Navigating Screens with Tweens and Teens

Dr. Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to the Kid Experts, where the complex is our every day. Each episode, we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge, and perhaps change, how you care for kids.

Welcome to Talking Pediatrics. I’m your host Dr. Kade Goepferd. As a pediatrician, a parent, and an educator, there are few things I get asked about more than issues relating to screens, social media, smartphones, video games, YouTube. My days are swimming with how to steer parents correctly. How to ask my patients about safety and how to set up boundaries for my own kids.

Here to help us navigate this overwhelming sea of screens is Erin Walsh, co-founder of the Spark and Stitch Institute, and formerly with the National Institute on Media and the Family. Erin is an educator, a speaker and author and a parent who has been bringing science and strategies to families, teachers, and the rest of us for nearly 20 years. She co-authored the national bestseller “Why Do They Act That Way? A Survival Guide to the Adolescent Brain for You and Your Teen” and her newest book, It’s Their World: Teens, Screens, and the Science of Adolescence will be published in May of 2025. Erin, thanks for joining me today. Oh, it’s such a treat.

Erin Walsh: Thank you for having me. Yeah, absolutely.

Dr. Kade Goepferd: So tell us how you got started in this work.

I got started in the work as my parents started one of the first education and advocacy organizations looking at media’s impact on kids. And I see you, if you’re not in the studio, you can’t see it, but you’re nodding your head like you’re on board with that idea of National Institute on Media and the Family. But I was a teenager at the time, so I was not necessarily on board with the mission of their work because my relationship with their work was arguments about why I had to do my homework before I played video games. But of course as I got older, I looked at the world around me, started working with kids and realized that we couldn’t have a meaningful answer, a meaningful set of questions about kids’ health or thriving or mental wellbeing without starting to take into account the powerful role that screens have in their lives. So we’ve been working together ever since.

Dr. Kade Goepferd: What you say in the title of your next book really has become true in the sense that yes, there were screens in my life 40 years ago when I was growing up, but there is not an element of my children’s life today that is not touched by a screen.

Erin Walsh: Correct

Dr. Kade Goepferd: In some way, shape or form.

Erin Walsh: More than kids spend sleeping, eating, in school with educators, coaches, doctors, teachers, guides, is the amount of time they spend with entertainment media.

Dr. Kade Goepferd: Yeah, absolutely. So I’ve encountered you in a few settings. We’ve had you as a keynote speaker, I’ve read your book that you co-authored and most recently I saw you speaking at my kids’ elementary school, which was delightful. I’m wondering what are some of the most common questions that you get from parents and caregivers about teenagers and screens? I’m guessing we get a lot of the same ones.

Erin Walsh: Yeah, a lot of those first questions that I get are kind of those where they’re seeking clarity and grounding in a confusing topic. So a lot of the questions are things like “when should I get my kid their first smartphone?” or “how many hours a day makes sense?” And so often looking for those really concrete numbers. Of course the challenge is that the answers to those concrete questions are not always totally straightforward or as simple as parents hope they will be. But I do think it reflects this idea that parents are a little overwhelmed and looking for what are those guideposts for making decisions that’ll protect my kid’s health.

Dr. Kade Goepferd: Certainly folks who are caring for kids in a pediatric setting are going to get asked, when should I get my kid a cell phone? Yeah. How do you answer that? I think what parents hope that we will say is a very specific age.

Erin Walsh: There is no secret science anywhere that says at this age, every child is ready to have responsible and healthy use of their own personal device. We see plenty of 16 year olds who struggle and 13 year olds who do better. So chronological age is tricky. I like to think of it more as a set of questions of what’s the purpose of the device?

Has that purpose persisted over time? So is it a passing, I want it because everybody has it or is there something, a need in the family, where having a device would help meet that need? Has it persisted over time? And then what’s the least amount of technology we could deliver to meet that family’s need for that kid? And I think that helps us get away from this idea that there’s an age in which a kid is ready for a fully loaded smartphone, that we think of it more as sort of a gradual release. The least amount of technology might be a smartwatch that can only contact parents for a little bit, or maybe a very simple phone that parents know all the contacts in it, but it’s not a portal yet to social media or the internet. Those kinds of questions can help us get towards more realistic solutions that are tailored to a specific family’s needs. I think delaying a fully loaded smartphone for as long as possible or as makes sense, is a pretty good idea.

