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BOLOGNA - Smartphones have become inseparable from adolescent life, but their impact goes far beyond communication and entertainment. According to paediatric experts, excessive and uncontrolled use can quietly reshape sleep, attention, mood, and even physical health. What begins as a harmless habit may gradually evolve into dependency, with consequences that often go unnoticed until they become significant. Understanding the risks, warning signs, and prevention strategies is essential for protecting teenagers' well-being in a hyperconnected world.
A series of recent scientific studies conducted all over the world
Physical and psychological risks from smartphones in adolescents: symptoms, warning signs and advice from SIP paediatricians. 75th Congress of the Italian Society of Paediatrics, SIP, Bologna, 29 May – 1 June 2019, Palazzo dei Congressi, Piazza della Costituzione 4. From habit to addiction, the step is short. Indeed, very short. This is the main risk faced by adolescents and pre-adolescents, who are increasingly using smartphones and tablets at an ever earlier age and are becoming more and more connected. The main risk, but not the only one. Too many hours bent over a screen can mean losing precious hours of sleep, irritating the eyes, causing neck and shoulder pain, and leading to distraction and inattention. It is not that the internet and social networks are entirely negative; indeed, in some cases they can help foster social relationships with peers, but hyperactivity focused on smartphones can become harmful to psychophysical health. This has been confirmed by a series of recent scientific studies conducted all over the world, which the Italian Society of Paediatrics has collected and examined in a Position Statement that will be presented at the 75th Italian Congress of Paediatrics opening today in Bologna.
Smartphone addiction is recognised as a genuine medical condition
Last year, SIP had already issued an official document on the correct use of media devices (mobile phones, smartphones, tablets, PCs, etc.) in children up to 8 years of age. The new Position Statement instead concerns pre-adolescents and adolescents, in particular the 11–17 age group. Most research has been conducted in the USA and in Asian countries such as China and South Korea, which were the first to experience the large-scale spread of digital technologies, as well as the possible risks of hyperconnection, such as social isolation and genuine addiction. In this regard, in South Korea – where smartphone addiction is recognised as a genuine medical condition on a par with alcohol or drug addiction – 8.4% of adolescents are affected. And in Italy? Few studies have investigated these aspects, but it is certain that new technologies are rapidly increasing among young people. According to ISTAT data from 2018 (1), 85% of adolescents aged 11 to 17 use their mobile phone daily, and 72% go online every day, a figure that was only 56% four years earlier.
A good relationship helps promote proper use of digital technologies
The most frequent users are girls (87.5% use their phone every day). Internet access is strongly driven by smartphones; only 27% connect via PC, compared to 40% in 2014. Around 60% of teenagers check their smartphone first thing after waking up and last thing before falling asleep (2). 63% (aged 14 to 19) use their smartphone at school during lessons; 50% report spending 3 to 6 extra-school hours per day with a smartphone in their hand (3). So how should parents behave with adolescent and pre-adolescent children who are too dependent on their phones? What warning signs should be watched for? “Dialogue and clear rules are needed,” explains the President of the Italian Society of Paediatrics, Alberto Villani. “We recommend that parents always maintain effective communication with their children, because a good relationship helps promote proper use of digital technologies. But it is also essential to establish clear rules and limits for the use of media devices: never at the table, never while doing homework unless they are being used for study purposes, never during family time, never before going to sleep.”
The consequences of improper smartphone use
“Rules,” adds Elena Bozzola, national secretary of SIP, “that apply first of all to parents, who should set a good example. Parents and paediatricians should also pay attention to certain warning signs, including frequent back pain, headaches, changes in sleep patterns, burning eyes and tearing, lack of interest, and an inability to detach from the smartphone. Furthermore, paediatricians should use check-ups as an opportunity to explore these aspects, asking questions about young people’s online lives, encouraging them to cultivate ‘real’ relationships, and informing them about the possible consequences of improper smartphone use. It is very important to network between parents and paediatricians with the aim of supporting and protecting our children.”
1 - Survey on bullying and cyberbullying. Statement by the President of ISTAT to the Parliamentary Commission on Childhood and Adolescence, 27 March 2019
2 - CENSIS Annual Report 2018
3 - National Observatory on Adolescence, January 2017
FOCUS ON THE SIP POSITION STATEMENT
WHAT EMERGES FROM THE RESEARCH
ADDICTION risk three times higher for girls The risk of addiction arises when smartphones are used compulsively. But how can it be recognised and distinguished from simple habit? Currently, few countries classify Internet and smartphone addiction as genuine disorders and have identified recognisable traits, including anxiety and irritability after a period of abstinence, failed attempts to switch off the phone, and impaired social relationships (see diagnostic criteria test below). Addiction is facilitated by the easy access to smartphones at any time of day and in any place, and is associated with mood swings, isolation, loss of control, anxiety, fatigue and depression. The Internet often represents a refuge, especially for more shy individuals with difficulty establishing relationships with peers: scientific evidence has confirmed that smartphone addiction can be caused mainly by boredom and loneliness. In general, girls are more exposed, with a risk three times higher than boys because they spend more time on media devices, especially in search of greater social relationships. In this context, parents play a crucial role in preventing this type of addiction by providing support and emotional education. A good parent–adolescent relationship helps prevent the risk of addiction by reducing the level of social anxiety often present among young people. When isolation becomes pathological, it is referred to as Hikikomori, a phenomenon that in Italy involves around 120,000 adolescents who spend more than 12 hours a day online, showing significant symptoms of psychiatric disorders.
