Skip to Content
A home for paediatricians. A voice for children and youth.

Digital media: Promoting healthy screen use in school-aged children and adolescents

Posted: Jun 6, 2019

The Canadian Paediatric Society gives permission to print single copies of this document from our website. For permission to reprint or reproduce multiple copies, please see our copyright policy.

Principal author(s)

Michelle Ponti, Digital Health Task Force

Paediatr Child Health 2019 24(6):402–408


Digital media are integrated into the everyday lives of children and adolescents, with potential benefits and risks for learning, mental and physical health, and for social life. This statement examines the cognitive, psychosocial, and physical effects of digital media on school-aged children and adolescents, with a focus on family routines, context, and activities. Evidence-based guidance for clinicians and families involves four principles: healthy management, meaningful screen use, positive modelling, and balanced, informed monitoring of screen time and behaviours. 

Keywords: Adolescents; Children; Development; Digital media; Family; Health; Screen use


Digital media are integrated into the everyday lives of children and adolescents, and health care providers are often asked about the effects of screen use on mental and physical health, and on family life. Current evidence shows that digital media differ in their impacts on cognition, psychosocial function and physical health, and that benefits and risks are nuanced. This statement provides evidence-based guidance for clinicians on promoting healthy screen use in school-aged children (5 to 12 years old) and adolescents (up to 19 years). It follows a previous CPS statement on preschool exposure to screens [1].   

A literature search of Medline and the Cochrane Library databases from January 2013 to February 2019 used the terms “digital media” OR “screen time” AND “physical health”, “mental health”, and “psychosocial”. Limits were applied for age (5 to 19 years), English language, and publication within the past 6 years, with a focus on journal articles, reviews, systematic reviews and meta-analyses. A search of the grey literature was also conducted, using paediatric and psychological association websites, reference lists, and information from screen research and advocacy organizations in Canada, Europe, and the United States.

Useful definitions

‘Screen time’ refers to time spent with any screen, including smart phones, tablets, television, video games, computers or wearable technology.

‘Digital media’ refers to content transmitted over the Internet or computer networks on all devices, unless particular ones are specified.

Harmful online behaviours, such as sexting and cyberbullying, are beyond the scope of this document. And although high screen use levels have been associated with underlying or, possibly, not-yet-diagnosed neurodevelopmental disorders [2][3], potential benefits and risks for this population also fall beyond the scope of this statement.


Three-quarters of Canadian parents are concerned about how much time children spend using media, reporting that 36% of their 10- to 13-year-olds spent 3 hours or more per day using digital devices for reasons unrelated to school work [4]. A national survey in 2013 reported one-third of students in Grades 4 to 11 are concerned about the amount of time they spend online [5]. However, school-aged children are increasingly required to use digital media at home and in school [6]. Media habits change throughout childhood [7], as time spent watching educational television (TV) peaks, typically in preschool, and entertainment TV, video games and social media take up more leisure time, usually by age 8 [7][8].

Potential benefits

  • Cable or online programs that are age-appropriate, co-viewed with family, and watched with purpose and limits, can be immersive, informative, screen experiences [9][10].
  • Screen media can improve children’s academic performance, enrich knowledge and literacy skills and help develop positive relationships with teachers and peers [11]-[13]. Screen-based programs and approaches can encourage both autonomous and collaborative learning, and stimulate inquiry [13][14]. Dynamic software and quality apps and games can increase proficiency and reduce learning gaps in mathematics [15][16].
  • Cooperative or competitive video games, played with family and friends, can reflect and function as traditional play, offering opportunities for identity, cognitive and social development [7][17]-[19]. Many children—especially boys—regularly socialize through games [5][7]. Some video gaming has been positively associated with increased sense of well-being, prosocial behaviour, and fewer conduct problems [19][20].
  • Recreational screen time at low levels (1 hour per day) has been associated with lower depression risk compared with no screen time [21].
  • Digital technology can help children make and maintain friendships, and early research suggests these relationships may be more diverse and gender-inclusive than those offline [22].  


  • Exposure to age-inappropriate or violent content, having a TV in the bedroom, and background TV can negatively affect development and behaviour [23][24]. Watching TV for more than 3 hours daily at 5 years of age predicted increasing conduct problems by age 7 [25]. Higher rates of recreational screen use are reported in children with higher depressive symptom levels and lower levels of physical activity [26].
  • Minority or marginalized students may have less access to quality Internet-based learning resources (which stimulate active, creative and critical engagement versus passive consumption), or the devices needed to access them [6]. Not all families or schools have the necessary resources to curate and limit children’s screen use. Economically disadvantaged and minority students and families consume significantly more media overall [27]-[29].
  • School-aged children often use a centrally located, shared family tablet or laptop at home for homework, gaming or socializing, but two recent Canadian surveys found they are often unsupervised [4][5]. Beyond lost opportunities to learn, play, and interact with family, solitary screen use greatly increases risk for exposure to negative or harmful content [4][5]. Also, research has shown that children may be overconfident about being able to protect themselves online [5].
  • Although dividing attention between two or more devices simultaneously (“media multitasking”) makes learning especially difficult [30], children 5 to 8 years old routinely try [31]. Multitasking has an immediate negative impact on both concurrent learning (in class or at home) and academic outcomes in children aged 12 and younger. It can disrupt reading efficiency, impair problem-solving and may undermine children’s confidence in their own ability to do homework [32]-[34].   
  • A stronger association between depressive symptoms and leisure-time screen-based sedentary activities is emerging from research in younger children, who appear to be more vulnerable to negative socio-cognitive outcomes from heavy screen use than teens [26][35].


