Patterns of Mobile Device Use by Caregivers andChildren During Meals in Fast Food Restaurants

WHAT’S KNOWN ON THIS SUBJECT: Mobile devices are ubiquitousin children’s lives, but how caregivers and children use them ineveryday situations, and how use of devices affects caregiver–child interactions, has not been studied.

WHAT THIS STUDY ADDS: In naturalistic mealtime observations,we documented the behavior of many caregivers whose attentionwas highly absorbed in their mobile devices, with varying childreactions to this absorption. This study raises several hypothesesabout mobile device use and caregiver-child interaction.

abstractBACKGROUND AND OBJECTIVES: Mobile devices are a ubiquitous partof American life, yet how families use this technology has not beenstudied. We aimed to describe naturalistic patterns of mobile deviceuse by caregivers and children to generate hypotheses about itseffects on caregiver–child interaction.

METHODS: Using nonparticipant observational methods, we observed55 caregivers eating with 1 or more young children in fast food restau-rants in a single metropolitan area. Observers wrote detailed fieldnotes, continuously describing all aspects of mobile device use andchild and caregiver behavior during the meal. Field notes were thensubjected to qualitative analysis using grounded theory methods toidentify common themes of device use.

RESULTS: Forty caregivers used devices during their meal. The dom-inant theme salient to mobile device use and caregiver–child inter-action was the degree of absorption in devices caregivers exhibited.Absorption was conceptualized as the extent to which primary en-gagement was with the device, rather than the child, and was de-termined by frequency, duration, and modality of device use; childresponse to caregiver use, which ranged from entertaining them-selves to escalating bids for attention, and how caregivers managedthis behavior; and separate versus shared use of devices. Highlyabsorbed caregivers often responded harshly to child misbehavior.

CONCLUSIONS: We documented a range of patterns of mobile deviceuse, characterized by varying degrees of absorption. These themes maybe used as a foundation for coding schemes in quantitative studiesexploring device use and child outcomes. Pediatrics 2014;133:e843–e849

AUTHORS: Jenny S. Radesky, MD, Caroline J. Kistin, MDMsC, Barry Zuckerman, MD, Katie Nitzberg, BS, JamieGross, Margot Kaplan-Sanoff, EdD, Marilyn Augustyn, MD,and Michael Silverstein, MD MPH

Department of Pediatrics, Boston Medical Center/BostonUniversity Medical Center, Boston, Massachusetts

KEY WORDSmobile device, cell phone, parent–child interaction, childbehavior, family meals

Dr Radesky conceptualized and designed the study, supervisedthe study, collected data, analyzed and interpreted data, anddrafted the initial manuscript; Dr Kistin supervised the study,contributed to study design, analyzed and interpreted the data,and critically reviewed the manuscript; Drs Silverstein andAugustyn contributed to study design, analyzed and interpretedthe data, and critically reviewed the manuscript; Ms Nitzbergand Ms Gross contributed to study design, collected data,analyzed and interpreted the data, and critically reviewed themanuscript; Drs Kaplan-Sanoff and Zuckerman contributed tostudy design, trained research assistants, analyzed andinterpreted the data, and critically reviewed the manuscript;and all authors approved the final manuscript as submitted.

www.pediatrics.org/cgi/doi/10.1542/peds.2013-3703

doi:10.1542/peds.2013-3703

Accepted for publication Jan 17, 2014

Address correspondence to Jenny S. Radesky, MD, BostonMedical Center, Vose Hall 4th Floor, 88 E. Newton Street, Boston,MA 02118. E-mail: jenny.radesky@bmc.org

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2014 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: The authors have indicated they haveno financial relationships relevant to this article to disclose.

FUNDING: All phases of this study were funded by The Joel andBarbara Alpert Endowment for the Children of the City andBoston University School of Medicine.

POTENTIAL CONFLICT OF INTEREST: The authors have indicatedthey have no potential conflicts of interest to disclose.

