Mental Health > Media History

Mental Health

Media History

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

AAP Feed run on 10/25/2023 9:29:32 AM. Article information last modified on 8/6/2023 9:02:39 AM.

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