Emily Wade (Host): Does this advice sound familiar to you? Limit your screen time. Go offline. Touch grass. Yeah, let's face it, this is hard advice for adults, but it's even harder for kids. It seems like screens are embedded in an adolescence life between scree-- streaming, between, your downtime, and having your phone permanently, like, pointed toward YouTube or TikTok, and, lest we forget, the school issues those Chromebooks.

And, also on top of everything else, AI is lurking in the background, omnipresent AI. on this episode of Off-Office Hours, we're gonna do things a little differently. today, I'm joined by Dr. Ed Levy, one of our beloved pe-pediatric primary care providers, and we are gonna talk through the questions he gets every day from parents about screens and phones and AI, especially around now, around the beginning of the school year.

So welcome to the podcast, Ed

Edward Levy, MD: Oh, Emily, thanks for having me, and for giving me an opportunity to talk about one of my simultaneously m- most favorite things to talk about and least favorite things to deal with as a parent. So, so this is great

Emily Wade (Host): Well, I'm really excited to have this conversation because I am a blank slate. I know nothing. I am a indulgent aunt to four nieces and one nephew, and I, I'm endlessly, endlessly impressed that parents have to deal with not only managing their own screen time and all of these things for themselves, but also kids on top of everything else.

So very excited to have this conversation. Also, my husband's a high school teacher, and, this stuff is the bane of his existence too. So I-- You know, it's-- Hopefully I'll, I'll learn some really handy tidbits I can send back to him. to get started, you're, you're always getting these questions about screens.

When parents are talking, talking to you about screens, what are they most worried about? And also at the same time, what are the things you're most worried about?

Edward Levy, MD: a lot of the, thing I think beneath what parents are worried about is a loss of connection, to their kid, both if the kid is always, like, on the screen or a loss of connection if the screen is managed and the tension that induces. the loss of development of, other key parts of a kid's life, their, their schoolwork, their relationships, their physical ability, even, like, their sleep.

so it's kind of insidious the way it can creep into, everything healthy that you wanna see from a kid. But I think the, the deepest thing is the way it affects the relationship, between parents and kids

Emily Wade (Host): So how do you go about suggesting a way in for a parent who's kind of overwhelmed and concerned about where to start with something like this?

Edward Levy, MD: what I start with is, is that this is a very hard thing to manage. it's not simple that it, it hits on a problem of parents really feeling very alone, and not having, a lot of other people. They don't necessarily have an aunt like you, Emily, who's gonna play with their kids while they make dinner or, or do an important project for work.

oftentimes people are, are very mobile in the society. They're not around extended family. They're intense about work and don't have necessarily a lot of time to build relationships, so they have to do everything, and, that makes it, that makes it hard. and then, you know, all these tech companies have armies of engineers and lobbyists who are creating a, a, a perfect storm of, engineered happiness for kids to be on screens.

So, the first thing is that, it's really hard to manage this. It's, it's, it's, it's a hard problem. there's a lot of data both ways. You know, there's fear-mongering. There's kind of a lot of passivity. other parents, even family members may not support you, in what you're trying to do and, and undermine it.

So, I start by saying that if people are wrestling with this, they're, they're probably pretty normal, and that it's, it's, it's a tough thing to do

Emily Wade (Host): I definitely-- I relate to that. I relate to that on my own personal level. So I, I can't imagine having to, to manage it for someone else. so if you're, if you're kind of like considering, you're, you're trying to start limiting screen, screen time and screen use, are there-- Does it-- Does the kind of screen matter?

Are we-- Is it something where it's like, are we worried about phones? Are we worried about the internet? Are we worried about, God, the, the phrase internet sounds so antiquated now. It's like the, the World Wide Web. are we worried about kind of like input? Like, like things like social media?

where, are the spots that it's like, this is relatively le-- this is less of a big deal, this is more of a big deal. Does that make sense?

Edward Levy, MD: the American Academy of Pediatrics, the healthychildren.org has some nice guidance that I would direct people to. And I think I want to talk about like the five Cs, which I think is a really, good way to think about it. and I like where they come out with that rather than with, like, strict time guidelines, although, you know, we can talk about time guidelines, too.

So the first is, and probably know your own child. You know, you, you have the best sense because different kids can handle different levels of responsibility and independence. there are some kids who have some vulnerabilities that are very prone to using the screens to distract from emotional situations or skill barriers that they need help moving through.

So it, it depends on the child. the second C that I like to focus on is it's not so much what's in the screens as what it crowds out. we used to, after a long trial and error , in my own family, develop, like, a bucket system. And so the, the screens-- There are certain buckets you need to fill every day to be a healthy, whole person.

