by Emily Oster
Most colds are minor, although they increase the risk of ear infection and other prolonged bacterial infections (bronchitis, walking pneumonia), which is why most doctors will tell you to come in if you are concerned, or if a fever lasts longer than a couple of days, or if your child gets worse after they’ve seemed to get better. Of these complications, ear infections are the most common. About a quarter of kids will have an ear infection by the age of one, and 60 percent by the age of four.9
If your kid does get sick, your doctor is your best resource. A very large share of sick visits to pediatricians are for colds, so although in many cases it’s not necessary for your child to be seen by a doctor, you wouldn’t be alone in having your kid checked out. You should also invest in a good general pediatrics book, which can do a more complete job at listing childhood symptoms than I can here. There are some references in the back; my favorite is The Portable Pediatrician for Parents by Laura Nathanson.
One thing that has changed since we were children: antibiotics. It used to be common to prescribe antibiotics for cold symptoms, at least some of the time. Not anymore.
Colds do not respond to antibiotics (they are caused by a virus), and your doctor shouldn’t (and typically won’t) prescribe them. Globally, overuse of antibiotics is a public health problem, since it contributes to antibiotic resistance. And even for your particular kid, antibiotics aren’t totally risk-free—they can contribute to diarrhea, for example. The move toward prescribing antibiotics sparingly is definitely a good thing.
For ear infections or other complications, antibiotics may still be prescribed, although even for ear infections, they may not be necessary. The prescribing guidelines for this condition are complicated and depend a lot on what the ear looks like, along with other symptoms. If your kid’s ear hurts, you are going to need to see your doctor.
In conclusion, enjoy your time in the land of snot! On the plus side, school-age kids get sick a bit less (two to four colds per year), so this doesn’t last forever.
The Bottom Line
Delayed motor development can be a signal of more serious issues, the most common of which is cerebral palsy.
Variation in motor development within the (very wide) normal range is not a cause for concern.
There are many approaches to evaluating motor skills; your pediatrician is your best partner in doing so.
Children get many, many colds—about one per month for the winter, at least until school age. Lotion tissues. Lots of lotion tissues.
14
Baby Einstein vs. the TV Habit
When I was a kid, we had one TV in the house. It was in the attic. My brothers and I were permitted to watch an hour of TV before dinner, and were limited to the PBS shows 3–2-1 Contact and Square One Television. In seventh grade I finally convinced my mother to let me watch 90210, since without it, I was doomed to social oblivion. I think she took pity on me in the hopes it would help (it didn’t).
My parents’ choice of programming—where Square One came after Sesame Street—reflected their desire to choose “educational” TV. Yes, we were allowed to watch TV, but at least it was something that would teach us letters and math.
Did we learn anything from these shows? I’m not sure. I certainly remember elements of Square One well—“Mathnet” and “Mathman” come to mind—but I do not associate them with any particular math concept. The one specific thing I do remember is a song—You never reach infinity, you just go on . . . and on . . . . I am sure I would have learned about infinity one way or another, but I think it is fair to credit the show. In the case of Sesame Street, there is actually good research suggesting that exposure to the show increases school readiness in kids ages three to five.
In the past thirty years, there has been tremendous progress both in educational programming and, in the past decade, other educational screen media. Where our parents had only Sesame Street, we as parents have a plethora of educational iPad games, DVDs, streaming videos, and so on. All of which promise early literacy and numeracy.
Sesame Street and similar shows (Dora the Explorer, Blue’s Clues) are aimed largely at the preschool set. For younger children, the Baby Einstein DVDs reign. Baby Einstein is an enormously popular video franchise that produces content aimed at infants and toddlers with a combination of music, words, shapes, and pictures. The goal of these videos is explicitly educational. They aim to teach children new words, for example, or new music. And certainly the company claims they are successful.
On the other hand, there is a tremendous amount of evidence suggesting that exposure to TV—and, more generally, to any screens—is associated with lower cognitive development. Researchers have shown that kids who watch more TV are less healthy and have lower test scores.
Which is it? Is showing your nine-month-old a Baby Einstein DVD the way to encourage them to be an early talker? Or are you just developing the Berenstain Bears’ dreaded “TV habit”?
The American Academy of Pediatrics falls squarely in agreement with the second answer. They recommend no TV or screen time at all for children under eighteen months, and no more than an hour a day, ideally consumed with a parent, for older children. In addition, they recommend choosing “high-quality” programming, such as that featured on PBS. That would include Sesame Street, although it would also include less learning-focused shows, such as the parent-despised Canadian-export Caillou.
But others argue that these recommendations are too conservative—and indeed, the AAP has wavered with them over time (until recently, it was no screen time until twenty-four months). The only way to answer is to go to the data.
