Assessing Child Readiness for Tech | Jenny Radesky, MD

Studies mentioned in this episode, in order mentioned:

Radesky, J. S., Silverstein, M., Zuckerman, B., & Christakis, D. A. (2014). Infant self-regulation and early childhood media exposure. Pediatrics, 133(5), e1172–e1178. https://doi.org/10.1542/peds.2013-2367

Radesky, J. S., Kaciroti, N., Weeks, H. M., Schaller, A., & Miller, A. L. (2023). Longitudinal Associations Between Use of Mobile Devices for Calming and Emotional Reactivity and Executive Functioning in Children Aged 3 to 5 Years. JAMA pediatrics, 177(1), 62–70. https://doi.org/10.1001/jamapediatrics.2022.4793

American Academy of Pediatrics (2024, April). The 5Cs of Media Use. AAP. https://www.aap.org/en/patient-care/media-and-children/center-of-excellence-on-social-media-and-youth-mental-health/5cs-of-media-use/

[Kris Perry ]: Hello! I’m Kris Perry, Executive Director of Children and Screens and your host of the Screen Deep podcast, where we go on deep dives with experts in the field to decode young brains and behavior in a digital world. 

Joining me today is Dr. Jenny Radesky, a developmental pediatrician and the co-medical director of the American Academy of Pediatrics Center of Excellence on Social Media and Youth Mental Health. Dr. Radesky is a leading expert on the impacts of both parent and child use of mobile technologies on child behavior and development. Today, we’ll explore developmental milestones across childhood and adolescence and what pediatric guidance can tell us about tech readiness along the way. Welcome, Jenny.

[Dr. Jenny Radesky]: Thank you for having me, Kris.

[Kris Perry]: First of all, Jenny, I want to say how honored we are at Children and Screens to have you join me on Screen Deep today. Your pioneering research coupled with your clinical and personal experience supporting children is unrivaled. 

Before we go deep into your research and how it has evolved over the years, I’m really curious. Why did you shift the focus of your career from a primary care doctor to researching the impact of digital media use on children?

[Dr. Jenny Radesky]: Well, I always wanted to be a researcher. I was at med school at Harvard and worked with some really amazing clinician researchers who were studying the developmental and fetal origins of adult disease. So we were following pregnant moms from their second trimester and following those babies until they were eight or nine years old when I left my research post with them. 

At that time, I was looking at neonatal and prenatal mercury exposure and children’s cognition. And I found that, you know, mercury had an effect on children’s language development when they were exposed to it in utero. But what had a much, much bigger effect was the family’s social circumstances: the poverty level, the amount of educational attainment a parent had the opportunity to get. Those created these huge gaps in language development and development in other social and emotional domains in the kids we were following. 

And so as I became trained in primary care and general pediatrics, I was seeing it in the clinic, too. I was seeing some families really struggling with accessing good childcare, preschool services, parents who are more stressed and depressed, and how that was affecting interactions with babies. So that’s when I decided I really want to study how we can support families in early childhood so their kids have the best chance at having healthy mental health and relationships through the life course. 

But it was when I was doing a year of primary care, right before my fellowship—and I was in Seattle, it was 2011, so the iPhone had come out a few years before the iPad was just coming out. I was doing primary care with all of these early tech adopters who worked for Microsoft or Amazon in the Seattle area. And mobile devices were now in so many exam rooms where they just hadn’t existed before, where kids would be playing on them or parents would take them out of their pocket and start Googling their child’s symptoms, you know, while I’m trying to talk to them about their child’s symptoms. So I felt like this is a fascinating phenomenon, these tiny computers that we’re now taking everywhere. This is clearly having a disruptive effect for good or for bad on families and communication and relationships. 

So I then went on to fellowship in developmental behavioral pediatrics at Boston Medical Center. This is a safety net hospital in New England, which mostly treats a Medicaid, immigrant, high-poverty population. So then I was really trying to study, how do these intersecting social and psychological and relationship issues that stressed families are facing with this new media environment where the pace of adoption of cell phones and tablets? And now, as we’re seeing with AI, it’s so fast because there’s a huge, huge business push and investor push for these things to grow fast and get to scale and families are really struggling with knowing how to adopt them in ways that didn’t disrupt their day-to-day life or their kids’ development. 

So it was just the kind of right time to be a researcher in child development and to be at the right place where I was seeing all of this new technology being adopted. So it’s been really fascinating and a challenge to study a fastly moving technology. You know, we’ve had to come up with new ways of tracking what families are doing online because just asking, “How much screen time did you get yesterday?” doesn’t capture the whole picture of what it feels like to live and parent in today’s digital ecosystem.

[Kris Perry]: Incredibly interesting that your career tracked along with the advent of these portable smart devices. And lately I’ve been reading about the differences between Gen X, Millennials, Gen Z, digital natives, all the generations that have had really different relationships to technology in an effort to help me grasp just how much the daily lives of children and adults have changed since the advent of the smartphone and personal tablets. 

Based on your research, there are many ways to use digital media at each stage and age. And there are two huge milestones when it comes to giving a child access to a connected device, right? First, in early childhood, when parents usually make the decision to let their child use a tablet or phone. And second, that important question of when to let a child or adolescent have a smartphone of their own. 

So, let’s start with the early childhood stage. Today’s parents obviously are really, really struggling to understand when they should introduce technology to young children. On the one hand, it seems to be widely accepted that too much screen time can be harmful. On the other hand, some parents feel that teaching children early to be digital natives is important for their future. So what can you tell us about the developmental stages of early childhood and what those tell us about when or if a child might be ready for a device in a more independent way—for example, without co-using with a parent?

