Anthony is a 17-year-old young man who was brought to my clinic by his mother for behavioral concerns.

“He’s spending more and more time alone in his room”.

Anthony sits on the exam table with his shoulders slumped, eyes down, fidgeting with his hands.

“I don’t know why she brought me here. I’m fine.” he says.

He looks tired, so I ask about how he’s been sleeping. Before he can answer, his mother chimes in, “He stays up all night on his iPhone.” She shares that when she has tried to restrict his phone use, she later awakens to find him hiding in his bed under the sheets staring at the screen.

“It’s not that bad, some of my friends don’t go to bed until 2:00 in the morning!” he argues.

“Are you tired?” I ask him.

“Nah, I just drink a Red Bull and I’m fine.” he replies. His mom contends that he often sleeps in, is late for school, and he has also been falling asleep after school.

As his mom starts to tear up, he admits “I do feel bad because my mom keeps getting letters from school when I’m late and it’s stressing her out. I tried to cut back on using my phone at night, but I just can’t seem to stop. All my friends are texting and posting. I don’t want to be left out. I want to know what’s going on and that keeps me up.”

His mother shares that his teacher is concerned about his failing grades, poor concentration and how he constantly has his phone out during class. “What?” he interjects. “Everyone else is on their phones too! It’s not my fault that TikTok memes are more interesting than math!”

I notice that he has gained a lot of weight since our last appointment. He discloses that sometimes he just doesn’t have an appetite all day, but late at night he gets so hungry that he devours a party-size bag of chips and it’s gone before he realizes it. He has also stopped playing soccer, which he used to love. “I don’t know. It just got boring,” he sighs.

When you inquire about what he likes to do instead, he replies “I usually just hang out in my room. I don’t really feel like going out.”

Mom is concerned about his growing isolation; he admits to feeling lonely and sad most days. I ask his mom to wait outside the clinic room so we can talk privately for a few minutes. He confides in me that he has found some “stuff” online about ways he could kill himself and he revisits the sites occasionally. But he sighs, “I wouldn’t ever do it because I wouldn’t want to put my mom through that. I know how much she loves me and how much it would hurt her.” He estimates using his phone for about 4 hours per day. I show him how to check his screen time on the phone then we check it together. The phone reports an average of 8.5 hours per day with YouTube, Snapchat and TikTok being the most utilized apps. He shrugs his shoulders and mutters… “Hmmm.”

Anthony, his mother, and I discuss the importance of healthy tech habits. We explore creating a Family Media Plan using HealthyChildren.org. I inform them that creating a Family Media Plan is a way to set media priorities that matter most to their family. The Family Media Plan includes a list of media priorities to choose from, practical tips to help make the plan work, and options to save/edit the plan. Since media habits are different for every household, the Family Media Plan can be customized to meet each family's needs. Mom admits that this will also help her with her own phone habits.

Today, the average 8- to 12-year-old uses about 5.5 hours of screen media per day and 13- to 18-year-olds use about 8.5 hours of screen media per day (1). If Anthony continues to use his phone at his current rate, for the rest of his life (presuming he lives until he is 90 years old), he would spend over 25 years recreationally staring at a screen. A growing body of research is linking excessive screen time, specifically social media, with poor sleep, anxiety and depression (2) and increased risk of obesity among children(3)(4). Anthony meets criteria for depression, and his cell phone is likely implicated in most, if not all of his symptoms. There is an opportunity cost to screen time, and that cost is the health and happiness of young patients, as it displaces their physical activity and social connection. Physicians must consider screen time as a key environmental factor when addressing mental health issues and lifestyle modification in the treatment of childhood obesity.

In my experience as a pediatrician, partnering with other physicians, mental health specialists, schools, local government, and community organizations is essential to raising awareness of the potential harmful impacts of screen time use. I recently co-founded TechWise SB, a grassroots collaborative comprised of pediatricians and mental health professionals working to support Santa Barbara children in establishing healthy relationships with screen-based technology. Together we are educating the community and advocating for effective policy, systems and environmental changes to create healthier and happier online experiences for youth.

1. Gibson, A. Common sense census: Media use by Teens & Tweens, 2021. CASSY. https://cassybayarea.org/common-sense-census-media-use-by-teens-tweens-2021/#:~:text=On%20average%2C%208%2D%20to%2012,more%20than%20their%20white%20peers.

2. Woods, H. C., & Scott, H. (2016). #Sleepyteens: Social media use in adoles-cence is associated with poor sleep quality, anxiety, depression and low self-esteem. Journal of Adolescence. 51, pp. 41-49. https://onlinelibrary.wiley.com/doi/full/10.1016/j.adolescence.2016.05.008

3. Pérez-Farinós, N., Villar-Villalba, C., López Sobaler, A.M. et al. The relationship be-tween hours of sleep, screen time and frequency of food and drink consumption in Spain in the 2011 and 2013 ALADINO: a cross-sectional study. BMC Public Health 17, 33 (2017). https://doi.org/10.1186/s12889-016-3962-4

4. Mihrshahi, S., Drayton, B.A., Bauman, A.E. et al. Associations between childhood overweight, obesity, abdominal obesity and obesogenic behaviors and practices in Aus-tralian homes. BMC Public Health 18, 44 (2018). https://doi.org/10.1186/s12889-017-4595-y

Dr. Kristen Hughes is a general pediatrician caring for low-income, racially and ethnically diverse population in Central California. During the COVID pandemic, she became acutely aware of excessive screen-time’s adverse health effects on children and teens. She has since founded a grassroots collaborative of physicians and mental health pro-viders, to raise awareness, provide education and effect systemic change in local school districts.