Approaches to children’s smartphone and social media use must go beyond bans
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj-2024-082569 (Published 27 March 2025) Cite this as: BMJ 2025;388:e082569
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Dear Editor
The topic of social media and its corrosive effect on the minds of teenagers has been brought into sharp focus in the last month with the airing of ‘Adolescence’ on Netflix. The story of a disenfranchised young male whose cultural isolation and vulnerability results in him being preyed upon by the dark forces of the internet to a murderous cost. Look at any group of teenagers in public spaces, how many will be looking around them, how many will be scrunched into their phones?
As a GP our mental health consultations with teenagers and young adults are on the rise. Depression, lack of meaning and body dissatisfaction are part of the main topics. Female teenagers' mental health has especially plummeted in the last ten years with the rise of hospital admissions steeply rising (112.8% in 2021-22) for self-harm and suicidality. (1) Females who have a screen time of more than 5 hours a day are three times more likely to be depressed than those who don’t.
There are louder and louder voices asking the question about whether the rise and availability of smartphones and internet are contributing to this. Studies are finding that 11 year olds can spend up to 9 hours a day on their phones. A Children’s Commissioner Survey found that 27% of British 11 year olds (2) have seen online pornography (without necessarily having actively searched for it) and there have even been tragic accidental deaths from being swept up in the latest online crazes (3).
Long term use of social media can lead to social deprivation, sleep deprivation, attention fragmentation and even addiction. One study in the USA estimates that teenagers receive on average 140 notifications a day. (4) Increasingly monetized, its main priority now seems to be to keep our eyes on screen to allow its adverts to grab our attention. ‘Enrage to engage’ (5) has been coined as an internal strategy to keep us looking. It is known that creating a strong emotional reaction will hold our attention more. Cynically using a Variable – Ratio Schedule of notifications, it manipulates its users to seek ever more feedback.
Jonathan Haidt describes, in his insightful and disturbing book ‘The Anxious Generation,’ (6) that we are raising a generation of children who are overprotected in the physical world and under protected virtually. Children are given less space to roam unsupervised and yet seemingly can go where they want to online. He hypothesizes that this leads to a deep lack of confidence in their ability to make their own decisions but also the constant sense of danger that being online can bring. It is estimated that at least once a day 14 year olds see something that deeply upsets them on social media. (7)
The teenage mental health consultation can often be one of the most unsettling. This can be a result of the difficulty to bridge the age gap to come onto their level, the lack of understanding of their world and pressures both from professional and parent, and the limited options of referral and support due to limited mental health resources. There are many anecdotal stories of young people reporting to actively harming themselves to speed up access to support.
There needs to be a serious debate now about the age of access for social media. Just as in other big profit industries such as Tobacco, Alcohol, Oil and Ultra Processed Food, we know historically that they cannot be trusted to regulate itself. The government needs to make a strong stand on this, or risk a generation of young people utterly failed by those who are entrusted to protect them.
1. Ward JL et al. Admission to acute medical wards for mental health concerns among children and young people in England from 2012 to 2022: a cohort study. Lancet Child and Adolescent Health Volume 9, Issue 2, p112-120, February 2025.
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(24)00333-X/fulltext#:~:text=Increases%20were%20particularly%20steep%20in,5%25)%20all%2Dcause%20admissions
2. https://www.childrenscommissioner.gov.uk/blog/growing-up-with-pornograph....
3. Lancaster: Inquest into 'social media craze' death of boy opens - BBC News
4. www.statista.com/statistics/1245420/us-notifications-to-social-app-ios-u...
5. Stolen Focus. Hari, Johanne. Bloosmbury 2022
6. The Anxious Generation. Haidt, Jonathan. Penguin 2024
7. https://www.bbfc.co.uk/about-us/news/half-of-children-and-teens-exposed-...
Competing interests: No competing interests
Dear Editor
In their initial study Goodyear et al recognise that there is an association between higher levels of time spent on smartphones and worse levels of mental health, sleep and educational achievement, yet state that smartphone bans in schools don’t work. In the latest study, this is expanded and in addition bans and age restrictions are just “stop gaps”.
The smoking ban is discussed as effective for where there is good evidence that a harmful substance causes extensive and clear-cut harms and that the harms outweigh the benefits. With the growing evidence of rates of worsening mental health, climbing rates of selfharm and suicide and eating disorders, I would agree that this is exactly the type of ban we need – specific restrictions, clear age restriction and health warnings visible on the product.