PEDIATRICS Volume 133, Number 4, April 2014 e843

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Mobile devices such as smartphonesand tablets are ubiquitous in children’slives.1–3 Parental use of mobile devicesin playgrounds, restaurants, or otherpublic venues with children has re-ceived criticism in the lay press,4,5 withconcern that parental distraction bythese devices may affect child safety oremotional well-being. Studies havedemonstrated unsafe driving6 and pe-destrian behavior7 while people aredistracted by mobile devices, but theways in which devices are being usedaround children, and the parentingbehaviors associated with such use,have not been investigated.

Depending on how they are used, mo-bile devices could have both positiveand negative impacts on family inter-actions.3 Devices can be used for familyentertainment, social support, or ac-cess to educational materials for chil-dren. However, mobile devices canalso distract parents from face-to-faceinteractions with their children, whichare crucial for cognitive, language, andemotional development.8–10 In addition,devices provide instant access to vid-eos and games, increasing the likeli-hood that screen time will replaceother enriching child activities or beused as a “pacifier” to control childbehavior. The complexity of mobile de-vice use and its potential positive andnegative effects on parent–child in-teraction remain unexplored.

Measurement of device use is morecomplicated than that of traditionalmedia such as television because of themultitude of ways devices can be usedand because of their constant acces-sibility. Most previous epidemiologicstudies of mobile device use have usedmethods such as retrospective self-report or review of cell phone recordsto assess frequency of use.11–15 How-ever, simply measuring the frequencyof device use fails to capture modes ofuse that are most relevant to parent–child interactions and thus may be

insufficient to describe the true impactof this technology on child health anddevelopment. A relevant categorizationframework is necessary to begin tostudy how mobile device use affectscaregiver–child interaction.

We sought to observe caregiver andchild use of mobile devices during adaily encounter when families wouldtypically talk and interact: while theyare eating together in a fast food res-taurant. We chose a method of natural-istic, anonymous observation, becausethis would allow description of real-lifeuse of devices around children, a cru-cial step in elucidating this complicatedbehavior.16 Through qualitative analy-sis and identification of themes fromdetailed observations of public behav-ior, we aimed to describe patterns ofhow caregivers and children use mo-bile devices around each other, withthe ultimate purpose of developinga categorization scheme of mobile de-vice use for future quantitative study.

METHODS

Study Design: Naturalistic,Anonymous Observation

We conducted 55 public, anonymousnonparticipant observations of care-givers and children eating in fast foodrestaurants in the Boston area duringJuly and August 2013. This method ofdirect, nonparticipant observation iscommon in the field of anthropology,and it involves the researcher blendinginwith theobservational settingsoas tonot affect the publicly observable be-havior of others while taking detailednotes about observed behaviors, theirsequence, and consequences. The pur-pose of this approach is to identifycultural patterns and generate hy-potheses for additional investigation.17

Field note data are particularly usefulwhen investigators hope to approachnovel cultural phenomena without ap-plying preconceived hypotheses, to

help develop classification systems,and to avoid social desirability bias.

This studywas considered exempt fromreviewby the Boston UniversityMedicalCenter Institutional Review Board.

Observation Sites and Participants

We chose to observe caregivers andchildren during meals because this isa daily routine in which face-to-facecaregiver–child interactions are con-sidered beneficial.18 It has been esti-mated that 40% of American meals areeaten outside the home,19 so fast foodoutings probably represent a sub-stantial proportion of family meals. Inplaygrounds or other public venueswhere adults use devices, children areoften occupied with their own pursuits,so fewer face-to-face interactions withcaregivers are expected to occur.

We performed observations in differentfast food restaurants in 15 neighbor-hoods in the metropolitan Boston area.These neighborhoodswere selected fortheir range of income, geographic lo-cation, and urbanicity. This samplingwasnot intendedtoberepresentativeofthe general population; rather, it pro-vided an opportunity to observe thebehavior of a diverse group of care-givers and children.

We observed any group in which anadult accompanied 1 or more childrenwhoappeared to be 0 to 10 years old (ie,infancy to elementary school age). Childage was estimated based on height,general appearance, and developmentalstatus. There was no upper limit of chil-dren or caregivers present and noexclusions based on language spoken.We did not study caregivers eating withanadolescent,becauseadolescentsarelikely to have different patterns ofmobile device use themselves.

