Using social media Web sites is among the most common activity of today's children and adolescents. Any Web site that allows social interaction is considered a social media site, including social networking sites such as Facebook, MySpace, and Twitter; gaming sites and virtual worlds such as Club Penguin, Second Life, and the Sims; video sites such as YouTube; and blogs. Such sites offer today's youth a portal for entertainment and communication and have grown exponentially in recent years. For this reason, it is important that parents become aware of the nature of social media sites, given that not all of them are healthy environments for children and adolescents. Pediatricians are in a unique position to help families understand these sites and to encourage healthy use and urge parents to monitor for potential problems with cyberbullying, “Facebook depression,” sexting, and exposure to inappropriate content.

Obesity has become a worldwide public health problem. Considerable research has shown that the media contribute to the development of child and adolescent obesity, although the exact mechanism remains unclear. Screen time may displace more active pursuits, advertising of junk food and fast food increases children's requests for those particular foods and products, snacking increases while watching TV or movies, and late-night screen time may interfere with getting adequate amounts of sleep, which is a known risk factor for obesity. Sufficient evidence exists to warrant a ban on junk-food or fast-food advertising in children's TV programming. Pediatricians need to ask 2 questions about media use at every well-child or well-adolescent visit: (1) How much screen time is being spent per day? and (2) Is there a TV set or Internet connection in the child's bedroom?

In 1999, the American Academy of Pediatrics (AAP) issued a policy statement addressing media use in children. The purpose of that statement was to educate parents about the effects that media—both the amount and the content—may have on children. In one part of that statement, the AAP recommended that “pediatricians should urge parents to avoid television viewing for children under the age of two years.” The wording of the policy specifically discouraged media use in this age group, although it is frequently misquoted by media outlets as no media exposure in this age group. The AAP believed that there were significantly more potential negative effects of media than positive ones for this age group and, thus, advised families to thoughtfully consider media use for infants. This policy statement reaffirms the 1999 statement with respect to media use in infants and children younger than 2 years and provides updated research findings to support it. This statement addresses (1) the lack of evidence supporting educational or developmental benefits for media use by children younger than 2 years, (2) the potential adverse health and developmental effects of media use by children younger than 2 years, and (3) adverse effects of parental media use (background media) on children younger than 2 years.

Exposure to violence in media, including television, movies, music, and video games, represents a significant risk to the health of children and adolescents. Extensive research evidence indicates that media violence can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed. Pediatricians should assess their patients' level of media exposure and intervene on mediarelated health risks. Pediatricians and other child health care providers can advocate for a safer media environment for children by encouraging media literacy, more thoughtful and proactive use of media by children and their parents, more responsible portrayal of violence by media producers, and more useful and effective media ratings. Office counseling has been shown to be effective. Pediatrics 2009;124: 1495-1503 INTRODUCTIONAlthough shootings in schools around the world periodically prompt politicians and the general public to focus their attention on the influence of media violence, the medical community has been concerned with this issue since the 1950s. 1-3 The evidence is now clear and convincing: media violence is 1 of the causal factors of real-life violence and aggression. Therefore, pediatricians and parents need to take action. 4 In 1972, the US Surgeon General issued a special report on the public health effects of media violence that was based on a growing and nearly unanimous body of evidence. 5 Ten years later, the National Institute of Mental Health issued a comprehensive review of the research on media violence and its effects, which outlined concerns about children's psychological health. 6 At a Congressional public health summit in July 2000, the American Academy of Pediatrics (AAP) was joined by the American Medical Association, the American Academy of Child and Adolescent Psychiatry, and the American Psychological Association in issuing an unprecedented joint statement on the impact of entertainment violence on children. 7 Also in 2000, the Federal Bureau of Investigation released a report on shootings in schools that stated that media violence is a risk factor. 8 In 2003, a panel of media-violence experts convened by the National Institute of Mental Health, at the request of the US Surgeon General, published its comprehensive report on the effects of media violence on youth, which revealed media violence to be a significant causal factor in aggression and violence. 9 Most recently, in 2007, the Federal Communications Commission (FCC) released its report on violent television programming and its effects on children and agreed with the Surgeon General that there is "strong evidence" that exposure to media violence can increase aggressive behavior in

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