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Beyond restrictions: Guidance for talking with families about social media use

November 1, 2023

An advisory issued by the U.S. Surgeon General this year described how social media has benefits and risks for children and adolescents and called for multistakeholder action ( The advisory built on years of mounting (and often frantic) public discussion about social media and teens, a topic that can be tricky to address in clinical practice for several reasons.

First and foremost, news coverage of social media often fails to reflect the nuance in the scientific evidence. Instead, the media often treats the topic like clickbait, with headlines such as “Have Smartphones Destroyed a Generation?” and “Social Media Toxic to Girls.”

Research has shown that the quality of press coverage of sensitive topics such as mental health and bullying can influence whether readers feel empowered or hopeless about the topic, which likely is the case with social media. When a pediatrician asks parents and adolescents about media use, it’s not surprising that they often seem ashamed, blame themselves or want to avoid the topic.

Second, “social media” is not a monolith but often is treated as such in research. Social media includes chat-, image- and video-based sites as well as social gaming experiences. Even on the same platform, users may have vastly different experiences, or their experience will vary day to day. Algorithms also recommend different content to users.

Finally, discussions can focus too much on what kids are doing “wrong” on social media and how we need to protect them rather than supporting their agency in navigating a digital environment that wasn’t always built with their needs in mind.

Pediatric providers know kids are creative and resilient and are good at seeing things from youths’ perspectives. Therefore, providers have an important opportunity to shift the conversation and clinical guidance. Here are a few ways to do that:

Change the conversation. Parents and patients may expect you to recommend restrictions such as limiting media use to two hours per day or not using it while doing homework. Instead, acknowledge that this can be a tough topic to discuss and how it’s important to understand each other’s experiences. Asking open-ended questions like “How is your relationship with social media?” or “What’s your favorite thing to do on your phone?” models curiosity and may reduce defensiveness from patients.

Support the child’s/adolescent’s agency. Providers who grew up without smartphones or social media apps need to check their own implicit reactions to new technologies and explore youths’ point of view. Asking what patients find inspiring, funny, toxic or overwhelming about social media and involving them in problem-solving will support self-directed behavior change.

Encourage critical thinking about digital design. Social media platforms are part of a digital ecosystem that makes money off of data collection and targeted marketing. Help parents and teens understand that tailored feeds not only keep them watching longer, but also help platforms get to “know” them better by building a marketing profile of their interests. Ask questions like “What do you do when something creepy shows up in your feed?” Then, encourage the use of blocking, privacy and preference tools to make their experience better. When patients realize that tech design has a role to play in negative experiences, they are less likely to blame themselves.

Consider the whole family. Suggest families use the AAP Family Media Plan. Be sure to address parent social media use, since it correlates with adolescent use and can interrupt important opportunities for emotional connection. Ask children and adolescents how they want their parents’ media use to change and why. Problem-solve ways the family can carve out time for activities that support the parent-child relationship, such as cooking, going to community centers, spending time outdoors and having brief conversations during car rides. Encourage parents to model the behaviors they want to see in their kids.

Start the conversation early. Emotional health and positive relationships with technology start in early childhood, and parents say they want advice about media when their children are young. Many infants and toddlers use video platforms, so this is an important window to recommend platforms that don’t have ads, influencers or other low-quality content. Help parents find ways other than devices and videos to calm young children. Support parents’ efficacy in making a media plan that works for their family, and revisit it at key transition points (e.g., birthdays, new school years). Remind them that children’s norms and expectations start in early childhood, and this is an investment in long-term healthy relationships with emotions and technology.

Dr. Radesky and Dr. Moreno are co-chairs of the AAP Center of Excellence on Social Media and Youth Mental Health. Dr. Radesky also is chair of the AAP Council on Communications and Media, and Dr. Moreno is a member of the council’s executive committee.




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