Exposure and Use of Mobile MediaDevices by Young ChildrenHilda K. Kabali, MD, Matilde M. Irigoyen, MD, Rosemary Nunez-Davis, DO, MPH, Jennifer G. Budacki, DO, Sweta H. Mohanty, MD,Kristin P. Leister, MD, Robert L. Bonner, Jr, MD

abstractBACKGROUND AND OBJECTIVES: Research on children’s use of mobile media devices lags behind itsadoption. The objective of this study was to examine young children’s exposure to and use ofmobile media devices.

METHODS: Cross-sectional study of 350 children aged 6 months to 4 years seen October toNovember 2014 at a pediatric clinic in an urban, low-income, minority community. The surveywas adapted from Common Sense Media’s 2013 nationwide survey.

RESULTS:Most households had television (97%), tablets (83%), and smartphones (77%). At age4, half the children had their own television and three-fourths their own mobile device.Almost all children (96.6%) used mobile devices, and most started using before age 1.Parents gave children devices when doing house chores (70%), to keep them calm (65%), andat bedtime (29%). At age 2, most children used a device daily and spent comparable screentime on television and mobile devices. Most 3- and 4-year-olds used devices without help,and one-third engaged in media multitasking. Content delivery applications such as YouTubeand Netflix were popular. Child ownership of device, age at first use, and daily use werenot associated with ethnicity or parent education.

CONCLUSIONS: Young children in an urban, low-income, minority community had almost universalexposure to mobile devices, and most had their own device by age 4. The patterns of usesuggest early adoption, frequent and independent use, and media multitasking. Studies areurgently needed to update recommendations for families and providers on the use of mobilemedia by young children.

WHAT’S KNOWN ON THIS SUBJECT: Interactivemobile media devices have revolutionizedchildren’s access to and experience of media, butresearch is lagging behind its adoption. A criticalfirst step is to understand when and how youngchildren adopt mobile media devices.

WHAT THIS STUDY ADDS: Our study found almostuniversal exposure, early adoption, and use ofmobile media devices among young children inan urban, low-income, minority community.Studies are needed to update guidelines on theuse of mobile media by young children.

Einstein Medical Center Philadelphia, Philadelphia, Pennsylvania

Drs Kabali and Irigoyen conceptualized and designed the study, designed the data collectioninstruments, supervised data collection, carried out the analyses, and drafted the initialmanuscript; Drs Nunez-Davis, Budacki, and Bonner participated in the study design, designed thedata collection instruments, and critically reviewed the manuscript; Drs Mohanty and Leisterparticipated in the study design and critically reviewed the manuscript; and all authors approvedthe final manuscript as submitted.

www.pediatrics.org/cgi/doi/10.1542/peds.2015-2151

DOI: 10.1542/peds.2015-2151

Accepted for publication Sep 24, 2015

Address correspondence to Matilde M. Irigoyen, MD, Chair, Department of Pediatric and AdolescentMedicine, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA 19141. E-mail:irigoyem@einstein.edu

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2015 by the American Academy of Pediatrics

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Mobile devices are quickly becomingthe preferred media choice forchildren because of their screen size,mobility, ability to stream content,interactive capability, and decreasingcosts.1,2 Children use mobile devicesto play games, watch videos,communicate, take pictures, andaccess applications (apps). Accordingto Common Sense Media’s nationwidesurvey, 72% of children ages 0 to8 years used a mobile device in 2013,up from 38% in 2011.3 Even moredramatic was the increase in the useby children ,2 years old: 38% in2013, up from 10% in 2011.3 Despitean overall increase in access, the2013 Common Sense Media surveyfound a large disparity in accessto mobile devices and apps amonglow-income and minority children.3

The rapid adoption of mobile devicesby children is likely to have an impacton family dynamics and child health,development, and literacy. However,research on the use of mobile devicesby young children is lagging behind itsadoption.2,4 The American Academy ofPediatrics’ policy recommendation to“discourage the use of media bychildren under the age of two”1 wasdrafted before the introduction oftablets in 2010.4 A critical first step isto understand when and how youngchildren adopt mobile devices andwhether this usage varies bypopulation groups. The objective ofthis study was to examine exposureand use of mobile media devices byyoung children in an urban, low-income, minority population.