Your sleep, your nutrition, your movement, your social connection, your schoolwork, maybe something like creative or community building. And so the question is not so much something bad is coming from the screen. It's what is it crowding out? And I think everybody has had the experience, like, of adults of s- going to a restaurant and seeing people out on their phones together.

And everybody has a sense, "That's weird. That doesn't seem right." You know? And so it's not so much the content coming in, although sometimes the content is problematic. It's more what else isn't happening, what's being crowded out. the third C is, is calmness. You know, is a child calm on the screen, and are they calm coming off it?

Because if there's too much agitation from the involvement or coming off it is too hard, those need to be tagged as problems to work through. the content does matter. You know, you know, there's certain content, you know, like Daniel Tiger or Sesame Street for younger kids, you know, that there is healthy content.

so you can't make a blanket statement about the digital ecosystem. And the last one is connection, is, you know, where I started is, are parents and kids connecting or are, is the, the digital, entertainment or enterprise interfering with that, with that connection. So I think that's a really helpful place to start.

and it's all those things together. but the biggest question is, you know, what is it crowding out? What, what is it taking away from?

Emily Wade (Host): That's, I like that, five Cs. I guess one question I have, especially, you know, I think, you know, onl- you, you touch on your-- only you, you know your child best. Are there points where it's like, you know, the-- a kid gets, gets a little older, they get, you know, they have some developmental changes, and then all of a sudden the things they were okay with maybe out of the blue, they're, they're starting to act out or they're kind of pushing back or trying to kind of push back on those lim-- on, on you trying to impose those limits.

what, what is-- how much of that should a parent kind of be worried about, and how much of that is just sort of like normal developmental aging?

Edward Levy, MD: I think that's classic normal development because, you know, very often one of the experiences people have, they see like a growth chart and they see this smooth line, but that's not how development works. You know, all of a sudden new brain centers switch on or new realizations or new experiences can really change in a very short time, people's sense of where things are.

So that's, that kind of all of a sudden things are okay, that's a classic experience of parenting. It's something that was working before, you know, things are calm. All of a sudden it stops working and you have to reinvent yourself and your relationship, and that's why I think parenting is a, a super hard job.

it's meaningful to try and support that

Emily Wade (Host): Absolutely. So, you know, at the same time that, you know, we have a kid who's maybe kind of like developing those, those feelings of wanting to kind of resist having controls placed on them, especially around things like screens, it's around the same time that it's like, "Hey, kid, it would be handy if you had a phone or, you know, a tablet or, you know, the school's gonna give you a Chromebook."

so, you know, you have this, you have this-- these external forces that are also, you know, operating on the situation. Are-- What, what is-- What are the points where it's like it makes sense to consider giving your kid a, a smartphone or, you know, kind of expanding past, you know, a computer or an iPad? L- What-- When, when are those kind of points that a parent should be kind of considering that it's like, "This is, this is my moment for, for the phone of it all"?

Edward Levy, MD: there are some like phone readiness questions, but, I don't think like they're really that strong what's out there, and so people are kind of left to their devices. I see people doing all kinds of things, you know, and there isn't like the pathway. So I think it's important to be thoughtful.

some people are using, call-enabled smartwatches that are less intrusive. You know, they don't have big screens, but they allow communication. some people just use tags. You know, you can use a flip phone. some of the devices have these lockdown settings. for example, there's a very little-known setting on the Apple phone, the assistive access, that kind of can really limit, what people, can do.

I know people who, just use landlines for kids to talk to their friends, you know, at certain ages. there are, are, lockdown apps like the Life360 platform or Qustodio. so you can find, you know, paid services like that. it's worth giving it some thought about which device you're gonna get and how it's gonna be locked down and how you're gonna connect to your kid about it.

but I would say There are assertions kids make, about their privacy, about the right to equity with their friends, about the necessity and harmlessness of devices that don't-- that sound good but don't really bear merit. And so, I really like the concept of parental presence. And parental presence, which is talked about, Chaim Omer, a psychologist, is being-- making kids clear that you are, you are their parent forever, you're deeply invested in how well they do-- in how well their life goes, and you, to some extent, know better than they do, and you're gonna accept that they're unhappy because you think that's what's necessary for their development.

So, and it's not an equal power relationship. But I think this gets back to this is hard stuff to do. You know, if, if you're-- kinda have your, sword and shield up all day at work and, and commuting and getting stuff done, there's a desire to have softness in one's family relationships. But at certain points in development, you know, there's very much and.

