The American Academy of Pediatrics says more access to violent images requires parents, doctors, and lawmakers to be more vigilant.

The American Academy of Pediatrics (AAP) is reiterating its long-standing appeal for parents to keep children away from violent movies and video games.

“Although there is broad scientific consensus that virtual violence increases aggressive thoughts, feelings, and behaviors, there has been little public action to help mitigate children’s exposure to it,” an AAP report, published today in the journal Pediatrics, states.

The authors point to decades of research that they say shows a link between exposure to violent video games and increased aggressive tendencies.

They also express frustration at the skepticism many maintain about the significance of that link.

“Some contend, rightly, that these correlations are in the small to moderate range, but they are stronger than the associations between passive smoking and lung cancer, and many municipalities have banned smoking because of that risk,” the authors write.

Read more: Do violent video games create aggression in children? »

In their report, the researchers outline specific recommendations for pediatricians, policymakers, the media, and parents.

“The challenge for parents is to come up with what we could call a healthy media diet, which in my opinion is as important as having a healthy food diet,” Dr. Dimitri Christakis, a pediatrician and the report’s lead author, told Healthline.

That means keeping an eye on quality as well as quantity of screen time, although the academy has recently loosened its recommendations on how much time young children should spend in front of a screen.

The recommendations on virtual violence are similar to those the academy put out in 2009. But an accompanying commentary covers new territory.

That includes how to navigate kids’ exposure to videos of real violence that are shared on social media and easily accessible via smartphone, like police shootings or acts of terrorism.

“This era is a turning point in what we used to consider virtual violence and we have to think about it now totally differently,” Dr. Rhea Boyd, pediatrician, and the commentary’s co-author, told Healthline.

With violent, real-world images popping up on social media feeds, anyone can become a witness to real violence, anywhere and anytime.

While clips like ISIS killings or police shootings are disturbing to almost anyone, adults are better equipped to deal with their feelings and express their thoughts out loud, Boyd said.

She added that a child’s reaction to this new kind of virtual violence would vary depending on who the child is and what community they are part of. For example, an African-American teenager watching the footage of Philando Castile’s death might react differently than a white teenager watching the same video.

“While the image of the child who consumed virtual violence before was this kind of nondescript child sitting in front of a television playing video games, I think the new image has to be a brown child watching these images on a cell phone,” Boyd said.

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A child might be spurred to social action, Boyd added, or might be traumatized.

She recommends that teens and their parentstalk about how to process these images with each other and with their pediatricians.

That advice is in keeping with the academy’s recommendation for dealing with virtual violence in general. Pediatricians and their patients should talk about media habits.

The academy also recommends legislative action, including a government run rating system for games and movies. Right now, industries make up their own ratings, which Christakis says are inconsistent and subject to “ratings creep.”

The Entertainment Software Association (ESA), the industry’s trade group, maintains that the self-regulated ratings are sufficient. The ratings are determined by the Entertainment Software Ratings Board (ESRB), created in 1994 by the ESA to assign ratings to games.

According to a statement on the ESA website, “Family advocates, elected officials, and government agencies have described ESRB as the gold standard for rating systems, and parents consistently report being satisfied with the level of information the ESRB rating system provides to help them select games for their children.”

Besides an independent rating system, the AAP also recommends that policymakers “should enact laws that prohibit easy access to violent media for minors.”

California policymakers tried to do just that, passing legislation in 2005 that would restrict the sale of violent games to minors. The law was challenged before it took effect, and was struck down in the Supreme Court on First Amendment grounds.

“This country has no tradition of specially restricting children’s access to depictions of violence,” Justice Antonin Scalia wrote in the 2010 decision. The United States does have a tradition — legally enforced — of limiting children’s access to depictions of sex.

Scalia went on to compare violence in games with violence in other art forms, like the classic book “Lord of the Flies,” which is often required reading in schools.

Read more: Playing ‘The Sims’ and other games help train the brain »

The court’s ruling was praised by many First Amendment advocates.

“If the depiction of violence triggers the power to censor, government can then use that violence as a proxy to censor the underlying message. ‘Lord of the Flies’ is a particularly good example in that the graphic violence serves a broader allegory about, among other things, human political and social organization (things that a government may very well want to censor),” Gabe Rottman, then a legal counsel for the American Civil Liberties Union (ACLU), wrote in a 2012 blog post.

Critics have described the AAP guidelines against screen time as technophobic and have compared the academy’s pursuit of violent video games with the social and governmental hysteria surrounding comic books in the 1950s.

In his interview with Healthline and in the report’s text, Christakis does associate new technology with new danger.

“As intense as ‘Grand Theft Auto’ is now, imagine playing it with Oculus Rift glasses and being in the scene itself,” he said.