Screen time remains a defining factor in the research of healthy media use. If high school students nationwide are like their peers in Ontario and Alberta, they spend more than 7.5 hours per day on various screens, with 20% of high-schoolers spending 5 hours or more per day on social media alone [36][37]. However, research suggests that teens are less susceptible to the negative effects of high screen time levels (i.e., over 6 hours per day) than younger children [17][21][38]. In adolescents, zero screen use or excessive use are associated with negative effects, while moderate use (typically reported as between 2 to 4 hours per day) is associated with some cognitive and psychosocial benefits [11][17][39][40][41]. The type (video game, TV, smartphone, computer) and timing (weekday or weekend) of screen use determined different effects on mental well-being in a non-linear fashion [39][42]. Content, context, and individual traits are other defining factors when assessing screen use effects. Evidence is not clear whether increased technology use may cause lower well-being or whether lower well-being results in increased technology use. There are likely unaccounted factors affecting both technology use and adolescent well-being [42]

The digital world can influence many adolescent milestones, including social connectedness with peers, sense of identity, independence from family, navigating the socio-cultural world, and developing autonomy [17][29][43]-[45]. However, being constantly online can contribute to feelings of alienation and social exclusion. Key developmental mechanisms of friendship and identity formation, such as self-disclosure [10][29][46][47] and experimenting with novel identities or roles, can influence online relationships either positively or negatively. One in 10 teens has reported ‘frequently’ using the Internet to ‘pretend to be someone else’ [44]. But most studies and surveys have found that adolescents communicate online with offline friends far more than with strangers and that, overall, their online behaviours and presentations of self closely mirror their offline activities, interests and personalities [44][48][49].

Parents often ask health care providers about the effects of screen time and technology use on family life. One cross-sectional analysis of 12- to 18-year-olds showed that although time spent on digital technology displaced face-to-face interactions with parents, it did not reduce quality of parent-child relationships [17][44][45][49]. More recent research suggests that when relationships are strong offline, newer technologies confer additional benefits [10][49][50], and frequent online contact appears to strengthen parent-teen relationships [44][50][51]. Parents report the biggest sources of conflict over media are the amount of time spent on screens and rules about when and how devices are used [4].

Potential benefits

  • Friendship is the leading motivator for adolescent life online, with older teens communicating most frequently with offline friends, and younger teens being more open to making new friends online [47]. Media use appears to improve self-concept in teens by enhancing perceived friendship quality [35][44][48][52]. Staying constantly “in touch” through texting, instant messaging and social networking is increasingly believed to fulfill a developmental “need to belong” [53].
  • Social media can be validating, when thoughts and experiences are shared with peers, or affirming, when teens get help to ‘bounce back’ from social rejection or isolation [44][54][55]. In a recent U.K. survey, 68% of teen respondents said they had benefited from social support online during tough or challenging times [39][56]. Social media sites can avert stigma and be safe, supportive places to explore sexuality and self-identity [48].
  • Positive effects on well-being, defined as positive emotions, psychosocial functioning and a sense of life satisfaction, are reported with moderate (around 2 to 4 hours per day) screen use [39].
  • Online communication may encourage isolated or socially anxious adolescents to engage in self-disclosure with peers and new contacts, which can enhance feelings of social connectedness and reduce depressive symptoms. These findings suggest that positive effects of communicating online may be stronger in adolescents who have less social support or are more uncomfortable socializing face-to-face [18][35][45]-[47][54][55][57]-[59]
  • Studies of action video game play in older children and teens have found short-term, game-specific increases in some cognitive skills, including attention, visual and representational processing [20][60] but also, notably, in executive function and visual spatial working memory [8][20][61]. Recent research increasingly links game play with enhanced well‐being, problem‐solving skills, positive intergroup relations, and physical activity [17][19][25][39][62][63].


