Children's Hospital Colorado

Understanding Problematic Internet Use

Addressing the unique needs of every child so they can be their unique selves.

The internet is a ubiquitous part of children and teenagers’ daily lives and has become a foundational component of how youth learn and socialize. Over the past decade, the amount of time that youth are spending online has continued to increase, and the variety of platforms and apps designed for youth grow each year. Additionally, children are plugging into online activities at increasingly younger ages. In the United States, the average age at which a child receives their first smartphone is 111, and Facebook is currently in the process of launching a new version of Instagram for youth under the age of 13.

The role of the pandemic in increasing internet use among youth

The pandemic has also led to an increase in the amount of time that youth at all ages are spending online and it is unclear what the long-term impact will be on children’s mental and physical health. Prior to the pandemic, research has documented a relationship between excessive screen time and increases in obesity as well as sleep disturbances in children and teens2. There is also evidence that youth mental health is negatively impacted by excessive time online and that over-engagement in online activities can serve as a way to avoid real life stressors, which further exacerbates mental health problems3.

Parents often feel overwhelmed when it comes to navigating and monitoring their children’s online activities and knowing what is and isn’t problematic in terms of screen time. Physicians can be a valuable resource in helping parents understand the risk and benefits of online time for kids and helping parents navigate the complex dilemmas facing our youth and their mental and physical health during the pandemic.

Problematic internet use or internet addiction

Problematic internet use (PIU), also known as internet and video game addiction, consists of three main factors, which include obsession (e.g. obsessive thoughts about checking social media), neglect (failing to complete homework due to internet use), and lack of control (unable to stop online activity). Youth who experience PIU often lose track of the amount of time they are spending online, have trouble concentrating on non-online activities, and they will rush through daily task to be able to return to online activities. Because social media sites have algorithms designed to sustain interest and reward use, many children are at risk for developing unhealthy internet use habits.

Youth who are most vulnerable for PIU are those with a history of mental illness, high endorsement of loneliness, shyness and those who tend to need high levels of social assurance from others. PIU most likely occurs in youth who access social media for more than two hours a day and for those who have multiple social media accounts. PIU is a serious problem that often needs professional treatment from a therapist who has a background in treating addiction or impulse control conditions.

Assessing internet use

Given the importance of online activities in a youth’s life and the connection between these activities and health outcomes, it is important for providers to routinely assess internet use habits. Such an assessment is helpful in being able to provide education to all families, but it may be especially necessary for youth who are at high risk for developing PIU.

Below are questions that can be helpful to get a thorough understanding of a youth’s internet habits:

  • Frequency and type:
    • How much time is spent online on weekdays at school and how much time after school?
    • How much time is spent online on weekends?
    • What are the primary sites visited (e.g. YouTube, TikTok) and how much time on each?
  • Active versus passive use:
    • How much time is spent online posting content? How much time is spent in real-time communication (e.g. IMing)? How much time is spent passively viewing content posted by others?
  • Content emotion:
    • Is the content viewed and shared primarily positive (inspiring quotes) or negative (unhappy status updates)?
    • Does the youth engage in or receive arguments, criticism or bullying online?
  • Online versus real life connections:
    • Is connection to friends/peers done more often in real life or online? Is the internet used to set up time to meet friends in real life or are most interactions completed through virtual platforms?

These questions can open an important dialogue between providers, youth and parents in getting a better sense of not just frequency of screen time and online engagement but the type, quality and purpose that encompasses this time. Such information is critical to customize guidance and advice to families on what is needed to help their youth develop healthy and appropriate use of the internet.


There are a variety of resources available to help educate and support families in developing healthy use guidelines for their home.


1 The Common Sense Census: Media Use by Tweens and Teens, 2019

2 #StatusOfMind, examining the positive and negative effects of social media on young people’s health. London: RSPH and Young Health Movement.

3 Glover J.A. & Fritsch S, (2018). #kidsanxiety.socialmedia: A review, Child Psychiatric Clinics of North America, 27, 171-182.