 violent acts on television annually, including many depictions of murder and rape. More
than 1000 studies confirm that exposure to heavy doses of television violence increases aggressive behaviour, particularly in boys (2,21–23). Other studies link television or
newspaper publicity of suicides to an increased suicide risk (24–28).

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The following groups of children may be more vulnerable to violence on television:

 children from minority and immigrant groups;

 emotionally disturbed children;

 children with learning disabilities;

 children who are abused by their parents; and

 children in families in distress (2,7).

Physicians who see a child with a history of aggressive behaviour should inquire about the child’s exposure to violence portrayed on television.

Nutrition

Because television takes time away from play and exercise activities, children who watch a lot of television are less physically fit and more likely to eat high fat and high energy
snack foods (9). Television viewing makes a substantial contribution to obesity because prime time commercials promote unhealthy dietary practices (15,29). The fat content of
advertised products exceeds the current average Canadian diet and nutritional recommendations, and most food advertising is for high calorie foods such as fast foods, candy and
presweetened cereals (14,29). Commercials for healthy food make up only 4% of the food advertisements shown during children’s viewing time (8). The number of hours of
television viewing also corresponds with an increased relative risk of higher cholesterol levels in children (8). Television can also contribute to eating disorders in teenage girls,
who may emulate the thin role models seen on television (8). Eating meals while watching television should be discouraged because it may lead to less meaningful communication
and, arguably, poorer eating habits (29,30).

Sexuality

Today, television has become a leading sex educator in Canada. Between 1976 and 1996, there has been a 270% increase in sexual interactions during the family hour of 2000
hours to 2100 hours(31). Television exposes children to adult sexual behaviours in ways that portray these actions as normal and risk-free, sending the message that because these
behaviours are frequent, ‘everybody does it’. Sex between unmarried partners is shown 24 times more often than sex between spouses (32–35), while sexually transmitted
infections and unwanted pregnancy are rarely mentioned.

Teens rank the media as the leading source of information about sex, second only to school sex education programs. Numerous studies document adolescents’ susceptibility to the
media’s influence on their sexual attitudes, values and beliefs (34,35).

A detailed guide to responsible sexual content on television, and in films and music can be found in other peer-reviewed publications (35).

Some people believe that the media can influence sexual responsibility by promoting birth control, such as condom use. No current empirical evidence supports this concept; it is
expected that the debate will continue.

Alcohol and smoking

Canada’s two largest breweries spend $200 million on advertising each year (36). On an annual basis, teenagers see between 1000 and 2000 beer commercials carrying the
message that ‘real’ men drink beer. Convincing data suggest that advertising increases beer consumption (34,37), and in countries such as Sweden, a ban on alcohol advertising has
led to a decline in alcohol consumption (38).

Tobacco products are not advertised directly on television in Canada. However, passive promotion occurs when, for example, a soap opera star lights a cigarette in a ‘macho’ act, a
Formula One race car has cigarette advertising on it or sporting events carry the names of tobacco companies. There is evidence that passive advertising, which glamorizes
smoking (28), has increased over the past few years.

Television is not the only way that children learn about tobacco and alcohol use; the concern is that the consequences of these behaviours are not accurately depicted on television.
One-half of the G-rated animated feature films available on videocassette, as well as many music videos, show alcohol and tobacco use as normative behaviour without conveying
the long term consequences of this use (39).

Advertising

Advertising can have positive effects on children’s behaviour. For example, some alcohol manufacturers spend 10% of their budget on advertisements warning about the dangers
of drinking and driving. In addition, although some health care professionals disagree about the health benefits of appropriate milk use, milk consumption has increased as a result
of print and broadcast advertisements.

The developmental stage of a child plays a role in the effect of commercials. Young children do not understand the concept of a sales pitch. They tend to believe what they are told
and may even assume that they are deprived if they do not have advertised products. Most preschool children do not understand the difference between a program designed to
entertain and a commercial designed to sell. A number of studies have documented that children under the age of eight years are developmentally unable to understand the
difference between advertising and regular programming (12,40,41).

The average child sees more than 20,000 commercials each year (12). More than 60% of commercials promote sugared cereals, candy, fatty foods and toys (12). Cartoon programs
based on toy products are especially attractive. Advertisements targeting adolescents are profoundly influential, particularly on cigarette use (4).

The question of whether children are more resilient to the influence of television is debated frequently. Most studies show that the more time children spend watching television,
the more they are influenced by it (4). Earlier studies have shown that boys may be more susceptible than girls to television violence (25).