  • Parental awareness of and involvement in their children’s online activities is a key moderator of excessive use and other risky behaviours [4][5][64]. However, at least one survey suggests that family rules governing screen use are declining, especially after Grade 7, for boys, and regarding meeting online acquaintances in person or visiting inappropriate sites [5].
  • Many adolescents report spending ‘too much’ time online. Half of teens in a large 2016 survey in the United States reported feeling “addicted” to their mobile devices [65]. Also, being the receiver (or sender) of instant messages with negative content has been correlated with internalizing symptoms of anxiety or depressive disorders [66].
  • There is a small but significant association between excessive screen time (more than 6 hours/day) and feelings of depression in teens [17][21][38]. One Dutch study found that adolescents having few or no close friends who passively ‘surfed’ (rather than connecting with people) online experienced more depression and anxiety over a one-year period [35]. For teens reporting stronger friendships, there was no such effect [17][35][38].
  • Frequent media multitasking has been linked to lower English and math scores, weaker working memory, lower sustained attention, and greater impulsivity in adolescents [32][61][67][68]. Over half of U.S. students have reported often or sometimes using social media while doing homework [69], and some research suggests that adolescents who are more prone to habitual multitasking may be the least able to learn effectively [61].
  • Studies have suggested that the time spent gaming matters, though only at very high levels.  Adolescents who spend more than 50% of their daily free time playing e-games have reported slight negative effects on overall well-being, as well as conduct problems, hyperactivity, peer problems and emotional problems [17][19]. Thus, when video game play exceeds a certain threshold, its positive influences diminish or disappear [17].
  • Because the adolescent brain is still learning to control impulses, regulate emotions and assess risks and consequences, adolescents may be developmentally predisposed to take risks online [70][71]. Socially anxious or depressed adolescents communicate online more often with strangers [46][53][54] and tend to self-disclose more [44]. Both boys and girls disclose personal information online [17][43][44]. A Canadian survey indicated that 43% of students in Grades 4 through 11 have engaged online with people they do not know offline, and 29% have posted their contact information (boys do this more than girls). Still, almost all boys (90%) and girls (89%) agreed with the statement “I know how to protect myself online” [5].
  • Parents perceive decreased family time and closeness in homes where many devices are used, and too much technology can erode family connectedness [49].


The most immediate risk to physical health associated with screens is from being distracted (texting or using headphones) while driving, walking, jogging, or biking. Research has consistently shown that screen use can adversely affect readily measured indicators of health [41], such as weight and sleep.  

Physical activity

While screen use alone may not directly displace physical activity (PA), research tends to confirm that already inactive adolescents spend more time using screens [17][41][72]. Current evidence also suggests that screen time impacts health more than overall sedentary time, but while longer and more frequent screen and TV viewing are significantly associated with unfavourable body composition and lower fitness measures [41][73], this relationship is not necessarily causal, nor is it consistent [41][74]. For example, while one Canadian study of 9- to 11-year-olds associated increased screen time with small reductions in PA and a slightly less healthy diet [75], a longitudinal study of 11- to 13-year-olds found screen-based sedentary behaviours not to be associated with less engagement in leisure time PA [17][76][77]. One recent longitudinal study of 14- to 24-year-olds found a positive relationship between moderate (1 to 4 hours per day) Internet use and participation in sports and clubs [78].


Compared with the mixed evidence of screen use effects on PA levels, the connections between eating or snacking while viewing [79]-[82] and weight gain are clearer [41]. In children and adolescents, TV viewing has also been inversely associated with fruit and vegetable consumption and positively associated with total energy intake, energy-dense drinks, snacks and fast food, with strength of association being small to moderate for children’s studies [83]. Several recent studies [83]-[89] have linked screen-based sedentary behaviour with unhealthy dietary intake. TV watching can suppress satiety signals [83], while fast food, sweetened beverage and restaurant ads contribute to intake [79]. Thus, diet and sedentary behaviour in young people may better explain associations between screen time and weight gain than displacement of PA [41][83].


Screens in the bedroom interfere with sleep duration and quality. While the number of bedroom TVs has declined in recent years, the presence of other screens has increased [75][79][89]-[91]. In 2014, 39% of Canadian students with cellphones (girls and boys) reported sleeping with them, including 51% in Grade 11, and 20% in Grade 4 [5]. Evidence is growing that newer technologies, along with TV, are displacing sleep time, causing emotional arousal, inhibiting melatonin release and disrupting sleep rhythms [44]. One study [92] found that trying to sleep near a TV (or with a TV in the room), and video or computer game play before bed, were all associated with shortened sleep duration and self-reported insufficient sleep or rest. Playing games on a mobile phone at bedtime was found to have the same effect [93].

Potential benefits:

  • Some screen activities promote PA. Studies have associated exergaming (e.g., Wii boxing) with increasing PA levels, energy expenditure, oxygen uptake and heart rate, as well as with raising percentage of total PA and reducing waist circumference and sedentary time [39][94]-[96].

  • Digital technologies that help to track PA, control weight and improve diet can promote healthy lifestyles [79][97]. Smartphone-based activities like geocaching provide motivation for PA [39]. One recent Canadian survey found that 20% of girls and 16% of boys sought information online for physical health issues [5], particularly during their high school years.  

  • Active video games can increase PA and decrease obesity measures in the short term, especially when part of a comprehensive weight control program and played as a team [79].


