Dr. Rick D'Alli is always amused when parents come to the Children's Center at Johns Hopkins School of Medicine convinced that their child's habit of staying up until 2 a.m. is a sign of manic depression and beg him to prescribe medicine.
The child psychiatrist usually recommends something else first: remove the television in the child's bedroom.
He was delighted this week when the American Academy of Pediatrics recommended the very same thing, citing known ill effects of television: It interferes with normal social and mental development and may be a cause of the growing problem of childhood obesity, poor school performance and violence by younger and younger kids.
The TV has become a kind of "20th century transitional object -- like the blanket Linus carries in the 'Peanuts' cartoon," D'Alli says. Removing it from the bedroom is "a simple, simple fix" for many childhood ailments, he says.
Though the academy has seriously lamented television's dangers for more than a decade, encouraging many doctors to routinely quiz parents about their kids' viewing habits, this is the first time the doctors' group offered specific ways to try to protect children from television's well-documented effects.
Besides removing the television from children's bedrooms, a report in the August issue of Pediatrics recommends that parents fill out a "media history" along with a medical history on their children.
And in a surprise to some doctors who have urged patients to follow the academy's guideline of limiting television to one or two hours a day, it recommends a complete television blackout for children under 2 years of age.
The reason: Babies need social interaction for their brains to develop properly. The goo-goos and gaa-gaas of the Teletubbies -- the pot-bellied creatures created by British television specifically to entertain 2-year-olds and shown on public broadcasting -- are not going to cut it.
"There's a little bit of wake-up call for us, now that the youngest ones are possibly exposed as well," says Dr. Judy Rubin, professor of pediatrics at the University of Maryland School of Medicine.
"It's a real reminder of what's good for kids: people are really good, and all those interactions. That's the gist of it. It's not so much that TV is bad; it's what it is substituting for," she says.
She and others say doctors have to choose from among a host of issues to raise in routine visits, but television-watching has never been on the agenda for babies.
That may change now, partly because pediatricians see themselves in a unique position to alter how the family works and to help them develop better long-term habits.
"No one else can be more preventive than a pediatrician," says Dr. Paul Bodnar, a pediatrician and official of Clinical Associates in Towson. He has questioned his patients' television-viewing habits for a decade, he says, and with each new study linking television to some ill, the doctor's role becomes more and more important.
By the time they are 17 years old, American children watch the equivalent of three years of television. Television and video games often replace neighborhood softball games, bicycling and other outdoor physical activity.
One result is the near doubling of childhood obesity. Between 11 and 14 percent of children are now considered overweight, compared with 5 percent in 1963. A study last spring by a Stanford University professor found that fourth-graders who watched less TV also lost weight.
But obesity -- and its life-long problems -- is but one issue associated with excessive television watching. The lack of social interaction is another problem. And although parents are advised that watching television is OK as long as they are aware of what children are watching and watch with them, busy parents are the first to admit that they use TV as a baby sitter.
Television robs the child of the opportunity to be creative on his or her own, to play with others, to interact with siblings and mom and dad.
The academy report calls on parents to educate their older children about television viewing and how to read its messages.
But small children don't have the skills to understand, and no one knows the effect it may have on toddlers exposed to shows like the Teletubbies.
"The brain has not been fully developed at all at that age," says Dr. Michael Brody, a Bethesda child psychiatrist who works on media issues for the Academy of Child and Adolescent Psychiatry.
"We know the effect of violence. We know effects on gaining weight, on reading, on academic performance," Brody said. "You are dealing with infants, 2 years old. Children that age need even more interaction with parents than older children. Are those images helpful?"
Brody said the academy recommendation shows "somebody had the nerve to challenge public broadcasting. Just because it's on public broadcasting does not mean it is correct for children."
The distributor of the Teletubbies show, the only one aimed at children younger than 2, said yesterday that parents use television as a treat and as a baby sitter, and that is unlikely to change.
"It's a bunch of malarkey," Kenn Viselman, president of the itsy bitsy Entertainment Co., which distributes the British series on PBS stations, said of the academy's blacklisting of his show.
But for children who suffer from depression, anxiety, attention deficit disorder -- as many as 5 percent of all children -- and other problems, television can make them worse, says D'Alli, the Hopkins psychiatrist.
"There isn't a clinician practicing today who can't tell the same story. Kids come to us with all kinds of issues. The child who is anxious and afraid of the dark has moved from the night light to the 'box light,' " he says, "and one way to figure out ways to treat children is to encourage good sleeping habits."
That's why he questions patients about their TV habits.
And when he tells them of the simple fix, the child's response is predictable: a gasp. "The parent often says 'Oh, Oh, Oh,' like they never thought of that. Then, 'OK, we will try it.' Eventually," D'Alli said, "they get used to it."
Sun wire services contributed to this report.