Education and parental involvement

14
High school programs promoting media awareness have been shown to be beneficial (4). They give students more understanding of how the media may affect them socially. In
Canada, the Media Awareness Network has a number of resources that can be used by both professionals and the public to promote media literacy. Their resources are
comprehensive, current and specifically applicable to Canadian culture (42).

Parents may use ratings but they must be used with caution. Currently, there is no consensus as to which rating system works best (43). Parental involvement in determining
desirable programming is the best choice. Parents have to monitor and control their children’s viewing habits.

Studies show that parents play an important role in their children’s social learning (44), but if a parent’s views are not discussed explicitly with children, the medium may teach
and influence by default. Other media, such as magazines, radio, video games and the Internet, also have the potential to influence children’s eating habits, exercise habits, buying
habits and mental health. If children are allowed to be exposed to these media without adult supervision, they may have the same deleterious effects as television.

Go to:

MUSIC VIDEOS

Music videos may have a significant behavioural impact by desensitizing viewers to violence and making teenagers more likely to approve of premarital sex (45). Up to 75% of
videos contain sexually explicit material (45), and more than half contain violence that is often committed against women. Women are portrayed frequently in a condescending
manner that affects children’s attitudes about sex roles.

Attractive role models are the aggressors in more than 80% of music video violence. Males are more than three times as likely to be the aggressors; blacks were overrepresented
and whites underrepresented. Music videos may reinforce false stereotypes. A detailed analysis of music videos raised concerns about its effects on adolescents’ normative
expectations about conflict resolution, race and male-female relationships (46).

Music lyrics have become increasingly explicit, particularly with references to sex, drugs and violence. Research linking a cause-and-effect relationship between explicit lyrics and
adverse behavioural effects is still in progress at this time. Meanwhile, the potential negative impact of explicit music lyrics should put parents and paediatricians on guard –
paediatricians should bring this up in anticipatory guidance discussions with teenagers and their parents. At the very least, parents should take an active role in monitoring the
music their children are exposed to (45).

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VIDEO GAMES

Some video games may help the development of fine motor skills and coordination, but many of the concerns about the negative effects of television (eg, inactivity, asocial
behaviour and violence) also apply to excessive exposure to video games. Violent video games should be discouraged because they have harmful effects on children’s mental
development (7,47). Parents should be advised to familiarize themselves with various rating systems for video games and use this knowledge to make their decisions.

The effect of violent video games on children has been a public health concern for many years. No quantitative analysis of video game contents for games rated as suitable for all
audiences was made until 2001 (47). The study concluded that many video games rated as suitable for all audiences contained significant amounts of violence (64% contained
intentional violence and 60% rewarded players for injuring a character). Therefore, current ratings of video games leave much room for improvement (43).

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INTERNET

Parents may feel outsmarted or overwhelmed by their children’s computer and Internet abilities, or they may not appreciate that the ‘new medium’ is an essential component of the
new literacy, something in which their children need to be fluent. These feelings of inadequacy or confusion should not prevent them from discovering the Internet’s benefits. The
dangers inherent in this relatively uncontrolled ‘wired’ world are many and varied, but often hidden. These dangers must be unmasked and a wise parent will learn how to protect
their children by immersing themselves in the medium and taking advice from the many resources aimed at protecting children while allowing them to reap the rich benefits in a
safe environment. The physician is in a good position to encourage parents and children to discover the Internet and to use it wisely.

The Internet has a significant potential for providing children and youth with access to educational information, and can be compared with a huge home library. However, the lack
of editorial standards limits the Internet’s credibility as a source of information. There are other concerns as well.

The amount of time spent watching television and sitting in front of computers can affect a child’s postural development (48). Excessive amounts of time at a computer can
contribute to obesity, undeveloped social skills and a form of addictive behaviour (9). Although rare, some children with seizure disorders are more prone to attacks brought on by
a flickering television or computer screen. No data suggest that television viewing causes weakness of the eyes. It may be different when a child is closely exposed to a computer
screen for long periods, although there are no definitive references to support this.

Other concerns include pedophiles who use the Internet to lure young people into relationships. There is also the potential for children to be exposed to pornographic material.
Parents can use technology that blocks access to pornography and sex talk on the Internet, but must be aware that this technology does not replace their supervision or guidance.

There is a wealth of information on coping with the vast resources of the Web, both good and bad. Above all, parents should be encouraged to appreciate that there is potential for
more good than bad, as long as one has the knowledge to tell the difference. Canadian youth claim the Internet as a defining part of their culture and an integral part of their daily
lives (6). Physicians and parents alike must be armed and ready to face that challenge and ensure that they reap the potential benefits as safely as possible (Table 1).

