Not long ago, teens had only a handful of ways to be exposed to gambling. Some might see a caregiver buy lottery tickets, others might watch a family member join fantasy sports leagues and some might encounter gambling on a family trip. Gambling was a behavior that had clear boundaries around it as "adults only."

But online gambling has literally changed the game, drawing millions of young people into the world of betting.

Platforms like FanDuel, BetMGM and DraftKings run ads 24/7, inviting young users to wager and win. Most will lose money, but that's only one concern. Gaming disorder, depression, substance use and thoughts of suicide are linked with compulsive gambling, which can start at any age.

No longer constrained to smoky casinos with bouncers only allowing adults to enter, gambling is now front and center. Teens now can get exposed to gambling through all types of media.

Major sports events often include advertisements or sponsorship by online betting companies. Teens who watch sports may begin to link those two things and lead to a normalization of sports betting.

Teens may also see digital ads for betting on social media if they follow sports teams, events or athletes. Seeing betting alongside sports content on social media may further establish this connection for teens. Plus, seeing this content on social media may allow teens to "follow" gambling companies. This leads to even more messaging and prompts teens to engage in this behavior.

Teens who play games online may see countless digital ads for betting sites. Most will find it easy to navigate gambling platforms, since many features look like gaming sites. Young people involved in fantasy sports leagues may already check stats and scores constantly, just like veteran gamblers do.

Top-selling games often have blind, chance-based "loot boxes." Teens can buy into these with in-game currency or real money for a chance to win rare prizes.

Online betting can make gambling even easier. In 2018, the Supreme Court struck down a federal law banning sports betting in most states. Mobile betting is now legal in 30 states, and in some, the legal gambling age is as low as18.

Even in states that prohibit gambling under age 21, teens can easily set up online accounts. Many platforms don't require proof of age or make it easy for kids to lie. Offshore sportsbooks and casinos operate outside the U.S., so young gamblers can place bets wherever they are.

Online gambling ads emphasize big wins and downplay risks, making betting even more tempting for teens. And since many have their own bank accounts, they can lose large sums in the blink of an eye.

You might find it hard to talk with your teen about gambling, especially if you like to buy the occasional lottery ticket or place online bets. Whatever your involvement in gambling, don't leave this topic untouched with your teen.

First and foremost, treating your teen with respect can start the conversation on a good note. Ask them what they already know about gambling using real world examples such as an advertisement you both see on TV. Discuss what it would be like to risk real money with them, asking how they would react if they placed money on a game and lost. Delve into the implications of that loss to give them possible scenarios.

It’s also important to talk about the health impacts of gambling. When you're discussing the true cost of wagering, try not to lecture your teen. At the same time, be honest about what gambling can do to the mind and body. Talk about how for some people, gambling is as real an addiction as drugs and alcohol. Explain other negative health impacts such as lost sleep, darkened moods and possible mental health impacts from financial stress or conflict.

Let your teen know you're in this together. Don't hide your gambling habits, even choices as straightforward as a lottery ticket. Consider saying: "I like gambling now and then, even when maybe I shouldn't. I'm worried you might struggle with this too."

If you are a problem gambler—or have been in the past—talking with your teen may feel especially tough. But your honesty and courage can transform your child's outlook and support their lifelong health.

Other ways you can support your child include setting a threshold for when concern needs to become action, monitoring their online accounts including possible gambling accounts, setting a cap on gambling losses (if you’re willing to allow it in small amounts), and keeping the door open for them to come to you for help.

If your teen's gambling spirals out of control, reach out to your pediatrician or family doctor. Your child may need focused therapy, social support, medication (or a combination of all) to break gambling habits.

Talk with your child's doctor if you notice signs like obsessive thoughts about betting and winning, friend networks that focus on gambling, worries or secretive actions around money, spending that seems out of control, signs of depression, anxiety or thoughts of suicide.

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Megan Moreno, MD, MSEd, MPH, FAAP, is a lead author of the policy statement, "Media Use in School-Aged Children and Adolescents." Dr. Moreno is co-director of the National Center of Excellence on Social Media and Youth Mental Health and principal investigator of the Social Media and Adolescent Health Research Team (SMAHRT) within the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health. Dr. Moreno also served on a committee for the National Academies of Science, Engineering and Medicine's report: "Preventing Bullying Through Science, Policy and Practice."

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