BABY EINSTEIN
The field of developmental psychology is interested in—among other things—the question of how children learn. Researchers in this area bring kids, even young infants, into their labs and study how they interact with other people, with new toys, with different languages, and so on.
Within this research, we can start to learn about the potential for infants and toddlers to learn from videos. The results are not very encouraging. In one example, children twelve, fifteen, and eighteen months old were shown either a live person or a person on TV demonstrating some actions with puppets.1 The researchers evaluated whether the children could repeat the action either in the moment or twenty-four hours later.
In all three age groups, when kids watched an actual person doing the action, some of them were able to replicate it a day later. The video demonstration was much less successful—the twelve-month-olds learned nothing, and the older kids learned much less than from seeing a live person do it.
Another example is a study where researchers tried to use a DVD recording to maintain exposure to non-native sounds. At birth, children are able to learn the sounds from any language, but as they age, they specialize in the sounds they hear regularly. Researchers tried to maintain exposure of English-speaking nine- to twelve-month-olds to Mandarin-language sounds, either through a live person or through a DVD.2 The live person worked well, the DVD did not.3
These results suggest it would be surprising if Baby Einstein worked. But we can go further, since there is randomized trial evidence on this specific question.
In a 2009 paper, several researchers set out to test directly whether young children—in this case, twelve- to fifteen-month-olds—can learn words from DVDs.4 They actually used a Baby Einstein product, a DVD called Baby Wordsworth, intended to increase vocabulary comprehension. Parents of children in the treatment group were given the DVD and told to have their children watch it regularly over six weeks. Children in the comparison group did not receive or watch the DVD.
Every two weeks, the researchers brought the children back into the lab and evaluated whether they had learned to either speak or understand new words. Over the course of the study, the number of words spoken and understood increased, since the kids aged. However, there were no differences in word
learning in the DVD and non-DVD groups. The study’s authors noted that the most significant predictor of both how many words the children spoke and how fast their vocabularies grew was whether their parents read them books. Other authors have extended versions of this study to kids up to age two and found similar results.5
Baby Einstein does not seem to live up to the name. This is not the way to bring your kid to the head of their day-care class. Of course, if you—gasp!—would like to use these videos to distract your kid while you, say, take a shower, vocabulary development may not be the goal. (More on the question of detrimental effects below.)
Videos may be a dud for baby learning. But there is more evidence that older kids can learn from television. If you have a preschooler and they watch any TV at all, you know this must be true. When Finn was two, he developed a disturbing habit of imitating Caillou (“But MOOOOMMMMMYYYYY, I don’t WAAANNNNTTTT to eat dinner”). He thought this was hilarious. There is no way he learned that from either us or his older sister.
Kids learn songs from movies and from shows, and can pick up names of characters and basic plot elements. Researchers in the lab have shown that three- to five-year-old kids are able to learn words from television.6
It shouldn’t be surprising, then, that they can also pick up some good information. Perhaps the strongest evidence of this comes from studies of the show Sesame Street, which debuted in the 1970s to enormous popularity and wide acclaim. The goal of Sesame Street was explicitly learning based. The idea was to increase school readiness for kids ages three to five. You can see this when you watch the show—they are focused on numbers, letters, and general pro-social behavior.
Early on, researchers used randomized trials to evaluate the effects of Sesame Street. In one evaluation, the group of families assigned to the treatment group had their televisions hooked up so they could access the show more effectively.7 The researchers found, over a period of two years, improvements in various measures of school readiness, including vocabulary.
The effects of Sesame Street seem to be long-lived. A more recent study looked back at the early years of the show and compared the kids who got early access to it—because of better TV reception—to those who got later access. The earlier-access kids were less likely to be held back in school at older ages.8 The show had bigger positive effects for children from more disadvantaged backgrounds, which could be due to differences in the other activities in their day, or to something else.
All this is to say that for slightly older children, television can be a source of some learning; this argues (among other things) for curation of what they watch. For very young children, what they watch may actually matter less, since they do not learn much from it, although you cannot rely on the TV to make your child a genius.
THE TV HABIT
Parental confession: I have never thought of television as a learning opportunity. My kids watch a bit of TV and it is heavily concentrated in time periods in which I need to get something done. At the end of the day on the weekend, when you’ve spent an entire day with the kids and need to cook dinner, it is awfully nice to send them off to watch TV for half an hour. The pull of the Baby Einstein videos for me was not that they would teach Finn anything, but that they might hold his attention for longer at a younger age.
If some quiet distraction is your goal, then your question is probably not whether TV is a learning opportunity, but whether it is detrimental. Does TV rot your child’s brain?
