Too much screen use among kids and teens – including endless social media scrolling, nonstop texting and hours of video games – can be harmful, and it has become a public health concern in the United States, according to a surgeon general’s advisory released Wednesday.
Officials at the US Department of Health and Human Services collaborated on the new advisory, as there is no confirmed surgeon general within the Trump administration.
The advisory warns that exposure to screens often begins before a child’s first birthday and increases with age.
By adolescence, children may spend more time on screens than they spend sleeping or attending school, the report said.
The advisory notes that the amount of time spent on screens reaches an average of four or more hours per day by the time a child becomes a teenager – and nearly half of adolescents admit that they lose track of the amount of time they spend on their phones.
Screen use can be associated with worse sleep, decreased functioning in school, less physical activity and weakened in-person relationships, according to the advisory.
Along with the warning on the harms of screen use, the new advisory includes a toolkit that offers recommendations on how to identify harmful behaviors around screens and how to limit screen time. For instance, it suggests that limits could be no screen time for children under 18 months old, less than one hour per day for children under 6 and two hours per day for ages 6 to 18.
Screen time warnings and recommended limits aren’t new. A policy statement from the American Academy of Pediatrics acknowledges that the amount of screen time per child could vary based on each family, their needs and school nights versus weekends – but time limits might range from less than one hour per day for toddlers and preschoolers to about one to two hours per day or more for school-age children and teens, not including school-related media.
“While screen use can have some benefits, the evidence of a range of risks to children’s overall mental and physical health is mounting,” US Health and Human Services Secretary Robert F. Kennedy Jr. wrote in the opening pages of the new advisory.
“Social media is only one aspect of this ongoing screen time problem. Behavior patterns involving gaming, online gambling, and other forms of virtual interaction are emerging. While this report uses ‘screen time’ as a widely understood shorthand, we want people to understand that we are referring to the entire digital ecosystem of apps, smartphones, tablets, chatbots, and other screen-associated devices and interfaces,” Kennedy said. “This Advisory is not only a warning, but also an invitation for all of us to enjoy a broader world, beyond the confines of screens.”
The advisory includes “calls to action” that provide recommendations for kids and teens, families, schools, healthcare professionals, policymakers and technology companies – including stronger parental tools, school-based phone restrictions and product design changes by technology companies.
Among these “calls to action,” the advisory recommends:
- Youth track their screen time, take breaks and create boundaries.
- Children complete all other activities, such as homework or extracurriculars, before screen use.
- Parents create a family media plan that covers who can use what screens, where, when, which content and for how long.
- Schools implement cell phone policy restrictions and prioritize assigning work in books or on paper to limit screen use.
- Healthcare providers include questions about screen use in annual well-child visits.
- Researchers study long-term impacts from screens and evaluate school cell phone policy bans or restrictions.
- Policymakers pursue laws that provide parents with controls, demand child safety and privacy protection.
- Tech companies display warnings about harmful screen use and adhere to and enforce age minimums.
- ‘It’s not one size fits all’
Some experts say they appreciate the Trump administration’s warnings on screen use and children’s health, but others emphasize that not all screen use is harmful, and in some cases, it can have benefits for children when used for educational purposes or to find belonging within communities.
Surgeon general’s advisories serve as some of the government’s strongest public health statements, designed to draw attention to issues that require immediate awareness and action. They often provide recommendations for how the issue should be addressed.
The latest advisory comes at a time when the United States has no surgeon general at all. Trump’s pick for the job, Dr. Nicole Saphier, a radiologist at Memorial Sloan Kettering Cancer Center, awaits a confirmation hearing, so the report was authored by a leadership team of HHS officials.
The new advisory was developed to build on the framework established by first lady Melania Trump’s “Be Best” initiative, which focuses on issues affecting children, including social media and cyberbullying.
The advisory includes strategies organized around five “Ds” to help reduce the negative impacts of harmful screen use:
- Discuss healthy screen use with household members.
- Do model the healthy screen use behaviors you would like to see.
- Delay screen time from the earliest age as long as possible and then establish age-appropriate screen time limits.
- Divert attention from screens to other healthy activities, such as physical activity.
- Disconnect from screens regularly.
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Earlier this year, the American Academy of Pediatrics updated its guidance around screen use to help families navigate the digital media landscape and “move beyond simple screen-time limits and focus on quality, context and conversation,” to foster a healthy relationship with screens.
