María Angustias Salmerón: ‘If you need your child to take a mobile phone with them to buy bread, it's better not to let them’

A paediatrician specialising in digital health, she defends the urgent need for everyone, not just minors, to disconnect and demand technology that, instead of capturing our attention, is at the service of human beings. 

We spoke to the expert following her participation in a debate on digital wellbeing and minors held at the Palau Macaya of the 'la Caixa' Foundation. 

You have been working with teenagers for years. How would you describe the current state of their mental health? 

The pandemic marked a very clear turning point not only in adolescence, but in the entire population. It was a period of tremendous stress that put many systems in check, including child protection systems. Although it would be simplistic to attribute the change to this single cause, the feeling is that ‘something is happening’: we are living in a more tense and nervous way, it seems that kindness is expensive and that there is less respect on a day-to-day basis. And children are sponges: they absorb what they see in their immediate environment and on the street. 

What role does technology play in this situation? 

The digital ecosystem is becoming increasingly complex. We are no longer just talking about screens, but all digital media: the Internet of Things, artificial intelligence... We see parents in the park looking at their mobile phones, children in restaurants isolated behind a screen and people walking down the street without paying attention to their surroundings. 

Social relationships are becoming increasingly impersonal, and face-to-face interaction is becoming more difficult. All of this affects us because we are made to live in tribes, in contact with nature and doing physical work, but we are making things very difficult for ourselves as a species. 

From your experience in consultation, what symptoms does a teenager who is misusing technology present? 

The signs are varied. Physically, we see rapid increases in myopia and cases of strabismus from having the screen too close for too long. There is also a very high incidence of sleep disturbance, the main cause of which is taking mobile phones to bed. When healthy habits such as sleep, physical exercise and diet are affected, this also has an impact on mental health. 

We are seeing children consuming pornography at a very early age and behaving in ways that are not appropriate for their age, teenagers with very violent behaviour and various addictions, such as eight-year-old girls' addiction to cosmetics, which is called cosmeticorexia. The list of effects continues to grow. 

We used to have screens before, and we often had the television on all day... 

The first studies on the effect of screens date back to the 1950s, coinciding with the arrival of the first televisions in homes. What happened when a television was turned on in a living room? Well, people usually fell silent. Those studies warned of how this could affect social interaction. They also studied its effects on eyesight and how certain content affected different age groups in different ways. 

What has changed? 

Portability. Before, you couldn't carry a cinema screen in your pocket, but now we have devices that allow us to watch films and do many other things anywhere. When the television was in a specific room in the house, the time spent in front of it was less. That is why many paediatricians insist on bringing back the desktop computer: it is less likely that a child will use it without parental supervision. 

What do you think of screens for educational use? 

We know that neurodevelopment is based on two factors: individual genetic capacity and the quality of the stimulus the child receives. And real-world stimulation—that of the physical world—is much richer than digital stimulation. If you put a child in front of a screen, they will receive immediate gratification just for moving a finger. On the other hand, if they play with real materials, they will surely seek out a playmate, experiment with textures, temperatures, colours... In a single activity, they will be developing many skills. 

Is there a recommended age for giving a child a mobile phone? 

The Spanish Paediatric Association argues that there is no safe amount of screen time for young children, so the recommendation is that the later the better. What I would say to parents is to ask themselves why they are giving their child a mobile phone. Is there an alternative way to achieve the same result without giving them a latest-generation smartphone? 

Many parents justify giving their children mobile phones so that they do not become isolated from their social circle. 

It is often said that teenagers interact through social media. I believe that we interact with platforms, not with people. Except for instant messaging, on all other social media platforms we are consuming content, liking posts, scrolling endlessly... It is a system similar to slot machines. 

The systems are designed to keep us connected. 

When the first studies on social media addiction emerged, they all raised the same question. It is understandable that one becomes addicted to compulsive shopping because access via mobile phones is permanent. But no one is addicted to social contact. So why do people get hooked on social media? 

Many teenagers believe they have lots of friends there, but this is not the case and they find it more difficult to form deep relationships. We see it on the street: they meet up in person, but all they do is look at their mobile phones, often not even talking to each other, each one doing their own thing. 

What do you think about giving children a phone as a safety measure? 

When a parent gives their child a device 'for safety', the problem is usually the parent's insecurity, not the child's. If you need them to take a mobile phone with them to go and buy bread, it's better not to let them because you probably think they're not ready yet. By doing this kind of thing, we send an ambiguous message. The child will think, 'Dad, do you think it's dangerous to go out on the street?' 

You often say that the problem with screens is not just a problem for teenagers, but for society as a whole. And you propose conscious digital disconnection. What does that involve? 

In my talks, I start by saying that I'm going to ‘give away time’. I ask people to look at their daily connection hours and multiply them by 365 days. Then I ask them what they would like to do with all that time. Conscious digital disconnection is a concept that appears in scientific literature and refers to becoming aware of one's own digital consumption. We have devices designed to carry around in our pockets and we even go to bed with them. I believe that life is short enough that we should ask ourselves what we want to do with our time. 

Sometimes it feels like disconnecting is almost a luxury: there are even ‘digital detox’ retreats. How can we do this on a daily basis? 

The Spanish Paediatric Association has drawn up a series of recommendations for the whole family, starting with adults. These are a series of guidelines based on scientific evidence, such as avoiding screens at mealtimes, but also in bedrooms, to ensure adequate sleep and greater safety, as teenagers are less likely to see certain things in the living room. Less obvious recommendations are also made, such as avoiding constant background noise, which has been shown to affect the development of short-term memory. The brain needs boredom and silence. 

Do you think action should be taken at the political level? 

I refuse to believe that technology has to be bad, but I do believe that technology companies are not going to make changes to solve these problems voluntarily. The alternative is to legislate with measures such as those we use with the pharmaceutical industry, which we ask to prove that the products it brings to market are not harmful. I don't know if we will reach that point, especially considering that technology is advancing so rapidly, but children must be protected by default. 

What role should educational institutions play in this issue? What is the responsibility of the school and what is the responsibility of families? 

We cannot divide children into compartments. Their education is not the responsibility of the school, the family, the police or the neighbour; it is the responsibility of society as a whole. Everything we do can be educational or not. So how can schools not have an educational role? Just as we fight for school canteens to offer quality food, we should also aspire to make schools screen-free spaces. No study has shown the benefits of using screens in schools, but there is plenty of evidence about their risks. 

What would you ask for in order to move towards a society that has a better relationship with technology? 

I would ask society in general to be aware of how much time it spends consuming, of what it pays attention to. I am not anti-screen, but I believe that the development of technology in recent times is giving us tools that can be dangerous. That is why I would ask technology companies to develop systems that are appropriate to human needs and, above all, that protect children. Technology that adds value, educates, protects and is truly at the service of society.