You know, kids are wonderful and fulfilling, and sometimes it's hard, and sometimes, you get disconnected. so that's-- there isn't, like, one clear pathway, but I would encourage people to push back against a kid saying, "I have, you know, unmitigated right to privacy and control, and what I do i-is, like, harmless and not your concern, and everybody else is doing it."

so I want parents to feel empowered to say, "Wait a second." and I wanna go back to that word and because these-- the digital ecosystem is a source of information and entertainment and connection and participation, and it's also a source of misinformation and, loss of skills, both in, in self-regulation and in connecting to other people.

obviously, there's this irony that we're putting out information on this digital platform that's gonna be consumed on a digital platform, so we can't get too negative about digital platforms. So, so both, both things are true It's part of our life and it needs to be monitored, regulated, just the way, you know, you wouldn't let a kid have an un- unlimited number of cookies, you know, over the course of the day

Emily Wade (Host): You had mentioned de-skilling, which I, I think is a really, I, hear that coming up more and more, especially around AI, the bane of my high school teacher husband's existence. And we work at, work at MIT, so we, we talk about AI. We're, we're in the AI landscape, and we can't hate on it entirely.

but we do have-- We, we do have this situation where it is becoming easy and beguiling for kids to use it as a shortcut at school, but also as a place to develop relationships with, with, you know, s-sentient, non-sentient, you know, entities, for lack of a better term. how much of that-- How much of that is kind of bleeding into the concerns that you're, you're getting with the parents that you're talking to?

And how do you recommend-- It's, it's so new, and it's overwhelming. how, how do you recommend that they kind of encounter and engage with this?

Edward Levy, MD: there's a really nice, actually this, mon- actually September's, Journal of Pediatrics just talking about this AI and the development of teen identity. and, you know, important, point we ma- they make is that only relationships can transmit cultural values. and that, you know, that what oftentimes, AI will just reflect back what, what it's being presented.

You know, 'cause it wants engagement and approval. you know, the, the whole sycophancy problem, sycophancy problem. But it can be a useful tool. So, it's important to connect around it to say, "Look, here's what, what it can do for you and what it can't do for you." But the de-skilling is, is really a concern and the, replacement of virtual relationships with real relationships.

But again, we have to acknowledge that, making real relationships is hard. You know, people can give you negative feedback. They can, be exclusive. They can be derogatory. they cannot be a fit, and you can just find a nice echo and mirror with the AI. So, it's, it's, it's problematic. and parents, you know, need to find ways to connect around it

Emily Wade (Host): Well, and it's also especially hard because it's, you know, as you said, and I, I certainly know this about the, the parents that are in my life, you know, we're in a, we're in a place where increasingly a lot of the parents that we interact with are-- they're busy, they have, they have hard jobs. They're, you know, often not by family members that can help and stuff.

And so, you know, sometimes it's, I'm sure, even beguiling for a parent to, you know, write to a chatbot to say, "Hey, I'm having some trouble here. Do you have some recommendations?" And so, you know, I think it's probably a little hard to, as a parent, feel like you ha- you have to be the person who's like the sheriff of AI to your kids, but it's also an appealing thing that you may wanna turn to for yourself.

Edward Levy, MD: no, absolutely. it's, it's can be a useful tool, and it can be, what feels like a very safe way of, of managing, challenges. the, sheriff metaphor, you know, the question we might look for a different meta- like how you mentor your kids around AI use, you know, and how you...

Because if you look back to the early recommendations, co-viewing and co-experiencing AI. the AAP recommendations highlight that the tablet is a problem because it's such, an individual experience, and kind of only one person. So co-viewing, co-experiencing, processing together, is, is the ideal.

it's hard, but, you know, it helps to kind of experience things together. and but that's a big energy flip, right, for a parent, and we just have to name that. Because the reality is, when a, when the kid's on a screen, you don't, you know, it frees you up. But on the other hand, if you have to modif- if you have to monitor it, then it ties you down to doing it with them.

And so there has to be a mix of like co-viewing. But doing settings so you can look at chat histories, is, is important

Emily Wade (Host): Now, for a parent whose kid is, you know, getting, you know, about to, you know, say, graduate high school and, you know, going off to college or something like that, wh- where, where you're at the kind of like toward the end of the journey, where do you start to kind of-- where should a parent start to sort of feel like, "Okay, I need to start kind of like stepping back a little bit," and how do I, you know, and how to kind of disengage with that without feeling like you've completely, you know, lost touch?

where, where where could a-- how could a parent sort of like make that-- those first steps?

Edward Levy, MD: so let me see if I get your question right. How can a parent, if they're kind of mentoring and monitoring, how they can prepare the kid to thrive when they can't be in that position anymore?