  • Texting while driving is a serious danger and an all-to-common practice among older adolescents [66]. In a recent survey, over 33% of students in Grades 10 to 12 reported texting while driving at least once in the past year. By Grade 12, this percentage had climbed to 46% [98].
  • The relationship between screen media exposure and obesity risk in children and adolescents depends on multiple (though modifiable) factors: sedentary behaviours, time spent on screens, eating while viewing, food and beverage advertising, and shorter sleep duration [79][99].
  • Having media in the bedroom is associated with increasing sedentary time, obesity risk, cardiometabolic risk, lower PA rates and shorter sleep duration [100].
  • Delayed bedtime and shorter sleep duration are consistent across media type and age group, with associated negative effects on learning, memory, mood and behaviour [101].
  • Even children who are not excessive screen media users have reported experiencing eye problems, headaches, not eating, and fatigue [102]. Canadian ophthalmologists recently emphasized the need for regular breaks from prolonged screen use, limits based on age and need, and a screen-free hour before bedtime [103].
  • Repetitive strain injury or musculoskeletal complaints are starting to be seen more commonly in clinical practice. 
  • Frequent sending and receiving of instant text messages can interfere with sleep [98][104][105]. Children may be more vulnerable than teens to physiological responses from central nervous system arousal and sleep disruption [26].
  • There is a correlational link between social media use and appearance anxiety, body image concerns, and disordered eating in adolescents [105]-[107].


Families, and children or adolescents within families, have different digital media considerations. While the physical and mental health issues associated with screen use are a routine part of counselling during health care visits, research examining direct impacts or causality is ongoing.

Health care providers can promote healthy digital media use by counselling every family to remember four essential ‘Ms’:  

MANAGE screen use. Advise parents to:

  • Make and regularly review or revise a Family Media Plan, including individualized time and content limits.
  • Continue to be present and engaged when screens are used and, whenever possible, co-view and talk about content with children and teens.
  • Discourage media multitasking, especially during homework.
  • Learn about parental controls and privacy settings
  • Obtain their child’s or teen’s passwords and login information for devices and social media accounts, to help ensure safety online and to follow online profiles and activities if concerns arise.
  • Speak proactively with children and teens about acceptable and unacceptable online behaviours.

Encourage MEANINGFUL screen use. Advise parents to:

  • Prioritize daily routines, such as interacting face-to-face, sleep, and physical activity over screen use.
  • Prioritize screen activities that are educational, active, or social over those that are passive or unsocial. 
  • Help children and teens to choose developmentally appropriate content and to recognize problematic content or behaviours.
  • Be a part of their children’s media lives. For example, join in during video game play and ask about their experiences and encounters online.
  • Advocate for schools, child care centres and after-school programs to consider developing their own plan for digital literacy and screen use.

MODEL healthy screen use:

  • Encourage parents to review their own media habits, plan time for alternative hobbies, outdoor play and activities.
  • Remind parents and adolescents of the dangers of texting or using headphones while driving, walking, jogging, or biking.
  • Encourage daily “screen-free” times, especially for family meals and socializing.
  • Ask whether screens are “off” when not in use, including background TVs.
  • Remind parents and teens to avoid screens at least 1 hour before bedtime and discourage recreational screen use in bedrooms.

MONITOR for signs of problematic screen use at any age, including the following:

  • Complaints about being bored or unhappy without access to technology.
  • Oppositional behaviour in response to screen time limits.
  • Screen use that interferes with sleep, school or face-to-face interactions.
  • Screen time that interferes with offline play, physical activities or socializing face-to-face. 
  • Negative emotions following online interactions or video games or while texting [108].

Let parents know that the occasional occurrence of these signs may be expected, and does not necessarily indicate problematic screen use.


The development of this statement was made possible through an unrestricted grant from TELUS Wise. This statement was reviewed by the following Canadian Paediatric Society committees: Mental Health and Developmental Disabilities, Community Paediatrics and First Nations, Inuit and Métis Health. Thanks also to Jennie Strickland, for statement drafting, and to Roxana M. Barbu, for reviewing the literature.


Members: Stacey Bélanger MD; Ruth Grimes MD (Board Representative); Janice Heard MD; Matthew Johnson (Director of Education, MediaSmarts); Mark Norris MD; Michelle Ponti MD (Chair); Alyson Shaw MD; Richard Stanwick MD, Ellie Vyver, MD; Elisabeth (Lisette) Yorke, MD.

