Harvard Says What?

Another study that says what we all knew.

Article: Television Viewing in Infancy and Child Cognition at 3 Years of Age in a US Cohort

Sounds very Harvard-y doesn’t it? Well, don’t be fooled. Let me break it down for you, this make take 17 minutes, so you can pop a DVD in for the toddler so that I can have your full attention. Don’t worry, I’ll wait for you.

The study is this. The Center on Media and Child Health, Children’s Hospital Boston, and Harvard Medical School joined forces to study the effect of television time on children from infancy to age three.

Using a large sample, and a diverse population the researchers measured the amount of time spent watching television and measured their visual and motor skills at age three. The results are fascinating.

There is absolutely no deleterious impact to cognitive and language abilities.

Translation into Momma Speak: if your infant watches TV you aren’t hurting them. Go ahead, do what you already knew was okay. Stop feeling awful about it too.

I found many parts of this study interesting, but I’m on a time crunch to get this posted. I’ll give you a brief outline of what’s worrisome.

  • The American Academy of Pediatrics has been recommending no screen time for kids under two for the last ten years
  • 7 out of 10 mothers ignore that advice
  • Mothers are made to feel awful for using the television as a tool to get some much needed time
  • Assertions are made about the quality of our parenting with absolutely no relevant research, just a hunch


What’s most interesting to me is that the same researchers who tell us to unplug our children would insist that sitting down to dinner together is the key to knowing your children, family unity and fighting obesity.

Dude, have you ever tried to cook dinner with a punchy 3 year old in the room? I will publicly announce that were it not for the Tivo my family would’ve been weaned on Chinese take out and tears.

I hope that this study is not misinterpreted (though I fear it will be) and the onslaught on perfectly capable parents ceases.

I am exhausted by the anti-Mommy message.
I’m doing what I can to raise my kids, and if you are truly interested in the quality of parent child relationships, why don’t you send some of the cash my way and I’ll do a study of the effects of a vacation.

This one vindicates me, and every woman I know.

Here’s the text, if you’re interested.
Page 1 of 7
Television Viewing in Infancy and Child Cognition at 3
Years of Age in a US Cohort
Marie Evans Schmidt, PhD,

Television Viewing in Infancy and Child Cognition at
3 Years of Age in a US Cohort

Marie Evans Schmidt, PhDa, Michael Rich, MD, MPHa, Sheryl L. Rifas-Shiman, MPHb, Emily Oken, MD, MPHb, Elsie M. Taveras, MD, MPHb

aCenter on Media and Child Health, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts; bObesity Prevention Program, Department of
Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts

The authors have indicated they have no financial relationships relevant to this article to disclose.

What’s Known on This Subject What This Study Adds

TVviewingamongolderchildrenhasbeenfoundtohaveadverseeffectsoncognition. TVviewingininfancydoesnotseemtobeassociatedwithlanguageorvisualmotorskills
at age 3.


OBJECTIVE. To examine the extent to which infant television viewing is associated with
language and visual motor skills at 3 years of age.

MEASURES. We studied 872 children who were participants in Project Viva, a prospec-peds.2008-3221
tive cohort. The design used was a longitudinal survey, and the setting was a doi:10.1542/peds.2008-3221

multisite group practice in Massachusetts. At 6 months, 1 year, and 2 years, mothers Key Words
reported the number of hours their children watched television in a 24-hour period, television viewing, infancy, media,
from which we derived a weighted average of daily television viewing. We used cognition

multivariable regression analyses to predict the independent associations of televi-Abbreviations
sion viewing between birth and 2 years with Peabody Picture Vocabulary Test III and TV—television

CDI—MacArthur Bates Communicative
Wide-Range Assessment of Visual Motor Abilities scores at 3 years of age. Development Inventory
PPVT-III—Peabody Picture Vocabulary
RESULTS. Mean daily television viewing in infancy (birth to 2 years) was 1.2 (SD: Test III
0.9) hours, less than has been found in other studies of this age group. Mean WRAVMA—Wide-Range Assessment of
Peabody Picture Vocabulary Test III score at age 3 was 104.8 (SD: 14.2); mean Visual Motor Abilities

NLSY—National Longitudinal Survey of
standardized total Wide-Range Assessment of Visual Motor Abilities score at age Youth-Child
3 was 102.6 (SD: 11.2). After adjusting for maternal age, income, education, EPDS—Edinburgh Postpartum Depression
Peabody Picture Vocabulary Test III score, marital status, and parity, and child’s Scale

CL—confidence limit

age, gender, birth weight for gestational age, breastfeeding duration, race/eth-

Accepted for publication Dec 5, 2008

nicity, primary language, and average daily sleep duration, we found that each

Address correspondence to Elsie M. Taveras,

additional hour of television viewing in infancy was not associated with Peabody MD, MPH, Harvard Medical School and
Picture Vocabulary Test III or total standardized Wide-Range Assessment of Harvard Pilgrim Health Care, Department of
Visual Motor Abilities scores at age 3. Ambulatory Care and Prevention, Obesity

Prevention Program, 133 Brookline Ave, 6th
floor, Boston, MA 02215. E-mail: elsietaveras@

