Headlines quickly followed the U.S. Surgeon General’s 2023 advisory on youth mental health and social media. It was cited by legislators. In school Facebook groups, parents shared it. It was printed by pediatricians and taped to the walls of waiting rooms. The document, which connected teens’ excessive use of social media to depression, anxiety, sleep disturbances, negative body image, and even suicidal thoughts, was comprehensive, well-written, and at times genuinely frightening. It was the type of public health statement that truly hits home by almost all measures.
Even so, there’s something that keeps bothering me as I sit with it. Teenagers, specifically those 13 years of age and older, were the primary focus of the advisory. Since most platforms technically require users to be at least 13, that framing made some sense. However, there are significant differences between the two. What about the two, three, four, and five-year-old kids who don’t have their own accounts but manage to watch hours of carefully chosen content every day? This is what the warning subtly ignored.
You can see it in practically any restaurant, waiting area, or family living room these days. A toddler in a car seat, a tablet placed in front of her face, and a looping YouTube video showing cartoon eggs being opened. Sitting on his grandfather’s lap, a three-year-old boy observes his grandfather browsing TikTok. These kids weren’t given their own phones. Nevertheless, the content discovered them. According to a 2024 survey, 65% of kids between the ages of eight and ten already use social media for up to four hours every day. This is the older end of a very young age group. Less than eight? The reality in the majority of households doesn’t change, but the data does.
The Surgeon General’s warning focused on adolescence as a crucial period of brain development, pointing out that teens are particularly vulnerable to the dopamine-triggering design of social media because the prefrontal cortex, which is in charge of judgment and impulse control, develops quickly during this time. That is accurate, and it is important. The years prior to adolescence are perhaps even more fundamental, but this is what the advisory failed to make clear. The development of a two-year-old’s neural architecture, the formation of attachments, the growth of their attention spans, and the gradual, laborious learning of emotional regulation all take place in an environment that now frequently contains screens designed to maximize engagement at all costs.
It’s possible that the omission was intentional, a calculated decision to concentrate on areas with the best research foundation. That makes sense. Science advances slowly, and screens for young children are a more recent aspect of an already complex issue. However, the quiet still has significance. Because when a public health advisory defines “youth” as starting at thirteen, it implies to parents, legislators, and tech companies that anything below that age is someone else’s problem to solve.
Due in part to the fact that children under the age of six are not officially users, tech platforms have largely escaped scrutiny regarding what happens when their content reaches them. They are merely travelers. And it’s possible that that loophole—if you can call it that—is causing more harm than anyone is currently measuring. Youngsters younger than six are unable to put what they’re watching into context, discern between a real-life relationship and a character on screen, and speak up for their own need to stop. They are more vulnerable than the teenagers the advisory was intended to protect in every significant way.
Observing this develop in legislative chambers and public health discussions, it seems that gathering the evidence isn’t the most difficult aspect. It involves determining that even though the youngest children are unable to vote, speak at hearings, or send emails to their representatives, they are still worth the institutional and political effort to protect. The warning from the Surgeon General was an essential step. It simply didn’t go back far enough.
