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,
ARTICLE

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.

ABSTRACT

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

www.pediatrics.org/cgi/doi/10.1542/
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: elsie
taveras@

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.

METHODS

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.

Covariates

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).

RESULTS

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).

DISCUSSION

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
scores.

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
account.22

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

TABLE1
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
language
Model 4: model 3 . average daily sleep duration from 6 mo 0.58 (0.45, 1.61) 0.24 (1.15, 0.66)
to2y

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
population.

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-

we

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,
was
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
duration.

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.

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