Population Care

How physicians can help parents address kids’ social media use

Sara Berg, MS , News Editor

Some state lawmakers and members of Congress are calling for regulation of social media, with some even looking to ban TikTok. Much of the concern is driven by the ways in which teens’ mental health is affected by their use of social media platforms.

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But regulation may not be the best way forward, argues Michael Rich, MD, MPH, a pediatrician who worked in the film industry for 12 years. He believes there is a way for health care and social media to join forces, to do good while doing well.

That is where Dr. Rich’s Digital Wellness Lab at Boston Children’s Hospital and Harvard Medical School comes into play—to mediate between tech companies and those who are concerned about the impact of media on kids.

“The internet's here to stay. Mobile media are here to stay. We have to learn to not only live with these devices and applications, but we've got to learn to thrive and harness them to make us all healthier, smarter and kinder to each other,” Dr. Rich said. “I do not believe that regulations clamping down will work because for years it’s been like playing whack-a-mole—we pass a law against this and something else pops up.”

Here is Dr. Rich’s view on how physicians and parents can better address social media, internet use and screen time.

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Social media use becomes a problem “when the basic needs of life are impaired. The first impairment we typically see is sleep, particularly with kids who take their smartphones to bed with them,” Dr. Rich said. “They’re staying up late, texting, on social media, watching YouTube, so sleep gets impinged on and so does homework.”

Social media use also can negatively affect relationships. “These kids withdraw into their phones or laptops or gaming consoles and they’re not spending time with family, with friends,” he said. “We have convinced ourselves that the near-infinite connectivity of these devices is as good or better than deep, sustaining connectedness with each other, which is actually getting eroded.”

AMA policy encourages primary and secondary schools to incorporate balancing screen time with physical activity and sleep into their health curricula. The AMA also encourages primary care physicians to assess pediatric patients and educate parents about balancing screen time, physical activity, social interaction, and sleep.

“Asking kids about media use is no longer a “wouldn’t-it-be-nice” add on. We have to recognize that this is the environment in which kids are growing up,” Dr. Rich said. “We have to operate with the assumption that these kids are using screens for much of their waking time and we have to integrate that into our medical histories and anticipatory guidance looking forward.”

“There are effective ways to use these screens and ways that thoughtless use can harm kids,” he said.

American children 8–12 years old spend about four to six hours a day using screens. For teens, the amount of screen time jumps to up to nine hours, according to the American Academy of Pediatrics (AAP). 

For grade-schoolers and teens, the AAP recommends not letting media displace other important activities such as quality sleep, regular exercise, family meals and “unplugged” downtime.

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It is important to recognize that unhealthy internet use is not an addiction. Instead, it is a disorder dubbed problematic interactive media use, which indicates underlying problems.

“We see it all as symptoms and manifestations of underlying conditions such as ADHD, anxiety disorders and mood disorders,” Dr. Rich said. “These self-soothing behaviors that become Problematic Interactive Media Use when they get out of control and start impairing physical, mental, and social health.

“PIMU is a young person’s attempt to feel better. It’s not the device doing harm to us. It’s what we’re doing with the device or the application that gets us in trouble,” he added. “At our clinic, among the hundreds of kids we’ve seen, we have yet to find one who didn’t have an underlying psychological issue that they were trying to soothe.”

“It’s the interactivity and variable rewards of gaming, social media, even information-binging that draws and keeps us in, rather than the device doing something to us,” Dr. Rich said.

Editor’s note: U.S. Surgeon General Vice Adm. Vivek Murthy, MD, has released an advisory on social media use and its impact on the mental health of children and adolescents.

“With near universal social media use by America’s young people, these apps and sites introduce profound risk and mental health harms in ways we are only now beginning to fully understand,” AMA President Jack Resneck Jr., MD, said in a statement. “As we grapple with the growing, but still insufficient, research and evidence in this area, we applaud the surgeon general for issuing this important advisory to highlight this issue and enumerate concrete steps stakeholders can take to address concerns and protect the mental health and well-being of children and adolescents.”