[Dr. Jenny Radesky]: Yeah. So let’s also think about the change in generations also because, like, when I grew up in the 80s, we had one television at home. We had a—we made an appointment with it to watch Saturday morning cartoons on the few broadcast stations that my parents allowed us to have, because they thought cable was too racy and full of, you know, violence and bad words and stuff like that. And we were offered a selection of cartoons or shows that were created by producers and script writers and casting directors and animators and other things that went through a whole process of media development. And there was a range of quality. You know, you had the kind of high quality educational stuff like Sesame Street and PBS Kids that were—you know, they meet criteria for being high quality because they put a lot of care and thought and planning to make sure their media is teaching kids the way kids learn and experience the world and not just gimmicky, grabbing their attention. 

And now, technology is so much easier for young kids to grab and activate with their voice with just the swipe or touch of a screen. So touch screens were a huge game changer when it came to little kids accessing technology, because otherwise you had to have a parent or caregiver set you up with the TV, turn it on with the remote if you didn’t know how to yet. You also had a much wider selection of media content that exploded with mobile devices, because now you have the app store where it’s really easy to create an app, post it on the app store, say it’s for kids, say it’s educational without any proof that it is, put some ads in there, put some data trackers in there to make some money off of it because we know kids love playing little games with stars and candy and all the other rewards and their favorite characters. And you just have this new business model that’s erupted around what children are consuming through screens. 

Then you also have the advent of this video sharing services, like YouTube that also had a lot of user-generated content. So no–no script writer, no casting directors, you know, no producers who are trying to be thoughtful to make sure this is really the, you know, the way kids learn. But, you know, a kid shopping for toys, and unboxing toys, and that becomes a whole new genre of toy unboxing videos, or satisfying slime videos, or people-playing-with-dolls videos that are so engaging and mesmerizing to young kids because they have all of this wish fulfillment in them that kids just are very drawn to, but they don’t have those same types of carefully thought out content and pacing and storytelling that we know makes good content for—or high quality educational content for kids. 

So back to your original question, like, so when is it appropriate to then give a device to a child that opens these doors to these video platforms and app stores that have a glut of lower quality, easy-to-digest content that takes your child’s attention and makes money off of it? So, that’s a really hard question for a parent to ask because they’re—in their mind, they’re thinking, “I would just like something to keep my child occupied for a little bit while I do the dishes. I would really love something to help me with long car rides. I would like something that makes parenting easier.” Because parenting feels really hard right now. There’s not enough child care. There’s, you know—parents are working really long hours. It’s—a lot of them are remote working and trying to multitask between having kids and being on a Zoom call. 

So, I explain all this not to make this feel like an impossible question to ask but because there’s so many layers of different things that shape when we introduce media to kids. And one of the hugest ones we hear about is just parent overwhelm: “I don’t have another set of hands. I’d like my child to sit still and do something calm.” And that could be on a TV, and it could be on a handheld device, a parent’s phone or a tablet that you get your child. The thing I tell parents is, “Your child doesn’t need a tablet.” They’re not going to be left behind if they don’t have a tablet. They’re so easy to use. It’s not like they’re learning new tech skills by swiping and downloading stuff. And they may be introduced and taught kind of informally by all that stuff that they can access on the app stores or on video sharing services. They may be taught, “Well, this is what matters. Having toys matters, collecting coins matters. All of this fun stuff is the—what I should be consuming online.” 

So I think that there’s a risk of, if you’re introducing a handheld technology without the oversight of—there’s a couple layers of oversight. One is download controls on that device to make sure your child can’t just download anything they see an ad for. Two is some time limits and some boundary controls, so that it’s not a device your child just takes everywhere and uses all the time on demand whenever they want because it’s such a high-pleasure, low-friction device that it’s gonna feel like—the child is gonna feel much more attracted to that than all the other moderately-frictionful things that happen in child development, you know? When you are playing outdoors in the dirt, you feel sticky or you get frustrated because you poked yourself with a stick, or you may get in an argument with the child who wants the toy that you are trying to build with in the yard, or you might feel more frustrated trying to draw and it’s not easy to exercise your motor control and get within the lines. 

So there becomes this kind of false level of like, you know, pleasure and satisfaction that’s often offered through apps and YouTube that we don’t really have to offer kids in real life. Real life has a lot of these little moments of, you know, what my mentors used to call your “tiny dramas” every day. You learn from your tiny dramas. You figure out, “How do I handle this? Oh, that went okay. I solved it.” Or you cry and you get upset and your caregiver comes and gives you a hug and helps you get past that feeling. And those feelings of solving it, and repair, and handling it, those are such important growth moments that this easy, easy button fix of  having a tablet and just putting it in front of the child is slowly kind of getting in the way of and having an unintended side effect of parents not feeling as successful or effective in handling their child’s tiny dramas throughout the day. You know, because if you always see the phone or the tablet as that solution, you don’t see the solution as inside you as a parent and saying like, “Okay, here it comes again.” 

This, you know—toddlers and preschoolers show bizarre behavior. They just do. It’s part of the way they learn and communicate. They have incredibly frustrating moments. They have incredibly amazing moments where they solve things and you’re like, “How on earth did you know how to do that?” And it’s all those little tiny dramas during the day that as a parent kind of unlock your— that window into your child’s mind of like, “Whoa, how did they figure that out? That’s so cool. Let’s work on that a little more.” Or the window into your child’s upset mind of, “Oh, he really wanted to do that by himself. Like, he’s gonna just cry and cry unless I let him try and figure this out on his own.” And that’s how you build a lot of part of your relationship, is knowing, “What’s going on in my kid’s mind?” And that’s what I worry would be displaced by overuse of a tablet.