Observational Methods

Researchers (J.S.R., K.N., J.G.) individuallyvisited restaurants between lunch

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and dinnertime, purchased food, andsat as close as possible to the easiestcaregiver–child group to observe. Ifno children were in the restaurant,researchers waited for a group to sitdown at a nearby table. Observationscontributed to the data set if therecorded portion of the meal lastedat least 10 minutes, all individualswere visible (visible from behindor profile was acceptable), and theobserver was close enough to recordfacial expressions and tones of voice ofmost members. The content of con-versation was not considered a pre-requisite because most device use andmealtime behaviors are nonverbal;however, spoken language was recor-ded when audible. In order to capturea variety of styles of device use, weinitiated record-taking regardless ofwhether a device was visible at thestart of the meal. Researchers tookpaper notes or typed on laptops withsecurity screens to preserve anonym-ity. Researchers received training onhow to respond if questioned abouttheir observations; however, at no timewere the researchers questioned byothers in the restaurant.

Researchers performing these obser-vations had background training in ei-ther child development (J.S.R., K.N.) oranthropology (J.G.). Additional trainingapplicable to our field observationsincluded reviewofmaterials on specificanthropological methods,17 practicesessions in restaurants, and guidancefrom a medical anthropologist on fieldnote taking.

Consistent with nonparticipant obser-vational methods,17 researchers re-corded detailed notes about what theywitnessed, the sequence of events,child and caregiver characteristics(eg, number, gender, estimatedage range),specific child and caregiver behaviors, andother unanticipated events. Observersalso recorded their own interpretationsof behavior and reactions. When making

interpretations, observers indicatedwhat behaviors led to this interpretation(eg, woman appears bored; has flat ex-pression, stares into space).

Analysis

Direct observations permitted inves-tigators to explore findings withoutimposing researcher-derived constructsor preconceived hypotheses. Field noteswere reviewed in detail with child be-havior specialists (B.Z., M.K.-S.), andthrough an iterative process, we useda grounded theory approach to developthemes related tomobile device patternsand caregiver and child behavior. Thegrounded theory approach involves sys-tematic reviewofqualitativedata toallownovel ideas and theories to emerge fromthe observations rather than imposingexisting theory or conceptual models toarrive at, or interpret, results.

Investigators(J.S.R., K.N.,C.J.K.)reviewedeach field note independently and dis-cussed the salient themes of each.Investigators then agreed on a set ofcodes to capture the presence or ab-sence of these themes, which wereapplied to each field note by usingDedoose software (SocioCultural Re-search Consultants, Manhattan Beach,CA).20 After 55 observations, thematicsaturation was reached.

We used accepted techniques to ensurethe validity of our data21,22: investigatortriangulation, whereby the investiga-tors who coded the data were fromdifferent disciplines and read the tran-scripts independently before meetingto ensure consensus of all codes applied;and expert triangulation, whereby thestudy’s methods, coding scheme, andresults were presented separately toa group of health services researchers,to parents of young children, and to childdevelopment experts.

RESULTS

Population

We conducted 55 observations in 15neighborhoods in the Boston area, withmedian incomes ranging from $45 604to $108 686. The majority of caregiver–child groups observed had 1 caregiverpresent (58.2%), and the number ofchildren ranged from 1 to 3 (Table 1).Most children appeared to be of schoolage (Table 1). Length of meal observa-tions ranged from 10 to ∼40 minutes.Of the 55 caregiver–child groups ob-served, 40 used a mobile device.

Dominant Theme: Absorption Withthe Mobile Device

Although many ways to categorize de-vice use were identified and discussed,the concept of absorption, defined as theextent to which the primary focus of thecaregiver’s attention and engage-ment was with the device rather thanthe child, consistently arose as mostsalient to the caregiver–child relation-ship. Three independent but overlap-ping characteristics of mobile device

TABLE 1 Observation and FamilyCharacteristics

n (%)

Day of the weekWeekday 36 (65.5)Weekend 19 (34.5)

MealtimeLunch (11:30 AM–2:00 PM) 26 (47.3)Midafternoon (2:00–4:00 PM) 4 (7.3)Dinner (4:00–7:00 PM) 25 (45.5)

