Prenatal Predictors of Media Use During Infancy

Abstract

Parental attitudes and behavior can impact infant media use, though all existing research examines this after the baby is born. However, many studies suggest that prenatal attitudes and behavior can influence parenting practices around many different types of parenting decisions. This study examines whether this extends to parenting practices surrounding media use during infancy. Participants consisted of 170 mothers who completed a number of questionnaires at two time points (prenatally and when infant was ∼16 months old). Results revealed that parents had many concerns about media before their child was born. More supportive prenatal attitudes regarding using media as a coping strategy was associated with higher levels of infant media use and technoference (i.e., when media interfere with the parent–child relationship). Additionally, prenatal media use by mothers was associated with higher levels of infant media use, but lower levels of technoference. Finally, prenatal depression was associated with higher technoference, while parental efficacy was associated with higher infant video chat. Implications of the study include discussion regarding media use at medical office prenatal visits and creating a family media plan before the birth of the child.

Introduction

The use of mobile devices with children under 2 years has tripled from 2013 to 2017 with children under 2 years spending an average of 42 minutes a day interacting with media.¹ The American Academy of Pediatrics (AAP)¹ policy can be a useful guide for parents with young children, stating to avoid media use under the age of 18 months, other than video chatting. The policy also advises that parents jointly use media with young children to facilitate learning. A number of parental attitudes and behaviors impact practices surrounding child media use. However, these studies are typically done after the child is born. Thus, the aim of this study is to examine prenatal maternal attitudes and behavior around media as predictors of parenting practices around media.

Prenatal attitudes and media

Research has consistently found an association between attitudes and behavior.^2,3 The theory of planned behavior⁴ and the theory of reasoned action⁵ provide a framework for the association between behavioral intentions and actual reported behavior. These theories suggest that attitudes are generally effective predictors of future behavior. A large literature suggests that prenatal attitudes can impact parenting behavior during infancy. For example, this framework has used prenatal attitudes to predict postnatal behaviors including feeding decisions,^6–10 co-sleeping,¹¹ and childcare.¹² Therefore, it is likely that prenatal attitudes also impact parenting behaviors around media.

A number of studies have found that current parental attitudes influence child media use,^13,14 but to our knowledge, only one study has examined parental attitudes about media during the prenatal period. Hutton et al.¹⁵ found that parents' prenatal attitudes regarding age of initiation for reading and television use was only a moderate predictor when the child was 2 months old. Though this study suggests that prenatal attitudes somewhat matter, it is limited in a number of key ways. First, the vast majority of children are not regularly using media at age 2 months, and the Hutton et al. study focuses on intention, not actual behavior. Second, this study does not examine mobile media use, which is rapidly increasing for infants and toddlers. Finally, this study only examines intentions regarding age of initiation. Though age of initiation is important, parents likely have many other attitudes regarding the content, value, and importance of media that might impact infant media use.

In this article, we explore whether maternal prenatal attitudes and behavior predict parenting practices around media use during infancy. Predictors include media coping attitudes, positive media attitudes, parental media use, depression, maternal efficacy, and media concerns. Research has suggested that, at times, parents use media as a form of coping, both for themselves and for their children. For example, parents may use media to occupy a child to accomplish a task or may use media as a means to calm a child down, both of which increase the amount of time children spend with media.^16,17

Additionally, parents who believe that media can be helpful to their children (e.g., educational value, prosocial messages),¹³ parents who spend more time with screen media themselves,^18,19 and parents who report depressive symptoms¹⁶ are more likely to report that their children use higher amounts of media. Conversely, parents who report having concerns about screen media^14,20 and mothers who report high levels of maternal efficacy,¹⁸ are more likely to have children who report lower levels of screen time. Parents may have deep-seated attitudes about all these issues before the child is even born, which may impact how they parent their child around media issues.

Infant media and parenting

We focus on a number of parenting behaviors around media as outcomes in this study including child media use, active parental media monitoring, parental technoference, and the use of video chat. Some research suggests that higher media time during infancy might be related to poor developmental outcomes.^21–24 The AAP recommends joint media engagement, particularly through active discussion of media²⁵ because infant learning increases when parents interact with children while viewing media.^26,27 In sum, media use can be problematic during infancy, but may also have educational value when viewed accompanied by a parent actively engage in helping the child learn.

