Pediatricians miss a big opportunity

Last month the American Academy of Pediatrics Council on Communications and Media issued a policy statement entitled “Media Use by Children Younger Than 2 Years.” The document reaffirms the AAP position of discouraging media use in children under age two, a position first articulated by the organization in 1999. The council based its recommendation on three factors, including the potential adverse health and developmental effects of media use.

Authors of the policy statement missed a big opportunity to mention to the public that visually induced seizures from electronic media are a possible health consequence worthy of concern. Instead, the AAP considered and listed the usual physiological and neurobehavioral outcomes that are typically measured in studies regarding media exposure:  behavior, attention, obesity, learning, mood, language development, and sleep. With the exception of obesity, all of these aspects of health and development can be indicators of seizure activity.

Why not even a mention of seizures, a well documented health risk?  Probably because visually induced seizures are considered so rare by the medical establishment that the vast majority of studies on media effects on children don’t even raise the issue. Interestingly, the policy statement didn’t mention the risk of media addiction, either. Too controversial perhaps—incredibly, there is still plenty of academic posturing about whether excessive time spent playing video games constitutes addiction.

In August 2004 the Epilepsy Foundation of America convened a task force on photosensitivity to review the considerable research on visually induced seizures and to make recommendations about prevention. In a paper published the following year in Epilepsia, the group concluded its findings by stating, “a seizure from visual stimulation represents a significant public health problem. No known method can eliminate all risk for a visually induced seizure in a highly susceptible person, but accumulation of knowledge about photosensitivity is now at a level sufficient to develop educational programs and procedures in the United States that substantially will reduce the risk for this type of seizure.”  

Who was supposed to take responsibility for this message and follow up? The nation’s pediatricians haven’t even received the message yet.

In its paper the task force laid out some of the methodological complexities and obstacles to ascertaining how common photosensitive seizures really are:  studies are generally done on selected populations that don’t represent an average cross-section, researchers have had varying definitions of what qualifies as an indicator of photosensitivity on an EEG, the inability of EEG to pick up all seizures, variation in specific stimuli that individuals respond to, the greater intensity of today’s computer graphics, and so on. As I’ve mentioned previously—and the Epilepsy Foundation photosensitivity task force states this—the conventional photosensitivity prevalence numbers are clearly an underestimation. Until researchers find ways to more accurately account for the number of those who are at risk, and recognize those whose symptoms are less easily noticed, doctors in the US aren’t going to take the problem seriously, and little progress will be made to protect the unsuspecting public against visual media-induced seizures.

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