Number of caregivers1 32 (58.2)2 23 (41.8)

Number of children1 27 (49.1)2 20 (36.4)3 8 (14.5)

Estimated caregiver ages20s 12 (21.8)30s 24 (43.6)40–60 17 (30.9)60+ 2 (3.6)

Estimated child agesInfant 6 (6.7)Toddler 16 (17.8)Preschooler 14 (15.6)School age 54 (60.0)

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use contributed to the degree of ab-sorption. These included the frequency,duration, and modality of use, childbids for attention and caregiver re-sponses during use, and whether deviceswere viewed separately or coviewed.

Frequency, Duration, and Modality ofUse

Caregiver degree of absorption de-pended largely on how frequently thedevicewas used, for what duration, andwhat apparent modality was in use(eg, phone calls versus typing or fingerswiping). Naturally, not bringing a de-vice out (n = 15) or having the deviceonly on the table (n = 3) was consistentwith no apparent absorption. In con-trast, many caregivers (n = 16) usedthe device almost continuously through-out the meal, eating and talking whilelooking at the device or only putting itdown briefly to engage in other activities(Table 2, excerpt 1). This pattern of useoccurred both with sole caregivers andthose who had another adult present, ofall age groups and both genders. Thehighest degree of absorption occurredwhen this nearly continuous use con-sisted of typing or making swiping fingermotions, rather than with phone calls,because the caregiver’s gaze was di-rected primarily at the device (Table 2,excerpt 3).

Absorption was not necessarily relatedto continuous use; it could occur in-termittentlyorat theendofmeals,whenmany caregivers took out their devicewhile the children were still eating orthe caregiver appeared bored (n = 8).Phone calls could be absorbing, butcaregivers usually maintained someeye contact with children during thesecalls, which did not last through entiremeals as texting or swiping could.

A lesser degree of absorption wasexhibited when caregivers used theirdevice for brief, intermittent periods,such as quickly checking their device,typing or texting for a brief time, or

responding to phone calls but thenputting the device away (n = 9). Thesecaregivers appeared to balance theirattention between device and child byusing it quickly when children wereotherwise engaged, and then returning

to conversation. A few caregivers heldtheir smartphones in their hands whiledoing other things (n = 3), suggestingto observers that their attention mayhave been partially on the device dur-ing other interactions.

TABLE 2 Observation Field Note Excerpts Illustrating Caregiver Absorption With Mobile Devices

Subtheme Excerpt

Decreased responsiveness to child (1)Femalecaregiverpullsoutherphone fromherpurseand looksat it.Girl [school age] is talking to her caregiver, caregiver is looking atthe phone, nodding a little while the child talks but not looking backat her or responding with words. Caregiver doesn’t appear to belistening but says a few words in response every once in a while.Girl asks caregiver about her manicure. Keeps asking herquestions but does not appear upset (cheerful facial expression,happy tone of voice) with the few words that caregiver says inresponse. Caregiver looks around the restaurant. Stares back ather phone. Child sways in her chair and keeps eating fries andasking caregiver questions. Caregiver looks up occasionally tograb a French fry or quickly say something to the girl and thencontinues to do something on her phone.

(2) Female caregiver is holding the baby in her lap and is staring ather cell phone. Both boys [preschool and school age] are sitting intheir chairs staring around. They appear to be almost finishedeating. Caregiver is finished. Caregiver looks up and asks themiddle boy if he can please finish in a frustrated tone of voice.Oldest boy is wiggling around in his chair. She says “sit down”without looking up from her phone. Oldest boy is looking at hisshoes, the ground, his chair, but not getting out of his chair. Shesays, “Just sit. Please listen,” and then looks at the middle boy andsays, “Just 2 more minutes. Please eat.”Middle boy starts whiningand picks up his juicebox. Caregiver looks up from her phone, andthe boy complains that his straw has fallen inside the juicebox.Caregiver takes it from him and says that he pushed it in and hecan’t have it anymore. Child seems unbothered. She asks him if heis finished eating, and he says he isn’t finished, then he gets up andwanders around the table. Caregiver gets up, holding the baby, andpicks up his plate and throws it out.