Many studies say yes. For example, a 2014 study shows that preschoolers who watch more TV have lower “executive function”—meaning less self-control, focus, etc.9 An earlier study, from 2001, shows obesity is higher among girls who watch more TV.10
These are just exemplars—many, many research papers correlate more television with bad outcomes. Among the most influential is a 2005 paper by Frederick Zimmerman and Dimitri Christakis.11 Using a large, nationally representative dataset, their goal was to relate television watching at early ages to test scores among children ages six to seven. The researchers categorized the children into four groups based on how much TV they watched in two age ranges: under three years old, and three to five years old. “High” TV watching was more than three hours a day; “Low” was less than that.
Twenty percent of children fell into what they called the “High-High” group: more than three hours of TV a day both before age three and between ages three and five. Twenty-six percent fell into the “Low-High” group: less TV before age three, more from ages three to five. Fifty percent were in the “Low-Low” group, and just 5 percent fell into the “High-Low” group.
The authors reported the differences among the groups in math, reading, and vocabulary test scores at age six. Their results suggest that watching more TV under the age of three lowers test scores; not a huge amount, but by the equivalent of a couple of IQ points. If you are looking in this data for evidence that TV is bad, which is what the authors argue, high watching before age three seems to be an issue.
However, watching TV at older ages doesn’t seem to matter. When the authors compared, say, the kids who watched only a little TV before age three and then a lot between ages three and five to the children who watched little TV before age three and little later, they found their test scores to be no different. If anything, the kids who watched more TV later had higher test scores than those who watched less.
This throws some cold water on the idea of avoiding TV for older children, but on its face, it does suggest that the recommendation of avoiding TV before age three is warranted. On the other hand, there are a few cautions. First, the kids in this study were watching a lot of TV. The average amount of television before the age of three is 2.2 hours per day, and the “High” TV group was watching more than 3 hours a day. It is challenging to extrapolate this to the question of, for example, whether you should allow your kid a couple of hours of TV per week.
Second, although the authors tried to control for this, it is very difficult to adjust for all the other differences between kids who watch a lot of TV and those who do not. The majority of the kids in the sample—75 percent—watched less TV between birth and age three; the ones who watched more must have been unusual in some ways. How do we know it was the TV and not these other things that matter? We can’t, which is why this is a hard result to interpret.
Some researchers have tried to do a better job adjusting for this second issue, in particular. In my view, the best causal evidence on this comes from a 2008 paper by two economists, one of whom is my husband (but really! I think it is a good paper for other reasons!).12 In fact, I like this paper so much that I also talked about it in Expecting Better. It’s a good example of how to think about generating causal conclusions for a complicated question. It’s also helpful for actual decisions about TV.
In the study, Jesse and his coauthor, Matt, took advantage of the fact that television was introduced to different areas of the United States at different times. This variation meant that when television was first introduced in the 1940s and ’50s, some kids had access to TV when they were children and some did not. Since the timing of when people got TV in their area was not related to other parenting inputs, a lot of the concerns raised about other papers could be avoided.
The idea was to see how having TV access as a young child related to test scores when kids were in school at slightly older ages. Jesse and Matt found no evidence that more exposure to television at an early age negatively affected later test scores. This suggests the correlations in other data may be just that—correlations, not causal effects. Of course, TV in the 1940s and ’50s differed from TV today, but kids in this time period did watch a lot of television, so the amount of TV isn’t very different.
These studies all focus on TV. But in the current parenting climate, screen time has expanded. Your kid can now watch TV on your phone or iPad, but also play games and apps and do all manner of other things. Is this type of screen time like
TV? Should it be limited?
We basically have no idea. There are a few studies, but they have pretty big flaws. An example is one paper—not even a paper, more of an abstract—that got a lot of press for showing that language delays were more common in children who had more exposure to a phone between the ages of six months and two years.13 But this has the same problem, probably even more extreme, as the paper on TV discussed before. What other features of the family correlate with a lot of phone time for a six-month-old? Is it not possible that those features are what are associated with language delay?
This isn’t to say that a lot of screen time is fine. We just do not really know.
LET’S BE BAYESIAN
The actual data we have on these questions is pretty limited. Based on what is available, I’d say we can learn a few things:
Children under two years old cannot learn much from TV.
Children ages three to five can learn from TV, including vocabulary and so on from programs like Sesame Street.
The best evidence suggests that TV watching in particular, even exposure at very young ages, does not affect test scores.
This may be helpful, but it leaves many questions unanswered. IPad apps—good or bad? Does sports on TV count as TV? Is there any amount of TV that’s really too much? What about iPad shows—is the fact that there are no commercials a good thing or a bad thing?