Children’s online safety took center stage during a Senate hearing in early 2024, when Meta CEO Mark Zuckerberg apologized to concerned parents following mounting criticism of the role social media companies played in contributing to children’s harm. What he and fellow tech company CEOs appeared to admit during Congressional testimony was the power of digital connectivity.
To that point, the Kids Online Safety Act, which passed the senate in July but stalled in the house, creates a duty for social platforms to take reasonable measures in the design and operation of products used by minors to prevent and mitigate specific dangers, including promotion of suicide, eating disorders, substance abuse, and more. While parents’ groups and children’s advocacy organizations generally supported the legislation, it was slammed by the American Civil Liberties Union (ACLU) as a “nationwide attacks on young peoples’ right to learn and access information, on and offline,” and an affront to their First Amendment rights.
If people weren’t paying attention to the effects of social media platforms on children, they certainly are now that the First Amendment has been evoked.
Previously, pediatricians issued strict guidance on how much time children should interact with screens and other digital technology. Owing to the explosion in digital tools and connectivity, the American Academy of Pediatrics (AAP) updated its guidelines in 2016 based on an understanding that “children and adolescents can have many different kinds of interactions with technology.” The AAP recommended evaluating the quality of interactions with digital media and not just the quantity or amount of time.
While digital media is now a ubiquitous part of kids’ lives, inherent risks remain. Design tactics often encourage users to engage in more content, more ads, and submit more data to personalized algorithms. The proliferation of misinformation further complicates children’s digital experiences, making it difficult for them to distinguish reliable educational content from false or misleading information. Clinicians, educators, and parents routinely sound valid alarms surrounding safety and the negative mental and physical health consequences on kids, including the impact on mood, attention span, and sleep, at a time when their brains are still developing.
Still, with 95% of teens having access to a smartphone and 97% reporting daily internet use, providers taking an abstinence stance towards online platforms are not doing their patients any favors. As clinicians, we have the power to harness digital technology for good and leverage it to improve child and adolescent health outcomes.
But where do we even start?
First is to rethink the anti-screen narrative and embrace the potentially controversial stance that technology, including social media, can be valuable to kids. We can take a page from the digital health tool playbook to craft an acceptable roadmap for online platforms. Despite a plethora of initial pushback, digital tools have offered many benefits for child and adolescent health. Smart watches have performed background monitoring for abnormal heart rhythms in children. Continuous glucose monitors forever altered how we manage diabetes, and connected inhalers are poised to do the same for asthma. Wearable technology allows clinicians to remotely monitor a child’s oxygen levels when they experience a respiratory illness.
Likewise, online platforms, including social media, exhibit a host of potential benefits. Promoting health empowerment, providing social connections, and removing barriers to education are all essential and plausible. Virtual mental health strategies promote access to care, and researchers have suggested that coupling standard fitness trackers with gamification and competition among peers can engage youth in physical activity. Online communities can provide curated educational programming, video coaching, and on-demand evidence-based tools, helping children and families navigate the complexities of healthcare and make informed decisions while building meaningful connections. Some research suggests online gaming platforms can positively impact cognition when deployed in the right setting.
Of course, there are very real issues surrounding consent, potential transmission of confidential health data, age-appropriate content restrictions, and inappropriate disease-specific algorithms that deserve careful attention. Yet, we need to treat these as hurdles to overcome, rather than excuses to never run the race.
Pioneers in the medical technology field have reimagined care delivery. Can we harness online platforms and social media for health promotion in the same way? Device developers quickly learned that children face unique challenges compared with adults. Collaborations between children’s hospitals as well as among providers forced companies to recognize that partnerships between industry and clinicians are essential to recognize the unique characteristics of children and ensure companies are focused on evidence-based outcomes that improve health — rather than compromising it.
While some tech leaders have expressed commitment to inclusive design and global representation, nuanced, safety-focused design is often viewed as throwing “sand in the gears” of fast-moving, over-promised product roadmaps. Online platforms historically have been loath to form these partnerships with providers, but they need to flip that narrative to make children’s health the priority. True progress in children’s digital health demands systematic collaboration across healthcare, technology, and community sectors, with clear accountability measures to ensure children’s health takes priority over market pressures.
Acting in the best interest of kids when designing and operating social media platforms shouldn’t feel like a violation of the First Amendment. These tools have enormous potential to impact our children, yet their development routinely leaves kids out of the conversation. It is no longer acceptable to simply tell children to avoid all online platforms, but it is also inappropriate to ignore the risks. Careful thought must guide the collaborative design of solutions that help kids grow into the healthiest versions of themselves.
Jeff Vergales, MD, MS, MBA, is a pediatric cardiologist at UVA Health, and director of clinical innovation at the University of Virginia School of Medicine in Charlottesville. Amy Molten, MD, is a pediatrician with Tufts Medical Center in Boston, and a health technology startup executive, advisor, mentor, and educator. Lindsay Stevens, MD, is a pediatrician and clinical informaticist with Stanford Children’s Health, and a Clinical Professor at Stanford University School of Medicine in Palo Alto.
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