Decreased conversation with child;child passive

(3) Female caregiver brings food over and sits down across from girl,they distribute the food and as [school aged] girl starts eatingcaregiver brings out her smartphone. There is no conversation.Caregiver appears to be typing into phone, holding it about 10inches away from her face, looking into it for long stretches duringwhich she does not look up. She stops typing and is staring at thescreen, touching it at points, holding itwithher righthandwhile sheleans her chin on her left hand, her facial expression flat. She hasbeen looking at it for about 2 min without any change of gaze, whilethe girl eats and looks around the room. Caregiver then puts phonedown on the table and takes a drink from her smoothie. She thenlooks at the girl for about 1–2 s and then down at her phone on thetable. The girl keeps eating, then gets up to cross the room to getmore ketchup. Caregiver is not watching her do this; she is lookingdown at the phone. The girl quickly returns and sits and eats,looking around the room while caregiver continues to hold thephone with her right hand and look at it, sipping her drink withoutmoving her gaze. She eats some fries slowly and continues to lookat the phone with a flat expression. Still no conversation. Thiscontinues through most of the meal. Now girl’s head appears to belooking right at caregiver, and caregiver looks up but not at thegirl, scans the restaurant with a flat expression and then eatssome fries and puts the phone down on the table.

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Bids and Responses

A second axis on which to categorizedevice use related to how childrenresponded when caregivers began touse a device and how caregiversmanaged this behavior. Some school-aged children were already engaged

in eating, talking to another child, orplaying with a toy and did not seem tochange their behavior based on care-givermobile device use, especially if theuse was brief. When caregivers werecontinuously absorbed in the device,some children did not make bids for

attention or conversationwith the adult(Table 2, excerpt 3).

Many children started to exhibit limit-testing or provocative behaviors dur-ing adult device absorption (Table 2,excerpts 4 and 5). The highest degreeof caregiver absorption was evidencedby responses such as gaze being di-rected primarily at the device, keepingthe gaze on the device while answeringquestions or giving instructions toothers, having a longer latency to re-spond to bids, or not responding tobids from others. In addition, care-givers absorbed in devices frequentlyignored the child’s behavior for a whileand then reacted with a scolding toneof voice, gave repeated instructionsin a somewhat robotic manner(eg, without looking at the child orrelevant to child behavior), seemedinsensitive to the child’s expressedneeds (Table 2, excerpt 2), or usedphysical responses (eg, one femaleadult kicked a child’s foot under thetable; another female caregiverpushed a young boy’s hands away whenhe was trying to repeatedly lift her faceup from looking at a tablet screen).

Using Devices Separately VersusCoviewing

Separate use of devices includedcaregiver use as described earlier butalso occurred when caregivers gavea device to a child for entertainmentpurposes or to seemingly control thechild’s behavior (n = 3). Smartphonesand tablets were provided to sometoddlers to apparently entertain thechild during or after the meal when thechild’s behavior became more active,such as crawling under the table. Somecaregivers showed absorption in theirown device while their toddler engagedwith a separate one (Table 3, excerpt 1).Even when the device was not offeredto the child, many children were fas-cinated by adults’ devices and madeattempts to grab or use them when

TABLE 2 Continued

Subtheme Excerpt

Child escalation/ caregiver raisingvoice during absorption

(4) Dad [was called Dad by one of the boys] sits down with 3 boys andbrings out a smartphone and starts swiping. Boys are talking toeach other, excited, eating, talking, seeming to goof around. Thedadlooks up at them intermittently when they exclaim something orraise their voices, but otherwise he looks at his phone, which he isholding in frontofhim. ...I cansee thatdad is scrolling throughsmalltext; looks like a web site, not e-mail. Again dad looks up at themwhen one of them exclaims something [inaudible] but then goesback to surfing web. At this point he puts the phone down from infront of his face, still holding it in hand, and points to youngest,instructing him on something. Then back to scrolling. ...Oldest boystarts singing “jingle bells, Batman smells,” and the others try tojoin in but don’t know the words. Dad not responding. They’remaking up their own words to the song now. Dad calls the littleone’s name and speaks in a mildly stern voice, and they stopsinging. Little one laughs. Dad continues to hold phone up in frontof face, looks over to boys, then back to phone. ...The boys startsinging “jingle bells, Batman smells” again, and dad looks up andtells them to stop in a firm voice. Then he looks back to phone. ...[end of meal] Again in stern voice, seeming exasperated, dad says,“HURRY UP!” and the boys are being silly, licking each other’scones, climbing on each other and on the divider between booths;dad keeps giving instructions in same tone of voice, sayssomething about not getting this again.