Dr. Kade Goepferd: One question that I often get asked as a follow-up to the smartphone question is, should I have rules around this phone? Do I need a contract with my kid around the phone if I’m going to get them something like a phone then,

Erin Walsh: Which is actually a great set of questions. We know that the technology is one piece of starting opening up this new world of access for kids. And probably the most important next steps are the supports we put around that device. And so you brought up contracts, right? So the American Academy of Pediatrics recommends making a family media plan, and that’s an opportunity for caregivers to sit down with kids and think, how are we going to use this safely? How are we going to keep this in balance? How are we going to make sure it doesn’t get in the way of other things that we value as a family? So having those kinds of conversations and making a family media plan that gets pretty specific is helpful. Not because it has to be some sort of legal contract that’s 20 pages long, but to really pinpoint what are the core safety measures we want? How do we want to use these pieces of technology to do good in the world? It’s easy to start thinking just in terms of harms, but how do we want to use these in positive ways? And then that becomes a living document we can return to when inevitably things get tricky, we will have issues, we will have challenges, and then we can come back and say, when we started this, we made these agreements. Let’s revisit those.

Dr. Kade Goepferd: I like the idea of setting those expectations so that there is something to go back to say, remember when we talked about

Erin Walsh: Yeah, this is not coming out of nowhere. And I think that idea of having kids generate ideas too, that it’s not just something we hand to them, sign this document a list of places you should not go, and then we don’t talk about it again, this is an opportunity for kids to brainstorm ideas as well, so they’re a little bit more invested, not that they turn to us later and say, well, thank you so much. I remember the agreement I made. But it’s opportunity not just to make agreements, but to also have conversations.

Dr. Kade Goepferd: I would imagine that something like inviting a child to help make agreements about technology is something that extends beyond smartphone. My 10 year old’s got Chromebooks for their birthday last year. That’s something that works well, beautiful. I would imagine for video games, all kinds of things.

Erin Walsh: Any new platform that we have access to, new game. I think of it as those moments where our kids’ digital worlds expand into a new space is a great time to think about what are the agreements we need to have around this new thing because this new thing is going to have different design, different ways that kids are interacting with each other. And so it invites new agreements and new conversations.

Dr. Kade Goepferd: And I think we as pediatric clinicians often get asked the question that you mentioned about how much screen time is too much screen time and there was an era in which the app had time limits and they’ve moved away from that. But tell me a little bit about your approach to that question.

Erin Walsh: I think time as sort of this old measure of screen time, which was just like minutes and hours in front of screen media is sort of a blunt instrument and a blunt measure that can help us in the extremes. So we know if we add up those minutes and hours and we are talking a lot of time, it’s probably a pretty good sign that we should be paying attention to what’s going on in that kid’s life, what they might be missing out on, what’s happening on those screens. But in that messy middle of the American Academy of Pediatrics used to say like two hours. And I think that’s a useful guide. It’s a useful starting place, but what we’re starting to really see in the data is that time is less important most often to kids’ outcomes less important than things like what are they doing? Who are they doing it with? What else could they be doing with that time? What are the specific strengths and vulnerabilities of that child? So it gets into a little bit more of a complicated picture. And so one of the things we talk about with families is sure, let’s talk about time a little bit just so we make sure we’re not in those extreme places, but then in that messy middle, are they sleeping?

Are they playing? Are they connecting with peers and with family daily? Do they have space or a place to focus on schoolwork or play depending upon their age, the work of their developmental stage? So we look for what’s happening around those screens. Are they interfering with those things? Talking about what’s happening on the screens, what kind of content are they viewing or interacting with?

Dr. Kade Goepferd: Having spent time around some adolescents who are newer in my life, one thing I’ve noticed with the high school age set is that while they may be on a video game, they are also on a headset with their friends and they’re also FaceTiming on the cell phone at the same time. So they’re on a screen, but they’re also socializing and they’re also in peer groups. And so it’s a really different way to think about screen time than maybe a traditional framework or even as kids age, how they’re using that.

