Dr. Christakis, is a Professor of Pediatrics, Director of the Child Health Institute at the University of Washington, and an international expert on children and media. He talked extensiverly to our editor Evie Mpras about a subject that is in everybody’s mind: How technology affects the cognitive and emotional development of our children.

“I remember the vibrant ‘kafenio’ (café) culture and mealtimes when I visited Greece in the past. Families spent hours engaging with one another.  Now everyone is holding an iPhone,” says Pediatric Doctor Dimitris Christakis.
Those of us familiar with Greek culture can picture this scene: gesticulating hands, expressive faces, exclamations, laughter. It is a picture less and less common, not only in Greek culture, but in most of the technologically advanced world.
What example does this set for our children? How does this affect the cognitive and emotional development of new generations?

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Dr. Christakis, the Director of the Child Health Institute at the University of Washington, examines the effects of digital technology on the development of babies and children. His book, The Elephant in the Living Room, co-authored with Frederick J. Zimmerman, is considered a defining work on this increasingly relevant research.

” It’s not about the screen, it’s about the experience.”

It is a practical approach which may appeal to parents who are resistant to eliminate all screen time from their homes. Christakis’ message empowers parents with information to manage the use of tech devices pragmatically and mindfully.

“The idea that a screen is a screen is a screen is stupid.” It’s not about the screen, it’s about the experience.” Christakis observes that although he and I are conducting the interview through a computer screen, we are discussing and interacting. Each family has the ability to consider and determine how screen use can be used in a balanced and healthy manner.

One bedtime math app study showed that its use improved math assessment in 1st graders. However, Christakis notes the significance of the fact that this app game was interactive. It included a nightly story that parents read to their children, which allowed an opportunity for dialogue with the child. “This is a model for what makes a good app,” he says.

Christakis has recently modified the American Academy of Pediatrics’ regulations of media use. He approached the issue with more detail in order to enable parents to appropriately handle the pervasive presence of technological devices, and consider the many facets and effects of tech use.

Previously, the AAP simply addressed hour limitations dependent on the age of the child. Based on Christakis’ recommendations, the AAP now recommends that parents prioritize quality content and encourages families to watch media together. The regulations also emphasize a balance between media use and activities that promote social interaction and physical activity. They advise designating screen-free time each day and media-free locations in the home.

Despite these official recommendations, Christakis himself does not allow screen time during the week in his home. He opts for mindful TV viewing once a week, after which the family discusses what they’ve watched. Many child psychologists, such as Dr. Laura Markham, also believe screen time should be limited to a few hours a week.  “Young children’s brains were designed to develop optimally by engaging with the physical world, and with the imagination—being told stories, for instance—rather than to be fed passive viewing that bypasses the need for imagination,” Markham says.

The first responsibility for parents is to monitor content. Christakis explains that the common denominator among children of all ages is that they imitate what they see. This applies to toddlers as well as adolescents and teenagers. Violent content and over-sexualized content has been proven damaging to younger viewers. Yet the scope of negative influence exceeds these two categorizations. “Children emulate any and all good behaviors and bad behaviors in TV. Find characters in shows that you like, that emulate your values.”


Does the child’s TV viewing offer an opportunity to discuss these values? Or a current political or social topic? Watching a documentary together with your children and discussing it is different than passively watching a fast-paced and over-stimulating cartoon. Finding ways to connect with children through a media experience is ideal.

Managing only content, however, does not mitigate technology’s effect on children’s brains. Time and pacing also have a significant effect.

The addictive potential of screen use is undeniable, Christakis asserts. He compares the “high” a baby feels from a simple physical act to the use of an iPad: A baby feels pleasure from dropping a cup over and over. The baby will drop it, the parent will pick it up, and the baby will continue to drop it over and over. She feels this pleasure because she has been given feedback that she made something happen: “I did it!” This activates a dopamine reward pathway to the brain: “I like that, do more of it, that is good.” Parents can use this to reinforce behavior in children that we like. When we say thank you and smile, the child feels rewarded from the cause and effect.

However, a child experiences the same cause and effect dopamine rush during screen use. The immediate ability to manipulate images or sounds on the screen is quite addictive, and children have a hard time disengaging.

While Christakis acknowledges that parents engaging with their children in interactive apps is indeed a more positive use of the device, “Nothing is better than sitting down with your child and doing a puzzle,” he says.

Christakis referenced a study conducted at the University of Virginia in 2015 led by psychologist Angeline Lillard, which concluded that children watching fast paced shows had reduced executive functioning. Executive functioning refers to skills involving mental regulation, self-regulation, and emotional regulation. They used the popular show SpongeBob SquarePants to contrast a much slower paced children’s PBS show. On average, the SpongeBob show changed scenes every 11 seconds. The children watching that show as opposed to the slower paced PBS show displayed significantly less executive functioning.

During his TEDX talk in 2011, Christakis showed similarly fast paced show clips from a Baby Einstein video and the Powder Puff Girls movie. The frenetic images and music are disorienting, even for an adult.

“Being a distracted parent sends a very bad message,”

The doctor discussed the direct correlation between early TV watching and attention problems. His research findings proved that children who played with blocks from an early age, and who play along with a caregiver had significantly higher assessments of language ability than in children who spent less interactive and “hands-on” play experience. He stated that interactive play, real-time play, must take precedence over fast paced media consumption in early childhood.

Parents, therefore, need to strategize. Christakis advices parents to evaluate what will work best for their family. It is wise to consider choice of content, time of media use allowed per week, allotting daily screen free family time, and finding opportunities to interact with one another through the use of technological devices.

Christakis encourages parents to question what exactly their children are getting out of their time on digital media. He also urges them to be aware of how they are modelling the use of tech devices to their children.

“Every hour spent with a digital device comes at the expense of doing something else.”

“Being a distracted parent sends a very bad message,” he says. Children imitate not only what they see on the screen, but how their parents use technology in their presence.  Parents are as susceptible to screen addiction as their children. Are we parents staring at our smartphones while we push our children on swings, while they eat, when they want to show us their latest drawing? “Every hour spent with a digital device comes at the expense of doing something else,” Christakis says.

Dr. Christakis observed a mother with her 18 month old baby at the Child Health Institute. The 18 month old got a shot and began to cry. Within seconds, the mother shoved her phone in her child’s face in an effort to console her. “Imagine!” Christakis exclaims, “What is being displaced there? They don’t need the damn iPhone.”
He pauses and says, “It worked. But why not give the baby a hug?”

Watch Dr Christakis’ TedX talk:

You can read the UVA study referenced in article here.

Dr Christakis full bio:
Dr. Christakis, is a Professor of Pediatrics, Director of the Child Health Institute at the University of Washington, and a pediatrician at Children’s Hospital in Seattle. Dr. Christakis is the author of over 100 original research articles and a textbook of pediatrics. He is also the author of The Elephant in the Living Room: Make Television work for your kids. (September 2006; Rodale) Dr. Christakis is an international expert on children and media. His research focuses on the effects of media on child health and development and has been featured on Anderson Cooper 360, the Today Show, ABC, NBC, and CBS news as well as all major national newspapers.