Family Social Media Usage


Clinical Report—The Impact of SocialMedia on Children, Adolescents, and Families

abstract Using social media Web sites is among the most common activity of today’schildrenandadolescents.AnyWebsite thatallowssocial inter- action is considered a social media site, including social networking sitessuchasFacebook,MySpace,andTwitter;gamingsitesandvirtual worlds such as Club Penguin, Second Life, and the Sims; video sites suchasYouTube; andblogs. Suchsitesoffer today’s youthaportal for entertainment and communication and have grown exponentially in recent years. For this reason, it is important that parents become awareof thenatureofsocialmediasites,given thatnotall of themare healthy environments for children and adolescents. Pediatricians are in a unique position to help families understand these sites and to encouragehealthyuseandurgeparents tomonitor forpotentialprob- lemswithcyberbullying, “Facebookdepression,”sexting,andexposure to inappropriate content.Pediatrics 2011;127:800–804

SOCIALMEDIAUSEBY TWEENSAND TEENS Engaging in various forms of social media is a routine activity that researchhasshown tobenefit childrenandadolescentsbyenhancing communication, social connection, and even technical skills.1 Social mediasitessuchasFacebookandMySpaceoffermultipledaily oppor- tunities for connecting with friends, classmates, and people with shared interests. During the last 5 years, the number of preadoles- cents and adolescents using such sites has increased dramatically. According to a recent poll, 22% of teenagers log on to their favorite social media site more than 10 times a day, and more than half of adolescents log on to a social media site more than once a day.2

Seventy-five percent of teenagers now own cell phones, and 25% use themforsocialmedia, 54%use themfor texting,and24%use themfor instantmessaging.3 Thus, a large part of this generation’s social and emotional development is occurringwhile on the Internet and on cell phones.

Because of their limited capacity for self-regulation and susceptibility to peer pressure, children and adolescents are at some risk as they navigateandexperimentwithsocialmedia. Recent research indicates that therearefrequentonlineexpressionsofofflinebehaviors,suchas bullying, clique-forming, and sexual experimentation,4 that have intro- ducedproblemssuchascyberbullying,5 privacy issues, and“sexting.”6

Other problems that merit awareness include Internet addiction and concurrent sleepdeprivation.7

Many parents today use technology incredibly well and feel comfort- able andcapablewith theprogramsandonline venues that their chil-

GwennSchurgin O’Keeffe,MD, KathleenClarke-Pearson, MD, andCOUNCIL ONCOMMUNICATIONSANDMEDIA

KEYWORDS Internet, cyberbullying, online harassment, Facebook depression, sexting, socialmedia, digital footprint, COPPA, advertising, social networking, bullying, adolescents, children

ABBREVIATION AAP—AmericanAcademyof Pediatrics

This document is copyrighted and is property of the American Academyof Pediatrics and its Board of Directors. All authors have filed conflict of interest statementswith the American Academyof Pediatrics. Any conflicts have been resolved through aprocess approvedby theBoard of Directors. The American Academyof Pediatrics hasneither solicited nor accepted any commercial involvement in the development of the content of this publication.

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard ofmedical care. Variations, taking into account individual circumstances,maybe appropriate.


All clinical reports from the American Academyof Pediatrics automatically expire 5 years after publication unless reaffirmed,revised, or retired at or before that time.

PEDIATRICS (ISSNNumbers: Print, 0031-4005; Online, 1098-4275).

Copyright©2011by the American Academyof Pediatrics

Guidance for the Clinician in Rendering Pediatric Care


drenandadolescentsareusing.Never- theless, some parents may find it difficult torelatetotheirdigitallysavvy youngstersonline forseveral reasons. Such parentsmay lack a basic under- standing of thesenew formsof social- ization,whichare integral to theirchil- dren’s lives.8 They frequently do not have the technical abilities or time needed to keep pace with their chil- dren in the ever-changing Internet landscape.8 In addition, these parents often lack a basic understanding that kids’ online lives are an extension of their offline lives. The end result is of- ten a knowledge and technical skill gapbetweenparentsandyouth,which createsadisconnect inhowthesepar- entsandyouthparticipateintheonline world together.9


Socialization andCommunication

Social media sites allow teens to ac- complishonlinemanyof the tasks that are important to them offline: staying connected with friends and family, making new friends, sharing pictures, and exchanging ideas. Social media participation also can offer adoles- cents deeper benefits that extend into their view of self, community, and the world, including1,10:

1. opportunities for community en- gagement through raising money for charity and volunteering for lo- cal events, including political and philanthropic events;

2. enhancement of individual and col- lective creativity through develop- ment and sharing of artistic and musical endeavors;

3. growthof ideasfromthecreationof blogs,podcasts,videos,andgaming sites;

4. expansion of one’s online connec- tions through shared interests to

include others from more diverse backgrounds(suchcommunication is an important step for all adoles- cents and affords the opportunity for respect, tolerance, and in- creased discourse about personal andglobal issues); and

5. fosteringofone’s individual identity andunique social skills.11

Enhanced LearningOpportunities

Middle and high school students are usingsocialmedia toconnectwithone anotheronhomeworkandgroupproj- ects.11 Forexample, Facebookandsim- ilar social media programs allow stu- dents to gather outside of class to collaborate and exchange ideas about assignments. Some schools success- fully use blogs as teaching tools,12

which has the benefit of reinforcing skills in English, written expression, and creativity.

