At our 2025 Spring Refresher continuing medical education conference in April, Joshua Stein, MD, presented on social media and teen mental health — a session responding to a past MAFP member resolution calling for more education on the topic.
Stein is a child and adolescent psychiatrist, serving as clinical director at PrairieCare Brooklyn Park Partial Hospital Program and as a consultant for the award-winning Psychiatric Assistance Line (PAL).
This summer, we followed up with him to provide guidance for family physicians on integrating digital health check-ins into clinical practice.
Why talk about digital health at checkups?
STEIN: Remember The Lion, the Witch and the Wardrobe? The kids step through a wardrobe into another world, live whole lives as royalty and return to find only moments have passed in the “real” world. Phones and social media can act like that wardrobe — kids enter a world adults often can’t fully see, much of it safe, but some exposing them to adult situations earlier than expected.
Online interactions can bring shame or guilt or conflict with family values, and kids may not know how to process them. Technology evolves so quickly that parents and clinicians can struggle to keep up. That’s why digital health — conversations about social media use, online safety and mental well-being — should be part of every checkup, just like school, sports, substance use and growth.
When should these conversations start?
STEIN: With our youngest patients. Just as we discuss car seat safety before a newborn leaves the hospital, it’s important to think about healthy technology use early.
Parents set the tone by modeling their own device use. These early conversations help families establish healthy patterns from the start.
The goal isn’t to spend an entire visit on the topic but to give families a framework they can use day to day.
What are the risks of heavy social media use?
STEIN: Excessive time on social media, smartphones and screens correlates with declining mental health, including more anxiety, depression, negative body image, self-harm and suicidal thoughts.
When kids spend more time watching other people’s curated, “perfect” lives, they lose opportunities for real-world exploration — playing with peers, talking with relatives, creating something new. Constant highlight reels fuel comparison and unrealistic expectations.
We’re also seeing attention changes. Quick-hit content — reels, snaps, short videos — can make it harder to sustain focus, practice delayed gratification or enjoy reading.
At stake are some of the best parts of being human: creativity, imagination and action.
What warning signs should physicians watch for?
STEIN: Parents who struggle to set limits, have given up or aren’t aware limits are important. About 14% of kids report being “constantly” on social media. Kids under 13 with smartphones often show worsened mental health, and older kids with unrestricted access can struggle as well.
Is there a recommended amount of screen time?
STEIN: There’s no universal guideline — it’s a family decision. Ideally, we’d want kids to avoid social media until age 16, but that’s not always realistic.
The focus should be on preparing, teaching and supporting kids so they build healthy habits, without making social media feel like a forbidden fruit.
Who is responsible for supporting healthy technology use?
STEIN: It’s not just parents.
Former Surgeon General Vivek Murthy, MD, issued the advisory “Social Media and Youth Mental Health,” highlighting risks and calling on tech companies and government to act. Companies can design products that engage users without being purely profit-driven, and policies can be implemented to better protect kids’ mental health.
Read the advisory at www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf.
How can physicians raise the issue during visits?
STEIN: Ask families:
- Do you have concerns about your own or your child’s social media use?
- Has your child been targeted online or exposed to inappropriate content?
Bringing these questions into routine visits — just as we do for lead exposure or firearms — helps normalize the conversation and makes digital health a standard part of care.
How can we help parents understand their child’s online world?
STEIN: Almost everything now has a social media component, even if a child isn’t on TikTok or Snapchat. They might be in a fantasy football league, playing Minecraft or using Roblox, all of which can include sharing images, memes or teasing. Parents should treat digital platforms like any tool: They carry privileges and risks.
Just as you wouldn’t give car keys to a 16-year-old without rules and safety guidelines, digital tools should be handled the same way. Clear family rules and expectations help kids develop healthy, responsible habits.
What questions help teens reflect on their own use?
STEIN:
- What are your friends doing online? And what about you?
- Use the “Four U’s”: Have you ever felt uncomfortable, uncertain, unwell or unsafe because of something online?
- Have you ever felt at risk, identified, scared or embarrassed?
- You can also flip the focus: “Do your parents ever struggle with phone use?” Kids usually answer yes. Follow up by asking, “Do phones get in the way of your family having fun together?”
What if parents don’t see a problem but harm may exist?
STEIN: That’s tricky. The disconnect may show up as depression, anxiety, body-image concerns or frequent arguments.
Referral to therapy can help. Families may need structured support to reconnect and reestablish balance — learn how to be present together, share experiences and connect beyond their devices.
The American Academy of Pediatrics Family Media Plan is a useful tool. It helps families create a living document covering screen limits, online safety, shared experiences and privacy. It can even be used in family therapy sessions.
It also helps to reflect observations in real time: “Even during today’s visit, your son has been on his phone, and you’ve checked yours a few times. We’re all pulled to our phones, but I worry this is taking over.” That can plant a seed, even if parents are defensive. Keep the door open; families often return when they’re ready.
What resources can help families?
STEIN:
- Family Media Plan: www.healthychildren.org/English/fmp/Pages/MediaPlan.aspx
- Surgeon General’s Advisory: www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf
- Monitoring tools: Services like Aura or Microsoft’s Family Safety offer walkthroughs for monitoring devices, blocking adult content or managing Wi-Fi access. (This is not an endorsement; many services arefor-profit.)
Anything else to add?
STEIN: If concerns go beyond screen use, family therapy can help.
Physicians can also consult the Psychiatric Assistance Line (PAL) for free, real-time guidance with a psychiatrist, whether for general advice or a patient in crisis. Consults are scheduled at times that work for physicians and prescribers: www.mnpsychconsult.com.
Originally published in Minnesota Family Physician.