095: Ask the American Academy of Pediatrics!

A couple of months ago, when I was interviewing listener Rose Hoberman for her Sharing Your Parenting Mojo episode, she casually mentioned after we got off air that her father in law – Dr. Benard Dreyer – is the immediate past president of the American Academy of Pediatrics, and would I like her to make a connection? I almost coughed up my water as I said yes, please, I very much would like her to make a connection if he would be interested in answering listener questions about the AAP’s policies and work.  Dr. Dreyer gamely agreed to chat, and in this wide-ranging conversation we cover the AAP’s stance on sleep practices, screen time, discipline, respect among physicians, and what happens when the organization reverses itself… Read Full Transcript Jen 00:01:37 Hello and welcome to the Your Parenting Mojo podcast. Regular listeners might recall that I launched a new segment of the show a couple months back called Sharing Your Parenting Mojo where I interviewed listeners about what they've learned from the show and what parenting issues they’re still struggling with. My second interview for this segment was with listener Rose Hoberman and at the end of our conversation she just kinda casually threw out, “so, you know, my father in law is actually a past president of the American Academy of Pediatrics. So let me know if you'd like to interview him.” And I was kind of shell shocked for a minute and I just said, yes, if you could set that up for me as soon as you can, I'd really appreciate it. So here with us today is Dr. Benard Dreyer who's Director of the Division of Developmental and Behavioral Pediatrics and also a Professor in the Department of Pediatrics at the Hassenfeld Children's Hospital, which is part of New York University Langone. Jen: 00:02:26 Dr. Dreyer works closely with children who have autism spectrum disorder, ADHD, language delays, genetic problems and behavioral difficulties in school. Dr. Dreyer received his M.D. from New York University and he held a variety of leadership positions within the AAP before serving as its president in 2016 and he continues to serve as its Medical Director for Policies. Dr. Dreyer has also hosted the SiriusXM Satellite Radio Show On Call For Kids, a two-hour show that has run two to three times a month since 2008, which is incredible coming from a podcast perspective. Welcome Dr. Dreyer. Dr. Dreyer: 00:03:02 Pleasure to be here. Jen: 00:03:03 So I solicited most of the questions from this interview from people who are subscribed to the show via my website and who get emails from me and they were able to email me back and send me their questions as well as those who are in the Your Parenting Mojo Facebook group. One thing that really stuck out to me as the questions started rolling in was the extent to which parents, at least in the US to some extent abroad, really like to know what the American Academy of Pediatrics says about a particular topic. And they might not always agree with the AAP’s position and they might even make a decision to ignore the AAP’s advice, but they always like to know what the AAP says before they do that. So the position that AAP takes really does carry a lot of weight. I wonder if you can walk us through what it's like to make one of these recommendations that are probably based on hundreds of studies with conflicting results and boil it down into something like no screen time for children under 18 months and no more than one hour a day for children ages two to five. How does that work? I guess starting at the beginning, how do you decide what studies to include? Dr. Dreyer: 00:04:06 Well, I think even before we decide what studies to include, there is the question of what topics should we have like policies or recommendations on. I think we choose topics based on what we think are the important issues for both pediatricians and practice where they're dealing with issues and so we hear from them and also what factors or issues are very important to parents. Then we look to see if there is enough evidence for us to actually make a recommendation, not every aspect of childcare, etc. is enough evidence for us to feel confident that we are making a recommendation that's based on it. So having said that, for each topic, we do a literature search through the medical and psychological and educational literature and we gather all the studies that exist there, the authors of each policy, review all those studies and throw out some of those studies because they're poorly designed, but include all the studies that are well designed from the research perspective so that we can be sure that their findings are useful. Dr. Dreyer: 00:05:31 As you said, sometimes these studies are conflicting and also sometimes we don't have complete information and we have to use whatever information we have to make a recommendation. I mean we don't choose studies to include, we review all the studies on a topic. So for example, screen time, we reviewed all the studies on screen time for young children and looked at the evidence as to, you know, on the one hand what we know about child development. So there might be studies, for example, that show that children under 18 months of age don't learn from a flat screen. So there are scientists that have studied, for example, language development with adults speaking to children through a flat screen versus speaking the same way to them live so that the child recognizes them as another human being at that young age and showing that they actually don't learn language well from a flat screen experience and certainly in the first year of life, whereas when they're interacting on a live basis with an adult, they actually learn. So that kind of study informs our policies from the point of view of how the child's brain works. We may then have other studies which look at whether children given video games, etc. learn or don't learn from those specific video games or for those specific iPad or other kinds of activities. So that's a different kind of study that's basically testing an intervention to help children learn. So therefore, I mean, we use studies based on physiology or biology or brain function versus studies that actually test an intervention usually in a randomized control way. Jen: 00:07:46 Okay. So I'm curious about whether children's development is the only or the primary concern or is there any weight given to kind of the family structure and parenting relationship? So what I'm thinking through as an example here is okay, we acknowledge the child is possibly not learning very much by looking at a screen for half an hour a day or an hour a day. But if the parent is getting some much needed alone time in that period of time and thus the parenting quality improves for the remainder of time that the pair interacting, is there any weight given to sort of that aspect of the relationship between the parents and the child or is the weight entirely on what is the child developmentally getting out of this particular screen time experience? Dr. Dreyer: 00:08:31 So that's a great question by the way. We do get input from parents on many policies. I can't tell you the exact input we got on the screen time. I was not one of the writers there, but we have a group of families called Family Voices, which often review our policies and give us feedback on them before we put them out to the rest of the world. So, we do get input from families. I can tell you that our recommendations are part of a conversation with families. In other words, this is our recommendation that children don't learn from screen time. That there is no good amount of screen time for them to have. Parents then take that and integrate that into the way they do their lives. I don't think we've ever told a parent that if you put your kid in front of a screen for 20 minutes, their brains will be fried, you know what I mean? Dr. Dreyer: 00:09:32 But we also know that on the average, US children under the age of two have one to two hours of screen a day. So therefore when we come down on our recommendations, our recommendations are also based on what we know many parents in the United States are doing, which is allowing their children to have two hours of screen time. So, therefore we think that's a bad thing for people to be doing because that's bad in two ways. One is children really learn from interactions with their parents or other adult caregivers at younger ages. So we want parents to talk to their kids, to play with them, to read books to them, etc. That's how children learn. And we want to encourage that which we do. We also know that too much screen time is associated with behavior problems in children where they become distracted. Dr. Dreyer: 00:10:35 They developed symptoms like ADHD. I don't mean that it causes ADHD, but they become somewhat scattered. There’s somewhat more aggressive behavior with those kids who have a lot of screen time. So, we want parents to understand that a lot of screen time is not a good thing. I often have parents asked me for example, well what happens if I just want to go into the kitchen and finished cooking something and my kid is watching TV for 20 minutes, is that terrible? The answer of course is no, but that 20 minutes often becomes an hour. So we want parents to really understand that actually under the age of about 18 months, there is nothing your kid is getting out of that and if you want to use it as a babysitter recognize that you’re using it as a babysitter, but alive babysitter would be better. Dr. Dreyer: 00:11:35 Who can talk to the kid. Jen: 00:11:36 For sure.