CONCLUSION. Television viewing in infancy does not seem to be associated with lan-harvardpilgrim.org
guage or visual motor skills at 3 years of age. Pediatrics 2009;123:e370–e375 PEDIATRICS (ISSN Numbers: Print, 0031-4005;
Online, 1098-4275). Copyright © 2009 by the
American Academy of Pediatrics

SINCE 1999, THE American Academy of Pediatrics has recommended no screen
media for children 2 years of age.1 Nevertheless, recent nationally representative data indicate that 68% of
children 2 years of age use screen media on a typical day, and one quarter of these children have a television (TV)
set in his or her bedroom.2 Additional data suggest most US-born infants 2 years of age watch between 1 and 2
hours of TV daily.3–6 Given the large number of infants who are regularly exposed to TV, and the large number of
parents who believe that it is good for their development, it is important to determine the effects of TV viewing on
the developing cognition of young children.
Several small, experimental studies from the 1970s and 1980s found negative associations of infant TV
viewing with subsequent cognitive and language development.7–9 An analysis of data from the National
Longitudinal Survey of Youth-Child (NLSY) (1986) has shown that each 1 hour increase in TV viewing before
the age of 3 years is associated with modest decreases in Peabody Individual Achievement Test reading
recognition (0.31 points) and reading comprehension scores (0.58) at age 6 years.10 Observational studies of
language development suggest varied effects of infant TV and video viewing, depending largely on the content
viewed. In 1 study, viewing specific programs between 6 and 30 months of age (eg, Dora the Explorer, Arthur)
was associated with improved language skills at 30 months, whereas viewing other programs (eg, Sesame Street,
Teletubbies) was associated with reduced language skills at 30 months.11 A recent cross-sectional survey found

e370 EVANS SCHMIDT et al

a 17-point drop in MacArthur Bates Communicative
Development Inventory (CDI) scores for each hour of
infant viewing of baby DVD/videos between the ages
of 8 and 16 months.12 Finally, a recent systematic
review found no controlled experimental trials of the
effects of broadcast TV programs on children 3 years
of age.13

There is also little to no evidence of any benefits of TV
viewing for children 2 years of age,14 yet many parents
believe TV helps their infants learn. In 1 recent survey,
29% of a large random sample (n . 1009) of parents
indicated the most important reason their children 2
years of age watch TV or DVD/videos is that they are
educational and “good for the child’s brain.”6 Almost
40% of parents of children 6 years of age, in a nationally representative survey, thought TV viewing “mostly
helps” children’s learning.4

The cognitive effects of TV viewing in infancy remain
uncertain. To our knowledge, there are no longitudinal
studies that have examined the association of TV viewing in infancy with language or visual motor skills at 3
years of age. The purpose of this study was to examine
the longitudinal association of TV viewing between birth
and 2 years of age (herein referred to as “infancy”) with
cognitive outcomes at 3 years of age. We hypothesized
that each additional hour of TV viewing before the age of
2 years would be associated with lower Peabody Picture
Vocabulary Test III (PPVT-III) and Wide-Range Assessment of Visual Motor Ability (WRAVMA) test scores at 3
years of age.


Population and Study Design

Study subjects were participants in Project Viva, a prospective cohort study of mothers and children. Details of recruitment and retention have previously been reported.15
Institutional review boards of participating institutions approved the study. All procedures were in accordance with
the ethical standards for human experimentation established by the Declaration of Helsinki.

After obtaining informed consent, we performed in-
person study visits with both mothers and children immediately after delivery and at 6 months and 3 years
after delivery. We obtained demographic and health history information via interviews and self-administered
questionnaires. Mothers also completed mailed questionnaires 1 and 2 years after delivery.

Of the 2128 women who gave birth to a singleton live
infant, 1579 were eligible for the 3-year follow-up, and
1294 completed some part of the 3-year visit in person.
We excluded 41 participants who were missing valid
3-year PPVT-III or WRAVMA data. Because our main
exposure was a weighted average of infant TV viewing
based on 3 time points (6 months, 1 year, 2 years), we
excluded 367 participants who did not have data for all
3 time points. We also excluded 14 infants born before
34 weeks’ gestation. In sum, data on TV viewing and
child age 3-year cognitive results were available from
872 mother-child pairs.

Main Exposure: TV Viewing

In the 6-month and 1-year questionnaires, mothers
were asked, “In the past week, how much time did your
infant (child) watch TV or videos? By ”watching,“ we
mean the amount of time that the child is in a place
where he/she can see a television that is on.” Response
options were in hours and minutes. In the 2-year questionnaire, mothers were asked, “In the past month, on
average, about how many hours a day does your child
spend sitting still watching TV/videos?” Response categories were: none, 1 hour a day, 1 to 3 hours a day, 4
to 6 hours a day, 7 to 9 hours a day, and 10 hours a
day. This measure of TV viewing, adapted from that used
in the NLSY data,16 is linked in a dose-response manner
with overweight among children17 and demonstrates
considerable tracking with TV viewing over the infant
and toddler years.18 Parental report, although overestimating children’s TV viewing in comparison to both
diaries and direct observation, seems to be well correlated with videotaped observation.19 Our study specifically examined TV viewing in infancy and its effects on
cognition at 3 years of age. We did not measure infants’
exposure to the Internet or computer games.