Principal author: Michelle Ponti MD


  1. Canadian Paediatric Society; Digital Health Task Force. Screen time and young children: Promoting health and development in a digital world. Paediatr Child Health 2017;22(8):461-8.
  2. MacMullin JA, Lunsky Y, Weiss JA. Plugged in: Electronics use in youth and young adults with autism spectrum disorder. Autism 2016;20(1):45-54.
  3. Mazurek MO, Wenstrup C. Television, video game and social media use among children with ASD and typically developing siblings. J Autism Dev Disord 2013;43:1258-71.
  4. Brisson-Boivin K. The Digital Well-Being of Canadian Families. Ottawa, Ont.: MediaSmarts: 2018: (Accessed May 8, 2019).
  5. Steeves V. Young Canadians in a Wired World, Phase III: Life Online. Ottawa, Ont.: MediaSmarts, 2014: (Accessed May 8, 2019).
  6. Turner KH, Jolls T, Hagerman MS, et al. Developing digital and media literacies in children and adolescents. Pediatrics 2017;140(Suppl 2):S122-26.
  7. Gutnick AL, Robb M, Takeuchi L, Kotler J. Always Connected: The New Digital Media Habits of Young Children. New York, N.Y: The Joan Ganz Cooney Center at Sesame Workshop, 2010.
  8. Anderson DR, Subrahmanyam K; Cognitive Impacts of Digital Media Workgroup. Digital screen media and cognitive development. Pediatrics 2017;140(s2):S57-61.
  9. MediaSmarts. The Good Things About Television: (Accessed May 8, 2019).
  10. Coyne SM, Padilla-Walker LM, Fraser AM, Fellows K, Day RD. Media time = family time: Positive media use in families with adolescents. J Adolesc Res 2014;29(5):663-8.
  11. Council on Communications and Media. Media use in school-aged children and adolescents. Pediatrics 2016;138(5):e20162592.
  12. Molyneux P, Godinho S “This is my thing!”: Middle years students’ engagement and learning using digital resources. Australasion J Educational Technology 2012;28(8):1466-86.
  13. National Association for the Education of Young Children/Fred Roger Center for Early Learning, 2012. Selected Examples of Effective Classroom Practice Involving Technology Tools and Interactive Media.
  14. Bruce CD. What works? Research into practice: Research Monograph no. 38; Technology in the mathematics classroom: Harnessing the learning potential of interactive whiteboards. Literacy and Numeracy Secretrariat (LNS) and the Ontario Association of Deans of Education: Student Achievement Division, 2012.
  15. Boaler J, Chen L, Williams C, Cordero M. Seeing as understanding: The importance of visual mathematics for our brain and learning. J Appl Computat Math 2016;5(5):325.
  16. Clark K. Serving underserved communities with instructional technologies: Giving them what they need, not what you want. Urban Education 2005;40(4): 430-45.
  17. UNICEF Office of Research – Innocenti. How Does the Time Children Spend Using Digital Technology Impact their Mental Well-being, Social Relationships and Physical Activity? An Evidence-focused literature review. Florence: Innocenti, December 2017: (Accessed May 8, 2019).
  18. Granic I, Lobel A, Rutger CME. The benefits of playing video games. American Psychologist 2014;69(1):66-78.
  19. Przybylski AK. Electronic gaming and psychosocial adjustment. Pediatrics 2014;134:e716-22.
  20. Eichenbaum A, Bavalier D, Green CS. Video games: Play that can do serious good. American Journal of Play 2014;7(1):50-72.
  21. Liu M, Wu L, Yao S. Dose-response association of screen time-based sedentary behaviour in children and adolescents with depression: A meta-analysis of observational studies. Br J Sports Med 2016;50:1252-8
  22. Marsh J. The relationship between online and offline play: Friendship and exclusion. In: Richards C, Burn A, eds. Children’s Games in the New Media Age: Childlore, Media and the Playground. New York, N.Y.: Routledge/Taylor & Francis Group, 2014: (Accessed May 8, 2019).
  23. Reid Chassiakos Y, Radesky J, Christakis D, Moreno MA, Cross C; AAP Council on Communications and Media. Children and adolescents and digital media. Pediatrics 2016;138(5):e20162593.
  24. MediaSmarts. Television’s Impact on Kids: (Accessed May 8, 2019).
  25. Parkes A, Sweeting H, Wight D, Henderson M. Do television and electronic games predict children’s psychosocial adjustment? Longitudinal research using the UK Millennium Cohort Study. Arch Dis Child 2013;98:341-8.
  26. Kremer P, Elshaug C, Leslie E, Toumbourou JW, Patton GC, Williams J. Physical activity, leisure-time screen use and depression among children and young adolescents. J Sci Med Sport 2014;17(2):183-7.
  27. Katz VS, Gonzalez C, Clark K. Digital inequality and developmental trajectories of low-income, immigrant and minority children. Pediatrics 2017;140(s2):e20161758.
  28. Bowles N. The digital gap between rich and poor kids is not what we expected. New York Times, October 26, 2018: (May 8, 2019).
