Rachel V Thomas

Health and Me

Children’s Mental Health In The Digital Age: Can Governments Protect Them Without Restricting Internet Access? | Interview

<span>Digital</span> technologies have transformed how children learn, communicate and access information. But concerns about mental health and online safety have prompted governments worldwide to consider restrictions on children's social media use. In India, Karnataka has announced a <span>social media ban</span> for children under 16. Other states, including Andhra Pradesh, Goa and Bihar, are considering age-based restrictions.

On October 15, the Supreme Court held that “the right to access and use the internet is a fundamental right of every individual.” A bench of Justices J B Pardiwala and K V Chandran added that children, “irrespective of their age, enjoy the same rights,” and that “the safety of our children and their freedom are not at odds with each other. Our children are entitled to both.”

The debate is not just about <span>screen time</span>. It also concerns how digital platforms are designed, how algorithms shape what children see and how these factors may affect their health and well-being.

A recent three-paper Series in <em>The Lancet</em> examines these issues through the concept of digital determinants of health: the digital systems, business models and design choices that influence health outcomes.

In an exclusive interview with <strong>HealthandMe</strong>, Dr. <span>Salman Fitrat Khan</span>, a member of the Youth Advisory Group for <em>The Lancet</em> Series on Digital Determinants of Health and a co-author of its umbrella review, “Associations of digital media use with health, behavioural and developmental outcomes in children and adolescents: an umbrella review and meta-analysis,” discusses how governments can protect children's mental health while safeguarding their digital rights. 

<strong>Also read: </strong><a href="https://www.healthandme.com/health-news/over-2-hours-of-daily-screen-time-linked-to-depression-obesity-in-young-people-lancet-article-156279639" data-type="tilCustomLink">Over 2 Hours of Daily Screen Time Linked to Depression, Obesity In Young People: Lancet</a>

<h2>Q. What does this Lancet Series mean for children and adolescents in India, where smartphone and social media use is rising rapidly? </h2>

<strong>Dr. Salman:</strong> India has the world's largest youth population, with about 65% of its people under 35. Digital access and media use are also expanding rapidly. At this scale, even modest adverse effects of digital media could add up to a substantial public health burden. 

India has an evolving regulatory framework for digital technologies and child protection. Existing safeguards include the Digital Personal Data Protection Act, 2023, which provides for verifiable parental consent for children, and the Protection of Children from Sexual Offences (POCSO) Act. 

However, enforcement remains uneven, and requirements for child-friendly platform design and systemic risk assessment are less developed than in some other jurisdictions. Restrictions on social media use by children under 16 are also being considered at national and state levels. 

Generative AI is already part of Indian children's lives. One consulting report found that 77% of children older than 10 had used it for schoolwork, although this is not a peer-reviewed finding. 

A major challenge is the lack of research from low- and middle-income countries. Very few studies we reviewed came from these settings. Locally led research is therefore crucial to understanding how rising smartphone and social media use affects children and adolescents in India. 

<h2>Q. Are parental screen-time limits enough, or should countries regulate platform design and recommendation algorithms? What measures do you suggest? </h2>

<strong>Dr. Salman: </strong>Parental limits alone are not enough. Current approaches place much of the responsibility on young people and families, even though many risks arise from systems largely beyond their control. No single measure, including age limits, is sufficient. 

The Series identifies device screen-time limits as an example of “technological solutionism” and proposes a broader approach: 

<ul><li>Safer platform design: Require age-appropriate defaults, safeguards for high-risk features and assessments of potential harm before new features are widely rolled out.</li><li>Protection from commercial exploitation: Ban behavioral advertising and commercial profiling of minors.</li><li>Platform accountability and transparency: Require companies to assess and mitigate mental health risks associated with recommendation systems and engagement-driven design. Improve algorithm transparency and provide vetted researchers with secure, legally protected access to platform data.</li><li>Age restrictions with safeguards: Design age-based limits that prevent exclusion and avoid broad identity-verification requirements.</li><li>Ongoing evaluation: Assess interventions continuously and adapt them as evidence emerges, including to address unintended consequences. </li></ul>

Support for parents remains important through caregiver resources and digital literacy. However, these measures should complement structural reforms rather than substitute for them. 