Main Outcomes: Child Cognitive Outcomes at Age 3

Trained research assistants administered the PPVT-III and
WRAVMA to children at home or in a research office at 6
months and 3 years of age. The PPVT-III measures receptive vocabulary and is correlated with IQ, as measured by
the Wechsler Intelligence Scale for Children (r . .90).20
The WRAVMA is a standardized assessment of visual-
motor abilities for children aged 3 to 17, and is moderately
correlated with IQ (r . .60).21 Three tests make up the
WRAVMA, comprising 3 different skill domains. They include a drawing test (visual motor), a matching test (visual
spatial), and a pegboard test (fine motor). Subtest scores
can be reported individually, or in combination, as a total
visual-motor integration composite.


On questionnaires and interviews, mothers reported
their age, education, household income, marital status,
parity, TV viewing, children’s race/ethnicity, and breast-
feeding duration. Mothers completed the Edinburgh
Postpartum Depression Scale (EPDS) when their child
was 6 months of age. We obtained children’s birth
weights and delivery dates from medical charts. At 6
months, 1 year, and 2 years after birth, we also asked
parents to report the number of hours their children
slept in a usual 24-hour period on an average weekday
and weekend day in the past month.

Statistical Analysis

Our main exposure was a weighted average of daily
infant TV viewing between birth and 2 years of age. To
calculate a weighted average of TV viewing from birth to
2 years, we created a sum that was weighted by the
interval of time between the data collection of all 3 data
points, and divided the sum by 2. In secondary analyses,
we also separately examined infant TV viewing from

PEDIATRICS Volume 123, Number 3, March 2009 e371

birth to 6 months, 6 months to 1 year, and 1 to 2 years,
with relation to PPVT-III and WRAVMA scores at 3 years
of age.

We first examined the bivariate associations of infant
TV viewing with other covariates and our main outcomes, which were PPVT-III and WRAVMA scores at age

3. We then used multiple linear regression models to
assess the independent effects of TV viewing on PPVT-III
and WRAVMA scores. In multivariable models, we included only those covariates that were of a priori interest
or confounded associations of TV viewing with cognitive
test scores. Model 1 was adjusted for child age and
gender. Model 2 included maternal age, education, marital status, parity, PPVT-III score, and household income.
In Model 3, we also adjusted for the child’s birth weight
for gestational age z score, breastfeeding duration, race/
ethnicity, and English language use. Because average
sleep duration could be a confounder of the relationship
between infant TV viewing and PPVT-III and WRAVMA
scores, in Model 4 we additionally adjusted for the
child’s average daily duration of sleep. We report regression estimates and 95% confidence limits (95% CLs) for
the main predictor, TV viewing during infancy.
To assess effect modification by maternal education,
we ran stratified models and tested multiplicative interaction terms in the final multivariable models. In the
stratified analyses, we dichotomized maternal education
into mothers who had graduated college versus mothers
who had not graduated college. We performed data
analyses with SAS 9.1 (SAS Institute, Inc, Cary, NC).


On average, children watched 0.9 (SD: 1.2) hours of TV
per day at 6 months of age, 1.2 (SD: 1.5) hours/day at 1
year of age, and 1.4 (SD: 1.1) hours/day at 2 years of age.
The weighted average of daily TV viewing from birth to
2 years was 1.2 (SD: 0.9) hours. At 3 years of age, mean
PPVT-III score was 104.8 (SD: 14.2), and mean standardized total WRAVMA score was 102.6 (SD: 11.2).

In bivariate analyses, children who lived in homes
with lower household incomes and lower maternal educational attainment were more likely to watch more
hours of TV per day (Table 1). In addition, black, Hispanic, and other nonwhite children were more likely
than white children to watch more hours of TV per day
(Table 1). Shorter duration of breastfeeding, less average
sleep per day, and higher BMI at age 3 were also associated with more TV viewing in infancy (Table 1).

In multivariable analyses adjusted for the child’s age and
gender alone, average daily hours of TV viewing in infancy
was associated with lower PPVT-III (1.18 [95% CLs:
2.22, 0.14]) and lower total standardized WRAVMA
(0.94 [95% CLs: 1.74, 0.13]) scores at age 3 (Table 2).
However, after additional adjustment for maternal age,
income, education, marital status, parity, and maternal
PPVT-III scores, the observed inverse relationship between
TV viewing in infancy and cognitive scores at age 3 became
null, suggesting that maternal characteristics had strong
confounding effects on the observed relationship (Table 2),
with maternal education and PPVT-III scores having the
strongest effects. In fully adjusted models, each 1-hour

increment in daily TV viewing from birth to 2 years was not
significantly associated with PPVT-III (0.58 [95% CLs:
0.45, 1.61]) or total standardized WRAVMA (0.24
[95% CLs: 1.15, 0.66]) scores at age 3.