Table 1

Benefits and risks of Internet use by children and youth

Benefits of the Internet

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  Near limitless information resource

 High degree of availability and affordability in most communities in the western world

 An asset for research or homework

 A communication tool for teachers and university professors with their students

 Rapid and inexpensive communication via e-mail and video linkage

 Access by the disabled to much that may otherwise be unavailable:

 Through technology that makes computer use possible

 By taking advantage of communication with peers that does not require that their disability be
visible

 Source of entertainment

General risks

 The Internet, by its interactive nature, is prone to use for excessive periods of time. ‘Internet addiction’,
also known as pathological Internet use or Internet addiction disorder, is a known problem among adults
and is no less a problem with children whose usage may be unlimited (30,49,50)

 Instant messaging and e-mail may interfere with legitimate work (schoolwork and in the workplace)

 Like television, excessive time spent on the Internet may interfere with normal socialization between child
and peers, and with family

 Excessive use fosters inactivity and, potentially, obesity

Misinformation

 Lack of monitoring for appropriateness or accuracy of information

 Health risks posed from following incorrect information

 Fostering inappropriate ideas for children and teenagers such as the following:

 Encouraging inappropriate weight loss and diets. To read more on this, see www.eating-
disorder.org/prosites.html or my.webmd.com/content/article/34/1728_85382

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  Generating a sense of need to acquire material goods

 False advertising or scams typically spread by e-mail

 Temptation to acquire (or steal) credit cards to pay for on-line services

Adverse effects on values

 Pornography: Underage children may accidentally or by design access pornographic sites

 Predators have access to minors through unsupervised use of chat rooms and e-mail

 Loss of inhibitions normally experienced when face-to-face, promoting sexual exchanges and promiscuity

 On-line gambling

 Potential for plagiarism in school work

 Promotion of hatred or violence through Web sites targeting a specific group, such as women,
homosexuals, and religious or ethnic groups

 Use of the Internet by school bullies to ridicule or spread hatred toward a victim

 Violence through video games, song lyrics and on-line bullying, access to hazardous materials or
information on making weapons
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RECOMMENDATIONS

 Physicians should regularly inquire about media habits when taking a psychosocial history, using the Media History Form developed by the Canadian Paediatric
Society (CPS) and the Media Awareness Network (51). They should also ask about video watching, use of video games, radio programs and time spent in front of the
computer, especially when dealing with aggressive and particularly vulnerable children and families (7).

 Physicians should become more familiar with the kinds of media to which their patients may be exposed, such as programs that portray irresponsible sex and
violence, and questionable Internet sites.

 Physicians should make parents aware of the significance of television early in a child’s life. By the end of the first year of a child’s life, there should be ground rules
for television viewing and healthy viewing habits should be established in the second year of life. Patient education tools developed by the CPS and the Media
Awareness Network can be used to supplement teaching. Visit www.caringforkids.cps.ca for more information.

 Physicians should continue to increase their own level of awareness about the most recent data on the influence of media on the development of their patients’
psychosocial health (www.media-awareness.ca is one of the most comprehensive Canadian resources for further education).

 Physicians are encouraged to learn about the scope of Internet-related issues to adequately advise parents during their visits for anticipatory guidance. The Media
History Tool (51) can be used to identify areas of concern and to facilitate discussion with parents and children. They can be encouraged to develop a family
agreement for on-line use at home. The Media Awareness Network Web site (www.media-awareness.ca) has suggestions on how to do this.

Physicians should encourage families to do the following:

 Families should be encouraged to explore media together and discuss their educational value. Children should be encouraged to criticize and analyze what they see in
the media. Parents can help children differentiate between fantasy and reality, particularly when it comes to sex, violence and advertising.

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  No child should be allowed to have a television, computer or video game equipment in his or her bedroom. A central location is strongly advised with common
access and common passwords.

 Television watching should be limited to less than 1 h to 2 h per day. Families may want to consider more active and creative ways to spend time together.

 Older children should be offered an opportunity to make choices by planning the week’s viewing schedule in advance. Ideally, parents should supervise these choices
and be good role models by making their own wise choices. Parents should explain why some programs are not suitable and praise children for making good and
appropriate choices.

 Families should limit the use of television, computers or video games as a diversion, substitute teacher or electronic nanny. Parents should also ask alternative
caregivers to maintain the same rules for media use in their absence. The rules in divorced parents’ households should be consistent.

Physicians who want to get involved in their communities can consider the following:

 Provide parents with resources and information to promote media awareness programs in their communities and schools. The Media Awareness Network
(www.media-awareness.ca) has resources and research reports for parents, teachers, teenagers and others.