<strong>Read More</strong>: <a href="https://www.healthandme.com/health-news/social-media-bans-for-kids-gain-ground-worldwide-will-they-work-article-154516653" data-type="tilCustomLink">Social Media Bans for Kids Gain Ground Worldwide: Will They Work?</a>

<h2>Q. Which digital features pose the biggest concerns for young people's mental health? </h2>

<strong>Dr. Salman: </strong>The Series does not rank these features, noting that platform design remains largely invisible in current research. However, it highlights several areas of concern: 

<ul><li>Engagement-maximizing design: Infinite scrolling, autoplay and hyper-personalized algorithms can encourage habitual use and have been linked to effects on attention, sleep and emotional regulation.</li></ul>

<ul><li>Engagement metrics and recommendation systems: Likes and follower counts may fuel anxiety, while recommendation systems can lead users into increasingly narrow content streams.</li></ul>

<ul><li>Notifications: Frequent notifications can interrupt attention and encourage reward-seeking behavior. </li></ul>

<ul><li>Appearance-focused content: Such content may contribute to depression, anxiety and body dissatisfaction, particularly among girls and young women. The Series' umbrella review found an association between body-ideal content and poorer well-being. </li></ul>

<ul><li>AI companions and generative AI: AI companions raise concerns about emotional manipulation, while generative AI can produce images of young people that may be used for exploitation and abuse. </li></ul>

<ul><li>Data-driven advertising: Children's data can be used for commercial targeting, including advertising unhealthy products. </li></ul>

These concerns do not mean that every child will experience harm or that every feature has the same level of evidence behind it. The Series highlights the need for better research into how platform design affects young users. 

<strong>READ: </strong><a href="https://www.healthandme.com/health-news/is-india-set-to-implement-a-social-media-ban-for-children-article-153832504" data-type="tilCustomLink">Is India Set To Implement A Social Media Ban For Children?</a>

<h2>Q. How should parents distinguish normal digital use from problematic use? </h2>

<strong>Dr. Salman: </strong>The Series defines problematic digital use by its pattern rather than the number of hours spent online. It involves loss of control, preoccupation and continued use despite harm. There is no universally consistent definition of problematic use in research. 

Warning signs include digital use that disrupts sleep, schoolwork or relationships, or displaces physical activity and face-to-face interaction. Late-night use can also be a concern. 

Heavy use, however, can be entirely normal for teenagers, including when they communicate with peers or explore their identities. Some forms of digital engagement can be beneficial, particularly moderate, socially oriented use. For young children, educational content watched alongside a caregiver was associated with better outcomes. 

Parents should avoid treating problematic use solely as a child's failing. This can overlook the role of platform design in shaping behavior. The Youth Advisory Group also described doomscrolling as a response to platform environments rather than simply a personal choice. 

<h2>Q. What would you want policymakers and technology companies to change first? </h2>

Why Young People Struggle | Suicide Risk & Warning Signs | World Suicide Prevention Day

<strong>Dr. Salman: </strong>Technology companies should prioritize two steps: 

<ul><li>Assess new products for potential harm before release.</li><li>Share data and internal research with vetted researchers. </li></ul>

For policymakers, the Series recommends treating digital determinants of health as a core public health responsibility. This includes:

<ul><li>Designating focal points within health ministries to coordinate with education and data protection authorities.</li><li>Prohibiting third-party tracking of minors in publicly funded health and education systems.</li><li>Auditing school platforms, youth health apps and major social media platforms used by adolescents.</li><li>Involving young people as partners in policymaking, not merely as consultees. </li></ul>

Where regulatory capacity is limited, practical starting points include incorporating digital risks into school health surveys and adolescent health programmes.