METHODS

Study Setting and Study Sample

We conducted a cross-sectional studywith a convenience sample of parentsof children 6 months to 4 years of agewho made a well or sick visit betweenOctober and November 2014 to apediatric practice at an academicmedical center in a low-incomeminority community in Philadelphia,Pennsylvania. We invited parents toparticipate in an anonymous, self-

administered paper survey whilewaiting to see the health careproviders. Parents who brought .1eligible child to the visit completed thesurvey only for the youngest child.

The study received exempt statusfrom the institutional review board.No financial incentives were providedfor participation. After surveycompletion, we invited parents toenter a raffle for an iPad. The contactinformation of the raffle participantswas not linked to their surveys.

Study Questionnaire

We developed a 20-itemquestionnaire (in English andSpanish) adapted from the Zeroto Eight Common Sense Media2013 nationwide survey.3 Thequestionnaire was determined tohave face validity by senior faculty(M.M.I., R.L.B.) but was not tested forreliability. Demographics includedchild’s age in years (,1, 1, 2, 3, or4 years), gender, ethnicity, and parenteducation. Parents were askedwhether they had previouslycompleted the survey.

To determine children’s access tomedia, we asked parents about mediaplatforms and Internet connectivity inthe household and whether their childhad his or her own media platform.Media platforms were categorized into4 types: television, mobile devices,computers, and video consoles. Mobiledevices were categorized into 3 types:smartphones, iPods, and tablets (eg,iPad, Kids Tablet, Kindle eBook reader,Samsung Galaxy Tablet, MicrosoftSurface Tablet). Computers includeddesktops and laptops. Video consolesincluded Xbox, PlayStation, andNintendo.

To determine children’s age at firstuse, we asked parents, “How old wasyour child when she/he first didvarious activities on a mobile mediadevice?” The activities listed weretouched or scrolled screen, calledsomeone, played video games,watched television shows, and usedapps.

To understand the circumstancesunder which parents let their childrenuse mobile devices, we asked parents,“How often do you let your child usethe mobile device when out runningerrands, doing chores around thehouse, keeping your child calm inpublic places, or putting your child tosleep?” Response options were “often,”“sometimes,” “hardly ever,” and “never.”

To measure children’s frequency ofuse of media, we asked parents, “Howoften does your child watchtelevision, play video games on aconsole, use a computer, watch video/television shows and/or use apps ona mobile device?” Response optionswere “several times a day,” “once aday,” “several times a week,” “once aweek,” “less than once a week,” and“never.” We combined responses into“daily” (several times a day, once aday, several times a week), or “lessthan daily” (once a week, less thanonce a week, never).

To measure children’s screen time, weasked parents, “How much time didyour child spend yesterday by him/herself watching television, playingvideo games on a console, watchingvideo/TV shows and/or using otherapps on a mobile device?” Responseoptions were “none,” “less than 30minutes,” “about 30 minutes,” “about1 hour,” and “more than one hour.”To compare findings with the 2013Common Sense Media survey, wecreated a continuous time variable byassigning a value in minutes to eachresponse: “none” = 0 minutes, “lessthan 30 minutes” = 15 minutes, “about30 minutes” = 30 minutes, “about1 hour” = 60 minutes, and “more than1 hour” = 90 minutes.

We asked parents how many appsthey had downloaded for their childand the name of their child’s mostcommonly used apps. For each app,we researched the description fromthe developer. Given the lack of acomprehensive, uniform ratingsystem of apps by either industry oran independent consortium, wecategorized apps based on the

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developer’s description aseducational (to promote cognitivedevelopment), entertainment (toentertain, any cognitive benefit wassecondary), and content delivery (toserve as a portal to mostly passivecontent, such as movies, cartoons,and video clips).

To assess children’s ability withmobile devices, we asked parents,“Does your child need any help tonavigate the mobile device?” and “Howoften does your child like to use morethan one type of media device at atime?” Responses were “always/mostof the time,” “sometimes,” and “never.”