AccessingHealth Information

Adolescents are finding that they can access online information about their health concerns easily and anony- mously.Excellenthealthresourcesare increasinglyavailable toyouthonava- riety of topics of interest to this popu- lation, suchassexually transmitted in- fections,stressreduction,andsignsof depression. Adolescents with chronic illnessescanaccessWebsitesthrough whichtheycandevelopsupportivenet- works of people with similar condi- tions.13 The mobile technologies that teensusedaily, namelycellphones, in- stant messaging, and text messaging, have already produced multiple im- provements in their health care, such as increased medication adherence, better disease understanding, and fewer missed appointments.14 Given that the new social media venues all have mobile applications, teenagers will have enhanced opportunities to learn about their health issues and communicate with their doctors.

However, becauseof their youngage, adolescents can encounter inaccu- raciesduring thesesearchesandre- quire parental involvement to be sure they are using reliable online resources, interpreting the informa- tion correctly, and not becoming overwhelmed by the information they are reading. Encouraging par- ents to ask about their children’s and adolescents’ online searches can help facilitate not only discovery of this informationbut discussionon these topics.


Using social media becomes a risk to adolescents more often than most adults realize. Most risks fall into the following categories: peer-to-peer; in- appropriate content; lack of under- standing of online privacy issues; and outside influences of third-party ad- vertising groups.

Cyberbullying andOnline Harassment

Cyberbullying isdeliberatelyusingdig- ital media to communicate false, em- barrassing, or hostile information about another person. It is the most commononlinerisk forall teensandis a peer-to-peer risk.

Although “online harassment” is of- ten used interchangeably with the term “cyberbullying,” it is actually a different entity. Current data sug- gest thatonlineharassment isnotas common as offline harassment,15

and participation in social network- ing sites does not put most children at riskofonlineharassment.16On the other hand, cyberbullying is quite common,canoccur toanyyoungper- son online, and can cause profound psychosocial outcomes including de- pression, anxiety, severe isolation, and, tragically, suicide.17


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Sextingcanbedefinedas“sending, re- ceiving, or forwardingsexually explicit messages,photographs,or imagesvia cell phone, computer, or other digital devices.”18 Many of these images be- come distributed rapidly via cell phones or the Internet. This phenome- non does occur among the teen popu- lation; a recent survey revealed that 20%of teenshavesentorpostednude or seminudephotographsor videosof themselves.19 Some teens who have engaged in sexting have been threat- enedor chargedwith felony child por- nography charges, although some states have started characterizing such behaviors as juvenile-lawmisde- meanors.20,21 Additional consequences include school suspension for perpe- trators and emotional distress with accompanying mental health condi- tions for victims. In many circum- stances, however, the sexting incident is not shared beyond a small peer group or a couple and is not found to bedistressing at all.4


Researchers have proposed a new phenomenoncalled“Facebookdepres- sion,” defined as depression that de- velopswhenpreteensandteensspend a great deal of time on social media sites, such as Facebook, and then be- gin to exhibit classic symptoms of de- pression.22–27 Acceptance by and con- tact with peers is an important element of adolescent life. The inten- sityof theonlineworld is thought tobe afactor thatmaytriggerdepression in some adolescents. As with offline de- pression, preadolescents and adoles- cents who suffer from Facebook de- pressionareatrisk forsocial isolation and sometimes turn to risky Internet sites and blogs for “help” that may promotesubstanceabuse, unsafesex- ual practices, or aggressive or self- destructive behaviors.


The main risk to preadolescents and adolescents online today are risks fromeachother,risksof improperuse of technology, lack of privacy, sharing toomuch information, orposting false information about themselves or oth- ers.28 These typesofbehaviorput their privacy at risk.

When Internet users visit variousWeb sites, theycanleavebehindevidenceof which sites they have visited. This col- lective, ongoing record of one’s Web activity is called the “digital footprint.” One of the biggest threats to young peopleonsocialmediasites is to their digital footprint and future reputa- tions.Preadolescentsandadolescents who lack an awareness of privacy is- sues often post inappropriate mes- sages,pictures,andvideoswithoutun- derstanding that “what goes online stays online.”8 As a result, future jobs and college acceptance may be put into jeopardy by inexperienced and rash clicks of the mouse. Indiscrimi- nate Internet activity also can make childrenandteenagerseasierformar- keters and fraudsters to target.


