A Decision-Making Algorithm for Children With Suspected Coronavirus Disease 2019

Abstract

weight across the life span certainly warrant exploration. However, the focus of our study was specifically to investigate the role of energy-balance behaviors in mediating the association between video game use and BMI in childhood. Inclusion of aggression, or other emotional drivers of weight, was therefore beyond the scope of the study.Additionally, while we agree that previous research suggests there is an association between aggression and BMI, 2 we also note that the evidence for an association between aggression and video game use in childhood is more mixed. For example, a meta-analysis of 101 video game studies in children found minimal associations between video game use and childhood aggression. 3 Furthermore, a previous longitudinal study using the same data set as our study (the UK-based Millenium Cohort) found no association between video game use at age 5 years and conduct problems at age 7 years (the only measure of aggression available in this data set). 4 This suggests it is unlikely that conduct problems (as an indicator of aggression) would have been considered for inclusion as a mediator within our final model had we explored this association. It is also important to highlight that in the United Kingdom, children are restricted in their ability to buy violent video games by the Pan-European Game Information age rating system. 5 This means video game use in our sample of 5-year-old children is unlikely to have included violent games, which are of particular concern in relation to aggressive behaviors. 6 We therefore feel that the inclusion of aggression as a potential mediator was not appropriate for this study. However, this is certainly an interesting area of research and future studies could consider exploring these associations further in cohorts of older teenagers and young adults, using appropriate measures of aggression and stress.