The new surgeon general’s advisory mirrors many of those recommendations, including creating a family media plan and modeling healthy media habits. The American Academy of Pediatrics also recommends employing the “5 Cs of Media Use,” which are for families to consider media in the context of their individual child, the content of media, how to stay calm or self-regulate around screens, and what other activities screens may crowd out and the importance of communication around screen use.
The relationship between screens and children’s health remains complex, said Dr. Courtney Blackwell, an associate professor of medical social sciences at Northwestern University Feinberg School of Medicine.
“That’s not to say on an individual level, some children in some contexts with some pre-existing conditions may experience some kind of challenges when it comes to screen use and mental health or physical health. But at the population level, the research is not definitive, I would say, to suggest screen time causes harm in and of itself,” Blackwell said.
Parents should not “panic” over their children’s screen time, she said, and she worries about the new advisory causing unintended stress.
“There can be positive uses of screen media, like ‘Sesame Street,’ and some kids find social support online, and they use it to connect with peers with similar identities at a time when identity development is critical in adolescence,” she said. “So it’s not just how long kids are spending on screens but really how they’re using it and the context of that use.”
Dr. John Mann, a professor of translational neuroscience at the Columbia University Vagelos College of Physicians and Surgeons, said public health warnings should more so focus on youth who exhibit “addictive” behaviors around screens – and not make blanket statements or recommendations for all children.
The new advisory describes how screen use may be harmful when a child “loses control” over it, such as showing symptoms of emotional withdrawal, or wants to stop but can’t and continues using screens despite negative consequences.
“What’s really more important is to assess to what degree is the adolescent addicted or shows addictive features in their use of their phone or social media,” Mann said.
In a study published last year in the journal JAMA, Mann and his colleagues found that higher levels of addictive screen use for social media and mobile phones among adolescents was associated with two to three times greater risks of suicidal behaviors and suicidal ideation compared with lower levels of use.
“If we look at it in that framework, what we should be doing is, we should be screening out those kids who show that and focus efforts of prevention on them, because the other group is not at risk,” he said. “It’s not one size fits all. It’s not the entire pediatric population or adolescent population of the United States that should be subjected to certain policies; it’s a subgroup of that population.”
Some experts argue that any guidance encouraging parents to consider and reduce their children’s screen time is going to be beneficial, said Kara Alaimo, a professor of communication at Fairleigh Dickinson University and author of the book “Over the Influence: Why Social Media is Toxic for Women and Girls – And How We Can Take It Back.” She added that she believes that herself.
“However, to some degree, screens affect different children differently, so it’s hard to take a one-size-fits-all approach. A lot depends on what a child is doing on a screen. Watching an educational program designed by early childhood education specialists is very different from consuming whatever YouTube’s algorithm serves up,” Alaimo said in an email.
“It’s also important to note that many 6-18-year-olds are already spending more than 2 hours per day on screens at school. No guidance is going to solve this problem unless it also includes a plan for reducing screen time at school,” she added. “The best recommendation would be for kids to avoid screens altogether. If you’ve ever tried to take a device away from a child, you’ve probably noticed it’s highly unpleasant. That’s because these devices are designed to get us all addicted. It’s far healthier for children to be playing, socializing, moving their bodies and getting outdoors.”
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New advisory, no surgeon general
Some people may question how a surgeon general’s advisory can be issued at a time when the nation has no confirmed surgeon general in place.
President Donald Trump initially picked Dr. Janette Nesheiwat, a New York family physician and former Fox News medical contributor, to serve as surgeon general for his second term. But her nomination was pulled just days before her Senate confirmation hearing last year. Wellness influencer Dr. Casey Means was then nominated, but last month, Trump pulled his nomination for Means amid questions over her vaccine views. He then announced Saphier as his third pick for the role.
Saphier is awaiting a confirmation hearing.
In the meantime, Assistant Secretary for Health Adm. Dr. Brian Christine has used his delegation of authority powers to allow HHS chief of staff and senior adviser Dr. Stephanie Haridopolos to carry out many of the duties of the surgeon general, including contributing to the development of the new advisory.
So until the next surgeon general is sworn in, Haridopolos is expected to promote surgeon general public health actions, advisories and guidance.
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