Beyond screen time: artificial intelligence, algorithmic media and the future of child health

Digital media has evolved from passive screen viewing into an algorithmically curated ecosystem of social platforms, short form video, games, generative artificial intelligence (AI), conversational agents, connected toys and educational technologies. These systems can support learning, creativity, communication, disability access and healthcare; however, engagement optimized design, commercial surveillance and synthetic content create risks that are not adequately captured by screen-time measures alone. This narrative review examines the effects of contemporary digital ecosystems on child and adolescent health and outlines implications for pediatric practice. PubMed/MEDLINE, Google Scholar and guidance from the World Health Organization, United Nations Children's Fund, UNESCO and the American Academy of Pediatrics were reviewed, with emphasis on evidence published from 2019 to June 2026. Associations have been reported between problematic digital media use and sleep disruption, reduced physical activity, visual and musculoskeletal symptoms, obesity related behaviours, anxiety, depressive symptoms, cyberbullying, disordered eating and impaired attention. Causal interpretation remains difficult because effects are heterogeneous, often small, bidirectional and strongly modified by age, content, context, displacement, family relationships and pre-existing vulnerability. AI adds distinct concerns: persuasive personalization, inaccurate health information, anthropomorphic dependency, deepfakes, sexual exploitation, biased outputs, privacy loss and erosion of learning through uncritical outsourcing. Benefits are also substantial when technologies are developmentally appropriate, evidence-based, inclusive and used with adult support. Pediatric counselling should shift from counting hours alone toward assessing the child's digital ecosystem, sleep, function, content, compulsivity, safety and relationships. Effective protection requires shared family practices, school digital literacy, safety by design, age-appropriate assurance, transparent algorithms, data minimization and independent research. The goal is not a screen free childhood but a child centred digital environment that supports health, agency and development.