 Promote the implementation of high school programs in media awareness, which have proven to be beneficial (4).

 Express support for good media. In addition to writing to stations that broadcast responsible and good television programs, physicians and parents can support
legislation that encourages more responsible media use.

 Support efforts to eliminate alcohol advertising on television with the same enthusiasm that led to the elimination of tobacco advertising.

 Consider accepting invitations to talk to parent groups, school boards and other organizations about the impact of media on children and youth. The American
Academy of Pediatrics and the Media Awareness Network have kits that include a fully scripted text, colourful slides, a fact sheet and audience handouts.
Visit www.cps.ca or www.media-awareness.ca for more information.

 Support further research on the impact of media on the mental and physical well-being of children and adolescents.

Parental styles
Your parenting style can affect everything from how much your child weighs to how she feels about herself. It's important to ensure your parenting style is supporting healthy growth and development because the way you interact with your child and how
you discipline her will influence her for the rest of her life

Researchers have identified four types of parenting styles:

 Authoritarian

 Authoritative

 Permissive

 Uninvolved

Each style takes a different approach to raising children, and can be identified by a number of different characteristics.

1. Authoritarian Parenting
Authoritarian parents believe kids should follow the rules without exception.

Authoritarian parents are famous for saying, "Because I said so," when a child questions the reasons behind a rule. They are not interested in negotiating and their focus is on obedience.

They also don't allow kids to get involved in problem-solving challenges or obstacles. Instead, they make the rules and enforce the consequences with little regard for a child's opinion.

Authoritarian parents may use punishments instead of discipline. So rather than teach a child how to make better choices, they're invested in making kids feel sorry for their mistakes.

Children who grow up with strict authoritarian parents tend to follow rules much of the time. But, their obedience comes at a price.

Children of authoritarian parents are at a higher risk of development self-esteem problems because their opinions aren't valued.

They may also become hostile or aggressive. Rather than think about how to do things better in the future, they often focus on the anger they feel toward their parents. Since authoritarian parents are often strict, their children may grow to become good liars in
an effort to avoid punishment.

2. Authoritative Parenting
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 . Authoritative parents have rules and they use consequences, but they also take their children's opinions into account. They validate their children's feelings, while also making it clear that the adults are ultimately in charge.

Authoritative parents invest time and energy into preventing behavior problems before they start. They also use positive discipline strategies to reinforce good behavior, like praise and reward systems.

Researchers have found kids who have authoritative parents are most likely to become responsible adults who feel comfortable expressing their opinions.

Children raised with authoritative discipline tend to be happy and successful. They're also more likely to be good at making decisions and evaluating safety risks on their own.

3. Permissive Parenting
Permissive parents are lenient. They often only step in when there's a serious problem.

They're quite forgiving and they adopt an attitude of "kids will be kids." When they do use consequences, they may not make those consequences stick. They might give privileges back if a child begs or they may allow a child to get out of time-out early if he
promises to be good.

Permissive parents usually take on more of a friend role than a parent role. They often encourage their children to talk with them about their problems, but they usually don't put much effort into discouraging poor choices or bad behavior.

Kids who grow up with permissive parents are more likely to struggle academically. They may exhibit more behavioral problems as they don't appreciate authority and rules. They often have low self-esteem and may report a lot of sadness.

They're also at a higher risk for health problems, like obesity, because permissive parents struggle to limit junk food intake. They are even more likely to have dental cavities because permissive parents often don't enforce good habits, like ensuring a child
brushes his teeth.

Are You a Permissive Parent?

4. Uninvolved Parenting
Do any of these statements sound familiar?

 You don't ask your child about school or homework.

 You rarely know where your child is or who she is with.

 You don't spend much time with your child.

If those statements sound familiar, you might be an uninvolved parent. Uninvolved parents tend to have little knowledge of what their children are doing.

There tend to be few rules. Children may not receive much guidance, nurturing, and parental attention.

Uninvolved parents expect children to raise themselves. They don't devote much time or energy into meeting children's basic needs.

Uninvolved parents may be neglectful but it's not always intentional. A parent with mental health issues or substance abuse problems, for example, may not be able to care for a child's physical or emotional needs on a consistent basis.

At other times, uninvolved parents lack knowledge about child development. And sometimes, they're simply overwhelmed with other problems, like work, paying bills, and managing a household.

Children with uninvolved parents are likely to struggle with self-esteem issues. They tend to perform poorly in school. They also exhibit frequent behavior problems and rank low in happiness.

6.

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