Background: The digital life of children and young people is characterised by frequent use of social media and digital games. Previous research has demonstrated detrimental health effects of problematic media use. However, links with health literacy (HL) have received little attention, although frameworks suggest health literacy to be a determinant of health behaviour. Methods: This paper draws on data from the representative Health Behaviour in School-Aged Children (HBSC) Study in Germany from 2022 with n = 6475 pupils. Associations between problematic social media use or gaming intensity with health literacy and socio-demographic and socio-economic characteristics were examined using bivariate and binary-logistic regression analyses. Results: The prevalence of problematic social media use was 11.1% and approximately one third reported to spend more than nine hours a week playing digital games. Low health literacy was found to be significantly associated with both forms of media use. In addition, problematic social media use was associated with a female and diverse gender, an age of 13 years, a migrant background and belonging to a type of school other than grammar/high school. High gaming intensity was associated with a male and diverse gender, belonging to the 13- and 15-years age group and low family affluence. Discussion: The results not only provide guidance for identifying adolescents with a high prevention need but also emphasize the relevance of health literacy for media use behaviour. Exemplary recommendations are taken up with reference to the international literature.