[Kris Perry]: What you’re really describing is self-regulation, which is a skill that you begin from the moment you’re born until the moment you die, practically. It’s such a hallmark of our humanity, our ability to succeed, our ability to create, and it’s such a critical skill. It’s such an important part of childhood that the way you describe being in the real world and coping and learning to thrive in the real world is setting you up for success later on. And this is so important in early childhood in particular. 

So, can you talk a little bit more about either observations you’ve seen in practice or in your research of children more and more being given a device to kind of pacify them or in a way disrupt their self-regulation skill building so that it gets the parent through a tough moment or a tough, you know, experience—you’ve described a couple of them like car rides and having to wait patiently, but if you could also take that micro-observation and talk about the macro—what does this really mean for society or childhood in general if we’re using devices in this way now for more than a decade?

[Dr. Jenny Radesky]: Well, to go back to what you said about self-regulation starts in infancy and kind of continues through your whole life, and you really are working throughout your life—more at different time points, especially early childhood and adolescence, and becoming a new parent. Those are all huge inflection points of learning self-regulation that you do from the inside out, not needing external regulators like a tablet or a glass of wine or you know, something else like that. But infants vary a lot in their innate self-regulation abilities. 

When I was at Boston Medical Center, I was a—like a research tech for a study looking at infants with neonatal abstinence syndrome. And some of them, you unwrap them, and they immediately turn bright red and mottled, and they cry and they stiffen up, and they cannot focus on you or on that little ball that I was trying to get them to focus on compared to other infants, some with substance exposure, some with not, but who are chill, and they’re like, “Okay, well that was a little bit weird but I’m going to settle back down,” right? So, many of us are parents of the kids who can get a little upset and settle back down pretty easily. But a subset of us raise kids who are more sensitive. These sensitive kids are sensitive in a sensory way, in an emotional way, in terms of their threshold of reaction to stress. They might have bigger intense emotions, a harder time waiting for things. They may wiggle their body more because that’s one way that they try to focus and kind of calm themselves down. 

And so we’ve done a couple of studies based on my clinical observations that it was these fussier infants, these more dysregulated little kids, who parents talk about using media as a coping strategy to say, “I just need them to be still for a while. I’m going to put them in front of the TV.” So we did a study looking at this large dataset of infants and toddlers, the Early Childhood Longitudinal Study birth cohort, and found that the infants at nine months old, who parents rated as more dysregulated, were more likely to consume more TV when they were two. So, I really was trying to question this idea that it’s always screen time leads to more difficult behavior, because often, you know, always the child brings something to the table in terms of their own individual characteristics. And that’s become a lot more, I think, accepted when we talk about individual heterogeneity towards media effects, like your response to social media or these little kids’ response to use of media for calming. 

And then we did a longitudinal study that was funded by the NIH, where we followed three- to five-year-olds at baseline, three months, six months. And at each of those time points, we asked the parents, “How likely are you to use media like a mobile device to calm your child down when they’re upset?” And we did a standardized scale of emotional reactivity and we found that it went both ways. So, in these little preschool-age kids who were more emotionally reactive were given media more to calm down. But also over time, the more media they were given to calm down, the worse emotional reactivity they had over time. Which was a hint to us that this may work in the moment to just make that affect go away. And as you’re—when you’re a parent and your child is just screaming at you and turning red in the face, you can understand how reinforcing it must be to just quell that immediately with a YouTube video or a bubble popping app. But you’re not addressing the underlying emotion that led to that behavioral reaction. 

The way you are—you know, I did a lot of training and fellowship in infant mental health or early relational health, which is about how a caregiver can sensitively respond in that moment to kind of say—and not get worked up themselves—but say, “Okay, here, this is what you’re feeling. Let me give you a hug. I’m here for you. Let’s try and calm down. Let’s try and solve this.” So that’s what this study suggested is that over time, we’re displacing those moments where the skill-building happens. But that skill-building takes a long time and it’s invisible to the parents right away. So you can imagine how the competing things of, “Well, in the moment, it’s very visible how quickly my child comes down,” but how we’re working on new resources to help families recognize, “Okay, but in the moment it’s a better investment in the long-term emotional health of my child to not have them dependent on using a mobile device to calm down or distract from negative feelings.” 

Now this is different. We think it’s different than just, “Okay, there’s a certain time of day I need to occupy my kids by turning on a show.” That this in-the-moment, “You’re upset, I’m handing you a device,” compared to a planned, intentional, “This is the time I cook and you guys are watching Odd Squad or something else.” But that is something that we’re studying with my collaborators, including Heather Kirkorian, who works with Children and Screens, you know, we really want to understand, are there certain types of this keeping kids occupied where it’s not a problem? And maybe it’s more of a resource for the family to say, “Hey, I’m going to use this positive media to keep my child occupied.” 

Now, in infancy, we don’t know how much of a risk that is compared to when kids are two, three, four, five. There’s a lot more they can learn from media at those ages if it’s well-crafted and has those positive and highly educational design, like, I’ve said before, Sesame Street or PBS Kids, where they’ve really put in the work to make sure that kids actually learn from their media.