Erin Walsh: Yeah, I think there’s two things, especially as we age up into adolescence. One of the things that we see is that this idea of even tracking minutes becomes really difficult. And so it actually positions parents as this sort of constant surveillance and can actually increase family conflict when we’re trying to get it down to the minute of what they’re doing. As you noted the presence or absence of a screen, it tells us something, but it certainly doesn’t tell us everything. But are they connecting in healthy ways to their friends and that actually it was really protective for their mental health depending upon what else is going on. So it matters.

Dr. Kade Goepferd: Let’s switch gears a little bit. We often have a lot of fears about screens and online activity and teenagers, and I want to get into some of those and talk about tips and guidance. But before we do that, what are some of the good things about this new world? We’ve invented all of these things not to just completely tank our teenagers mental and emotional wellbeing, but what are some of the benefits that teenagers now have from all of this technology in their life?

Erin Walsh: Our concern, it can actually make us miss some of the really positive benefits that are happening right before our eyes with our patients. We do have data that media and technology can be really protective for kids, especially as we look at adolescents and as we were just talking about kids gaming together, like forming healthy relationships and extending and deepening those relationships beyond the school day. We know that kids do better when they find communities where they feel seen and known and valued. And so experiencing that sense of belonging can happen online and especially if they’re not experiencing that in school or in their neighborhoods, that being able to have those spaces where they’re able to connect with people who maybe share their identities or share their interests is actually really protective for mental health. We know that kids are seeking information about their health and their mental health, and while we are of course worried about misinformation and sort of the fire hose of toxic information, we are really glad when kids are curious about how do I take care of myself? How do I find information to support my decision making? And we know they’re looking online for that stuff so when they can access the good stuff, it’s very protective. So being able to create and take voice and the issues that they care about, all of those things are great for kids.

Dr. Kade Goepferd: My child who I won’t name because he would kill me for sharing this story, but I did mention the Chromebooks, and we have a rule with our Chromebooks that they will be checked. We’re going to check their search history every now and then. And just because we’ve kind of set some boundaries around what’s okay and what’s not okay, and if they run across something that is kind of scary to them or they haven’t seen before, they have questions about they can come talk to us and they won’t be in trouble. And so I was doing a screen check and one of my sons was looking up “what is herpes?”. That was what he was looking up and I don’t know why he was looking that up. Good question. Fair question. So my instinct was to say, why are you looking this up? Where did you hear this word?

Whatever. I tried to temper that and I said, Hey, I noticed you looked this up. And then I said, what did you find out? What did you learn? And then I said, I actually think there’s some really great websites that can teach you this information. And so I would love if you have questions like this about a word or bodies or something like that, I’m going to favorite some websites for you because there is actually bad information out there that I don’t want you to have. I think it was a good lesson for me. Don’t freak out. Maybe it’s an opportunity for redirection. There is good information on the internet. Totally.

Erin Walsh: Yeah. And two things that I love about that story, even though I understand your child might be mortified that you shared it. One is that you are modeling how to be an askable adult. As kids get older, we know that one of the number one reasons they don’t come to us when things get tricky or challenging online is because they’re afraid we’re going to overreact, freak out and take their devices. That’s not to say that we never have a tool in our toolkit saying that that app isn’t going to work for now, but that power of taking a breath and coaching parents that we’re working with to approach their kids with a little curiosity, tell me about what you found. And also putting those guardrails up of the question’s. Good. But I know you deserve reliable answers, and I can be one of the ways that I can help you find those resources.

Dr. Kade Goepferd: But don’t give me too much credit because when I first came to him with this discovery, this will give you a little history of my parenting, he said to me, okay, fine, take my computer away. And I said, no, I don’t want to take your computer away. That wouldn’t teach you anything. I want to help you. And this is, I think, an opportunity for us to learn about something. Taking it away isn’t the answer, but he just assumed that’s what I was going to do. So maybe I have a little grace to go there. Well, we’re all on the road. Let’s dive in a little bit about social media also something that we hear a lot about out there, and I think parents have a lot of fears about in the landscape of social media. Are there apps that are better or worse boundaries that you frequently recommend around social media? Help us help parents when they ask us what to do about social media?