  29. Montgomery KC, Chester J, Milosevic T. Children’s privacy in the big data era: Research opportunities. Pediatrics 2017;140(Suppl 2):S117-21.
  30. Ontario Ministry of Child and Youth Services. On My Way: A Guide to Support Middle Years Child Development. Toronto, Ont.: Queen’s Printer, 2017: (Accessed May 8, 2019)
  31. Rideout V. Common Sense Census: Media Use by Kids Age Zero to Eight. San Franciso, CA: Common Sense Media, 2017.
  32. Uncapher MR, Lin L, Rosen LD, et al. Media multitasking and cognitive, psychological, neural and learning differences. Pediatrics 2017;140(S2):e20161758.
  33. Rideout VJ, Foehr UG, Roberts DF. Generation M2: Media in the lives of 8- to 18-year olds. Menlo Park, CA: Henry J Kaiser Family Foundation, January 2010: (Accessed May 8, 2019).
  34. Carrier LM, Rosen LD, Cheever NA, Lim AF. Causes, effects and practicalities of everyday multitasking. Developmental Review 2015;35:64-78.
  35. Selfhout MHW, Branje SJT, Delsing M, et al. Different types of Internet use, depression, and social anxiety: The role of perceived friendship. J Adolescence 2009;32:819-33.
  36. Boak A, Hamilton HA, Adlaf EM, Henderson JL, Mann RE. The Mental Health and Well-Being of Ontario Students, 1991-2017: Detailed findings from the Ontario Student Drug Use and Health Survey. CAMH Research Document Series (No. 47). Toronto, Ont.: Centre for Addiction and Mental Health, 2018.
  37. Katapally TR, Laxer RE, Qian W, Leatherdale ST. Do school PA policies and programs have a role in decreasing multiple ST behaviours among youth? Prev Med 2018;110:106-13.
  38. Ferguson CJ, Everything in moderation: Moderate use of screens unassociated with child behavior problems. Psychiatric Quarterly 2017;88(4):797-805.
  39. Przybylski AK, Weinstein N. A large-scale test of the Goldilocks hypothesis: Quantifying the relations between digital-screen use and the mental well-being of adolescents. Psychological Science 2017;28(2):204-15.
  40. Suchert V, Hanewinkel R, Isensee B. Sedentary behavior and indicators of mental health in school-aged children and adolescents: A systemic review. Prev Med 2015;76:48-57.
  41. Stiglic N, Viner RM. Effects of screentime on the health and well-being of children and adolescents: A systematic review of reviews. BMJ Open 2019;9:e023191.
  42. Orben A, Przybylski AK. The association between adolescent well-being and digital technology use. Nature Human Behaviour 2019;3:173-82: (Accessed May 8, 2019).
  43. Mills KL. Possible effects of internet use on cognitive development in adolescence. Media and Communication 2016;4(3):4-12.
  44. George MJ, Odgers CL. Seven fears and the science of how mobile technologies may be influencing adolescents in the digital age. Perspect Psychol Sci 2015;10(6):832-51.
  45. Lee SJ. Online communication and adolescent social ties: Who benefits more from Internet use? J Computer-Mediated Communication 2009;14:509-31.
  46. Valkenburg PM, Peter J. Social consequences of the internet for adolescents: A decade of research. Current Directions in Psychological Science 2009;18(1):1-5.
  47. Peter J, Valkenburg PM, Schouten AP. Developing a model of adolescent friendship formation on the Internet. Cyberpsychology & Behaviour 2005;8(5):423-30.
  48. Underwood MK, Rosen LH, More D, Ehrenreich S, Gentsch JK. The Blackberry Project: Capturing the content of adolescents’ test messaging. Dev Psychol 2012;48(2):295-302.
  49. Williams AL, Merten MJ. iFamily: Internet and social media technology in the family context. Family & Consumer Science Res J 2011;40(2):150-70.
  50. Weisskirch RS. Parenting by cell phone: Parental monitoring of adolescents and family relations. Journal of Youth and Adolescence 2009;38(8):1123-39.
  51. Weisskirch RS. No crossed wires: Cell phone communication in parent-adolescent relationships. Cyberpsychology, Behavior and Social Networking 2011;14(7-8):447-51.
  52. Davis K. Young people’s digital lives: The impact on interpersonal relationships and digital media use on adolescents’ sense of identity. Computers in Human Behavior 2013;29(6):2281-93.
  53. Veissière SPL, Stendel M. Hypernatural monitoring: A social rehearsal account of smartphone addiction. Front Psychol 2018;9:141.
  54. Radovic A, Gmelin T, Stein BD, Miller E. Depressed adolescents’ positive and negative use of social media. J Adolesc 2017;55:5-15.
  55. Gross EF. Logging on, bouncing back: An experimental investigation of online communication following social exclusion. Dev Psychol 2009;45(6):1787-93.
  56. Lenhart A, Smith A, Anderson M, Duggan M, Perrin A. Teens, Technology and Friendships: Video games, social media and mobile phones play an integral role in how teens meet and interact with friends. Pew Research Center, 2015: (Accessed May 8, 2019).
