Abstract
BACKGROUND: Digital media exposure has become an integral component of childhood and adolescence, profoundly reshaping developmental environments worldwide. The Italian Pediatric Society (SIP) Digital Dependency Commission aim to provide indications for families and paediatricians to minimize the potential consequences related to media device and social media use in minors. MATERIALS AND METHODS: A systematic review of the international literature was performed in Pubmed searching for Mesh key terms from 1st January 2018 to 1st April 2025. Outcomes of interest encompassed physical health, obesity, neurocognitive development, sleep, visual health, mental well-being, behavioural addiction, and cyberviolence. RESULTS: The analysis demonstrates that excessive and unregulated digital media exposure is associated with sedentary behaviour, unhealthy dietary patterns, obesity, and cardiometabolic risk. High screen use is linked to language delays, impaired attention, reduced executive functioning, and structural brain changes. Evidence reveals sleep disruption, with delayed sleep onset, reduced duration, and circadian rhythm disturbances. Visual health is compromised through increased symptoms of digital eye strain and accelerating myopia progression. Mental health outcomes include anxiety, depressive symptoms, emotional dysregulation, loneliness, and social comparison stress. Problematic digital, gaming disorder, cyberbullying and online violence often coexist with psychological distress and emotional and behavioural difficulties. DISCUSSION: The findings highlight digital media exposure as a multifaceted and powerful determinant of pediatric health. On the base of these findings, the SIP Digital Dependency Commission provide the following recommendations: Delay introduction of personal smartphones until at least 13 years of age; use simplified models until 18. Avoid unsupervised Internet access before age 13; enable parental controls thereafter. Postpone social media access ideally until 18, but not earlier than 14 years. Prohibit device use during meals, before bedtime, and within bedrooms. Encourage outdoor activities, sports, reading, and creative play as primary developmental experiences. Promote school-based digital literacy education, including privacy protection, cyber-ethics, and critical evaluation of sources. Pediatricians should routinely evaluate screen habits during visits, screen for risk factors, and counsel families using anticipatory guidance. CONCLUSION: Coordinated action by clinicians, educators, parents, and policymakers is essential to promote a balanced and healthy digital ecosystem for children and adolescents. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13052-026-02198-6.