[Kris Perry]: In a previous role I was in, we worked closely with public television and developing shows and literally went out and hired psychologists and developmental pediatricians to help them script the shows and make sure they contain pedagogical value. And I’m really glad you flagged that there are those kinds of programs still and there are the other kinds of programs where the motivation is really more about marketing and time on screen. Can you talk a little bit about that difference in quality and the content for young children that most are consuming today, really both kinds? Researchers often recommend that young children only be exposed to high quality content if they’re exposed to digital media at all. So can you help us, can you help parents understand what quality—what does that even mean?

[Dr. Jenny Radesky]: Yeah, and it’s nuanced. And when I explain—I’m about to explain the different criteria we look at, and then I often hear parents say back, “Alright, that’s a lot. I’m a busy person. I can’t deal with all of that.” So the quick answer is, “Well, if you go to a nonprofit like PBS Kids or Sesame Street that’s done all this work, that in study after study is not linked with developmental delays and actually kids can learn better from their content.” Like that’s the quick, easy way that—and that’s why the American Academy of Pediatrics and our Center of Excellence recommend, you know, if your child’s going to watch media in their early years, go with these nonprofits. They’re not trying to make money off your kids’ eyeballs. 

There are a couple other indicators. Another quick and easy one is like do you like watching along as a parent? If these characters irritate you and you think they’re kind of shallow and gimmicky or they influence your child in ways that you’re like, “Eh, I don’t like you acting like that,” you know, turn it off. There’s so much content out there. Use your consumer power as a parent and just take that out of your child’s lineup. If there’s lots of ads or any purchase pressure, that is a red flag of a media that just wants your child’s money or monetization rather than the kind of best interest of wellbeing or learning. 

And then there’s other things that we’re coding in our research where we look at things like extraneous visual effects. We term this as like “bedazzling.” Like it’s just, you don’t need it. It’s just there for like extra kind of nonsense. We know young kids, their attention orients so easily, is grabbed so easily by flashy features, bells and whistles. So, if you see something that just has sparkles everywhere and extra giggles and, you know, just it seems a little bit overdone, that’s another sign that they’re more grabbing your child’s attention by more of the bells and whistles. 

You want your child to be engaged because it’s a good story. Kids learn from storytelling and watching meaningful characters go through something, like Daniel Tiger or Elmo. They love these characters because they know them, they develop this parasocial relationship, and there’s a good story that teaches them about some new concept or role models. You know, how to act with a friend, how to handle it when something disappointing happens. So, that sort of positive or negative role modeling is another thing we code in our research. 

We look at whether there’s branded content. So, if it just seems like there’s lots of filler from toy companies or candy companies, like, that’s another sign of lower quality media. And if it’s, like I said before, if there’s lots of, like, slime and vicarious pleasure, where it feels like it’s the equivalent of, like, you watching the Kardashians, I guess. I don’t know. This is like one example that sometimes resonates with families where it’s like, “Okay, it’s like my guilty pleasure, just, but it’s a bit…” That’s the sort of stuff where if you’re thinking of your media food pyramid or your diet, like, you can have a little bit of that sort of, like, sweets and those pleasures, but like it shouldn’t be your main thing your child’s consuming, like watching kidfluencers, you know, drive around in fancy cars and show off their gorgeous mansions and other stuff like that.

[Kris Perry]: When did you introduce your own children to digital media?

[Dr. Jenny Radesky]: So we—Let’s see, so I have a 15-year-old now and an 11-year-old. My 15-year-old was—I had him when I was in residency in pediatrics. We were lucky, or made the decision, that my husband would stay at home because I had a really heavy workload. So I was really lucky. I had built in childcare. And I think that that was one reason it wasn’t something that we felt this need of like, “Ugh, just, like, put him in front of the TV so we can get something done.” But I remember, I had a lot—with my kids, I tend to have a very curious approach to media where I’m like, “Oh, let’s try that out and then we can learn from that experiment.” And I don’t mean big things, like, “Let’s try out a phone.” I mean, like, little stuff, like, “I wanna see how my one-year-old reacts to Baby Einstein on YouTube. Like, let’s see what happens.” You know, I just have a researcher mindset. So, I found some of that fascinating that, like,  he would just like stare and giggle and do all the stuff. And I was like, “How do they do this? Like, this is clearly just like little mesmerizing toys, you know, going back and forth.” 

Then my mom sent me this HBO series on poetry, baby poetry. It was so lovely. It was the Jack Frost poem, William Carlos Williams poems and there were different songs that they adapted and animations. I liked co-viewing it because I thought it was beautiful and it was poetry, which I like. So he would watch it, he was probably a year and a half, and he thought it was cool, and then he was learning language, so he would—we would say the poems together or sing the songs together. So that’s another example of, like, a type of media that you as a parent actually like to co-view and then you take what you saw on the screen and you transfer it or you launch it into your 3D social and physical space with your child. And so I think that is where well-crafted media has a really nice space in families’ experiences. Now that same 15-year-old and I, watch Dune and Dune II together, and we love all the nerding out about the storylines and the characters. So in my household, I see media as a source of storytelling and art and connection, when you use it intentionally that way. 