  57. Bonetti L, Campbell MA, Gilmore L. The relationship of loneliness and social anxiety with children’s and adolescents’ online communication. Cyberpsychol Behav Soc Netw 2010;13(3):279-85.
  58. Laghi F, Schneider BH, Vitoroulis I, et al. Knowing when not to use the internet: Shyness and adolescents’ on-line and off-line interaction with friends. Computers in Human Behavior 2013;29(1):51-7.
  59. Valkenburg PM, Jochen P. Social consequences of the internet for adolescents: A decade of research. Current Directions in Psychological Science 2009;18(1):1-5.
  60. Anderson CA, Bushman BJ, Bartholow BD, et al. Screen violence and youth behavior. Pediatrics 2017;140 (Suppl 2):S142-7.
  61. Cain MS, Leonard JA, Gabrieli JDE, Finn AS. Media multitasking in adolescence. Psychon Bull Rev 2016;23:1932-41.
  62. Adachi PJC, Willoughby T. The Link between playing video games and positive youth outcomes. Child Development Perspectives, March 2017.
  63. Etchells PJ, Gage SH, Rutherford AD, Munafò MR. Prospective investigation of video game use in children and subsequent conduct disorder and depression using data from the Avon Longitudinal Study of Parents and Children. PLoS ONE 2016;11(1):e0147732.
  64. Sherbert Research. Children’s Online Behaviour: Issues of Risk and Trust; Qualitative Research Findings. Ofcom. 23 September 2014: (Accessed May 8, 2019).
  65. Common Sense Media, 2016. Dealing with devices: The parent-teen dynamic: (Accessed May 8, 2019).
  66. Underwood MK, Ehrenreich SE, More D, Solis JS, Brinkley DY. The Blackberry Project: The hidden world of adolescents’ text messaging and relations with internalizing symptoms. J Res Adolesc 2015;25(1):101-17.
  67. Duff BRL, Yoon G, Zongyuan GW, Anghelcev G. Doing it all: An exploratory study of predictors of media multitasking. Journal of Interactive Advertising 2014;14(1):11-23.
  68. Kononova A. Multitasking across borders: A cross-national study of media multitasking behaviors, its antecedents, and outcomes. Int J Communication 2013;7:1688-1710.
  69. Common Sense. Common Sense Census: Media Use by Tweens and Teens 2015: (Accessed May 8, 2019).
  70. Pharo H, Gross J, Richardson R, Hayne H. Age-related changes in the effect of ostracism. Social Influence 2011;6(1):22-38.
  71. Crone EA, Konijn EA. Media use and brain development during adolescence. Nature Communications 2018;9:588.
  72. Decelis A, Jago R, Fox KR. Physical activity, screen time and obesity status in a nationally representative sample of Maltese youth with international comparisons. BMC Public Health 2014;14(1):664.
  73. Carson V, Hunter S, Kuzik N, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: An update. Appl Physiol Nutr Metab 2016;41:S240-65.
  74. Melkevik O, Torsheim T, Iannotti RJ, Wold B. Is spending time in screen-based behaviors associated with less physical activity? A cross national investigation. Int J Behav Nutr Phys Act 2010;7:46.
  75. LeBlanc AG, Broyles AG, Chaput JP, et al. Correlates of objectively measured sedentary time and self-reported screen time in Canadian children. Int J Behav Nutr Phys Act 2015;12(1):38.
  76. Mills KL. Effects of Internet use on the adolescent brain: Despite popular claims, experimental evidence remains scarce. Trends in Cognitive Sciences 2014;18(8):385-7.
  77. Gebremariam MK, Bergh IH, Andersen LF, et al. Are screen-based behaviors longitudinally associated with dietary behaviors and leisure-time physical activity in the transition into adolescence? Int J Behavioral Nutrition and Physical Activity. 2013;10:9.
  78. Romer D, Bagdasarov Z, More E. Older versus newer media and the well-being of United States youth: Results from a national longitudinal panel. J Adol Health 2013;52(5):613-9.
  79. Robinson TN, Banda JA, Hale L, et al. Screen media exposure and obesity in children and adolescents. Pediatrics 2017;140(Suppl 2):S97-101.
  80. Yan H, Zhang R, Oniffrey TM, et al. Associations among screen time and unhealthy behaviors, academic performance, and well-being in Chinese adolescents. J Environ Res Public Health 2017;14:596.
  81. Börnhorst C, Wijnhoven TM, Kunešová M, et al. WHO European Childhood Obesity Surveillance Initiative: Associations between sleep duration, screen time and food consumption frequencies. BMC Public Health 2015;15:442.
  82. Boylan S, Hardy LL, Drayton BA, Grunseit A, Mihrshahi S. Assessing junk food consumption among Australian children: Trends and associated characteristics from a cross-sectional study. BMC Public Health 2017;17(1):299.
  83. Pearson N, Biddle SJ. Sedentary behavior and dietary intake in children, adolescents and adults: A systematic review. Am J Prev Med 2011;41(2):178-88.
  84. Borracino A, Lemma P, Berchialla P, et al. Unhealthy food consumption in adolescence: Role of sedentary behaviours and modifiers in 11-, 13- and 15-year-old Italians. Eur J Public Health 2016;26(4):650-6.