In addition, Goodyear refers to the use of seatbelts in cars as a successful public health response. I would totally agree. To drive a car an individual must be of a responsible age, with training with legislated safety features used. To drive without these the individual faces penalties and legal consequences due to the risk of harm to self and others. Apply this to smartphones, where a child can currently access harmful pornography or self-harm content which may harm their mental, development and physical health and compare to the seatbelt analogy – an older teen who has been suitably protected and educated about online risks and is able to navigate their smartphone safely at the right age, who does not face these risks due to age-appropriate access, education and safety restrictions.
Goodyear appears to suggest that social media is a life skill – whilst technology and digital literacy is clearly required, social media is not and allowing access to platforms which perpetuate self-harm and suicide content is of no benefit to a developing child.
Finally, using the rights-based approach only re-iterates weak arguments. The clear message from the UNCRC states that children have the right to be protected from sexual exploitation and abuse, protected from mental or physical violence and supported in recovery from harm. The current online set up is failing our children and is in direct contravention to the UNRCR.
Competing interests: No competing interests
Dear Editor,
Goodyear et al accept that 'increased time spent on phones and social media is generally linked with worse physical, mental, and educational outcomes', but argue that 'simply restricting access to devices can undermine children’s rights to technology design and education that will help them thrive as adults in today’s world'. In the article they argue this from a children's rights perspective, which appears valid.
I would offer an alternative view from the perspective of an occupational physician, an area of medicine that specialises in risk assessment and protecting people (usually employees) from hazards. I would ask if the authors are familiar with the concept of the 'hierarchy of controls', which is a well understood model within the health and safety industry for risk mitigation. The hierarchy (in order of effectiveness from most to least) is:
1) Eliminate the hazard
2) Substitute (replace the hazard)
3) Engineering controls (isolate people from the hazard)
4) Administrative controls (change the way people work with the hazard, for example through education or reducing time each person spends on hazardous task)
5) Personal protective equipment (individual protections)
Under the Health and Safety at Work etc. Act 1974, and subsequent Management of Health and Safety at Work Regulations 1999, employers are expected to undertake adequate risk assessments to identify potential hazards and to mitigate risk where possible by applying the hierarchy of controls. It's worth also noting that the law sets out duties employers have, not just to their employees but also to members of the public (including children at school).
The Health and Safety Executive provide specific advice for schools on applying the law (see https://www.gov.uk/government/publications/health-and-safety-advice-for-...) which states clearly 'Pupils should be safe in school'.
It does appear that in the case of smartphone use by children (and particularly in the school environment) there is increasing evidence of hazard and potential harm, yet the appropriate approach to risk mitigation (i.e. to eliminate the hazard where possible) has been set aside for a preference to place administrative controls (such as education and recommendations of individual behaviour change). In the longer term, I am sure that improved product design (i.e. engineering controls as per the hierarchy) will be possible but for the time being it appears that duties under the health and safety legislation are not being adequately balanced against the rights of the child identified in the article.
In workplace settings, we often have to balance safety against individual rights (for example the rights of a disabled employee to work in safety critical role, where their safety and that of others may be affected by their disability) and it is almost always the health and safety legislation that takes precedence.
I completely agree that the rights of the child must be considered in this complex area of policy, but we must not forget that most rights are relative and need to be held in balance with others.
We cannot rely on some future protections to keep safe the children of today, and if elimination (i.e. banning social media or devices below a certain age) is the best mitigation available currently then I would congratulate the jurisdictions who have been early adopters of such measures. We won't get a second chance to protect the youth of today.
Kind regards,
Dr Chris Edmond
Competing interests: No competing interests
Re: Approaches to children’s smartphone and social media use must go beyond bans
Dear Editor
In the introduction to their paper Goodyear et al report that the overall health effect of smartphones and social media on children is “not clear cut” [1]. They seem to imply that the standard of the criminal justice system of “beyond reasonable doubt” needs to be achieved before public health intervention rather than the more usually applied civil judicial threshold of “balance of probabilities”[2].
The difficulty in analysing scale of risk and harm, especially in children, is the issue of biological and psychological heterogeneity as well as balancing the level of the benefit against the severity of the harm. In addition to this social media is a rapidly evolving and changing landscape with both new products appearing and new features being added to existing products. For example the Royal Society for Public Health’s (RSPH) report [3] into this topic in 2017 did not include “Tik Tok” which by 2023 had become the second most popular site used by UK children (53%) [4].
