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 |
Copyright © 2000 AAP Feed run on: 5/14/2024 Article information last modified on: 8/6/2023