Kid influencers on YouTube are marketing junk food and sugary beverages to their fellow kids, and they’re racking up billions of page views, according to a new study published Monday in the journal Pediatrics.

The study demonstrates how advertisers are seeking to take advantage of new avenues to market their wares to children.

“We should approach YouTube influencer videos with skepticism, even with videos that seem to be educational or kid-friendly,” said senior author Marie Bragg, an assistant professor of public health nutrition with joint appointments at New York University’s School of Global Public Health and Langone Medical Center.

The researchers analyzed videos posted by the five most-watched kid influencers on YouTube in 2019. The influencers were between the ages of 3 and 14. The study team noted whether the influencers played with toys or consumed food, such as McDonald’s meals, keeping tabs on the amount of time they spent on a given activity.

Of the 418 YouTube videos that fell within their search criteria, the researchers found that 179 of the videos featured food or drinks, with 90% of those instances showing unhealthy branded items, such as fast food.

Those specific YouTube videos were viewed more than a billion times.

A new kind of marketing

Keeping track of what types of food advertising children are exposed to is important. That’s because dietary habits during childhood can have a significant effect on their likelihood of their becoming obese or developing cardiovascular disease and Type 2 diabetes later in life, according to past research.

And while much food advertising takes place on television, companies have increasingly turned to the growing audiences on social media sites such as YouTube.

One of the most important aspects of the study, Bragg said, was simply bringing attention to the fact that YouTube’s most popular under-18 hosts are frequently promoting products directly, and kids are often glued to the message.

“This kind of marketing is uncharted territory for families and researchers,” she said. Parents “may think they’re setting their kids down to watch another kid play in their backyard,” not children promoting Chicken McNuggets for a fee.

That’s particularly true during the pandemic with parents turning to screen time to keep kids occupied when there are fewer in-person activities and parents are working from home.

“Child exposure to unhealthy food, beverage, and other content on YouTube needs to be regulated,” said Dr. Jenny Radesky, lead author of the American Academy of Pediatrics policy statement on digital advertising to children, via email. “‘Host-selling’ — the practice of trusted characters promoting products within their own videos — needs to stop on YouTube, because it’s not allowed on TV.” Radesky was not involved in the study.

One major type of YouTube influencer video, which can feature food, is the phenomenon known as “unboxing videos,” in which people open up boxes of products while they narrate or comment on what they’re doing. The videos can blur the line between a product review and advertising outright.

“While the adult digital ecosystem is driven by ad revenue and persuasive design, that doesn’t mean that children’s digital spaces should be,” added Radesky, who is also an assistant professor of pediatrics at the University of Michigan. “We need a new children’s design code of ethics in the US.”

One popular YouTube channel, Ryan’s World, which was one of the five major influencer channels featured in the study, boasts more than 26 million subscribers. It features videos with food and stars a young boy who frequently plays with toys on screen.

“Parents shouldn’t allow their children to watch unboxing videos or other influencer content,” said Josh Golin, executive director of the Campaign for a Commercial-Free Childhood, via e-mail.

“Young children view the stars of these videos as peers and friends and don’t understand that the reason YouTube stars like Ryan are so enthusiastic about products featured in there is because they are stealth marketers.”

These videos can be particularly successful because viewers feel as though they have a personal or friendly relationship with the star. “Research shows that kids who watch these videos are more likely to nag their parents for products — and throw a tantrum if they say no — than if they watch traditional TV commercials,” Golin said.

The emerging awareness around YouTube influencers and food product placement in their videos could stoke change in the industry, as stars continue cultivating their relationship with their fans.

“Ryan’s World cares deeply about the well-being of our viewers and their health and safety is a top priority for us,” said Susan Yin, a spokesperson for Sunlight Entertainment, the production company for Ryan’s World, via email.

“As such, we strictly follow all platforms terms of service, as well as any guidelines set forth by the FTC (Federal Trade Commission) and laws and regulations at the federal, state, and local levels.”

She said that Ryan’s World “welcomes” the new study from the American Academy of Pediatrics.

“As we continue to evolve our content we look forward to ways we might work together in the future to benefit the health and safety of our audience,” Yin said.

CNN reached out to Google, the parent company for YouTube, to comment on this story, but hasn’t heard back. CNN also reached out to McDonald’s and SNAC International, the leading trade association for the snack industry. (“SNAC” stands for snacking, nutrition, and convenience.)

A new law to protect children

The Federal Trade Commission and state authorities should strengthen regulations concerning product placement on YouTube videos that feature young children, the NYU researchers argued.

CNN has reached out to the FTC for comment.

Bragg also pointed to the Kids Internet Design and Safety Act; the legislation was introduced by Democratic US Sen. Ed Markey of Massachusetts and US Sen. Richard Blumenthal of Connecticut in March.

The legislation would build on protections in the Children’s Online Privacy Protection Act, passed in 1998, before the rise of YouTube and other online platforms such as TikTok and Snapchat.

The bill seeks to protect children from the effects of influencer marketing as well as design features such as auto-play, which can increase the amount of time kids spend on screens or using apps.

The KIDS Act would ban auto-play settings and push alerts on sites frequented by kids and teens. And it would prohibit websites from promoting unboxing videos or content in which hosts sell products to children. The bill would also make it illegal for sites to recommend content to kids or young teens involving nicotine, tobacco or alcohol.

Those new regulations would be particularly important in helping communities historically at risk of exposure to advertising of junk food and sugary beverages, as well as the long-term health risks those products can pose.

Although the researchers didn’t focus on how the food and beverage product placement affects dietary choices, they called for more research on it.

“Companies consider Black youth as cultural trend setters,” Bragg said. “They purposely target Black youth with these sorts of products.”

Whenever possible, she recommended that parents limit the amount of time their children spend watching YouTube, even for content that appears to be kid-friendly or educational. And Bragg argued that pediatricians can help inform parents about the ways marketing can be disguised as entertainment.

“If your child uses YouTube or YouTube Kids,” Radesky said, “know that they are going to be the target of a lot of marketing they probably won’t understand. They might be highly influenced by favorite YouTubers, and not realize their favorite videos are essentially commercials. Help them be more savvy.”