  85. Falbe J, Willett WC, Rosner B, Gortmaker SL, Sonneville KR, Field AE. Longitudinal relations of television, electronic games, and DVDs with changes in diet in adolescents. Am J Clin Nutr 2014;1173-81.
  86. Elsenburg LK, Corpeleijn E, van Sluijs EM, Atkin AJ. Clustering and correlates of multiple health behaviours in 9-10 year-old children. PLoS One 2014;9(6):e99498.
  87. Mazarello Paes V, Hesketh K, O’Malley C, et al. Determinants of sugar-sweetened beverage consumption in young children: A systematic review. Obes Rev 2015;16(11):903-13.
  88. Pérez-Farinós N, Villar-Villalba C, López Sobaler AM, et al. The relationship between 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 2017;17(1):33.
  89. Wetherington H, Pan L, Sherry B. The association of screen time, television in the bedroom and obesity among school-aged youth: 2007 National Survey of Children’s Health. J Sch Health 2013;83(8):573-81.
  90. Noonan RJ, Boddy LM, Knowles ZR, Fairclough SJ. Cross-sectional associations between high-deprivation home and neighborhood environments, and health-related variables among Liverpool children. BMJ Open 2016;6(1):e008693.
  91. Chaput J-P, Leduc G, Boyer C, et al. Electronic screens in children’s bedrooms and adiposity, physical activity and sleep: Do the number and type of electronic devices matter? Can J Public Health 2014;105(4):e273-9.
  92. Falbe J, Davison KK, Franckle RL, et al. Sleep duration, restfulness, and screens in the sleep environment. Pediatrics 2015;135(2):e367-75.
  93. Jiang X, Hardy LL, Baur LA, Ding D, Wang L, Shi H. Sleep duration, schedule and quality among urban Chinese children and adolescents: Associations with after-school activities. PLoS One 2015;10(1):e0115326.
  94. Lamboglia CM, da Silva VT, de Vasconcelos Filho JE, et al. Exergaming as a strategic tool in the fight against childhood obesity: A systematic review. J Obes 2013;2013:438364.
  95. Lanningham-Foster L, Foster RC, McCrady SK, Jensen TB, Mitre N, Levine JA. Activity-promoting video games and increased energy expenditure. J Pediatr 2009;154:819-23.
  96. Lu AS, Kharrazi H, Gharghabi F, Thompson D. A Systematic Review of health videogames on childhood obesity prevention and intervention. Games for Health J 2013;2(3):131-41.
  97. Favotto L, Michaelson V, Davison C. Perceptions of the influence of computer-mediated communication on the health and well-being of early adolescents. Int J Qualitative Studies on Health and Well-being. 2017;12:1335575.
  98. Cook S, Boak A, Hamilton HA, Mann RE, Manson HE, Wickens CM. Teens and texting while driving: The prevalence and correlates of texting while driving among a population-based sample of Ontario students. Traffic Inj Prev 2018:1-6.
  99. Common Sense media research brief: Advertising to children and teens, 2014: (Accessed May 8, 2019).
  100. LeBlanc AG, Katzmarzyk PT, Barreira TV, et al. Correlates of total sedentary time and screen time in 9-11-year-old children around the world: The International Study of Childhood Obesity, Lifestyle and the Environment. PLos ONE 2015;10(6):e0129622.
  101. Cain N, Gradisar M. Electronic media use and sleep in school-aged children and adolescents: A review. Sleep Medicine 2010;11:735-42.
  102. Smahel D, Wright MF, Cernikova M. The impact of digital media on health: Children’s perspectives. Int J Public Health 2015;60:131-7.
  103. Canadian Association of Optometrists/Canadian Ophthalmological Society. Joint position statement: Effects of electronic screens on children’s vision and recommendations for safe use, 2017: (Accessed May 8, 2019).
  104. Maras D, Flament MF, Murray M, et al. Screen time is associated with depression and anxiety in Canadian youth. Prev Med 2015;73:133-8.
  105. Roberts J, IZA – Institute of Labor Economics (U.K.), 2016. Social Media Use and Children’s Wellbeing: (Accessed May 8, 2019).
  106. Nuffield Council on Bioethics. Response to the Science and Technology’s Committee inquiry on the impact of social media and screen-use on young people’s health, March 2018: (Accessed May 8, 2019).
  107. Holland G, Tiggmann M. A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image 2016;17:100-10.
  108. Brooks M, Lasser J. Tech Generation: Raising Balanced Kids in a Hyper-Connected World. New York, NY: Oxford University Press, 2018, cited in Pinola M. New York Times Smarter Living Guide: How (and When) to Limit Kids’ Tech Use, September 2018: rref=collection%2Fspotlightcollection%2Fguides&action=click&contentCollection=topics®ion=stream&module=stream_unit&version=latest&contentPlacement=4&pgtype=collection&redirect=true (Accessed May 8, 2019).

Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.

Last updated: Feb 7, 2024