(5) Girl [young school aged] comes back to the table, is scratchingher head with the fork, looking at her parents [she called themMom/Dad]. They are looking at their phones. She has a cookie nowthat her brother gave her. Dad reaches over the table and startseating the daughter’s food. She frowns and says that it is her food.He responds saying, “You aren’t eating it, and I bought it, so I’mgoing to eat it.” She shrugs it off and keeps eating her cookie. Dadis scolding boy about something. Both girl and boy look at eachother and are smiling. Boy gets up to throw his trash away. He’sstanding up. Mom is still looking only at her phone, dad is eating,and daughter is drinking from her soda cup. Girl is playing withher noodles with her finger. Dad yells at her to stop. He takes herfood away from her and is cleaning up the table. Girl is talking,mostly to the boy. Mom is still looking at her phone. Dad talks to thechildren to scold them, then goes back to looking around the foodcourt. Mom is still looking at her phone. Dad is looking at herphone with her now. Daughter takes her fork and starts stabbinga container on the table. Mom looks at her and scolds her. Dadkeeps telling her to stop, but she continues with a big smile on herface. Mom finally looks up and scolds her. The girl continues whatshe is doing. The fork snaps, and both parents look up and tell her,“STOP.” She laughs, and the boy laughs. ...[later in meal] Mom isshowing something to all of them on her phone. Boy is reaching hisarm out, and the girl is hitting it, while the girl screams. Dad tellsthem to stop. Mom is still looking at her phone. Girl gets off of herchair and starts swinging the boy’s chair around. Dad tells her toget back in her chair in stern voice. Mom doesn’t look up from herphone.

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they were on the table or peered overtheir caregiver’s shoulder to see whatthey were doing.

Shared device use was also observed(n = 4). On several occasions thecaregiver offered the device to thechildren to pay joint attention to a videoor photos or to apparently look thingsup during conversation (Table 3, ex-cerpt 2). These caregivers weredeemed less absorbed in the devicebecause their primary focus of con-cern appeared to be the shared expe-rience with the child.

DISCUSSION

Through detailed observations of care-givers and children eating together infast food restaurants, we characterizedhow mobile devices are used by care-givers and children in natural settings,with the most dominant theme beingabsorption in the device. Degree ofcaregiver absorption was determinedby frequency, duration, and modality ofdevice use, how the child reacted to thecaregiver’s device use and resultingchild bids and caregiver responses,and whether the device was shared.

Caregivers who used devices rangedfrom having the device on the table toalmost constant absorption with thedevice throughout the meal. Althoughdetailed analysis of interpersonalinteractions was beyond the scope ofthis study, we did find it striking thatduring caregiver absorption withdevices, some children appeared toaccept the lack of engagement andentertained themselves, whereas othersshowed increasing bids for attentionthat were often answeredwith negativeparent responses. Child use of deviceswas less common (most children wereengaged in eating, playing with otherchildren, or playing with “kid’s meal”toys) but appeared to be for the pur-poses of entertainment or behaviorcontrol. Children were almost alwayscurious about what adults were doing

on devices, and sharing information ormedia on devices appeared to bea source of joint enjoyment for adultsand children. These findings warrantadditional study but are an importantfirst step in the study of how devicetechnology affects the daily inter-actions that are so important to childdevelopment.