Data Analysis

In the analysis, we excluded repeatsurveys. Statistical analysis was donewith SPSS version 21 (IBM SPSSStatistics, IBM Corporation), withadditional analysis and visualizationsin Tableau version 8 (TableauSoftware, Seattle, WA). We evaluatedthe survey data by using descriptiveand bivariate analysis. Surveyresponses varied in completeness,and we report the sample size andresponse rate for each question. Weused bivariate analysis (x2) toexamine the relationship of childgender, age (in years), ethnicity(African American, Hispanic, allothers), and parent education (lessthan high school, high school, somecollege, college graduate or higher)on the following outcomes: childmobile device ownership, child usedmobile device before age 1, andfrequency of mobile device use (manytimes a day vs daily or less). Todelineate the characteristics of thestudy population, we aggregated thezip codes of the raffle participantsand did a comparative demographicanalysis with the US Census BureauAmerican Community Survey data forthe 5-year data 2009 to 2013.5

RESULTS

We invited 423 parents of children6 months to 4 years of age toparticipate in the study: 17 refused,

and 40 did not return the survey.We excluded an additional 16surveys because parentsacknowledged previousparticipation, leaving a final sampleof 350. Most parents (n = 289,81.2%) entered the raffle.

Demographics of Study Population

The study population waspredominantly minority and lowincome (Table 1). Children’s age andgender were uniformly distributed,and the ethnicity was predominantlyAfrican American. A zip code–levelcomparison with the US CensusBureau American Community Survey2009 to 2013 showed that theeducational level reported by thestudy participants was nearlyidentical to the census datadistribution.5 The median householdincome in the study population zipcodes was $28 098 per year, with apoverty rate of 29.2% (at or below100% of the federal poverty level).

Children’s Media Exposure

Almost all households had televisions(97%), most had tablets (83%) andsmartphones (77%), and more thanhalf had video consoles (56%),computers (58%), and Internetaccess (59%). Child ownership of

media devices increased with age(Table 2). Starting at age 2,ownership of mobile devicessurpassed that of television. At age 4,one-half of the children had their owntelevision and nearly three-fourthstheir own mobile device. The mostpopular device was a tablet, ownedby two-thirds of 4-year-olds. Childownership of mobile devices was notassociated with child gender,ethnicity, or parent education.

Age at First Use of Mobile MediaDevices

Overall, 338 children (96.6%) hadused a mobile device, and 12 (3.4%)had never used. The age of first usedecreased with each successive agecohort (Table 3). Children’s use ofmobile devices under the age of 1 wasnot associated with child gender,ethnicity, or parent education.

Circumstances in Which Parents LetTheir Children Use Mobile MediaDevice

Most parents let their children playwith mobile devices (often orsometimes) to do chores (70%, 229/327), keep the child calm in publicplaces (65%, 213/327), or runerrands (58%, 190/327). One-quarter of parents (28%, 92/327)used a mobile device to put theirchild to sleep.

Frequency of Media Use

Most children watched television ona daily basis, regardless of age(Fig 1). Nearly half (43.5%) ofchildren ,1 year old used a mobiledevice on a daily basis to play games,watch a video, or use apps; thepercentage increased to 76.6% in2-year-olds and plateaued thereafter.The frequency of daily use of mobiledevices significantly increased withage (P , .001) but was not associatedwith child’s gender, ethnicity, or parenteducation.

Daily Screen Time

On average, children spent45 minutes a day watching television,

TABLE 1 Demographics of Study Population

Child Age (n = 348) n %

,1 y 51 14.71 y 85 24.42 y 68 19.53 y 72 20.74 y 72 20.7

Gender (n = 347)Female 180 51.9Male 167 48.1

Ethnicity (n = 348)African American 259 74.4Hispanic or Latino 48 13.8Other 23 6.6Asian 13 3.7White 5 1.4

Parent education (n = 326)Less than high school 41 12.6High school graduate 129 39.6Some college 93 28.5College graduate 43 13.2Graduate school 20 6.1

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27 minutes watching televisionshows or videos on a mobile device,22 minutes using apps on a mobiledevice, and 15 minutes playing gameson a video console. Television screentime remained constant across allage groups, but mobile device screentime increased with age (Fig 2).

Applications

Half of the parents (52%)downloaded apps on their mobiledevices, and of these, halfdownloaded 5 to 10 apps and halfdownloaded .10. Parents indicatedthat half or more of the apps had beendownloaded for their child’s use.Educational, entertainment, andcontent delivery apps were popularacross all age groups (Fig 3).YouTube, a content deliveryapplication, was popular amongchildren ,1 through 2 years of age.Use of Netflix, another contentdelivery application with a paidsubscription, was first reported for2-year-olds, with increasing usethrough age 4.

Child Ability With Mobile MediaDevice

One-quarter (28.2%) of 2-year-oldsdid not need any help navigating amobile media device, and 60.9%needed help sometimes (Table 4).Almost half (42.9%) of 4-year-olds

never needed help. Half of 4-year-oldsliked to use multiple media platforms(ie, television and a tablet) at thesame time (28.6% sometimes, 21.4%most of the time).