Parental technoference, or the parental use of technology interfering with parent–child interaction and communication, occurs on a daily basis for most individuals.²⁸ Parental technoference is associated with a number of negative outcomes for children and adolescents, including increased internalizing and externalizing behavior,²⁸ lower levels of parental warmth, and higher levels of cyberbullying and anxiety.²⁹ One recent study found that technoference during infancy was associated with a host of negative outcomes including impaired emotional well-being, poor behavior, and language delays.³⁰

Finally, the AAP recently updated guidelines regarding infant media use so that video chat platforms are excluded from the recommendation to limit infant media use before 18 months. Research in this area suggests that 89 percent of families with infants use video chat to keep in touch with distant family members,³¹ and that children can recognize and build social connections through video chat.³²

Study aims

The aim of this study is to examine how prenatal maternal attitudes and behaviors around media influence parenting behaviors during infancy. Based on theory^4,5 we expect that more supportive attitudes concerning media coping and media positivity and higher maternal media use will be associated with higher infant media use, technoference, video chat, and less active mediation. Conversely, attitudes supportive of media concerns will be associated with more active mediation. Additionally, we expect that lower maternal depression and higher maternal efficacy will be associated with lower infant media use, technoference, and higher levels of video chat and active mediation.

Materials and Methods

Participants

The participants for this study were from Project M.E.D.I.A. (Media Effects on Development from Infancy to Adulthood), which is an ongoing, longitudinal study of media and child development. One hundred and seventy pregnant women (between 20 and 40 weeks pregnant) were recruited to participate in the study. Forty-six percent were pregnant with their first child, 29 percent had one existing child, 18 percent had two existing children, and the other 7 percent had 3+ existing children. These women completed questionnaires regarding current media use and their attitudes toward media use, mental health, and parental efficacy (prenatal wave). Additionally, they completed a number of questionnaires after their child was born, ∼2 years later (wave 1). There was an 87 percent retention rate across the waves.

Children averaged 16.60 months (SD = 2.62). At wave 1, mothers averaged 32.50 years (SD = 7.35). For ethnicity, ∼78 percent of mothers were White, 5 percent were Black, 10 percent Hispanic, ∼4 percent were Asian, and 2 percent were multiracial. In terms of parental education, 56.1 percent of mothers had a bachelor's degree or higher. For income categories, 8 percent made <$30,000 per year, 27 percent made between $30,000 and $60,000 a year, 40 percent made between $60,000 and $100,000, and 23 percent made over $100,000. Approximately 82 percent of the mothers were married, 7 percent were single, never married, 9 percent were living with an unmarried partner, and <2 percent were divorced, widowed, or separated.

Procedure

Participant families for Project M.E.D.I.A. were recruited from a large mountain west city through a data collection firm. Participants were recruited through flyers in doctors' offices, social services offices, and free clinics. Additionally, some participants were recruited through a targeted online search (social media and blogs), focusing on affinity groups related to pregnancy, infants, or toddlers.

Measures

Parent media use (prenatal)

Participants were asked to estimate the amount of time they spent using media each day on a 1 (not used) to 6 (more than 4 hours a day) scale.³³ Media included television, computer, books/magazines, video games, tablets, apps, music, social media, and texting. Items were asked for a typical weekday and weekend. Items were first summed for weekday and weekend. Then, weekday scores were multiplied by 5 and weekend scores were multiplied by 2 and then summed, with higher scores indicating higher amounts of weekly media use.

Media attitudes (prenatal)

Three different types of attitudes regarding the media were measured during the prenatal phase. Media concerns were measured using five items based on interviews of parents by Radesky et al.³⁴ Participants were told “We are interested in understanding which (if any) concerns you might have in the future over your future child.” Then participants rated how concerned they were about five different items using a 5-point Likert scale on a 1 (not at all) to 5 (a great deal) (Table 1). Reliability was α = 0.89.

Table 1.

Prenatal Media Concerns

Potential concern	Percentage who agreed “A fair amount” or “A great deal”
Inappropriate content (violence, sex, drugs, etc.)	67
Inattentive as a result of screen media	57
Addicted to screen media	59
Miss out on other opportunities as a result of screen time	55
Habit of media multitasking	46

Media coping consisted of two items modified from Radesky et al.³⁵ examining attitudes toward using media as a form of parental coping. Participants were asked to rate their agreement with each statement on a 5-point Likert scale on a 1 (strongly disagree) to 5 (strongly agree). Items included “Media are a good way to keep my child occupied while I get other things done” and “Media are a good way to help calm your child down when he/she is upset.” Reliability was α = 0.72.

Finally, Media positivity consisted of four items³⁴ examining positive reasons why parents might let their future child use media. This was measured on a 4-point Likert scale on a 1 (not at all) to 4 (a great deal) Likert scale. Examples include “The educational value of media.” Reliability was α = 0.70.

Depression (prenatal)

Depression was measured using the 10 item Center for Epidemiological Studies Short Depression Scale (CES-10³⁶). Participants answer statements regarding their own feelings and behaviors in the last week. Participants answer statements on a 4-point Likert scale from 1 (Rarely or none of the time [less than 1 day]) to 4 (All of the time [5–7 days]). Items are averaged, with higher scores indicating more depressed symptoms. Example includes “I felt depressed.” Reliability was α = 0.72.