And then my younger kid probably had some, like, secondhand exposure to PBS Kids and stuff when my older son was a preschooler. They’re about four years apart. But one of my experiments I did with him was I had a—I brought home a tablet from my lab that had some apps installed on it and he was, like, two, but I just wanted to see how he reacted to all the rewards and all the stuff like that. And boy, he was like, “What? I got a present?!” and he—we still say that to him, like he’s so reward-sensitive and we’re like, “He got a present!” because he couldn’t stop using it. He was, like, so obsessed with these games that had persuasive design and he was like, “The treasure chest opened! Look at all these coins!” And I was like, “Of course a two-year-old doesn’t know the difference between these fake gimmicky coins on a screen and like the real coin— gold coins you might get in real life.” So, that was kind of a sign for me that we didn’t get him his own tablet because it was too hard to regulate at home. 

And he’s the one who I’m now negotiating—all weekend, Kris, all weekend. He was talking to me about the phone he wants. I mean, it’s been really interesting and he’s—so he’s 11 now. He’s in sixth grade, you know, his brother got his phone when he was in eighth grade. We—it just felt like he was ready and mature by that point, and my 11-year-old is not that mature right now, has some impulse control issues, but is, like, super creative and, like, loves being on my phone and playing Garage Band and other stuff that he creates music and stuff. But that’s another individual difference that I think parents should try to note for their kids: “Which of my kids really struggle to put the device down, or to turn the TV off, or to follow tech rules? And which ones can”—say, like, if you lay out an expectation—“‘Okay, you can watch two Paw Patrol episodes, and then turn it off.’” And then see who does that and who doesn’t. It’s hard for kids, but if you set that expectation, and maybe have a little reward afterwards where you get, you know, a sticker or a high five or a, “I’m proud of you” moment afterwards, you can see which kids respond to just that behavioral structure and reinforcement of, “I gave you an expectation, you followed the rule and good job,” and you’re teaching that kid how to self-regulate and turn it off, and which kids really struggle with that. 

And there’s a subset of kids often who are more sensitive or impulsive or have executive functioning challenges where it’s just hard for them to keep track of time. They’re very easily drawn in by all the visual stuff that’s on media. And then those, you may need to be more intentional. You know, that’s one area I’d love to explore more in my research is like, which are the subset of kids that might have more problematic media use? And how do we set them up with more positive kind of boundaries and media content early on so that it doesn’t turn into something that impairs their functioning and doesn’t get in the way of—you know, for my 11-year-old, we work hard on getting him into a theater group or music classes or something else, because his default would be watching The Simpsons.

[Kris Perry]: Yeah, I absolutely love these examples because you’re taking me back in time and remembering watching Thomas the Tank, and then the kids falling in love with trains and we’d have to get toy trains and build train tracks, or later we would read Harry Potter and then they got really interested in magic and in fantasy, and I really love that example you gave of taking what might be on the screen in 2D and deliberately, intentionally trying to pull that interest into their 3D real life so that it’s a fuller, more sort of comprehensive experience. And that was a really, really helpful example. 

You’ve been laying out in your own family, the differences between your kids and their temperament and how that has forced you or led you to making different decisions about their readiness for devices or different content that they can watch. And it helps me remember that lots of parents hear about screen time limits. That’s one of those things that comes at you pretty quickly. And yet, there’s so much more to it based on everything you’ve said so far. And I was thinking about the AAP Center of Excellence and you happened to lead that and you came out with something called the 5 Cs recently, which I think is a really useful tool for helping parents understand more than just screen time limits. Would you mind briefly walking us through what those 5 Cs are and that framework and how parents can apply it in their homes?

[Dr. Jenny Radesky]: Yeah, yeah, that’s great, because you got it. That is exactly why we developed the 5 Cs. The main things we were hearing in our first year of launching the Center of Excellence, which is funded by the federal government through the Substance Abuse and Mental Health Services Administration. They wanted a center to create evidence-based resources for families about healthy relationships with media and social media. And when we talk to parents or pediatricians, screen time was the main way they thought about healthy media use. And if you’re only thinking about time, you’re missing so many other dimensions that the evidence says are really important for kids’ healthy relationships with technology. Now, time limits still matter, especially in early childhood. And that’s really more about having boundaries so that it’s at a consistent time of day and your child isn’t begging for more and more and it’s not getting in the way of sleep or other things. 

But here are the five Cs. I’ll lay them out for you. These were influenced by the 3 Cs approach from Lisa Guernsey. So she’s been an expert in early childhood media for a long time. She inspired a lot of my thinking and her three Cs were child, content, context, of understanding how is media affecting young kids? So we approached her and asked if we could adapt it too. The 5 Cs are child, content, calm, crowding out, and communication. Context is such a big thing, so we decided to make it a little bit more specific to families’ everyday lives. 

So, “child” is really thinking about what we’ve been talking about, these temperament differences, what is going on in your child’s mind, really understanding their experience and being very child-centered in our approach. Children usually don’t thrive in an environment where the parent is just trying to control and restrict and not really understanding the underlying drivers of, “Why does my kid want to use YouTube so much? Why does my kid want to use social media?” If you don’t understand the driver, you kind of can’t meet the child where they are and offer them an alternative media experience or help them do the media experience they want but in a healthier way. 

The second C is “content.” Content quality is super important from early childhood through the adolescent years in shaping whether this is a positive or negative experience, whether kids have developmental delays in early childhood or more depressive symptoms or eating disorder symptoms or other things in adolescence. Because if you’re consuming more negative content or more dehumanizing content or hate-filled content, that—teens don’t like it. They’re not searching for it. They say it often winds up in their feeds and so that leads us to in earlier childhood, really choosing the highest quality stuff for our kids that’s really worth their attention. And then in older kids, helping to figure out, “Do we want to be using media that has a feed in it where a computer decides what content you see, or do we want to more just watch streaming and watch some shows and videos that have had that producer and script writer and casting director and all that care that’s gone into producing that media?” And then if they are an older teen who wants to have a feed, knowing how to control your feed because you can down-rank things or shut things off or unfollow or block people who are stressing you out more. But it’s also, this is a place where we’re advocating for more care being taken by the companies that have algorithms in their products to make sure they’re not recommending unsafe or negative content to young people. 