DISCUSSION

This study describes the patterns ofvery early and nearly universaladoption of mobile media devicesamong children 0 to 4 years of age inan urban, low-income, minoritycommunity. Most children had accessto mobile devices in their household,and by age 4, 3 out of 4 children hadtheir own mobile device. At age 2,most children were using mobiledevices on a daily basis and spendingcomparable screen time on televisionand the mobile device. Educationaland entertainment apps werepopular, in addition to contentdelivery sites such as YouTube andNetflix. Most 3- and 4-year-olds wereable to use mobile devices withouthelp, and 1 in 3 were mediamultitasking. Child ownership of amobile device, use before age 1, anddaily use of the device were notassociated with the child’s gender,ethnicity, or parental education.

Our study found that householdownership of tablets doubled since2013,3 reflecting the pervasive nature

of digital technology. Moreover, wefound that most children had theirown tablet by age 4, a remarkableuptake of technology considering thatin 2013, nationwide, ownership ofmobile devices among children aged0 to 8 years was in the single digits.6

By age 2, 3 out of 4 children wereusing mobile devices on a daily basis,quadruple the 17% rate reported in2013 by Common Sense Media.3 Wealso found that daily screen time fortelevision had decreased and mobilescreen time had quadrupledcompared with 2013.3 In a recentMiner & Company7 survey, childrenaged 2 to 12 years preferred to watchvideos on a mobile device rather thanon television. Increased ownershipand patterns of use strongly suggestthat mobile devices, more specificallytablets, are displacing television asmajor sources of media consumptionfor young children.7

Most children started using mobiledevices in their first year of life, anduse was enabled by parents who gavechildren a device to use and to keep.Three out of four parents gavechildren a mobile device when doingchores and to keep them calm; 1 out of4 to put children to sleep, twice therates reported in a 2013 NorthwesternUniversity national survey.6 TheNorthwestern and Miner studies alsofound that parents gave or took awaymobile devices to reward or punishtheir child’s behavior.6,7 This suggeststhat mobile devices are used as “digitalpacifiers” to placate or distractchildren or as means to managechildren’s behavior. Alternativeexplanations include parents’ desire toeducate their child or have their childcommunicate with someone or engagein play.7,8 In the Northwestern study,although parents used media as a toolfor managing daily life, most parents(70%) did not think the devices madeparenting easier.6

Child ownership of a mobile deviceimplies ready access and use ondemand. Child ability to navigate thedevice also implies independent use

TABLE 2 Children’s Ownership of Media Platforms by Age Cohort

Media Platform Overall(n = 348), %

,1 y(n = 51), %

1 y(n = 85), %

2 y(n = 68), %

3 y(n = 72), %

4 y(n = 72), %

Television 32.8 23.5 23.5 23.5 43.1 48.6Mobile media deviceTablet 36.2 9.8 20.0 27.9 54.2 63.9Smartphone 5.5 3.9 5.9 4.4 5.6 6.9iPod 2.6 0.0 0.0 1.5 6.9 4.2

Video game console 11.5 3.9 3.5 8.8 19.4 20.8Computer 5.7 3.9 0.0 5.9 5.6 13.9

TABLE 3 Age at First Use of Mobile Media Device by Age Cohort, N = 348

Age at First Use ,1 y (n = 51), % 1 y (n = 85), % 2 y (n = 68), % 3 y (n = 72), % 4 y (n = 72), %

,1 y 92.2 69.4 50.0 48.6 40.31 y 0.0 28.2 41.2 31.9 20.82 y 0.0 0.0 7.4 15.3 23.63 y 0.0 0.0 0.0 2.8 12.54 y 0.0 0.0 0.0 0.0 0.0Never used 7.8 2.4 1.5 1.4 2.8

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and exploration. Little is known abouthow children’s independent activity onmobile devices affects their cognitive,social, and emotional development.What is known is that parental “jointmedia engagement” is an importantway to enhance the impact ofeducational media.2,4,8,9 In a CooneyCenter nationwide 2013 survey,parent engagement accounted for athird of the time 2- to 4-year-oldsspent with mobile devices.8 Commonreasons for parent engagement wereto protect the child from inappropriatecontent and to spend time with thechild.8 In a recent qualitative study,

parents of young children expressedambivalence about the effects ofmobile media exposure on their childand their own ability to set limits.10

Parents are seeking anticipatoryguidance on the use of media for theirchildren, and additional research isneeded to develop recommendationsin this area.8,10

Our study also found that 1 in 3children used several media devices atthe same time. Media multitasking is awell-known behavior of youth, but ourstudy is the first, to our knowledge, todescribe it in children aged #4 years.