We further examined whether the association between
TV viewing and PPVT-III and WRAVMA scores varied by
maternal education. In the multivariable models stratified
by maternal education, we observed some differences but
no significant interactions. For example, in final multivariable models, each additional hour of infant TV viewing
was associated with a 0.88 increase in the PPVT-III score
among children whose mothers who did not graduate college (95% CLs: 0.99, 2.75) and was associated with a

0.19 increase in the PPVT-III score among children whose
mothers who did graduate college (95% CLs: 1.09, 1.47)
(P for interaction term . .46).
In secondary analyses, we examined the separate relationships of TV viewing as measured at ages 6 months, 1
year, and 2 years with 3-year PPVT-III and WRAVMA
scores (Table 3). Separate multivariable analyses at 6
months, 1 year, and 2 years did not show any significant
associations with PPVT-III or total standardized WRAVMA
scores at age 3 (Table 3).


In this prospective study of children followed from birth
to 3 years of age, average daily TV viewing by infants
between birth and 2 years of age was associated with
lower language and visual motor skills at age 3 in unadjusted models. However, after adjustment for maternal,
child, and household characteristics, this association disappeared. Contrary to parents’ perceptions that TV viewing is beneficial to their children’s brain development,4,6
we found no evidence of cognitive benefit from watching TV during the first 2 years of life. In our analyses, the
effects of TV viewing during infancy on cognitive abilities at 3 years of age seem to be confounded by shared
sociodemographic and environmental determinants of
both TV viewing and lower cognitive development

To our knowledge, this is the first study to investigate
longitudinal associations between infant TV viewing
from birth to 2 years of age and both language and
visual-motor skill test scores at 3 years of age. Our findings are consistent with a recent cross-sectional study
that found no associations between infant (8–16
months) or toddler (17–24 months) TV/video viewing
and contemporaneous CDI scores.12 They also parallel
studies that have found no association between duration
of TV viewing by older children and adolescents (irrespective of content) and their academic achievement,
when relevant characteristics of study participants, such
as their IQ and socioeconomic status, were taken into

Our findings differ from those found by secondary
analysis of data from a longitudinal cohort of children in
the NLSY, in which investigators reported that TV and
video viewing before the age of 3 was associated with
lower Peabody Reading Achievement and Wechsler
Memory for Digit Span scores at age 6.6 Differences in
study design may account for our different results. First,

e372 EVANS SCHMIDT et al

Participant Characteristics According to TV Viewing Among 872 Mothers and Their Children in Project Viva

Prevalence or Mean (SD) of Characteristic According to Hours of Average Daily TV Viewed From
Birth to 2 Years

Overall 0to <0.5h 0.5to <1h 1to <2h >2h Pa
(N . 872) (n . 203) (n . 185) (n . 346) (n . 138)

Maternal characteristics
Age, y 32.7 (4.8) 33.6 (4.6) 32.4 (4.8) 32.7 (4.8) 31.7 (4.8) .003
Education, n

High school 43 (4.9) 8 (3.9) 8 (4.3) 16 (4.6) 11 (8.0) .0001
Some college 163 (18.7) 20 (9.9) 31 (16.8) 70 (20.3) 42 (30.4)
College graduate 331 (38.0) 57 (28.1) 74 (40.0) 145 (42.0) 55 (39.9)
Graduate degree 334 (38.4) 118 (58.1) 72 (38.9) 114 (33.0) 30 (21.7)

Household income, n

$40 000 76 (8.7) 11 (5.4) 17 (9.2) 30 (8.7) 18 (13.0) .01
$40 000–$69 999 168 (19.3) 29 (14.3) 29 (15.7) 72 (20.8) 38 (27.5)
$70 000 579 (66.4) 152 (74.9) 125 (67.6) 225 (65.0) 77 (55.8)
Don’t know/missing 49 (5.6) 11 (5.4) 14 (7.6) 19 (5.5) 5 (3.6)
Marital status, n
Married/cohabitating 828 (95.1) 197 (97.0) 175 (94.6) 330 (95.7) 126 (91.3) .10
Single/divorced/widowed 43 (4.9) 6 (3.0) 10 (5.4) 15 (4.4) 12 (8.7)

Parity, n
0 425 (48.7) 92 (45.3) 93 (50.3) 176 (50.9) 64 (46.4) .59
1 318 (36.5) 75 (37.0) 65 (35.1) 128 (37.0) 50 (36.2)

2 129 (14.8) 36 (17.7) 27 (14.6) 42 (12.1) 24 (17.4)
Depression at 6 mo, n .31
EPDS score 12 61 (7.5) 15 (7.7) 8 (4.6) 25 (7.7) 13 (10.3)
EPDS score 12 758 (92.6) 181 (92.4) 166 (95.4) 298 (92.3) 113 (89.7)

PPVT score 107.8 (14.5) 113.7 (14.4) 108.2 (12.9) 105.6 (15.0) 102.9 (12.7) .0001