The third C is “calm.” This one’s pretty straightforward. If you’re using media as your main way to calm yourself down and you don’t have other coping strategies, that feeds more into problematic media use. Meaning, you’re more likely to pick up a phone to vent or to just try to numb yourself and escape rather than—and that’s called avoidant coping—rather than trying to figure out, “What am I feeling? What led to this? How do I handle this?” And then that goes again from early childhood into those teen and adult years, too. It’s important for adults to recognize how much we might be using tech as an avoidant coping tool. 

The fourth C is “crowding out.” This term I got from listening to a podcast where the Surgeon General Vivek Murthy was speaking where he used that term and I was like, “That’s it. That is totally what’s happening with displacement.” Displacement is our academic word of why we think media has negative effects on kids: “But it’s so fun and frictionless, why would I stop and go to sleep?” That’s what crowding out is. Or I also liked it because so many families, they have this love-hate relationship with how much time they’re spending on media and they don’t feel good about how long they’re spending on a feed. So helping put the agency back with them to say, “Okay, what are you missing out on? What do you want to crowd back in? How do you want to get better sleep? How do you want to get outdoors more? Let’s make a plan to reduce your media use so we are crowding back in all those positive things.”

And then lastly, “communication.”  A lot of the communication between parents and kids around media has that control dynamic to it, and that often makes kids shut down or sneak media use. And so what we want to have more is—I like how the Center for Digital Thriving talks about being a coach, not a referee, or how to see this as ongoing conversations to have with some open-minded curiosity and to show kids, “Okay, I want you to come to me if negative things are happening. I can help you with it and I’m not going to immediately take away all your technology, but I will help you decide what boundaries to place. You deserve boundaries because I don’t want those kids being mean to you. I don’t think that negative content should be in your feed.” There’s so much shame that occurs around cyberbullying, sextortion, and all the sorts of things that we really worry about those harms that kids experience on social media. And if we haven’t opened up lines of communication with our kids, they may not feel like they can come to us about these deeply shameful experiences. So the more—I encourage families just to start talking about it in early childhood, like, “Why is that influencer being so weird? Why, you know, why are they showing off like that?” Or, “Why are so many ads popping up?” Or, “I don’t really like the way that character was treating another character.” That’s those early digital literacy conversations. And then also the conversations about, “Why is it so hard to put my phone down?” Those are other conversations about our emotional relationships with technology that can start earlier. You don’t have to wait till someone’s a teenager and be like, “Is anyone bullying you?” Kids are not gonna open up to those direct inquiries, but you might just start more chats when you hear about something in the news and you’re driving in the car together to be like, “Oh my gosh, did you hear about the you know kid who got chatted by some weirdo stranger on that gaming platform and, you know, what do think of that? Do you think kids know when it’s an adult or when they think it’s another kid?” Kids are much more likely to open up if they talk about what other kids are doing online and not just themselves, or their parents own online fails because we all, as I know from my research, spend a lot of time on our phones as well. Parents do.

[Kris Perry]: You mentioned your own kid building a case for getting his own phone just this weekend and smart devices have just become a huge part of children’s lives and we’ve heard from parents over and over again about how they don’t know the right time to introduce them. I’m seeing figures that over 40% of kids ages 8 to 12 now have their own smartphone. The Anxious Generation is getting lots of buzz, but we’re seeing really concerning data on the number of hours teens are using smartphones, as well as their worsening mental health. Using the 5 Cs and your understanding of developmental readiness, what are some behavioral signs parents should look for when it comes to getting a child ready for a smartphone?

[Dr. Jenny Radesky]: You know, before we go through those 5 Cs, I want to recognize that smartphones are—they contain so much. Like, they’re not really developmentally appropriate for some adults, honestly. Like, they’re so packed with attention-grabbing, engagement-prolonging designs. And so many adults have problematic relationships with their phones, too. But until we can get low cost starter phones for all kids—and what do I mean by a starter phone? I mean, wouldn’t it be great if you, say, your eight-year-old needed to move between different households during the week and you wanted a quick way to text with them and all their phone had was text, calls with your approved contacts, maybe a map or GPS, maybe photos, maybe some music. Like that would be a great, child-centered design of a phone. And there’s no data collection, there’s no ads, like it just does the job. But a flip phone does some of that, but it can’t do all of that. There’s no business case yet for really making a ton of money off of those sorts of limited devices because a lot of operating systems make a lot of money off their app stores where you download all these apps that collect your data or try to show you ads. I will say there are some starter phones available that cost more money. So if you’re a family who has money to spend on a Pinwheel or a Gab or one of these other types of devices, that’s often an easier step to take because it just has more safety settings in it. And then if you do have, like, a hand-me-down smartphone or you want to—all your carrier has is a smartphone, you can also lock that down so that it really just is the types of apps you want your child to have. Maybe no browser, no news or other sorts of apps that contain a lot of adult-oriented content. 

