(CNN) — There is not enough evidence to determine whether social media is safe enough for children and teens when it comes to their mental health, according to a new recommendation from the U.S. Surgeon General.
Tuesday advisory notes that while there are some benefits, using social media poses a “serious risk of harm” for children. It requires increased research into the impact of social media on youth mental health, as well as action by policy makers and tech companies.
The 25-page advisory comes as more states seek tougher rules on social media platforms, including efforts in Montana to ban TikTok.
The general advice to surgeons is designed to highlight pressing public health issues and make recommendations on how to address them, a new report notes. Previous recommendations focused on youth mental health wider, health misinformation and the use of an antidote for opioid overdose naloxone.
“We are in the midst of an adolescent mental health crisis and I am concerned that social media is contributing to the harm that children are experiencing,” Chief Surgeon Dr. Vivek Murthy told CNN.
“For too long, we’ve put the entire burden of managing social media onto parents and children, despite the fact that these platforms are designed by some of the world’s most talented engineers and designers to maximize the amount of time our children spend on them,” he said. “So it’s not a fair fight. It’s time for us to have the support of parents and children.”
The guide reviews the available evidence on the impact of social media on the mental health of adolescents, noting that social media use among children is “almost universal”: up to 95% of children aged 13 to 17 report using social media, with more than a third say they use it “almost constantly”. And while 13 is usually the minimum age to use social networking sites in the US (the age Murthy earlier said is too young, the advisor notes that almost 40% of children between the ages of 8 and 12 also use platforms.
“We need to acknowledge the growing amount of research into the potential harms, increase our collective understanding of the risks of social media use, and act urgently to create safe and healthy digital environments,” the guide reads.
The report cites several ways that social media can harm youth mental health, noting that the teenage years are a particularly sensitive time for brain development. It includes detailed research that has shown correlations between social media use and depression and anxiety, as well as poor sleep, online bullying and low self-esteem, especially for girls.
One study of 6,595 American teens aged 12 to 15 found that those who spent more than three hours a day on social media were twice as likely to experience symptoms of depression and anxiety as non-users. He also cites studies that showed that reducing social media use led to improved mental health.
Using social media comes with the risk of exposure to dangerous content, including images of self-harm, “which can normalize such behavior,” the advisory says. It also cites 20 studies that have found a significant link between social media use and body image issues and eating disorders.
Murthy told CNN that the three most common things he hears from children about social media are: “first, it makes them feel worse about themselves; second, it makes them feel worse about their friendships; but thirdly, they cannot free themselves from it.
Excessive use of social media can disrupt important healthy behaviors, including sleep, the advisor warns, noting that platforms are often designed to engage users with push notifications, autoplay and infinite scrolling features, and algorithms that use user data to customize content recommendations. He cites the belief of some researchers that exposure to social media, with over-stimulation of the brain’s reward centers, “could trigger pathways comparable to addiction.”
The guide’s summary of the potential risks of social media use to youth mental health spans five pages; its description of the potential benefits takes only half a page. She notes that social media can provide a positive community and connection with others, which can be especially important for children who are often marginalized. He cites research showing the mental health benefits of lesbian, gay, bisexual, asexual, transgender, queer, intersex and other youth through peer interaction and race-related “identity-affirming content” that was positive for adolescents colored girls. Finally, she notes that social media can be helpful in connecting some children to psychiatric care.
The guide provides recommendations for families struggling with social media use, including creating family media plans, encouraging children to develop personal friendships, and modeling good social media behavior.
Murthy said this is something he and his wife have discussed for their children, who are now 5 and 6.
Their plan is to delay social media use at least until high school graduation; try to find other families to work with who share similar inclinations, “because there is strength in numbers”; and to reassess when children are in high school to see if better safety standards have been put in place “and are actually enforced,” he said.
“None of these activities are easy for parents,” he admitted. “That’s why we’re pushing this guidance so hard to urgently justify taking action.”
Adam Kovacevich, founder and CEO of the Chamber of Progress tech coalition, said online platforms have heard the concerns of parents and researchers and have implemented features to protect younger users, such as limiting nighttime notifications.
“I’m sure child protection efforts are well-intentioned, but we shouldn’t jeopardize teen privacy by requiring them to verify their age or cutting off their access to supportive online communities,” Kovacevich said in a statement.
Murthy says he hopes the report will spur action on multiple levels, such as increased research and funding, policy changes, and especially increased transparency and action by tech companies.
“Independent researchers tell us all the time that they are having a hard time getting full access to the information they need from tech companies about the impact on children’s health,” he said.
Murthy said social media companies should be subject to similar child protection standards as other industries.
“We’re first applying this safety approach to other products that children use, from medicines to car seats to toys,” Murthy said. “We have to do it here too.”