Maternal postpartum TV viewing, hr/wk
6 mo 11.4 (8.6) 6.5 (5.1) 9.9 (6.1) 12.1 (7.7) 19.1 (11.6) .0001
1 y 10.5 (8.8) 5.6 (5.5) 8.9 (5.7) 11.2 (8.2) 18.0 (11.8) .0001
2 y 10.3 (8.2) 5.8 (4.8) 9.0 (7.2) 10.8 (7.1) 17.2 (10.8) .0001

Child characteristics

Gender, n
Boy 433 (49.7) 99 (48.8) 100 (54.1) 174 (50.3) 60 (43.5) .30
Girl 439 (50.3) 104 (51.2) 85 (46.0) 172 (49.7) 78 (56.5)

Race/ethnicity, n
Black 80 (9.2) 6 (3.0) 17 (9.2) 32 (9.3) 25 (18.1) .001
Hispanic 21 (2.4) 5 (2.5) 6 (3.2) 8 (2.3) 2 (1.5)
Other 121 (13.9) 24 (11.8) 21 (11.4) 58 (16.8) 18 (13.0)
White 650 (74.5) 168 (82.8) 141 (76.2) 248 (71.7) 93 (67.4)

Birth weight for gestational age z score 0.25 (0.94) 0.29 (0.92) 0.21 (0.92) 0.23 (1.00) 0.29 (0.81) .79
BMI z score at age 3 0.45 (1.01) 0.20 (1.04) 0.40 (0.89) 0.58 (0.97) 0.58 (1.14) .0001
Breastfeeding duration, mo 6.6 (4.5) 8.5 (4.1) 6.9 (4.4) 6.1 (4.6) 4.5 (4.3) .0001
Average sleep from 6 mo to 2 y, hr/d 12.3 (1.1) 12.5 (1.1) 12.4 (1.1) 12.3 (1.1) 12.1 (1.2) .002
Primary language, n

English 844 (96.8) 195 (96.1) 178 (96.2) 337 (97.4) 134 (97.1) .80

Other 28 (3.2) 8 (3.9) 7 (3.8) 9 (2.6) 4 (2.9)
Average child TV viewing from birth to 2 y, hr/d 1.2 (0.9) 0.3 (0.1) 0.7 (0.2) 1.4 (0.3) 2.8 (0.9) .0001
PPVT-III score 104.8 (14.2) 106.2 (14.1) 103.1 (14.1) 105.7 (14.0) 102.6 (14.4) .03
Total WRAVMAb 102.6 (11.2) 103.4 (11.5) 103.1 (11.1) 102.1 (10.8) 102.2 (11.9) .57

Drawing 99.4 (11.1) 100.1 (12.0) 99.2 (9.8) 99.1 (10.6) 99.5 (12.7) .73
Pegboard 98.9 (10.9) 99.1 (11.3) 99.9 (11.6) 98.6 (10.3) 98.3 (10.7) .52
Matching 108.2 (13.2) 108.7 (12.8) 108.6 (13.3) 108.0 (13.1) 107.5 (13.7) .80

a P values are from a . 2 test for categorical characteristics and analysis of variance for continuous characteristics.
b Total WRAVMA score is the sum of the drawing, matching, and pegboard subset scores, standardized to a mean and SD of 15.

our study measured outcomes at age 3, whereas the viewing before the age of 2 has a lesser impact on
previous study measured outcomes at age 6. Our study developing cognitive abilities than TV viewing as mea-
measured TV viewing up to age 2, whereas the previous sured between 2 and 3 years of age. The previous study
study measured TV viewing up to age 3. It is possible that measured outcomes of reading skills and memory that
the effects of TV on infants are not apparent until chil-may be affected by TV differently than vocabulary
dren are older than age 3 and more verbal, or that TV (PPVT-III) or visual motor skills (WRAVMA). Finally,

PEDIATRICS Volume 123, Number 3, March 2009 e373

TABLE 2 Adjusted Associations of Average TV Viewing From Birth to 2 Years of Age With Child
Cognitive Outcomes at 3 Years of Age

Models PPVT-III, Estimate Total WRAVMA,
(95% CLs) Estimate (95% CLs)
Model 1: age . gender 1.18 (. 2.22, . 0.14) 0.94 (. 1.74, . 0.13)
Model 2: model 1 . maternal age, education, marital status, 0.56 (. 0.46, 1. 58) 0.33 (. 1.18, 0.52)
parity, PPVT-III score, and household income
Model 3: model 2 . child birth weight for gestational age z 0.90 (. 0.09, 1.88) 0.22 (. 1.08, 0.65)
score, breastfeeding duration, race/ethnicity, and English
Model 4: model 3 . average daily sleep duration from 6 mo 0.58 (0.45, 1.61) 0.24 (1.15, 0.66)

the previous study recorded much higher levels of average TV viewing (2.2 hours/day for children 3 years of
age) than our study (1.2 hours/day for children 2 years
of age), so developing cognition may only be affected at
higher exposures to TV than were reported in our study

Our study had several strengths. First, we collected
prospective data on TV viewing from birth through 2
years of age. Second, our analysis included the ability to
control for a large variety of sociodemographic and en-


fects of infant TV viewing on PPVT-III scores.