So, let’s assume we’re talking about a starter device in terms of, you’re not giving them a smartphone that’s fully loaded with access to the app store and everything. When is a child ready for that more simpler aspects of a smartphone? I’d sa—this is kind of how I’ve been talking about it with my 11-year-old. One is, let’s talk about the first C, “child.” How well is that child able to self-regulate their other tech use? So this could be their school-issued Chromebook, the TV that they might watch, their gaming platform. Are they already showing some maturity around being able to turn it off, not download things without you—your permission, or following your time rules or your bedroom rules. If you have a child who is still, as my 11-year-old called, “feening” for tech, you know, and isn’t showing a lot of restraint, they’re probably not ready for a smartphone that they can take everywhere. So in that case, you might, you know, choose something like a flip phone or, you know, in my case, I’m like, “Maybe if we can reach some of these readiness milestones”—he’s highly, highly motivated—“maybe we could think about a smart watch or something with more limited functionalities.” 

Another sign of readiness, because those smart watches still cost a couple hundred dollars, is not losing stuff. So if you have a kid who often is like, “Oh, I left that in my locker” or, “I don’t know where that is” and all of their mittens and jackets, you’re, like, picking them up from the school. That’s a child that’s going to have a harder time keeping track of a handheld device that your family is paying hundreds of dollars for. So you might think about a cheaper phone, like a flip phone, or working out other ways that you, you know—in our case, my son can bike to school. It’s very close. I’m not worried that he’s going to need to be texting us regularly. And so we—if you have a child who’s frequently disorganized, losing stuff, and then also not taking responsibility for stuff. Let’s say they make up—everyone makes mistakes, everyone crosses a line sometimes. But if then they’re kind of not owning up to stuff, not being a problem solver, that’s also a sign that they might do things impulsively with their friends online, say something that they regret. And then it gets screenshotted by someone and then they get into a big old, you know, argument with peers. And so that was another conversation I had with my son this weekend where I said, “Listen, sometimes you say silly things that get attention, but when you say that in a text, it can be permanent. Like, someone can screenshot it and send it around. And so you—when I’ve seen that in school, you can hold it together and not say rude things to the teacher, or your play practice director, you’re great with her—I want to see that sort of respect and responsibility online, too.” Having a kid who’s a little bit more mature and not always trying to grab attention from everyone else is that criteria. 

The last criteria doesn’t have to do with the child. It’s the parent. How ready is that parent or caregiver to have regular conversations and check-ins about how it’s going, to set the parental settings or controls that are available on either Apple or Android devices, to say, “All right”—I always recommend you start with things more restricted—“Like, I’m going to approve your contacts. I’m going to approve your downloads. I’m going to restrict you from being on this app that’s too time consuming,” but having regular conversations to say, “Okay, you’re showing more responsibility now, we can loosen up some of these restrictions.” And that’s kind of what we’ve done with my 15-year-old is we started with more time restrictions. We always keep the downtime around bedtime because then there’s just no question—like, it’s just not something you bring into your room and text with your friends until midnight.  But those—it’s always so much easier to start with things—with more rules for your child to get used to and then as they prove themselves and show that they’re having a pretty healthy relationship with it, you can lessen things up and give them more independence.

[Kris Perry}: What role could or should pediatricians play in helping families evaluate children’s health around media use?

[Dr. Jenny Radesky]: So, pediatricians address so many of the health behaviors that are so intertwined with media use. We want kids to get healthy, good night’s sleep. Eating healthy, exercising, positive family relationships, positive peer relationships, doing well in school. All of these intersect somehow with your media use habits because it could be displaced or interrupted or you might have negative or positive peer interactions through media. 

But we heard from pediatricians that the current way of talking about it just around screen time wasn’t working. It wasn’t opening up conversations. It was just felt like, “Here’s a rule. And if you don’t follow this rule, you’re not a good parent.” So that’s where the 5 Cs come in. I’ve actually had pediatricians say, they hold up the sheet that we created as a handout and they say, “Hey, there’s a new way that we’re supposed to talk about media use. And it’s not as judgy or guilt-inducing. Do you want to hear about it?” Or, “These have some tips that feel a lot more doable than just about, you know, limiting screen time.” So I’m hoping that as more pediatricians get trained in this approach—and we’ve trained thousands this year—that they feel more confident opening up conversations about media use. And at least, if all they can do is plant the seed of, “Try communicating with your kid about this regularly in an open-minded way.” Just that, I think, can help improve a lot of behavior change and setting some intentional boundaries around tech use at home. 

Because the truth is, parents, as you know, they call this their number one hardest part of parenting. So they’re looking for answers. They just don’t want answers that make them feel bad, worse about themselves, or make them feel stuck. Like, “I can’t do that perfect thing, so I must be terrible.” So we’re giving them lots of other ways that can still make this healthy, but don’t create this all-or-nothing standard of, “You’re either a low tech parent or you’re everything else.” And honestly, I think the research shows that you don’t have to be this overly-restrictive, low-tech parent. It takes a lot of work to have media in your household because you need to do a lot of teaching and boundary setting around it, because the media is not designed in a way to help us set those boundaries right now. But it’s worth that investment of the work because it’s going to help your child be savvier about this and not be my son when he was two, just being like, “I got a present!” You know, like that just feels like so much of media right now, is just like hooking and providing pleasure. And as adults, we too need to recognize the way we’re getting hooked in through all the pleasure mechanisms that exist through our feeds, through mobile games, other things that are, you know, taking up our attention or helping us feel more relaxed during stressful times, but they’re not solving the underlying problem.