Maternal efficacy (prenatal)

Prenatal maternal efficacy was measured using an adapted version of the Parenting Sense of Competence Scale.³⁷ The scale consistent of 16 items on a 7-point Likert scale from 1 (Not at all representative of me) to 7 (Strongly representative of me) that pertain to mothers' perceptions of their competence on basic skills required in caring for an infant. An example includes “I imagine myself in most circumstances, even when I am tired, able to cope well with meeting my baby's needs.” Reliability was α = 0.87.

Child media use (wave 1)

Parents were asked to estimate their child's daily electronic media use including TV or DVDs, smart phone, and tablets (Barr R, Kirkorian H, Radesky J, et al. Beyond screen time: a synergistic approach to a more comprehensive assessment of family media exposure during early childhood. Unpublished work 2019.). Each item was measured on a 6-point Likert scale from 1 (not used) to 6 (more than 4 hours a day). Items were asked for both a typical weekday and weekend and were subjected to the same process as described for parental media use.

Active mediation (wave 1)

This was measured using four items Valkenburg et al.'s parental mediation scale.³⁸ Parents were asked to rate how often they engaged in a variety of active mediation strategies with their child on a 4-point Likert scale from 1 (never) to 4 (often). Examples include “Try to help the child understand what s/he sees on TV?.” Reliability was α = 0.91.

Video chat (wave 1)

This was measured first by asking “Does your child ever use video chat (e.g., FaceTime, Skype, WhatsApp video call)?” If parents answered “yes,” then they were asked to identify the person the child most regularly video chatted with and then rated how frequently they chatted with that person using a 1 (less than once a month) to 7 (6 or more times per week) point Likert scale.³⁹

Technoference (wave 1)

Technoference was measured using four items.⁴⁰ The question stem read, “There are often times when parents have to use their smartphone or tablet when spending time with their child. How likely are you to use your phone or other device (e.g., to make calls, text, check email, watch a video, check social media)?” Parents were then asked to rate how often technoference occurred during different contexts (e.g., “during playtime” and “at the playground”) using a 5-point Likert scale of 1 (I never do this) to 5 (Very likely). Reliability was α = 0.67.

Results

Descriptive results

Approximately 75 percent of children used any electronic media, with the average being just under 1 hour a day. Parents were moderately concerned about media before their child was born (Table 1). Approximately 38 percent agree (or strongly agree) that media are a good way to keep their child occupied when they need to get others things done, while only 16 percent agree (or strongly agree) that media are a good way to help calm child down when upset. Table 2 shows bivariate correlations between all major variables. Additionally, a multivariate analysis of variance (MANOVA) revealed that parents with other children (multigravida) were higher on media coping (p < 0.01) and parental efficacy (p < 0.01) than primigravida parents and this will be used as a control variable in subsequent analyses.

Table 2.

Correlations Between Study Variables

	1	2	3	4	5	6	7	8	9
1. Maternal media use (pn)	—
2. Media concerns (pn)	−0.02	—
3. Media coping (pn)	0.25^***	0.00	—
4. Media positivity (pn)	0.22^**	0.08	0.20^**	—
5. Depression (pn)	0.03	−0.04	0.05	−0.03	—
6. Efficacy (pn)	−0.10	−0.10	−0.08	0.09	−0.35^***	—
7. Child media use (W1)	0.29^***	−0.07	0.30^***	0.15	−0.06	−0.05	—
8. Active mediation (W1)	0.01	−0.07	0.07	0.16	0.12	0.02	0.17	—
9. Technoference (W1)	−0.02	0.16	0.28^***	0.04	−0.04	−0.03	0.04	−0.04	—
10. Video chat (W1)	0.02	−0.10	0.07	0.11	0.02	0.21^*	0.15	−0.00	0.06

p < 0.05, ^**p < 0.01, ^***p < 0.001.

pn, prenatal, W1, wave 1.

Main analysis

A path analysis was constructed in Mplus (v. 8.1) to examine prenatal attitudes and behaviors (including parental media use, the three types of media attitudes, maternal depression, and parental efficacy) on infant media use, parental use of active mediation, infant video chat, and technoference. Children in the home, marital status, maternal employment and hours, and ethnicity were all used as covariates. As a reminder, outcomes were measured approximately 2 years after prenatal measurement. The model was fully saturated so fit statistics are not reported here (Figure 1).

FIG. 1.

Path analysis of prenatal maternal attitudes and behavior predicting infant media use and parenting behaviors around media.