This study raises several hypothesesthat might be explored in future quali-tative or quantitative work. For exam-ple, what content or reasons for mobiledevice use (eg, work, entertainment)are associatedwith thehighest levels ofcaregiver absorption? It will also beimportant to explore how caregiversconceptualize their own mobile deviceuse and whether they have any rulesabout use during family times. Care-givers have always had to multitask ortoggle their attention between care of

children and other activities, but ismobile technology particularly ab-sorbing or pervasively available, so thatit ismoredifficult to staypresent duringinteractions with children? Do childrenreact to this by making more bids forattention during caregiver device use?What are the longer-term effects offrequent exposure to others’ “presentabsence,”23 during which a companionis physically present but his or herthoughts are elsewhere? In addition, itwill be important to know more aboutpatterns of child use and modes ofshared use that harness joint attentionbetween caregivers and children. In afuture separate study, we plan to uselaboratory-based videotaped mealtimeencounters to further refine and oper-ationalize our coding scheme using thethemes presented in this study andbegin to quantitatively examine these

TABLE 3 Observation Field Note Excerpts Illustrating Separate Versus Shared Use of Devices

Subtheme Excerpt

Separate (1) Child [toddler age girl] wiggles and looks around the roomwhile she chews on the corner of the bread, reaching her handout and touching female caregiver’s upper arm. Caregiver istyping on the tablet and has not looked up to child. Child thenputs her hand into caregiver’s hair and turns her bun (lookspainful) while caregiver is looking at tablet; caregiver looks upto child, says something to her, and puts the tablet on the tablein front of the child and brings up a Disney app. The child putsthe bread down and leans over the table, standing on the seat,and starts tapping on the tablet with face about 8–10 inchesaway from it, continues to wiggle. She doesn’t seem able tomake it work, so she starts to make whining vocalizations ...a minute later caregiver notices the child is having difficultyand leans over with her to help, and sets up a video. While thevideo runs the child keeps babbling and jargoning in a fussyway. Caregiver is now eating and looking at her smartphone.Child wriggles, standing on seat, not appearing to pay fullattention to video. Caregiver brings over her smartphone andputs it down in front of the child, who now has both devices infront of her and is looking at one or the other for brief periods.

Shared (2) The family sat talking and eating. Another man came to therestaurant with his dog and left it tied outside while he wentinside to order. While inside, his dog started howling forattention. Many people stopped to watch the dog, and themalecaregiver got his cell phone out and gave it to the older boy totake a picture or videoof thedog. They joked that thedogwouldbe famous on YouTube. ...The caregiver finished his meal andgot his phone out from his pocket. He talked to the boys andappeared to be looking up things on his phone that they weretalking about. After doing that for a few minutes he put hisphone away. The family spent the rest of their meal talking andeating and making jokes.

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hypotheses regarding family inter-actions.

Because no previous studies have ex-amined this topic, our goal was toperformasmall, hypothesis-generatingstudy that helps to understand howadults balance attention and engage-ment between a ubiquitous technologyand the children in their care. Severallimitations to our study must be men-tioned. We should not draw conclusionsabout relationships between mobiledevice use and caregiver–child in-teraction from our results. This wasa descriptive study using anthropo-logical observational methods; we didnot code device use or frequency ofbehaviors quantitatively, so could not

statistically test associations. Althoughdiverse sites were sampled and clearpatterns of device use noted, it is pos-sible that we did not describe the en-tire range of how devices are used,particularly with regard to child deviceuse, which was uncommon in thegroups we observed.

CONCLUSIONS

This study documents a range of pat-terns of mobile device use, includinga large proportion of caregivers whowere highly absorbed with their hand-held devices. These themes can be usedto characterize device use for futurestudies examining associations be-tween mobile device use and child or

caregiver outcomes. We hope ourfindings will help generate additionalresearch and discussion about the useof this technology around children.

ACKNOWLEDGMENTSWe thank The Joel and Barbara AlpertEndowment for the Children of the Cityand the Boston University School ofMedicine for funding this study. Wethank Lisa Messersmith, PhD, BostonUniversity Department of Anthropology,for her assistance with research assis-tant training. We also thank BetsyGroves,MSWLICSW,BostonMedicalCenterDivision of Developmental BehavioralPediatrics, for her help with the-matic analysis.

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Food RestaurantsPatterns of Mobile Device Use by Caregivers and Children During Meals in Fast

  

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