The kids aren’t alright – GPs must lead debate on social media ban

Dr Helen Thomas explains the need for a public health campaign to tackle smartphone and social media use in children and young people

Frontline GPs are well versed in public health education and the changing needs of our population. From the 1970s doctors have campaigned for changes in tobacco use. In the 80s, HIV/AIDS campaigns saved many lives. Today, we encourage vaccine uptake, sensible drinking, cancer screening tests and more.

But, there’s another crisis unfolding now. Aside from the deterioration of chronic diseases and the backlog of referrals, the pandemic threw a new public health challenge at us. Our reliance on technology and social media was double edged: On the one hand, it let us continue to work, learn, and socialise; but on the other hand, it accelerated our dependence on, and abuse of, social media and screens.

And nearly three years on, the social consequences are still emerging. Whilst many people suffered mental health deterioration, our children’s mental health in particular is in shreds and of huge concern. Whilst it would be easy to entirely blame the Covid pandemic for our new obsession with screens, evidence has shown that this has been steadily climbing for many years before which has led to the drastic need for a new and urgent public health campaign. Indeed, Australia has already led the way by recently implementing a ban on social media for under-16s.

It is no shock to any GP reading this that we are seeing huge numbers of children struggling with anxiety and depression. Equally unsurprising are the rates of ADHD referrals being the highest they have ever been. All this, coupled with increased numbers of self-harm, eating disorders and body dysmorphia and suicide has left CAMHS services overwhelmed – and children and their families struggling.

These omnipresent devices are designed to be addictive, allowing instant access to inappropriate and harmful content; one in four children use their devices in ways defined as addictive behaviour. Children report being lonely and isolated despite being in almost constant presence of their peers online.

The rapid fire, dopamine-fuelled apps are causing cortical matter restructuring and neurotransmitter changes resulting in children needing constant boosts of this online drug – the pull of the addiction is unrelenting. School grades are dropping and teachers are struggling with children who can’t focus and engage. We are seeing clear correlations with problematic phone use and new ADHD diagnoses. 

All these mental health issues are leading to swathes of parents bringing their children to the GP or directly to mental health providers with a surge in referrals of over 50% in the last two years. But of course, the waiting time for referrals are lengthy, with 75% of parents reporting that their child’s mental health deteriorated during this wait. 

Though mental health rightly dominates the conversation, these devices can also have a very physical impact. Children and young people are 10 times more likely to sustain musculoskeletal injuries due to poor posture and neck craning to look at devices. They are also likely to experience repetitive strain and pain associated with prolonged use in the upper limb. There has been a significant increase in children diagnosed with myopia, and when combined with all-screen use this affects nearly 80% of children.

There’s no secret that we have a childhood obesity problem to contend with too. Those with highest reported device use are those with the most significant obesity issues. Smartphone use is also a major sleep-disrupter, affecting brain development, emotional regulation and wellbeing. This has a knock-on impact on children’s concentration, attention, and overall wellbeing. 

There’s also the urgent matter regarding safeguarding and child sexual abuse material (CSAM) – which in itself could warrant a whole other article. Self-generated CSAM has increased by 400% since 2019. A 2021 Ofsted report showed that of the girls asked, 88% said they were sent sexual pictures they did not want to see ‘a lot’ and 80% reported that they were pressured for sexual images ‘a lot.’ 

In no other way do we allow this blatant exploitation of our children or permit harm to their health. Over half the children and young people when asked about their device use would like to reduce it and prefer to have opportunities to be with others in youth groups or social settings. Whilst it is undeniable that we live in a digital age, where children learn online and will go on to be online in their adult lives, it is at this developmentally crucial age where we need to put in clear guidelines and legislation to protect their health and futures. 

The ignorant arguments of allowing children the choice to explore digital opportunities demonstrates how little is properly understood in the public domain about the devastating effects of social media and smartphones. Expecting the industry that perpetuates the problem for profit gain to appropriately moderate children’s use of it is preposterous. As health professionals, we would not advocate for children to drink or smoke cigarettes because they should have a choice. We know better. We make evidence-based decisions. As doctors we make an oath to uphold the wellbeing of our patients, and our children need us to prioritise them now.

A national public health campaign needs to be delivered now. Health professionals from GPs up to the Chief Medical Officer need to be clear – and with one voice demand: safe screen use; no social media for children; repairs to the damage that those already affected have accrued. GPs are frontline and therefore we are in prime position to start the conversations about screen use, consider using screening tools to identify problematic smartphone use (PSU) and educate/signpost for support. There is already a pilot public health campaign in Hampshire preparing to launch, with resources and training for clinicians and families, education on screening tools for PSU and a clinical trial to gather robust data to demonstrate smartphones and social media are causing harm to our children. 

We didn’t know the harms when these devices first came along, but we do now. We need to work to protect our children from the dangers of smartphone and social media – like we have with health harms before. 

Dr Helen Thomas is a salaried GP in Hampshire. She is a member of Healthcare Professionals for Safer Screens, and a parent supporter and healthcare advocate with Smartphone Free Childhood.