Erin Walsh: Yeah, I mean, it’s another tricky one. I will say that when I said there’s no secret number about what age kids should get a first smartphone or cell phone, we do have slightly better data at this point on social media and adolescent mental health insofar as we see these windows of sensitivity where during certain developmental stages, kids have sort of an outsized sensitivity to potential social media harms. And so one of those windows is in early adolescence where those developmental changes like sensitivity to rewards and peer feedback come on a collision course with a lot of the ways that popular platforms are designed around social comparison and popularity metrics, and honestly, designing platforms for overuse because their goal is to get kids online as long as possible. That intersection of that early adolescent vulnerability with the attributes of some of these platforms can get tricky for a lot of kids. So we don’t have robust causal data that says every kid that gets on social media has these negative outcomes. But I think we see enough strong associations in that early adolescent phase that delaying social media as long as possible is starting to make a lot of sense.

Dr. Kade Goepferd: Sure. So early adolescence to me sounds like not before high school, is that,

Erin Walsh: Yeah, what we’ve seen in the data is this 10 to 14, 15 is where we think of that sort of window of sensitivity, where we see this outsized impact of harms. Does that mean if we have a family sitting in the office and their kid is on Snapchat that inevitably everything’s going to get negative? We don’t quite see that clear of a relationship, but it certainly means that if kids are on social media earlier than that, that they should have a lot of support around that experience, monitoring conversations, trying to make those experiences sort of smaller and as safe as possible given that they weren’t built with adolescent mental health and development in mind.

Dr. Kade Goepferd: So say we’re in the office and we see a kid who’s on Snapchat. Is that an opportunity maybe for us to talk to a parent about what kind of rules do you have about Snapchat or what kind of boundaries? What do you suggest that we tell them?

Erin Walsh: Yeah, I mean, I think those kinds of curious questions are great. So understanding how are you approaching it? Is it just they’re on it all the time? We’ve never talked about it. And then really thinking about those two things of content and what’s happening around the kids. So how are you monitoring the actual interactions that are happening in a place like Snapchat or their For You page on their TikTok feed? Because the kinds of content and interactions they have really matter. They really do drive outcomes. So what’s happening within the app and then what’s happening around the app? So I think asking parents questions about is, is it getting in the way? Is it getting in the way of stuff that as a clinician, kids need to grow up in safe and healthy ways. So is it getting in the way of sleep? Is it getting in the way of socializing face-to-face with friends? Is it getting in the way of school? Those are the kinds of things we want to look out for, what’s happening inside the app and then what’s happening around it and asking those curious questions of parents of how are they approaching it and how do they think of this app in terms of what are their fears and what are the power struggles or challenges happening? Or maybe they’ve got a lot of plans around how they’re trying to make it safe for their kid.

Dr. Kade Goepferd: You mentioned two of the big three that were on my mind, Snapchat and TikTok. We’ve got to talk about YouTube. YouTube is the bane of my existence as a parent, but also as a pediatrician. I see two-year-olds on YouTube, and then I know teenagers are just spending hours and hours on YouTube. In my head is the little Sound of Music. How do you solve a problem like Maria, how do we solve a problem like YouTube? Give me your best YouTube advice.

Erin Walsh: Well, at first I just want to affirm that I appreciate you bringing up YouTube because oftentimes people want to talk about the newest, the TikToks of the world, the newest thing. They’re in the headlines. But when we look at the data, Common Sense Media data in the last couple years, the number one app that kids and teens can’t live without is YouTube.

It takes up an extraordinary amount of their time. And with YouTube shorts, the lines between these different platforms are quickly disappearing. So what do we do? I think a couple of thoughts. So one is talking with caregivers a little bit about what they know about how to create smaller, slightly more safe playgrounds for kids within YouTube. So if they have younger children, making sure they know about YouTube Kids, that it is a version of YouTube that is designed to have more age appropriate content. It’s not a perfect system, but it is certainly better than plopping down a 6-year-old with the full range.

The challenge with that for our older kids is that most 13-year-olds are not like, oh yeah, I am super happy in YouTube Kids. This is just a place where all my friends are. There are ways where you can create a supervised YouTube account through Google Link where you can at least create a situation, whereas a parent, you can get a look at their search history and a look at their viewing history that’s not just reliant on the sort of organic search that you can see that’s easily erased and where you can actually do things like turn off autoplay or approve certain creators feeds or channels and those kinds of things.