Brainy Baby) between 8 and 16 months of age
vey of Income Dynamics found that viewing violent

vironmental predictors of cognitive outcomes. Finally,
obtained measures of both vocabulary and visual
motor skills through the PPVT-III and WRAVMA tests.
There have been very few studies of the effects of TV
viewing in infancy on subsequent cognitive or language
test performance. None to date have examined the ef-
A limitation of this study is that we did not measure
the content of the TV/video viewed by the infants. Al-
though only a few studies have been conducted, there is
emerging evidence that content is an important media-
tor of the effects of TV on infants. For example, 1 lon-
gitudinal study of children from 6 to 30 months age
found the effects of TV viewing on language skills at 30
months depended on the specific programs viewed.11 A
cross-sectional study that found no association between
tions with outcomes of interest.19
general infant TV/video viewing and language skills
found that viewing infant videos (eg, Baby Einstein,
associated with significantly lower CDI scores.6 Finally, a
recent analysis of longitudinal data from the Panel Sur-
CONCLUSIONScognitive test scores
are not manifested until later in development.
TABLE 3 Adjusted Associationsa of Infant TV Viewing at 6

Months, 1 Year, and 2 Years of Age and Cognitive

Outcomes at 3 Years of Age

Models PPVT-III, Total WRAVMA,
Estimate (95% CLs) Estimate (95% CLs)
6 mo 0.43 (0.32, 1.18) 0.01 (0.65, 0.66)
1 y 0.24 (0.37, 0.85) 0.02 (0.55, 0.52)
2 y 0.59 (0.28, 1.46) 0.29 (1.06, 0.48)

a Models include the following variables: maternal age, education, marital status, parity,
and PPVT-III score; household income; child birth weight for gestational age z score,
breastfeeding duration, race/ethnicity, English language, and average daily sleep

e374 EVANS SCHMIDT et al

TV/video content before the age of 3 doubled the likelihood of attention problems in childhood.23

This study may have been limited by maternal characteristics and infant TV viewing among our study population. Despite the racial and ethnic diversity in our
participant pool, the education and income levels of the
mothers were relatively high, and only 16% of children
in the sample watched TV in excess of 2 hours each day.
With older children, research indicates that moderate TV
viewing (1 to 10 hours per week) is positively associated
with academic achievement, whereas heavier viewing
(in excess of 10 hours per week) is negatively associated
with achievement.24 It is possible that the relatively low
levels of infant TV viewing in our participant pool did
not result in cognitive differences that might become
measurable at higher levels of TV viewing. Finally, our
TV viewing estimates were obtained through parental
report. Although this has been found to be a valid measure of TV viewing,19 past research has indicated parental
estimates, when compared with viewing diaries, yield
overestimates of child TV viewing and smaller correla-
Because previous research has shown effects of TV viewing before age 3 on
at age 7,10 it remains unclear
whether early TV viewing has effects on cognition that

In this prospective study, TV viewing between birth and
2 years of age was neither beneficial nor deleterious to
child cognitive and language abilities at 3 years of age.
Although unadjusted analyses showed lower cognitive
abilities among those who had more hours of TV exposure during infancy, these differences disappeared when
analyses were adjusted for maternal, child, and household characteristics.

The potential benefits of limiting exposure to TV in
early childhood are multiple and include less exposure
to violent media content,1 improved diet quality,25 lower
risk of overweight and obesity,26 lower risk of attention
problems,27 and improved sleep quality.28 Although
more research is needed, our findings suggest that the
quantity of infant TV viewing is not associated with
either poorer or better cognitive outcomes at age 3. At
our present state of knowledge, pediatricians and parents will need to evaluate other health and developmen

tal outcomes to determine the best strategies for TV
viewing among infants and children.


1. American Academy of Pediatrics. Media education. Pediatrics.
1999;104(2 pt 1):341–343
2. Rideout VJ, Vandewater EA, Wartella EA. Zero to Six: Electronic
Media in the Lives of Infants, Toddlers and Preschoolers. Menlo Park,
CA: Henry J. Kaiser Family Foundation, Children’s Digital
Media Centers; 2003
3. Vandewater EA, Rideout VJ, Wartella EA, Huang X, Lee JH,
Shim M. Digital childhood: electronic media and technology
use among infants, toddlers, and preschoolers. Pediatrics. 2007;
119(5). Available at: www.pediatrics.org/cgi/content/full/119/
4. Rideout V, Hamel E. The Media Family: Electronic Media in the
Lives of Infants, Toddlers, Preschoolers, and Their Parents. Menlo
Park, CA: Henry J. Kaiser Family Foundation; 2006
5. Pierroutsakos SL, Hanna MM, Self JA, Lewis EN, Brewer CJ.
Baby Einsteins everywhere: the amount and nature of television and video viewing of infants birth to 2 years. Presented at
the International Conference for Infant Studies; May 8, 2004;
Chicago, IL
6. Zimmerman FJ, Christakis DA, Meltzoff AN. Television and
DVD/video viewing in children under 2 years. Arch Pediatr
Adolesc Med. 2007;161(5):473–479
7. Carew JV. Experience and the development of intelligence in
young children at home and in day care. Monogr Soc Res Child
Dev. 1980;45(6–7):1–115
8. Nelson K. Structure and strategy in learning to talk. Monogr Soc
Res Child Dev. 1973;38(149)
9. Gottfried AW, ed. Home Environment and Early Cognitive
Development: Longitudinal Research. Orlando, FL: Academic
Press; 1984
10. Zimmerman FJ, Christakis DA. Children’s television viewing
and cognitive outcomes: a longitudinal analysis of national
data. Arch Pediatr Adolesc Med. 2005;159(7):619–625
11. Linebarger DL, Walker D. Infants’ and toddlers’ television
viewing and language outcomes. Am Behav Sci. 2005;48(5):
12. Zimmerman FJ, Christakis DA, Meltzoff AN. Associations between media viewing and language development in children
under age 2 years. J Pediatr. 2007;151(4):364–368
13. Thakkar RR, Garrison MM, Christakis DA. A systematic review
for the effects of television viewing by infants and preschoolers.
Pediatrics. 2006;118(5):2025–2031
14. Garrison MM, Christakis DA. A Teacher in the Living Room?
Educational Media for Babies, Toddlers, and Preschoolers. Menlo
Park, CA: Henry J. Kaiser Family Foundation; 2005

