American children and adolescents are being exposed to increasing amounts of media violence, especially in television, movies, video games, and youth-oriented music. By age 18, the average young person will have viewed an estimated 200 000 acts of violence on television alone.1 Video game violence, children’s cartoons, and music lyrics have become increasingly graphic. In movies, action films depict anatomically precise murders, rapes, and assaults; with each sequel, the number of deaths increase dramatically.2 Although media violence is not the only cause of violence in American society, it is the single most easily remediable contributing factor.3
According to recent Nielsen data, the average American child views 21 to 23 hours of television per week.4 By the time today’s children reach age 70, they will have spent 7 to 10 years of their lives watching television.5 Although movies and video games are more graphic in depictions of violence, television is the single most important medium in the lives of young people (98% of all American households have at least one television set).4 Despite public concern about television violence, the amount of television violence has not changed appreciably in the past two decades: the level of prime-time violence has remained at three to five violent acts per hour, and violence in Saturday morning children’s programming ranges between 20 to 25 violent acts per hour.6-8 American media are the most violent in the world, and American society is now paying a high price in terms of real-life violence.9,10
Some people in the entertainment industry maintain that: 1) violent programming is harmless because no studies exist that prove a connection between violence in the media and aggressive behavior in children and 2) young people know that television, movies, and video games are simply fantasy.11 Unfortunately, they are wrong on both counts. Over 1000 studies–including a Surgeon General’s special report in 197212 and a National Institute of Mental Health report 10 years later13–attest to a causal connection between media violence and aggressive behavior in some children.3,6,9,14,15 Studies show that the more “real-life” the violence portrayed, the greater the likelihood that it will be “learned.”16,17 Likewise, the portrayal of violence as being justified (particularly by the “good guy”) is the single most prevalent notion in American media and the most powerfully reinforcing one.9,18 At young ages (before age 8), children cannot uniformly discriminate between “real life” and “fantasy/entertainment.” 14,16,19 They quickly learn that violence is an acceptable solution to resolving even complex problems, particularly if the aggressor is the hero.9
The only country in the world with nearly as much entertainment violence as the United States is Japan. Yet Japanese society is far less violent than American society. If media violence contributes to real-life violence, why isn’t Japanese society more affected? A 1981 study20 found that the nature of the portrayal of violence is different in Japan: the violence is more realistic and there is a greater emphasis on physical suffering (ie, the consequences of violence are emphasized). Interestingly, in Japan the “bad guys” commit most of the violence, with the “good guys” suffering the consequences–the exact opposite of American programming. In this context, violence is seen as wrong, a villainous activity with real and painful consequences, rather than as justifiable.10
Media violence may: 1) facilitate aggressive and antisocial behavior; 2) desensitize viewers to future violence; and 3) increase viewers’ perceptions that they are living in a mean and dangerous world.9,21,22 Although less is known about video games and their effects, the media violence literature provides grounds for concern.23 Media studies range from content analyses (monitoring the amount of violence contained in programming), to naturalistic studies (studying children as television is introduced into their culture), to longitudinal correlational studies (following a population of children for years and sometimes decades).14,24 As one leading researcher noted recently, the controversy is over.25 The vast majority of studies conclude that there is a cause-and-effect relationship between media violence and real-life violence. This link is undeniable and uncontestable. Even if the overwhelming scientific evidence did not exist, there would still be ample reason to oppose violent programming based on common sense, philosophical, humanistic, or aesthetic grounds.26
American media have also succeeded in glamorizing guns in a way that endangers the public health of youngsters and adults. At a time when guns rank as one of the leading causes of death among children and adolescents,27 gun-play and references to guns are still rife on prime-time television, in the movies, in video games, and in music lyrics. The United States is the most heavily armed nation on earth.28 Any programming that makes these instruments of killing more attractive, glamorous, or desirable is dangerous, unhealthy, and unethical.

The American Academy of Pediatrics therefore makes the following recommendations:
1. Pediatricians should urge the entertainment industry–television network and cable executives, television and movie writers, producers and directors, and video game manufacturers–to demonstrate sensitivity to the issue of media violence in a timely and substantial fashion. In the interests of creative freedom and free enterprise, voluntary attention to this issue is preferable. Voluntary remedies should include, but not be limited to, parental advisories, ratings systems, and careful (ie, late night) placement of programming and promotions with violent content.

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2. Pediatricians should applaud the cable/network industry’s recently published guidelines regarding violent programming (see Table) and urge adherence to them.

3. Pediatricians should contact their local stations regarding violent programming for children and the need to curtail it sharply, replacing it with educational nonviolent programming for children. There is no substitute for reducing both the amount and the graphic nature of current media violence on television, in movies, and in video games.

4. Pediatricians should strongly urge networks to avoid programming with the gratuitous depiction of weapons and to carry programming that depicts the consequences that violence can have on family and society.

5. Pediatricians should urge musicians and music producers to exercise voluntary restraint by creating nonviolent lyrics and music videos.

6. Pediatricians should urge all broadcast media to sponsor at least a 1-day moratorium on violence in their programming each October during national Child Health Month.

7. Pediatricians should ask parents to monitor their children’s consumption of all media closely and to limit total television viewing to no more than 1 to 2 hours per day. Consistent efforts should be made to help parents understand that by watching television with their children and discussing the content, they can address many potentially objectionable content areas.

8. Pediatricians are encouraged to become educated about the issue of media violence, to incorporate that information into their anticipatory guidance, and to become advocates for reducing violence in the media. encourage schools and parents to teach or continue teaching media literacy to children. This involves discussing how the media work, the intent of commercials and programming, and whether their messages are appropriate. Children who are “media literate” are more resistant to harmful media effects.3,14,29
10. Pediatricians should communicate with the Federal Communications Commission (FCC) to strictly enforce The Children’s Television Act of 1990, which mandates that every local television station has an obligation to produce some educational programming for children. Major efforts should be made to
9. Pediatricians should increase the quantity and quality of educational programming for children and teenagers, so that “good” programming will vastly overwhelm “bad” programming.

11. Further research is needed to determine how to mitigate the harmful effects of media violence.