Too much screen time can take its toll.

A study out of Hungary, of all places, looked at about 6,000 16-year-olds and found that 4.5 percent were in the at-risk category having high levels of depression symptoms, low self-esteem and elevated social media use.

Another study, published in November, from the University of Lancaster, England,  looked at the many studies done on social media and teens and also found some negative affects to social media and teens when it came to depression, but researchers also found that social media, when used well, could actually help with depression.

What is a parent to do?

Dr. Julie Alonso-Katzowitz, a child and adolescent psychiatrist at Dell Children’s Hospital and University of Texas Austin Dell Medical School, says the important thing is to measure how social media is affecting your child’s life.

If you’re seeing your child using social media in exclusion of real life friends, real life hobbies and real life relationships with the family, those are big red flags.

Dr. Julie Alonso-Katzowitz specializes in child and adolescent psychiatry.

Are they irritable or angry in a way that seems unjustified? Do they view their cellphone as their only lifeline to friends? Are they isolating themselves?

Alonso-Katzowitz is working with a stilted population, in that they are coming to her at her office or she’s seeing them in the hospital because of underlying problems, but she has seen teens talk about suicide or try to commit suicide because of cyber bullying or an incident on social media that has made things worse. She sees kids withdrawing, not doing schoolwork or after-school activities, not sleeping or have real-life relationships.

Removing access to the phone or computer can help them get things on track in the short-term, but eventually it has to be about knowing how to use social media correctly.

“With everything else in life, moderation is key,” she says. “You don’t want to give them untethered access to social media 24-7.”

That means making sure that sleep is a priority. There should be a cut-off time when the phone is turned in and placed in a charger away from the child. If not, the phone will be dinging all night long with notifications of their friends posting stuff or texting them.

Parents also can set some phone-free zones like at the dinner table.

Parents also should be have a discussion about real-life friends verses virtual friends. Alonso-Katzowitz has worked with families where a young teen was “befriended” and then pursued by an older person.

And parents should be talking to their kids about the permanence of what they post or text. Those things can have lasting implications and kids often have regrets that they cannot take it back.

With all things adolescence, using social media correctly is a skill that takes time and maturity to develop. “In general, teenagers don’t have the same kind of insight and judgment as adults have in regards to decision making and perspective making,” she says. “They can’t evaluate those situations as well as adults can.”

Social media can be useful, Alonso-Katzowitz. She’s seen kids find a support network or finding people who were interested in some of the same things they are through social media. That can help lessen depression.

There are two schools of thought when it comes to kids and social media: the monitor everything and set filters school, and the mentor your child to give your child guidance and skills school. 

Last fall, the American Academy of Pediatrics changed its recommendations about screen time and children. Instead of  setting a two-hour limit for school age children, it’s about quality versus quantity. And for the younger set, it should be avoiding anything other than video chatting with grandma before 18 months, and then only picking quality educational programming after that.

If you think your child might be having signs of mental illness, read this story about what you can do and how to engage their friends in helping them get better.