15. Gillman MW, Rich-Edwards JW, Rifas-Shiman SL, Lieberman
ES, Kleinman KP, Lipshultz SE. Maternal age and other predictors of newborn blood pressure. J Pediatr. 2004;144(2):
16. Baker PC, Keck CK, Mott FL, Quinlan SV. NLYS Child Handbook, Revised Edition: A Guide to the 1986–1990 National Longitudinal Survey of Youth Child Data. Columbus, OH: Center for
Human Resource Research Ohio State University; 1993
17. Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz GA,
Dietz WH. Television viewing as a cause of increasing obesity
among children in the United States, 1986–1990. Arch Pediatr
Adolesc Med. 1996;150(4):356–362
18. Certain LK, Kahn RS. Prevalence, correlates, and trajectory of
television viewing among infants and toddlers. Pediatrics. 2002;
19. Anderson DR, Field DE, Collins PA, Lorch EP, Nathan JG.
Estimates of young children’s time with television: a methodological comparison of parent reports with time-lapse video
home observation. Child Dev. 1985;56(5):1345–1357
20. Dunn LM, Dunn LM. Examiner’s Manual for the Peabody Picture
Vocabulary Test. Circle Pines, MN: American Guidance Service;
21. Adams W, Sheslow D. Wide Range Assessment of Visual Motor
Abilities. Lutz, FL: Psychological Assessment Resources, Inc;
22. Schmidt ME, Vandewater EA. Media and attention, cognition,
and school achievement. Future Child. 2008;18(1):63–85
23. Zimmerman FJ, Christakis DA. Associations between content
types of early media exposure and subsequent attentional
problems. Pediatrics. 2007;120(5):986–992
24. Williams PA, Haertel EH, Haertel GD, Walberg HJ. The impact
of leisure time television on school learning: a research synthesis. Am Educ Res J. 1982;19(1):19–50
25. Miller SA, Taveras EM, Rifas-Shiman SL, Gillman MW. Association between television viewing and poor diet quality in
young children. Int J Pediatr Obes. 2008;3(3):168–176
26. Robinson TN. Reducing children’s television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;
27. Christakis DA, Zimmerman FJ, DiGiuseppe DL, McCarthy CA.
Early television exposure and subsequent attentional problems
in children. Pediatrics. 2004;113(4):708–713
28. Thompson DA, Christakis DA. The association of TV viewing
and irregular sleep schedule among children less than 3 years
of age. Pediatrics. 2005;116(4):851–856
PEDIATRICS Volume 123, Number 3, March 2009 e375

Facebook Comments

Comments 31

  1. “…if you are truly interested in the quality of parent child relationships, why don’t you send some of the cash my way and I’ll do a study of the effects of a vacation.”

    That’s awesome.

  2. nothing like a pack of braniacs to substantiate the obvious.

    you will be happy to know that both of my kids (now 16 and almost 20) watched TV at that age so I could shower. They are both great students with excellent social skills

    hey, parenting is hard enough without having to feel guilty for enough time to yourself to get the basics done.

    great post jessica, comprehensive in an ever-charming gottlieb sort of way

  3. Amen! The mommy guilt over TV is so deflating. My kids are bright, articulate, smart and socially skilled, and they watch TV every day (GASP).
    Thanks for sharing this!

  4. BLESS you for posting this. The guilt needs to stop. Obviously, parental interaction trumps TV watching…..but sometimes the TV is the best way to settle the kids down enough so mom can get a break!!

  5. THANK YOU for posting this. I, of course, have spent the last 13 years ignoring the recommendations on television, which – as you point out – is a useful tool as long as it isn’t overused. :) It has taken me a long time, but I finally accept that I’m a good mother to my daughter.

  6. I think it’s one thing to have your child watch a bit of TV here and there, and another entirely to plop them down for hours on end. I’m certainly not anti-TV, but it’s good to keep everything in moderation which I think this study definitely pointed out.