The analysis revealed that prenatal maternal media use was associated with higher levels of infant media use (β = 0.15, p = 0.03), but lower levels of technoference (β = −0.29, p < 0.001). In terms of attitudes, media coping attitudes were also positively related to higher levels of infant media use (β = 0.23, p = 0.002) and higher technoference (β = 0.16, p = 0.02). No other prenatal attitudes related to media were associated with any outcome measured in this study. Higher levels of parental efficacy were associated with a greater frequency of infant video chat (β = 0.30, p = 0.005) and higher maternal depression was associated with higher levels of technoference (β = 0.29, p = 0.004). In terms of controls, maternal employment was associated with higher infant media (β = 0.27, p = 0.02) and not being married was associated with more technoference (β = 0.38, p < 0.001). No prenatal attitudes or behavior was associated with active mediation during infancy.

Discussion

Prenatal attitudes regarding media use impacted a number of parenting behaviors around media. However, this depended on the type of attitude and parenting behavior measured, with attitudes surrounding media as a coping mechanism and parental media use being the strongest predictors.

Though a minority of parents endorsed using media as a coping strategy for their infant, more supportive attitudes were associated with higher levels of infant media use and technoference. Media coping involved utilizing media to distract children when the parent needed to get something done and also to help calm a child down when upset. This confirms a large literature suggesting that prenatal attitudes around parenting influence maternal behavior after the child is born,^5,6,9,11,12 and extends this to media-related behaviors. If parents feel like media may be a good coping strategy in terms of child distraction and emotion-regulation, children tend to use more screen media during infancy. This may increase the overall amount of time young children spend engaging with screen media, which might be related to a host of outcomes during infancy.^21,22,24

Prenatal maternal media use also was associated with higher infant media use. This supports a growing body of literature suggesting that parental media use might impact child media use.⁴¹ Parents set the tone in terms of family media use, with some families being more media centric than others, where multiple family members all use media at higher levels. This study adds to that literature by suggesting that maternal media use before the child is even born also contributes to the family media ecology as a whole.

More supportive media coping attitudes was also related to higher levels of technoference by mothers. It may be that parents who feel like media might be a good strategy in terms of parenting may also be utilizing media as a way of coping themselves during parenting situations. The technoference field is a small, but growing field and on the whole suggests that technoference is related to negative outcomes during multiple contexts (couple relationships, family relationships, etc.).^28,40,42

This is the first study, to our knowledge, that shows prenatal attitudes might impact technoference during infancy. Additionally, maternal prenatal depression was also associated with higher levels of technoference. Many mothers may still be dealing with postpartum depression, and may be using their phone to cope with stressful parenting situations. One study indicates that maternal depression is associated with technoference during play and chore time with children.⁴³ Interestingly (and against hypotheses), prenatal maternal media use was negatively associated with technoference, suggesting that prenatal attitudes might be more important than parental media use in terms of predicting high technoference.

There were also a few surprising findings. Prenatal media concerns and media positivity did not influence any parenting behavior around media. In other words, being concerned about negative media effects (such as children becoming addicted to media) did not impact infant media use. This might be explained by the third person effect, where parents might be concerned about media effects in general, but think their child is somehow immune.⁴⁴ Additionally, there were no prenatal predictors of active mediation. According to the AAP,²⁵ joint media engagement with children is vitally important at this age. It is possible that parents are unaware of the AAP guidelines and have not thought much about the ways in which they will use media with their children. Additionally, we had very few prenatal predictors of video chat (apart from parental efficacy).

Though the study had a number of strengths, including the prenatal measurement and the longitudinal nature of the study, there are a number of limitations. Notably, the sample is not particularly diverse in terms of ethnicity, socioeconomic status, or marital status. We hope future research examines these questions in more diverse populations. Additionally, we did not examine postnatal attitudes on our variables of interest and instead focus on behavior. It is likely that prenatal attitudes impact postnatal attitudes, which then impact behavior. Finally, we focused on primary caregivers in the current study, though the majority of parents were married. Secondary caregivers' attitudes around media likely also impact parenting around infant media and we hope that future research examines the interplay between parents around decisions involving media for young children.

On the whole, these results suggest that some prenatal attitudes and behaviors might impact parenting behaviors around media use during infancy. Given that media use by infants is the highest it ever has been,¹ we encourage media education from a number of sources. For example, practitioners could discuss media use during obstetrician visits or prenatal parenting classes. Discussions of media could also be included in a host of other pregnancy-related sources, such as pregnancy magazines and books, pregnancy websites, and home health programs. Media are often discussed during well child checkups by pediatricians; however, media are rarely discussed before the child is born. We recommend that providers and media producers encourage mothers to think about a family media plan and how they want to manage media after the child is born.

Footnotes

Acknowledgments

We thank the School of Family Life, and the College of Family, Home, and Social Sciences at BYU, and recognize the generous support of the many private donors who provided assistance for this project. We also thank those families who were willing to spend valuable hours with our team in interviews and the many students who assisted in conducting the interviews. Finally, we thank Nona Evelyn Brown for inspiring this research.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

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