You walk by an outdoor restaurant and see a toddler watching a movie on an iPad while his parents eat dinner. Your first thought is:

• a) those parents deserve a break
• b) screens don’t belong at meal time
• c) is the video educational?
• d) alert: bad parenting

Is there an app to help us decide how to respond? No. But a quorum of pediatricians might be able to help.
From 1999 till 2016, the American Academy of Pediatrics (AAP) discouraged the use of screen media by children under two (which might have led an informed passerby to loosely circle answer d while feeling slightly judgmental). But just last month, the AAP departed from its previous strict restriction on screen exposure for this age group.
There was a lot of media attention heralding the departure from the “no screens under two rule.” Some celebrated the beginning of the end of the “screen wars.” In reality, while the new guidelines offer a more nuanced view of screen exposure, the debate will likely rage on. Screens continue to pervade modern life so rapidly that research can’t keep up.
Let me fill in some background on why the AAP changed its recommendations. The “no screens before two” rule was first issued in 1999 as a response to interactive videos for infants such as Baby Einstein. Research showed these videos decreased children’s executive functioning and cognitive development. In October 2011, the AAP reaffirmed its original statement regarding infants and toddlers and media. The AAP’s statement cited three reasons: a lack of evidence on children learning from television or video before age two, studies showing a link between the amount of TV that toddlers watch and later attention problems, and studies pointing to how parents and playtime are affected by always-on TV. Since this statement was developed through  a lengthy internal review process, it was drafted before the iPad was first introduced to the market in April of 2010. So for the last five years, the strict restriction on screen time included touch screens even though the committee hadn’t evaluated the emerging research on this media.
In the intervening years, many doctors and scientists urged the AAP committee on children and media to revisit their recommendations and take a more balanced approach to media. In 2014, Dr. Michael Rich, the director of the Center on Media and Child Health at Boston Children’s Hospital, urged experts to base their recommendations on evidence-based decision making instead of values or opinions. He criticized pediatricians for focusing too much on negative effects and overlooking the positive effects of media on children. Later that year, Dr. Dimitri Christikas, director of the Center for Child Health, Behavior, and Development at University of Washington, suggested rethinking the guidelines to distinguish between TV and interactive screens. Dr. Christikas was one of the first researchers to determine that the time babies and toddlers spend in front of the TV was detrimental to their health and development. He posited that the time young children spend interacting with touch screens is more analogous to time playing with blocks than time passively watching a television. In 2015, a trio of pediatricians published an article offering further support for the idea that interactive media necessitated different guidelines than television. In the same article, they recognizing the need for further research and argued that doctors should emphasize the benefits of parents and children using interactive media together.
So what are a quorum of pediatricians saying in 2016?
The new AAP guidelines still set rather strict restrictions for children under eighteen months. The AAP recommends that infants and toddlers only be exposed to screens for the purpose of video chatting with family members. This squares with some emerging observational research but likely also displays pediatricians’ understanding of modern life. The new AAP guidelines say parents can introduce children between 18 and 24 months to education shows. For children between the ages of two and five, the AAP recommends a max of one hour per day of “high-quality programs,” which they define as PBS and Sesame Network.
But there remains a lot that pediatricians, neuroscientists, and developmental psychologists cannot say conclusively. How does a small child clamoring to watch videos of herself affect a child’s conception of self?  Does the sensory experience of interactive screens have negative effects on small children’s brains?
Scientists continue to approach the research regarding long-term effects of this exposure from different perspectives. In fact, earlier this month, at the annual meeting of the Society of Neuroscience, new research was presented which hinted at the possible detrimental effects of touch screens on young brains. Dr. Jan Marino Ramirez, from the Center for Integrative Brain Research at the Seattle Children’s Research Institute, presented new research which revealed that excessive exposure to sensory stimulation early in life had significant effects on the behavior and brain circuits of mice. The mice acted like they had attention deficit disorder (ADD), showed signs of learning problems, and engaged in risky behavior. Ramirez therefore recommends minimizing screen time for young children. In a recent interview, Dr. Leah Krubitzer, an evolutionary neurobiologist at University of California, Davis, was less concerned about the detrimental impacts of screen time. She believes the benefits may outweigh the negative effects. Krubitzer argues that fast-moving interactive touch screens may prepare children for our increasingly fast-paced world.
So, parents of young children can now feel less guilty encouraging their toddlers to video chat with family across the country. And possibly we have a more clear answer for the scenario above (e.g., If the child is at least two years old, the appropriate response is c, at least for now).