Media History
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Please check one answer for each question. If the question does not apply to your family (ie, you do not own a computer or mobile device), leave that section blank.
Child's Name __________
Date __________
|
Television (including on mobile screens) |
| Does your child watch more than 1 to 2 hours of TV per day? |
□ Frequently |
□ Sometimes |
□ Never |
| Do you watch TV with your child or know what your child is watching? |
□ Frequently |
□ Sometimes |
□ Never |
| Do you discuss TV shows with your child? |
□ Frequently |
□ Sometimes |
□ Never |
| Does your child have a TV in his or her room? |
□ Yes |
□ No |
|
| Do you limit your child's watching of TV shows that often contain violence, sex, foul or explicit language, or images of tobacco or alcohol use? |
□ Frequently |
□ Sometimes |
□ Never |
| Do you have rules about when TV can be watched? |
□ Yes |
□ No |
|
| Do you allow your child to eat meals or snacks while watching TV? |
□ Yes |
□ No |
|
| Does your child ask you to buy products he or she sees advertised on TV? |
□ Frequently |
□ Sometimes |
□ Never |
|
Movies and Videos
|
| Do you allow your child to watch movies or videos that are R-rated? |
□ Frequently |
□ Sometimes |
□ Never |
| Do you read movie reviews to know the content of PG-13 movies? |
□ Frequently |
□ Sometimes |
□ Never |
| Does your child have nightmares or trouble sleeping after watching movies? |
□ Frequently |
□ Sometimes |
□ Never |
| How often does your child watch music videos on TV? |
□ Frequently |
□ Sometimes |
□ Never |
|
Music
|
| Are you familiar with the type of music your child listens to? |
□ Yes |
□ No |
|
| Have you talked to your child about lyrics that you object to? |
□ Yes |
□ No |
|
| Do you set limits on the types of music your child listens to? |
□ Yes |
□ No |
|
|
Video Games (including handheld) |
| Are you familiar with the types of games your child plays? |
□ Yes |
□ No |
|
| Do you check a game's rating before you rent or buy it? |
□ Yes |
□ No |
|
| Do you allow your child to own or download games with violent content? |
□ Frequently |
□ Sometimes |
□ Never |
| Do you limit the number of hours your child plays these games? |
□ Frequently |
□ Sometimes |
□ Never |
|
Internet (Web sites, including social networking sites accessible by computer and handheld devices) |
| Do you monitor Internet use? |
□ Frequently |
□ Sometimes |
□ Never |
| Does your child have a computer in his or her room? |
□ Yes |
□ No |
|
| Are you familiar with the types of Web sites your child visits? |
□ Yes |
□ No |
|
| Do you talk to your child about the best use of the Internet? |
□ Frequently |
□ Sometimes |
□ Never |
| Have you purchased blocking software that prevents your child from visiting inappropriate/pornographic Web sites? |
□ Yes |
□ No |
|
|
Books
|
| Do you read to your child or does your child read at least once a day? |
□ Yes |
□ No |
|
| Do you provide your child with a variety of reading materials? |
□ Yes |
□ No |
|
| Do you talk to your child about the books that you read together or that your child is reading on his or her own? |
□ Frequently |
□ Sometimes |
□ Never |
|
Do you have any specific concerns about:
|
| Your child's use of tobacco, alcohol, or illicit drugs? |
□ Yes |
□ No |
|
| Your child's own sense of body image or sexuality? |
□ Yes |
□ No |
|
| Displays of aggressive behavior or use of foul language? |
□ Yes |
□ No |
|
https://publications.aap.org/patiented/article-pdf/708374/peo_document069_sp.pdf
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Article information last modified on 8/6/2023 9:02:39 AM.