Emily Wade (Host): Yes. Yes

Edward Levy, MD: so ultimately, you know, the, the hope is that you and ex- by 18 you've transmitted a lot of values.

You know, in by, by all these things you've done before, by, you know, getting them healthy food, by making sure the family goes outside, by all the parenting you've done, you know, prepares you that, that they have instilled your values. 'Cause there are p- no matter how much they fight you, there are pieces of you inside them.

You have transmitted who you are, and they, by evolutionary and biological means, are somewhat obliged to either say yay or nay to the values that they've gotten from you. And hopefully they'll say more yay than nay. But again, it's gonna depend somewhat on the kid and their own trajectory

Emily Wade (Host): So there is, and we're adding to it, an overwhelming amount of advice about kids and technology. It's, you know, it's one of, one of the many topics that has kind of created almost an infodemic, if you will. where are good places where parents can go? I mean, obviously pediatrician is a very good, good place to go, but are-- where are some good places that parents can go to kind of like get information, especially when they're feeling kind of like overwhelmed or like this is almost like an insurmountable task that needs to be resolved?

Edward Levy, MD: I, you know, I totally agree with you, and I'm really glad, Emily, that you bring up that issue with the info epidemic because, you know, looking at the literature, it's not a very clean or clear literature that you de-definitely have the answer. if people want to familiarize with themselves, two of the big names in terms of raising the alarm about social media are Jonathan Haidt, H-A-I-D-T, the, NYU psychologist, and, Jean Twenge, T-W-E-N-G-E, who have kind of focused on the harms.

Boston's own, like Peter Gray at BC, who used to collaborate with Jonathan Haidt, you know, takes more position. There is something to this, but the correlation you're saying is much stronger, is-- you're saying is much stronger than it actually is. We have to look at other things like play and academic expectation and other pieces of the culture that explains mental health.

So those are some of the names you can start to familiarize yourselves. there, is an additional resource from the American Academy of Pediatrics. You can download the Family Media Plan. And then there's another good nonprofit, Common Sense Media, that you can search that has a lot of guidance, about, a variety of different platforms and content and, you know, how to, how to think about things

Emily Wade (Host): Well, that sounds great, and we will make sure that those links are down below on, on, in this, in the, description here. so if we wanted our parents to kind of take away one thing from this conversation, especially the next time that, you know, they- they've tried to kind of gently moderate their kids', screen time or, you know, social media use, and they're, they've gotten pushback, and they're just feeling discouraged and overwhelmed.

And if they, if we, if we could give them one kind of piece of advice or, or word of optimism, what would that be?

Edward Levy, MD: you know, I was thinking, about that. parents matter tremendously. and you do matter, you're not simply a chauffeur and a cook and a provider of Wi-Fi. but to feel that you matter, takes some risk and some persistence and some time and energy. there's a lot of potential energy in being a parent and converting it to the kinetic energy of parenting, is, is, is the trick.

So what do you need to do to support yourself? You know, how do you manage stress in your other life, your exercise, your sleep, if you're a mom going through perimenopause, you know, or is that being addressed? who is on your team? in many ways, I'm really struck by how, you know, great people really their life is their work and their kids and don't necessarily feel supported, by, by family, friends, and other people in the community.

So, have a support network. You know, make that, make that something that you, invest in

Emily Wade (Host): I think that's a really great way to kind of wrap up this episode, and especially because I think especially if you are a part of the MIT community and the MIT health community, we have so many people who are ready and excited to be on your team. And so make sure that, you know, we have, we have care for every member of the family, and make sure that you are going to health.mit.edu and, checking out everything that we have to offer and, maybe, maybe even setting up, up an appointment for yourself or for your kid.

we-- You know, I believe, I believe, Ed, that you are accepting new patients, so

Edward Levy, MD: Yep, definitely. Definitely

Emily Wade (Host): Always, always great to, become a part of the MIT health family. All right. Well, thank you so much for being on the show. And,

Edward Levy, MD: Well, Molly, thank you. Thanks for your great questions and, and helping frame this and, for being a dedicated aunt to your four and nieces. They're lucky to

Emily Wade (Host): Oh, Yeah

Yeah

Edward Levy, MD: support. we'll talk another time

Emily Wade (Host): Yep. Thank you. Thank f- you for educating me. I feel like I, I have some tools now, so maybe I'm not gonna be just so, quite so indulgent anymore. well, this has been a great episode of Office Hours, and if you have a question for Office Hours, go to health.mit.edu/thrive and you can send in your question.

Until next time, see you later