WHAT'S KNOWN ON THIS SUBJECT: Mobile devices are ubiquitous in children' s lives, but how caregivers and children use them in everyday situations, and how use of devices affects caregiverchild interactions, has not been studied. WHAT THIS STUDY ADDS:In naturalistic mealtime observations, we documented the behavior of many caregivers whose attention was highly absorbed in their mobile devices, with varying child reactions to this absorption. This study raises several hypotheses about mobile device use and caregiver-child interaction. abstract BACKGROUND AND OBJECTIVES: Mobile devices are a ubiquitous part of American life, yet how families use this technology has not been studied. We aimed to describe naturalistic patterns of mobile device use by caregivers and children to generate hypotheses about its effects on caregiver-child interaction. METHODS:Using nonparticipant observational methods, we observed 55 caregivers eating with 1 or more young children in fast food restaurants in a single metropolitan area. Observers wrote detailed field notes, continuously describing all aspects of mobile device use and child and caregiver behavior during the meal. Field notes were then subjected to qualitative analysis using grounded theory methods to identify common themes of device use.RESULTS: Forty caregivers used devices during their meal. The dominant theme salient to mobile device use and caregiver-child interaction was the degree of absorption in devices caregivers exhibited. Absorption was conceptualized as the extent to which primary engagement was with the device, rather than the child, and was determined by frequency, duration, and modality of device use; child response to caregiver use, which ranged from entertaining themselves to escalating bids for attention, and how caregivers managed this behavior; and separate versus shared use of devices. Highly absorbed caregivers often responded harshly to child misbehavior. CONCLUSIONS:We documented a range of patterns of mobile device use, characterized by varying degrees of absorption. These themes may be used as a foundation for coding schemes in quantitative studies exploring device use and child outcomes. Pediatrics 2014;133:e843-e849

Among children aged 6 years or younger, there is no convincing evidence that prenatal cocaine exposure is associated with developmental toxic effects that are different in severity, scope, or kind from the sequelae of multiple other risk factors. Many findings once thought to be specific effects of in utero cocaine exposure are correlated with other factors, including prenatal exposure to tobacco, marijuana, or alcohol, and the quality of the child's environment. Further replication is required of preliminary neurologic findings.

ROVIDING QUALITY PEDIATRIC care for young children involves matching the needs and expectations of families with the organizational structure and clinical practices of pediatric providers. There is growing evidence of deficiencies in the quality of health care for children, including low rates of preventive services, 1 persistent disparities in health status, 2 and lack of a usual source of care among ethnic and racial minorities and children in low-income families. 3 Specific limitations have been noted in the quality of care related to developmental and behavioral services for children in the first 3 years of life, 4-7 particularly regarding gaps between recommended and actual care received. 8,9 In a national survey, only 23% of 2017 parents of young children discussed discipline and early learning with their child's clinician, and over half Author Affiliations are listed at the end of this article.