So there are some things on the technical side and we can provide supports if that’s useful. Most things when it comes to kids in tech, there’s a tech side and that’s half the work. And the other side is the coaching and conversations and curiosity of “tell me more about why you like this.” Yes, yes. Tell me about Mr. Beast and what, and so giving parents, the American Academy of Pediatrics does have a beautiful set of questions for different developmental stages that parents can be asking their kids about the content that they’re seeing online. And so having that in our hands, if parents are like, I don’t know the words to ask, and making sure that we say, well, here are 10 questions you can ask your 10-year-old about.

The places that they like to go, which YouTube will be on that list?

Dr. Kade Goepferd: Oh, a thousand percent.

Erin Walsh: So plugging in what we do know, unfortunately, is that parental controls as a standalone tool doesn’t really reduce risky behavior. So it has to be in combination with these conversations. How do you organize and help them make sense of what they’re seeing and hearing which your conversation with your kid is a beautiful example of, I saw you searched for this.

Dr. Kade Goepferd: Yeah, tell me more. Do I need to know about this? It’s tough. And I think generationally, so I’m Gen X, I would not consider myself a digital native, and I had to learn all these things for myself about how to turn off the autoplay. And one of my kids had subscribed to like, oh my god, like 50 different people. And I had no idea. I don’t subscribe to anything. And so we had to go through and talk about that. I mean all these different things, and it is hard. And it wasn’t until I actually heard you give the talk at the elementary school, I dunno, it was maybe the weekend or two after that, and I saw my kid had subscribed to something. It was like this Mr. Pineapple. So I was like, oh my gosh, it’s the dumbest. I watched it. And what I wanted to say was, this is dumb and it’s making you dumber and I don’t want you watching it.

And instead after hearing you talk, I said, tell me why you like this, which is hard. But yeah, I mean it’s a whole thing. And I think one of the biggest questions that we get asked, and I’m sure you get asked, and I didn’t ask it, I know the answer is, what app or what control should I put on my device to keep my kids? They don’t work. And I think it’s really not teaching them the skills that they’re going to need long term. So I think restricting when they’re younger as much as you can, but I think really as they get older, giving them the tools and the skills to navigate probably better.

Erin Walsh: Yeah, I mean those parental controls, they’re useful as a tool. And if we think of them as one tool of many, it has a role, especially when kids are new to devices, it’s like, okay, we’re going to try to make this a smaller playground as a standalone strategy though it just doesn’t work. Let’s say we observe that our kid is consuming hate content or health mis-information or self-harm content. I mean, certainly we want to start with curious questions and it’s okay to then really think about what extra supports might this child need? What else might be going on? Oftentimes tech challenges. There’s other stuff that’s not always about the tech. So making sure we’re sort of keeping an eye on, if a parent says, well, they’re on YouTube all day every day after school, there may be something else that they’re trying to avoid. There may be undiagnosed social anxiety, we don’t know, but trying to get a sense of the whole picture rather than just, I monitored you and I’m confiscating your device.

Dr. Kade Goepferd: Yeah, absolutely. There are two concepts that I want to go over with you before we close that. I’d really love to hear you talk a little bit more about having looked into some of the work that you’re doing. So this concept of digital well-being, I really like how that sounds as a concept, but I’d love to hear a little bit more about what you mean by digital well-being and how we can kind of cultivate that in patients and families.

Erin Walsh: It sounds pretty, and it’s really hard for any of us. I don’t think a lot of the adults that we see have necessarily found this balance. So there isn’t one agreed upon definition, but we like to think of it as tech use that supports whole human health. So sometimes people talk about that as balanced, responsible, intentional tech use, but it’s that technology plays a role in our lives in supporting our sort of mental, physical, spiritual health and development. So it’s not interfering, but also maybe promoting and being open to the idea that it could help us attend to our physical and mental health. And I think that it is not easy. Our devices are designed often to get us on them more, and that can quickly sort of get in the way of some of those sort of basic ingredients for thriving for kids, but it can help us move towards those as well. So I think that sort of thoughtful or intentional use is part of the picture there.

Dr. Kade Goepferd: And I think what I really liked and gravitated toward as a pediatrician with this concept of digital well-being is that it’s a phrase or a term or a way that I could ask about it in a checkup. So I could say, now I’d like to talk to you about your child’s digital well-being. So we’ve just talked about all these other things, nutrition and all these things, and maybe even just having a set of four or five questions: what devices do they have access to? Is any device or digital part of their environment interfering with their sleep? Even just a handful of questions to check in about this concept of digital well-being. I really thought that could be helpful for us as we’re trying to support the whole health of our patient.