  7. I worked on a major federally funded study right after I graduated from college, thinking that maybe social science research was a field I’d like to go into.

    I wound up thinking I’d have been better off going into Voodoo (and I probably would have done society more good as well…just think what I could accomplish if I knew how to to put hexes on, say, politicians or annoying celebrities).

    As the saying goes, there are lies, damned lies and then there are statistics.

  8. I am in the same boat as amyz5 but my kids are still young 17mo and 4 mo. I wouldn’t get a shower if I didn’t turn on a vid of Bear in the Big Blue House or Elmo. Now I shower at night when the kids are asleep, but I still “zombify” our eldest every now and then so I can cut up veggies and stuff for dinner. Otherwise we would live at the local cafe eating turkey melts everyday.
    This does not excuse parents that just leave their kids in front of the TV 24/7, I don’t know how someone could do that my toddler is way too entertaining to play with to just leave her their to be a zombie all day.
    And Jen, I have to agree with you as someone who majored in the sciences and loved statistics. To some extent you can “prove” anything depending on how you set up your study/research project. I think trusting our gut is a necessity as parents instead of bending to the every whim of a bunch of scientists and bureaucrats who do not love our kids anywhere near as much as we do.

  9. There seem to be studies that support TV for toddlers and turning it off. I agree that it is all about balance. I am a speech language pathologist with a blog, articles and reviews of educational toys and books based on their language value. Everyone agrees on the importance of play. Visit Play on Words Here
    Sherry Artemenko

  10. Post

    Sherry, with all due respect, sometimes it’s okay to just play without Trying to educate.

    Sometimes a wooden spoon with a metal pot is great and sometimes the TV helps me get stuff done.

    Just sayin’

  11. Post
  12. I am one of those “horrible” mothers that use the tv as a babysitter. But if you really want the tv to work as a babysitter, you can’t use it all the time. So it’s only on 2-3 hours per day. Like most moms, showers and meal preparation would never get done without the babysitter.

  13. If tv watching stunted kids intellectual growth, everyone under the age of fifty would be drooling idiots.

    I do think, however, the way tv shows are edited today with short scenes and the past pace of many shows has altered our attention spans a bit – children and adults.

  14. I saw something interesting on the news today after reading your post last night. I can’t remember if it was local Portland, OR, news, or CNN, but they reported on the same study.

    Your report mentioned how television has no negative effects on a child’s development, whereas the TV news segment I watched emphasized the opposite, more negative spin of TV having no positive effect on a child’s development.

    Could this be a classic case of TV news reporting the negative to gain more viewers? Wouldn’t be surprised, and thought you might want to know.

  15. Post
  16. Post
  17. Scott is right.

    You should read the study. It states that TV does indeed have negative associations with kids’ health and cognition, but that the associations disappear when you control for other factors. In fact, TV has neither negative *nor* positive impacts on its own. It’s just that kids in more supportive and well-off households watch less TV than those in more challenged households, and kids in more supportive and well-off homes are smarter and healthier.

    Additionally, the study doesn’t cover the content of the TV watched, whether the parent watched the TV with the kid, etc. The only thing the study claims is that “TV is not inherently evil,” and that’s an important counterpoint to zero-TV zealotry.

  18. Post

    @Seamus and @Scott I have posted the entire text of the study. It does not state that there’s a negative impact, it cites other studies that loosely correlate tv watching to obesity, but we could also look at the merits of that study.

    The reality is that zealots have (once again) gotten policy changed in an attempt to ridicule, blame and alienate perfectly good mothers.

  19. Pingback: Now That Harvard Has a Sullied Reputation

  20. I read something this year that said that it wasn’t tv that was bad, but what the child is doing while they are watching it. When the tv is on all day, children tend to go about doing other things and their attention to whatever task they are trying to do gets broken as the tv interrupts them. It didn’t matter if it was child-related or adult tv. So basically, using the tv all day as a babysitter created shorter attention spans, but using limited tv created a situation where the child pays attention to the program. That was better. So if your child starts doing something else, turn the tv off so they can concentrate on what they are doing.

  21. What the past studies, and perhaps this one (I admit to not reading the whole thing), fail to point out is that the *quality* and appropriatness of the program matter. It’s not like my 5 and 3 year old sons are parked in front of game shows or CSI. Noggin rocks. Ditto for PBS. They do actually learn something from the programs they watch. And by the way, they each get to pick one show a day to watch while I make a home cooked meal. We all sit at the table to eat every single night.

    One more thing, we limit media time to 1 hour a day. That means TV, Didj/Leapster/Wii (usually reserved for weekends though)/computer games on noggin.com or pbskids.org. We’re all about getting outside to play, not melting our brains. I do enough of that on Twitter.

  22. Pingback: Should Yesterday’s Media Adopt Trends of Today? at A PRotégé’s Approach

  23. Pingback: Dr. Dimitri Christakis: International Expert on Media and Child Health… and Marketing

  24. Pingback: >Could Baby TV Not Be As Bad As We Thought? | chefdruck.com

Leave a Reply

Your email address will not be published. Required fields are marked *