A recent NBC news report described Sadie, a happy, healthy 15-year-old who had dreams of becoming a lawyer or veterinarian. She had survived her mother’s drug addiction, but was then faced with perceived teenage challenges of appearance, which included braces and beautiful red hair.
Other kids online made fun of both the hair and the braces, constantly calling attention to both. Soon the bullying devolved into “just kill yourself.” She cried incessantly. Weeks later, she put an end to her meaningful life.
Major depressive disorders and suicide in teens have increased by over 225 percent and 85 percent respectively in the last two decades. One review of seven independent studies found a direct association between heavy social media and Internet use and frequency of suicide attempts.
In May, the U.S. Surgeon General released a report titled “Surgeon General’s Warning on the Harm of Screen Use.” Coincidence or not, smartphones became available in 2009, about the time of these extremely disturbing increases in mental health problems in youth. Given these impressive data, it is important to examine the association of smartphone usage and their various applications (social media, messaging, gaming, and now chatting) with the physical and mental well-being of our children today.
(AP file photo)
The daily duration of smartphone use has been increasing over the last decade. A recent report found that teens in the U.S. averaged over seven hours per day screen time, including nearly five hours on social media (up 30 percent since 2015). Younger children are also developing use of smartphones. The American Academy of Pediatrics (AAP) recommends no screen time for children under 2 years of age, one hour per day for children 2-4 years, and two hours per day for
children 5-12 years.
While no specific time limit is offered for teens, the focus is on quality of screen use. Still, the seven hours of daily use noted above would be considered excessive.
What have we learned over the last decade about the association of cell phone use and its various applications with children’s health and well-being? In terms of physical health, excessive phone use has been associated with sleep problems, eating disorders, obesity, and initiating use of alcohol, tobacco, and marijuana. Greater screen time, particularly at night, is associated with later bedtimes, fewer hours or sleep, and poor-quality sleep. In a study of third-grade children, high levels of total screen time were associated with lower achievement in reading and math. Higher screen time levels were associated with lower vocabulary development in 2-year-old English children.
Perhaps the effect of greatest concern regarding excessive screen time usage is on the emotional and mental well-being of children. In a report that summarized over 150 studies, social media use was associated with higher levels of depression, thoughts of self-harm, substance abuse, and worse self-perception. Similar results were found for video gaming and other digital media use such as messaging.
Some social media communications among teens are frightening. It is concerning that 3-5 percent of children experience “sextortion” before adulthood. Nearly five out of 20 teenagers have experienced cyber-bullying, which has been associated with depression, anxiety, social withdrawal and thoughts about suicide.
The recent Surgeon General report points out the latest trend in cell phone use: AI chatbots. The rapidly expanding engagement with AI introduces new risks regarding mental and physical well-being of teens. In a recent study, 60 percent of teens reported they had used AI at least once, with nearly half experiencing at least one harmful interaction with AI. In a recent case, a teen died by suicide after an AI bot “counselor” supported the child ending their life.
There are potential benefits of social media use such as education and fostering social connections with family and friends and community participation. Screens can offer safe emotional regulation and focused learning for children on the autism spectrum. Still, the evidence summarized here suggests that actions need to be taken now to minimize the negative effects of social media use on children and teens.
Responsibility weighs heavily on tech companies that have built the digital environment that children inhabit. This year jurors of landmark lawsuits have found Meta and Google liable for intentionally creating addictive platforms that cause mental-health harm. These verdicts suggest that the tech companies will be forced to help improve this landscape or face massive penalties in civil and criminal litigation.
As noted in the recent Surgeon General’s report, parents, schools, communities and policymakers should guide youth to using technology in a balanced and safe way, combining digital skills with physical activity, adequate sleep, and offline experiences. Families can create a media plan which includes discussing who can use what, when, where, which content, and for how long media can be used, with no screen time at meals.
Given the concern regarding insufficient sleep plaguing adolescents, families could agree to no screen time in the hours before, during, and after bedtime. Parents who model healthy screen time and create experiences that displace screen time, such as cooking a meal together, can significantly decrease their child’s tech usage.
Schools could implement bell-to-bell ban policies to eliminate multi-tasking during school hours, except those children who need devices as part of their Individual Learning Plan. Fortunately, Arkansas, led by Gov. Sarah Sanders and supported by a bipartisan Legislature, implemented such a policy in 2025. Schools could teach digital citizenship by using resources and tool kits which integrate digital skills in health education and other classes. They could also create opportunities to displace screen time during the school day such as building opportunities for physical activity during required recess and after school.
Finally, targeted policies which allow parents greater control to manage their children’s screen time, privacy settings, content exposure, and account controls should be considered. Given the prevalent use of social media by children younger than 13 years old, policies that require more robust age verification are critical in mitigating the risk associated with screen addiction.
The U.S. House of Representatives recently passed the Kids Internet and Digital Safety Act, which would require strong design safeguards, create new and better tools to support young people online, prohibit targeted advertising to all children and teens, and strengthen data privacy protections. This was supported by all four Arkansas representatives. The Senate has not yet acted on this. We urge Sens. John Boozman and Tom Cotton to support its passage.
While general social media restrictions are not part of the current discussion in the U.S., a recent pilot study from the U.K. determined that such restrictions for children ages 13-17 years resulted in improvements in sleep, mood, concentration, family interactions and general well-being.
The use of smartphones and their various applications such as social media and chatting are now part of the world of children and adolescents. Given the impressive array of negative effects of excessive or inappropriate use of smartphones, all of us–parents, school officials, policymakers and community members–have roles to play in protecting our children from this threat.
Patrick Casey, Gary Wheeler, Debra Fiser, and Whit Hall are members of the Jacobi Group, a panel of senior Arkansas pediatricians addressing child advocacy and public policy.