A recent household survey conducted by the Central Statistics Office (CSO Ireland) showed that amongst 18-29 year olds, 64% felt social media had a negative effects on their mental health as opposed to just 6% who reported a beneficial effect [5]. So while some reported benefit this is overwhelmed by those reporting harm.
The commonly reported health benefits of social media are accessing information, support, identity expression and wellbeing [3] which are thematically similar to what the authors quote. However the harmful impacts are often of a categorically higher degree of severity such as sexual exploitation [6], suicide [6], mental health disorders [6] and an increase in disordered eating behaviours [7] amongst others. This difference in outcome between benefit and harm is exacerbated by the fact that most of the benefits could be achieved through non algorithmically-driven digital platforms (i.e. web-sites) or off-line (help-lines), while the harms are mostly unique to the technology of social media.
The exposure of youth to pornography is a paradigmatic exemplar. While a number of adolescents may report it provides entertainment the associated increase in harmful sexual attitudes and behaviours surely outweigh this trivial benefit irrespective of the numbers on either side [8].
Finally, as a paper grounded in a rights based framework it is astounding that they authors do not acknowledge that the engagement of a child with commercial, profit driven, algorithmic-enabled social media should remain a choice and not the accepted default position. There are a number of valid reasons that an individual might not wish to use social media, such as “poor use of time, preference for other forms of communication, preference for engaging in other activities, cyber-safety concerns, and a dislike of self-presentation online” [9].
In my opinion the greatest infringement upon the human rights of children today is experienced not by restrictions imposed by adults but social norms imposed by peers upon those that force unwilling participants into the “influence of peer groups who socially compel addictive behaviours” [10]. Too often the avoidance of FoMO” (Fear of Missing Out) [3] is benignly seen as a valid reason or benefit of social media usage rather than the glaring example of peer group coercive control that it is.
Goodyear et al are right in asserting that digital technologies are here to stay and for children to prosper they need digital literacy skills. It is possible to stay connected, informed and productive on line without exposing oneself to the significant harms of algorithmically-controlled social media sites and this should be the focus of public policy and education. As Thomas Paine once wrote “A long habit of not thinking a thing wrong, gives it a superficial appearance of being right”.
References:
1 Goodyear VA, James C, Orben A, Quennerstedt M, Schwartz G, Pallan M. Approaches to children’s smartphone and social media use must go beyond bans. https://doi.org/10.1136/bmj-2024-082569
2 Williams CR Burdens and Standards in Civil Litigation. Sydney Law review 2023 accessed on 02/04/2025 https://posh.austlii.edu.au/cgi-bin/viewdoc/au/journals/SydLawRw/2003/9....
3 Royal Society for Public Health. #StatusofMind Social media and young people’s mental health and wellbeing. 2017. https://www.rsph.org.uk/static/uploaded/d125b27c-0b62-41c5-a2c0155a8887c...
4 Ofcom Children and Parents: Media use and Attitudes. 2023. https://www.ofcom.org.uk/siteassets/resources/documents/research-and-dat...
5 Central Statistics Office COVID-19 Our Lives 5 Years On Social Impact. 2025. https://www.cso.ie/en/releasesandpublications/fp/fp-c19si/covid-19-ourli...
6 Ghai S, Magis-Weinberg L, Stoilova M, Livingstone S, Orben A Social media and adolescent well-being in the Global South. Curr Opin Psychol 2022; 46:101318. doi:10.1016/j.copsyc.2022.101318 pmid:35439684Negata JM, Zamora G, Al-Shaoibi AAA,
7 Dahlgren CL, Sundgot-Borgen CS, Kvalem IL, Wennersberg AL, Wisting L. Furher Evidence of the association between social media use, eating disorder pathology and appearance ideals and pressure: a cross-sectional study in Norwegian adolescents. Journal of Eating Disorders 2024 https://doi.org/10.1186/s40337-024-00992-3
8 Government Equalities Office, Women and Equalities Unit. The relationship between pornographt use and harmful sexual attitudes and behaviours: literature review. 2021. https://www.gov.uk/government/publications/the-relationship-between-porn...
9 Baker RK, White KM In their own words: why teenagers don’t use social networking sites. Cyberpsychol Behav Soc Netw 2011 https://doi.org/10.1089/cyber.2010.0016
10 Adjorjan M, Ricciardelli R. Smartphone and social media addiction: Exploring the perceptions and experiences of Canadian teenagers. Canadian review of Sociology 2021 https://doi.org/10.1111/cars.12319
Competing interests: No competing interests