Screens and Teens: Recommendations for Youth Cell Phone and Social Media Use
By: Jake Swartz, MD & Jeff Bostic, MD, EdD

The internet, video games, and social media are now frequent components of daily life of youth:

  • 95% of adolescents have access to smartphone
  • 84% of teens use social media
  • 89% of teens are online several times a day                          
  • 45% of teens are online almost all times
Multiple risks are association with screen/social media use:
  • Interference or compete with sleep, exercise, homework, social life, or family activities
  • Exposures to harmful/inappropriate content (e.g., sex, drugs, violence, etc.), excessive ads (consumerism), and dangerous people
  • Cyberbullying
  • Oversharing personal information, collection of privacy data from teen users, and risk of Identity theft or being hacked
Media use is associated with several psychological factors relevant to primary care clinicians:
  1. Multi-tasking although seemingly pervasive these days it is actually counterproductive and counter to how our brain works. We can multitask with different brain domains/areas (i.e. walking and talking is cognitive and motor function multitasking) However, when attempting to split our attention/watching multiple screens, our brains function sequentially not simultaneously and thus will try to quickly switch tasks. In fact, people may lose up to 40% in productivity by multitasking.  Listening to music usually interferes, although soft, slow instrumental music (usually classical, jazz, easy listening) can be helpful if someone is sensitive to ambient noise (e.g., those who have experienced trauma and are vigilant to noise)
  2. Proximate Use: 95% of 18-29 year-olds keep their cell phones next to their beds, and 50% check it if they awaken; learning to turn off (or charge) one’s phone at night in another room is preferable
  3. Quantizing One’s Value: Youth often measure their likability (and self-esteem) by how many “likes” they receive when posting a message or picture; while a “like” does provide a small surge of dopaminergic pleasure, the tendency to gauge one’s worth by these “likes” inhibits self-esteem; those who spend 2+ hrs/day on social media report greater depression and sleep difficulties; for girls particularly, increased social media use doubles their risk for body image and unhealthy eating
  4. Primacy Effect: the first “pages” users see when Internet “surfing” are given more weight and are more influential than subsequent pages which are often guided by money and paradigms not curated by content, thus it is important to educate youth to avoid such influence
  5. Family Dinner With Screens: Families who eat while watching screens eat more fast food, overeat more mindlessly, and were less satisfied with their meals, so family meals without screens/texting, etc., are preferable (although topics for discussion may have to be identified beforehand)
General recommendations encouraged by American and Canadian Pediatric and Child Psychiatry organizations include:
  1. Minimize (replace) screen time:
  • For children younger than 2 years, play/interact with child instead of have them view screens.
  • For children 2-5 years, limit routine or regular screen time to less than 1 hour per day.
  • Ensure that sedentary screen time is not a routine part of child care for children younger than 5 years.
  • Maintain daily ‘screen-free’ times, especially for family meals and book-sharing.
  • Avoid screens for at least 1 hour before bedtime, given the potential for melatonin-suppressing effects.
  1. Mitigate (reduce) the risks associated with screen time:
  • Be present and engaged when screens are used and, whenever possible, co-view with children.
Be aware of content and prioritize educational, age-appropriate and interactive programming.
  • Use parenting strategies that teach self-regulation, calming and limit-setting.
  1. Adults should model healthy screen use:
  • Choose healthy alternatives, such as reading, outdoor play and creative, hands-on activities.
  • Turn off their devices at home during family time.
  • Turn off screens when not in use and avoid background TV.
  1. Social Media Safety:
  • Instruct teens not to share full names, addresses, phone numbers, social security numbers, passwords, and bank or credit card numbers
  • Turn off location enabled services
  • Use “apps” which limit internet access to age appropriate sites.
  • Parent control apps are usually “conquered” within months, dissuading reliance on them.
  1. Pediatricians: ask about screen and social media usage
  • How often, how much, is it affecting functioning?
  • Is there evidence of cyberbullying? (from patient or from others regarding patient)
  • Encourage parents to taste/partake in their child’s media use so they better know what they are being exposed to


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