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Digital technologies have transformed how children learn, communicate and access information. But concerns about mental health and online safety have prompted governments worldwide to consider restrictions on children's social media use. In India, Karnataka has announced a social media ban for children under 16. Other states, including Andhra Pradesh, Goa and Bihar, are considering age-based restrictions.On October 15, the Supreme Court held that “the right to access and use the internet is a fundamental right of every individual.” A bench of Justices J B Pardiwala and K V Chandran added that children, “irrespective of their age, enjoy the same rights,” and that “the safety of our children and their freedom are not at odds with each other. Our children are entitled to both.”The debate is not just about screen time. It also concerns how digital platforms are designed, how algorithms shape what children see and how these factors may affect their health and well-being.A recent three-paper Series in The Lancet examines these issues through the concept of digital determinants of health: the digital systems, business models and design choices that influence health outcomes.In an exclusive interview with HealthandMe, Dr. Salman Fitrat Khan, a member of the Youth Advisory Group for The Lancet Series on Digital Determinants of Health and a co-author of its umbrella review, “Associations of digital media use with health, behavioural and developmental outcomes in children and adolescents: an umbrella review and meta-analysis,” discusses how governments can protect children's mental health while safeguarding their digital rights. Also read: Over 2 Hours of Daily Screen Time Linked to Depression, Obesity In Young People: LancetQ. What does this Lancet Series mean for children and adolescents in India, where smartphone and social media use is rising rapidly? Dr. Salman: India has the world's largest youth population, with about 65% of its people under 35. Digital access and media use are also expanding rapidly. At this scale, even modest adverse effects of digital media could add up to a substantial public health burden. India has an evolving regulatory framework for digital technologies and child protection. Existing safeguards include the Digital Personal Data Protection Act, 2023, which provides for verifiable parental consent for children, and the Protection of Children from Sexual Offences (POCSO) Act. However, enforcement remains uneven, and requirements for child-friendly platform design and systemic risk assessment are less developed than in some other jurisdictions. Restrictions on social media use by children under 16 are also being considered at national and state levels. Generative AI is already part of Indian children's lives. One consulting report found that 77% of children older than 10 had used it for schoolwork, although this is not a peer-reviewed finding. A major challenge is the lack of research from low- and middle-income countries. Very few studies we reviewed came from these settings. Locally led research is therefore crucial to understanding how rising smartphone and social media use affects children and adolescents in India. Q. Are parental screen-time limits enough, or should countries regulate platform design and recommendation algorithms? What measures do you suggest? Dr. Salman: Parental limits alone are not enough. Current approaches place much of the responsibility on young people and families, even though many risks arise from systems largely beyond their control. No single measure, including age limits, is sufficient. The Series identifies device screen-time limits as an example of “technological solutionism” and proposes a broader approach: Safer platform design: Require age-appropriate defaults, safeguards for high-risk features and assessments of potential harm before new features are widely rolled out.Protection from commercial exploitation: Ban behavioral advertising and commercial profiling of minors.Platform accountability and transparency: Require companies to assess and mitigate mental health risks associated with recommendation systems and engagement-driven design. Improve algorithm transparency and provide vetted researchers with secure, legally protected access to platform data.Age restrictions with safeguards: Design age-based limits that prevent exclusion and avoid broad identity-verification requirements.Ongoing evaluation: Assess interventions continuously and adapt them as evidence emerges, including to address unintended consequences. Support for parents remains important through caregiver resources and digital literacy. However, these measures should complement structural reforms rather than substitute for them. Read More: Social Media Bans for Kids Gain Ground Worldwide: Will They Work?Q. Which digital features pose the biggest concerns for young people's mental health? Dr. Salman: The Series does not rank these features, noting that platform design remains largely invisible in current research. However, it highlights several areas of concern: Engagement-maximizing design: Infinite scrolling, autoplay and hyper-personalized algorithms can encourage habitual use and have been linked to effects on attention, sleep and emotional regulation.Engagement metrics and recommendation systems: Likes and follower counts may fuel anxiety, while recommendation systems can lead users into increasingly narrow content streams.Notifications: Frequent notifications can interrupt attention and encourage reward-seeking behavior. Appearance-focused content: Such content may contribute to depression, anxiety and body dissatisfaction, particularly among girls and young women. The Series' umbrella review found an association between body-ideal content and poorer well-being. AI companions and generative AI: AI companions raise concerns about emotional manipulation, while generative AI can produce images of young people that may be used for exploitation and abuse. Data-driven advertising: Children's data can be used for commercial targeting, including advertising unhealthy products. These concerns do not mean that every child will experience harm or that every feature has the same level of evidence behind it. The Series highlights the need for better research into how platform design affects young users. READ: Is India Set To Implement A Social Media Ban For Children?Q. How should parents distinguish normal digital use from problematic use? Dr. Salman: The Series defines problematic digital use by its pattern rather than the number of hours spent online. It involves loss of control, preoccupation and continued use despite harm. There is no universally consistent definition of problematic use in research. Warning signs include digital use that disrupts sleep, schoolwork or relationships, or displaces physical activity and face-to-face interaction. Late-night use can also be a concern. Heavy use, however, can be entirely normal for teenagers, including when they communicate with peers or explore their identities. Some forms of digital engagement can be beneficial, particularly moderate, socially oriented use. For young children, educational content watched alongside a caregiver was associated with better outcomes. Parents should avoid treating problematic use solely as a child's failing. This can overlook the role of platform design in shaping behavior. The Youth Advisory Group also described doomscrolling as a response to platform environments rather than simply a personal choice. Q. What would you want policymakers and technology companies to change first?    Dr. Salman: Technology companies should prioritize two steps: Assess new products for potential harm before release.Share data and internal research with vetted researchers. For policymakers, the Series recommends treating digital determinants of health as a core public health responsibility. This includes:Designating focal points within health ministries to coordinate with education and data protection authorities.Prohibiting third-party tracking of minors in publicly funded health and education systems.Auditing school platforms, youth health apps and major social media platforms used by adolescents.Involving young people as partners in policymaking, not merely as consultees. Where regulatory capacity is limited, practical starting points include incorporating digital risks into school health surveys and adolescent health programmes.

children’s mental health in the digital age: can governments protect them without restricting internet access? | interview

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