Erin Walsh: I love that, imagining that conversation happening in a room, because I do think that this word “screen time” holds a lot of baggage for parents. I just had the opportunity to interview one of the authors of the American Psychological Association’s health advisory on teens and mental health and social media, and I asked her, what are some of your biggest concerns? And one of the concerns she raised was parental shame related to screen time and how it shuts down conversations between professionals and caregivers. It shuts down conversations between parents and kids. And not that we would come at it in a shy way, but screen time kind of has a lot of baggage around it. And I do think that idea of, let’s talk about digital well-being, just like we’re talking about all these other kinds of well-being and the questions that you just asked, asking about how’s your kid doing? What are you observing? Because one kid can play video games and feel creative and collaborative and inspired, and another kid is irritable, angry and explosive. Different kids, same game. So how’s your child? What about these other things we know? Is it, what about sleep and connection time with family and friends and learning time? Is tech helping or hurting in those spaces?

So those are the kinds of follow-up that I think that framework of digital well-being invites looking at, sort of the whole system and the whole kid.

Dr. Kade Goepferd: And then the other sort of concept, and we talked about this already a little bit, is this concept of a relationship-based approach to screen time, particularly I think with kids, but I think also with teenagers that there’s not a good app or a bad app or a good website or a bad website. But can you just maybe help us close with that and kind of describe what a relationship-based approach to screens would look like.

Erin Walsh: If we knew from the data all screens are just bad all the time, then maybe this idea of parents or caregivers just being on off regulators might make sense where it’s just like our job is to enforce rules, rip devices out of kids’ hands and turn things off. That works okay with little babies for whom we don’t have a lot of data that the screens help. But the reality is, and the American Academy of Pediatrics new five Cs around screen time of child content, calm, crowding out communication illustrates the complexity of all of those things matter to whether tech is helping or whether it’s hurting. And I think this does invite this sort of relational approach to helping kids think about, for example, what do you do with big feelings? So it’s not just turn that off, it’s a mindless waste of time, but you’re feeling angry. What do we do with anger? Those are the kinds of coaching that seems kind of far afield from screen time, but actually is really important to helping kids use tools in responsible ways. So I think that from control to connection, and not just, I’m here to monitor and supervise, but I’m here to listen. I’m here to set boundaries, but I’m also here to coach and help you problem solve. Young people often say to me, I don’t think adults get how complicated it is. That it’s not always as simple as just turning my phone off. This stuff spills over into real life.

Dr. Kade Goepferd: Well, and my kids are always telling me all the time that I don’t get it. I’ll say, it’s time to go turn that off, or it’s time to eat, turn that off. They’ll say things to me like, well, you don’t understand, because if I don’t get to the end of this thing or the end of, then I lose all my progress. And of course, that holds no weight with me, but I can see from their perspective, they’ve spent 75 minutes trying to get to the end of this app and Roblox or whatever.

Dr. Kade Goepferd: It’s totally annoying, but I do think trying to develop some understanding could be helpful.

Erin Walsh: Yeah, it’s that combination. I think sometimes when it comes to tech, we feel like we have to decide between our concern and our gratitude for the benefits or boundaries and warmth and curiosity. And I think what we see in the evidence is that kids really do better when we can do both. When we can hold firm boundaries and we can play with them, game with them, watch with them, ask questions, and be curious. And both of those things are sort of the secret sauce, not easy to implement. Its not an easy time to be a caregiver, but what we do know is that they pay off as kids grow.

Dr. Kade Goepferd: Yeah. Well, thank you so much. This was a great conversation today. Thank you for joining us today. Thank you so much. What a wonderful conversation.

Thank you for listening to Talking Pediatrics. Come back next time for a new episode with our caregivers and experts in pediatric health. Our showrunner is Cora Nelson. Episodes are produced, engineered and edited by Jake Beaver and Patrick Bixler. Our marketing representatives are Amie Juba and Krithika Devanathan. For information and additional episodes, check us out on your favorite podcast platform or go to childrensmn.org/talkingpediatrics.