In youth and adults, mediamultitasking has been associatedwith task inefficiency, lapses inattentiveness, and safety hazards.11

Media educational experts have calledfor the development of methods thatmore accurately replicate real-lifemultitasking to assess its impact onattention span, distractibility, timemanagement, and social interaction.12

Media multitasking is pervasive, bothin school and at home, and additionalresearch is needed to evaluate itsimpact on child development andways to approach itconstructively.11,12

FIGURE 1Percentage of children engaging in daily media use by activity and age cohort.

FIGURE 2Daily media screen time in minutes by activity and age cohort.

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Compared with 2013 nationwidesurveys, our study foundsignificantly increased access tomobile devices in this low-incomecommunity,3,6 documenting a rapiddecline of the digital divide. Possiblecontributing factors are decreasingcosts, marketing strategies, andsubsidies by cellular serviceproviders. The increase in mobiledevice ownership may provideopportunities to enhance schoolreadiness and address educational

inequality for young children in low-income communities, such as thisone. However, experts have voicedconcerns about persistent ethnicand socioeconomic disparities inaccess to high-quality digitaltechnology.8,11 The Cooney surveyfound that most parents would likeexpert guidance on media contentquality, and low-income andminority parents were even morelikely to express this need.8

Independent reviews can help

identify high-quality streamingcontent and apps, a major challengeconsidering the .80 000“educational” apps for youngchildren and the hundreds ofthousands of titles available forstreaming content.13 An additionalchallenge is how to disseminate thisinformation to parents, educators,and health care providers.8,11

This study has several limitations. Westudied children’s use of media in anurban, low-income, minoritypopulation, and findings may not begeneralizable. The Common Sensesurvey instrument has been used bysubsequent studies6 and is presumedto have face validity, but data havenot been published on its validity andreliability. The parent survey wasself-administered and subject torecall and social desirability bias.Time and frequency estimates fromparents may not be reliable; however,the question on screen time focusedon “yesterday” in an effort to increase

FIGURE 3Children’s Favorite Applications by Category and Age Cohort, N = 343.

TABLE 4 Children’s Ability With Mobile Media Device by Age Cohort, N = 336

,1 y(n = 51), %

1 y(n = 81), %

2 y(n = 64), %

3 y(n = 70), %

4 y(n = 70), %

Does your child need any helpto navigate mobile device?Never 27.5 14.8 28.2 34.3 42.9Sometimes 21.5 49.4 60.9 55.7 50.0Always 51.0 35.8 10.9 10.0 7.1

How often does your childlike to use multiple mediadevices at the same time?Never 69.3 62.6 57.5 48.6 50.0Sometimes 28.8 21.7 25.8 30.0 28.6Always 1.9 15.7 16.7 21.4 21.4

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reliability. The strengths of this studyare its large sample size andhomogeneous population. Theclassification of apps was based onthe description from the appdeveloper and not by an independentreviewer.

CONCLUSIONS

Our study found early and almostuniversal exposure and earlyadoption of mobile media devicesamong young children in an urban,low-income, minority community.Our findings do not address theimpact mobile media devices have onchildren and their families; they

simply describe the pervasive natureof digital exposure and the patternsof use. These findings can be used asa catalyst for additional discoveryon the impact of mobile media inyoung children and their families.Access to, familiarity with, and skillusing mobile devices are a first stepin achieving digital literacy. However,socialization with parentalengagement and modeling arecritical for the development ofhealthy and productive ways tointegrate digital technology intofamily life.11,14 Future studies areneeded to guide the development ofrecommendations for both healthcare providers and families on the

use of mobile media by youngchildren.

ACKNOWLEDGMENTS

We thank Marie Katrina Tan, MD, andSonika Loona, MBBS, for their assistancewith data collection and data entry. Wethank Charles Davis for his invaluablefeedback on this research study. Lastly,we thank Sherry Pomerantz, PhD, forher assistance in statistical analysis andreview of the manuscript.

ABBREVIATION

app: application

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

FUNDING: No external funding.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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