SLEEP up to 6 and a half hours lost per week Smartphone use before sleeping has a negative impact on the circadian sleep rhythm because it causes stimulation and difficulty falling asleep: recent studies show that the use of media devices before bedtime reduces total sleep duration by as much as 6 and a half hours during the school week. Using media devices for 5 or more hours increases the risk of sleeping less compared to those who use them for only one hour per day. Recent research also confirms that sleep is essential for the mental and physical functioning of our body and that when it is insufficient or inadequate it is linked to the onset of cardiovascular diseases, metabolic dysfunctions and diabetes. Furthermore, poor sleep quality leads to negative consequences in young people’s lives such as fatigue, depression, alcohol disorders, obsessive-compulsive disorders, substance abuse and poor academic performance.
LEARNING risk of distraction in studying According to scientific evidence, excessive smartphone use, unless it is for study-related research, can lead to a superficial approach to learning, reduced concentration and increased distractibility, resulting in poor academic performance.
INATTENTION +5% accidents caused by smartphones Hyperactivity focused on smartphones is associated with greater cognitive distraction and inattention that can occasionally endanger users’ lives. For example, according to recent data from the US CDC (Centers for Disease Control and Prevention), the United States recorded a 5% increase in fatal accidents involving adolescents in 2018: among the causes was improper smartphone use by young people listening to music, playing games or replying to messages while walking or crossing the road. Here too, the example of parents is fundamental for children: adolescents with parents who usually talk on the phone while driving are more likely to repeat this behaviour.
DON'T MISS THIS WEEK:
VISION pay attention to burning and dry eyes Exposure to tablets and smartphones can also affect vision. Continuous smartphone use can cause dry eye syndrome. The young person may experience a foreign body sensation in the eye and/or burning eyes, symptoms very similar to dry eye. Moreover, smartphones are used at a close distance due to their small screen, leading to eye strain, glare and irritation. Excessive close-range use of smartphones may influence the development of a condition called “acquired concomitant esotropia”, meaning it can cause a type of strabismus that occurs when diplopia first appears affecting distant vision and then also near vision.
MUSCLES watch out for neck and shoulders Excessive smartphone use can cause joint and muscular pain. Some international studies have shown that 70% of adolescents experience neck pain, 65% shoulder pain, and wrist and finger pain in 46% of cases. Musculoskeletal disorders related to smartphones can be influenced by many factors, including screen size, number of text messages sent and hours per day spent on smartphones. Some researchers have found that texting is one of the factors that contributes most to stress on the cervical spine and neck in hyperconnected users, meaning those who spend more than 5 hours per day.
POSITIVE ASPECTS a help for peer relationships Smartphone use also has positive aspects relating to social interaction. In particular, some studies have observed that online interaction may help adolescents overcome shyness and isolation and relate to others. It has also been suggested that adolescents, especially girls, use the internet as an opportunity to establish relationships without worrying about how others judge their physical appearance. For adolescents who feel isolated and depressed, the internet and smartphones can help improve mood, increase autonomy and independence, foster acceptance by peers and boost self-esteem.
The 5 recommendations of SIP paediatricians
1 - Talk to your child – it is important to encourage open communication between parent and adolescent, explaining to young people what positive and intelligent use of media devices means, paying attention to the content they post and read, and reminding them that it is essential to protect online privacy to safeguard themselves and their family.
2 - Understand, learn and monitor – parents should monitor the time their child spends on tablets, smartphones and PCs, learning about the available technologies themselves in order to understand them as much as possible, playing with them and sharing media device activities where possible.
3 - Set clear limits and rules – it is necessary to limit the time spent using smartphones, tablets and PCs during the day or at weekends, establishing precise prohibited times such as during meals, homework and family gatherings. Consider media as an opportunity for the whole family to watch films together or share social content, chats and videos.
4 - Set a good example – as a parent, example is fundamental; therefore mothers and fathers should first limit their own smartphone use when with family and during meals; it is also important that parents always choose appropriate content and language on social networks.
5 - Network – collaboration between parents, paediatricians and healthcare professionals is essential to protect and support young people through information campaigns that raise awareness of both the positive aspects and the risks of excessive use of media devices.
ARE YOU ADDICTED TO YOUR SMARTPHONE?
Diagnostic criteria for recognising smartphone addiction in adolescents (developed from studies in South Korea). You are using your smartphone improperly if you present 3 or more of the following symptoms:
- Difficulty resisting the impulse to use the smartphone
- Irritability and anxiety during a period of smartphone abstinence
- Using the smartphone for longer than you intended
- Persistent desire and/or failed attempts to stop or reduce smartphone use
- Inability to detach from the smartphone
- Excessive and prolonged smartphone use despite awareness of a physical or psychological problem caused by hyperconnection.
You already have damage if you have 2 or more of the following symptoms:
- Excessive smartphone use causes persistent or recurring physical or psychological problems
- Smartphone use occurs in situations of physical danger (e.g. using a smartphone while driving or crossing the road) or risk of other consequences in daily life
- Excessive smartphone use compromises social relationships, academic results or work performance
- Excessive smartphone use “steals” your time
THE 10 WARNING SIGNS for parents and paediatricians to recognise the risk of smartphone addiction in adolescents
1 - Weight gain or loss
2 - Headaches and back pain
3 - Visual disturbances or eye problems
4 - Changes in sleep patterns
5 - Poor personal hygiene
6 - Online connection replacing face-to-face relationships
7 - Lack of interest in daily life activities and inability to talk about anything other than what is seen online
8 - Poor academic performance
9 - Withdrawal symptoms when the device is inaccessible
10 - Compulsive checking of online information
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