[Kris Perry]: Right. I mean the design, the persuasive design, that even parents fall prey to is very real and I think this more empathetic approach, whether it’s from pediatricians or researchers or others that are saying, “We understand that the device itself is designed in such a way that it’s really hard for you to put it down. You know it’s gonna be hard for your child. We’re here to try to support you in this journey.” But—we’re not gonna touch on this today, Jenny, but you and I both know that some of these design features are really upstream design. There are changes needed upstream so that devices and parents and families aren’t all individually struggling to get that exact right mix that’s good for each individual child. 

Beyond tech readiness, your work and research have touched on so many areas of child media use and health. What’s the one finding or project you’ve been involved with that gave you the biggest aha moment.

[Dr. Jenny Radesky]: I think when I—so in our research, we track parents’ phones. And when I look at all the apps that parents are using and how they’re using them into the evening hours, that’s usually where I get a lot of insight. And it’s not a revolutionary, like, “Aha, this is what’s the solution to this.” But it helps me really understand what families are experiencing. They’re exhausted. They are living stressful lives. They’re often using their phones—parents are often using their phones—to destress at the end of the day. And those evening hours on parents’ phones are often filled with streaming video, social media with feeds or mobile games or YouTube. So these are all these high-pleasure, low-friction environments that I think are serving this calming function for a lot of parents, but then they’re often extending past midnight and then parents feel bad that it’s gotten in the way of their sleep. 

So the aha there has really been about solutions for—I really wish the design, as you just said, that upstream design respected people’s time and attention more, where if you had a plan for an evening bout of calming or funny media use and then it let you go, that would be amazing. Like, “autonomy-supportive design” is what I call it with my collaborators that work on this, where they might reconfigure the settings or the feed speed or the amount of friction in an app or these little micro-frictions that help you disengage. Like, that’s what we need more of. And we need more designs that give the user an option to like, I’m going to turn off my feed at certain times of days. Because maybe I just want to be having some direct messaging back and forth with my friends at certain times of day, but I don’t want to get sucked in by the feed. That’s an autonomy-supportive design that lets the user decide what they want out of their phone experience. Instead of the companies—these are incredibly powerful wealthy companies—saying, “Here’s what you get. This is what Instagram looks like. This is what TikTok looks like.” 

And I think that some of the policies that you and I have been advocating for are saying, “Wait, it doesn’t have to be designed this way. You’ve designed this to optimize for profits or data collection or ad views, but we could be designing around other metrics like how not good of a night’s sleep did that parent get last night or how much positive content did their feed help them engage with rather than doomscrolling?” So that’s where my aha really shifted after, you know, writing the AAP guidelines in 2016 where Dimitri Christakis and I were the authors of the early childhood guidelines. We were focused on, “What can parents do around media to make it healthier for kids?” Right now I’m much more flipped and focused on, “What could the tech industry do and policymakers do to make this easier for families across the board?”

[Kris Perry]: Well, you just drew the perfect analogy to the point you made at the beginning about kids in the real world experiencing friction when they’re playing or experimenting outside. And here you’re saying, “Wouldn’t it be nice if some of those features of the real world were brought into our digital world and there were points of friction and points of struggle so that you could experience that same developmental opportunity online?” 

I could talk to you for hours about all of this, but we have to wrap up soon, so I want to ask you: What’s the one piece of advice you would give at this point in time to a parent to help a child lead a healthy digital life?

[Dr. Jenny Radesky]: I’d start with, there’s many ways to do this right. So don’t believe that you need to join any certain type of camp or brand of parenting. Trust yourself and your relationship with your child and give yourself the time and space to play and build that relationship with your child early on, because that makes it easier. And give yourself the time, even if it’s 20 minutes a day, to just single-task on you and your child. Because that is good for your own mental health and it really helps you learn about your child and know how to manage their negative behavior when it does arise. So if you just start from that place, all of the media-related parenting is easier because then you know your child—what are they ready for? What are they not ready for?—and you can set a plan that works for your family. 

So that’s my other piece of advice, is just be intentional. Have a plan. There’s so much about media that is trying to control us or get us to buy things, get us to click things, get us to hover over things. And the more we show our own autonomy and intentionality to say, “This is when I think my child’s going to be ready for a device. I’m not going to just be listening to all the marketing. You know, this is the type of show I think leads to the calmest behavior in my child and I’m gonna get rid of the others that are, you know, making them more irritable.” When you really start from that point of, “I know my kid, I know my family, I know what works for us,” you’ll feel less guilty about where and when you choose media to go come into your family’s life, you’ll get more out of the media that you’re choosing because it’ll feel like you planned it that way and it’s worth it to you, and you’ll also be, in a secondhand way, teaching your child to show that same intentionality in their relationship with media. So that is the ultimate goal, is to raise a child who doesn’t just react to every bell and whistle that’s being thrown at them by the digital environment. That makes a great consumer who clicks on things and makes people money, but we don’t want to groom our kids to be consumers. We want to help teach them to be good humans who use digital media in an intentional way, in ways that support your family’s well-being. 

So that’s not a simple, quick answer. Nothing in parenting is a simple, quick answer. But it is simple in terms of it being very focused on you as a family, knowing yourself, knowing your child and knowing where media is helping you versus undermining you.

[Kris Perry]: Jenny, thank you for sharing your expertise and personal perspective with us today. Your work continues to shape how we understand children’s development in a digital world and how we can better support them. To learn more, check out the episode notes on our website for links to the AAP’s 5 Cs, our smartphone readiness tip sheets, and additional resources. Thanks for listening to Screen Deep. If you found this conversation helpful, please subscribe and leave us a review. I’m Kris Perry. See you next time.