Many socialmedia sites displaymulti- ple advertisements such as banner ads,behaviorads(ads that targetpeo- pleon thebasisof theirWeb-browsing behavior), and demographic-based ads (ads that target people on the ba- sis of a specific factor such as age, gender, education,marital status, etc) that influence not only the buying ten- denciesofpreadolescentsandadoles- cents but also their views of what is normal. It is particularly important for parents to be aware of the behavioral ads, because they are common on so- cialmediasitesandoperatebygather- ing information on the person using a site and then targeting that person’s

profile to influence purchasing deci- sions. Such powerful influences start as soon as children begin to go online and post.29 Many online venues are now prohibiting ads on sites where children and adolescents are partici- pating. It is important to educate par- ents, children, and adolescents about this practice so that children can de- velop into media-literate consumers and understand how advertisements can easilymanipulate them.


Manyparents are aware that 13 years is the minimum age for most social media sites but do not understand why. There are 2major reasons. First, 13 years is the age set by Congress in the Children’s Online Privacy Protec- tion Act (COPPA), which prohibits Web sites from collecting information on children younger than 13 years with- out parental permission. Second, the official termsof service formany pop- ular sites nowmirror theCOPPA regu- lations and state that 13 years is the minimum age to sign up and have a profile.This istheminimumagetosign on to sites such as Facebook andMy- Space. Therearemanysites forpread- olescents and younger children that do not have such an age restriction, suchasDisneysites,ClubPenguin,and others.

It is important that parents evaluate thesitesonwhichtheirchildwishesto participate to be sure that the site is appropriate for that child’s age. For sites without age stipulations, how- ever, there is room for negotiation, andparents shouldevaluate thesitua- tion via active conversation with their preadolescents andadolescents.

Ingeneral, ifaWebsitespecifiesamin- imum age for use in its terms of ser- vice, the American Academy of Pediat- rics (AAP) encourages that age to be respected. Falsifying age has become


common practice by some preadoles- centsandsomeparents.Parentsmust be thoughtful about thispractice tobe sure that they are not sending mixed messages about lying and that online safety is always themainmessagebe- ing emphasized.


Pediatricians are in a unique position to educate families about both the complexities of the digital world and the challenging social and health is- sues that online youth experience by encouraging families to face the core issues of bullying, popularity and sta- tus, depression and social anxiety, risk-taking, and sexual development. Pediatricians can help parents under- standthatwhat ishappeningonline is an extension of these underlying is- sues and that parents can be most helpful if they understand the core issues and have strategies for deal- ing with them whether they take place online, offline, or, increasingly, both.

Some specific ways in which pediatri- cians canassist parents include:

1. Advise parents to talk to their chil- dren and adolescents about their online use and the specific issues that today’s online kids face.

2. Adviseparentstoworkontheirown participation gap in their homesby becoming better educated about themany technologies their young- sters are using.

3. Discusswith families theneed fora family online-use plan that involves regular familymeetings to discuss online topics and checks of privacy settings and online profiles for in- appropriate posts. The emphasis should be on citizenship and healthy behavior and not punitive action, unless trulywarranted.

4. Discuss with parents the impor- tance of supervising online activi- ties via active participation and communication, as opposed to re- motemonitoringwitha“net-nanny” program(softwareusedtomonitor the Internet in the absence of parents).

In addition, the AAPencouragesall pe- diatricians to increase their knowl- edge of digital technology so that they can have a more educated frame of reference for the tools their patients and families are using, which will aid in providing timely anticipatorymedia guidanceaswell asdiagnosingmedia- related issues should they arise.

Toassist familiesindiscussingthemore challenging issues that kids faceonline, pediatricians can provide families with reputable online resources, including “SocialMediaandSextingTips”fromthe AAP ( june09socialmedia.htm),30 the AAP Inter- net safety site (,31

and theAAPpubliceducationsite,Healthy ( english/search/pages/results.aspx? Type�Keyword&Keyword�Internet� safety),32 and encourage parents to

discuss these resources with their children. Pediatricians with Web sites or blogsmaywish to create a section with resources for parents and chil- dren about these issues andmay sug- gest a list of or links to social media sites that are appropriate for the dif- ferent age groups. In this way, pedia- tricianscansupport theeffortsofpar- entstoengageandeducateyouthtobe responsible, sensible, and respectful digital citizens.

LEADAUTHORS GwennSchurgin O’Keeffe,MD KathleenClarke-Pearson,MD

COUNCIL ONCOMMUNICATIONSAND MEDIA EXECUTIVE COMMITTEE, 2010–2011 DeborahAnnMulligan,MD, Chairperson TanyaRemer Altmann,MD Ari Brown,MD Dimitri A. Christakis,MD KathleenClarke-Pearson,MD Holly Lee Falik,MD David L. Hill,MD Marjorie J. Hogan,MD Alanna Estin Levine,MD KathleenG. Nelson,MD GwennSchurgin O’Keeffe,MD

PAST EXECUTIVE COMMITTEE MEMBERS BenardP. Dreyer,MD Gilbert L. Fuld,MD, Immediate Past Chairperson Victor C. Strasburger,MD

LIAISONS Michael Brody,MD–AmericanAcademyof Child andAdolescent Psychiatry BrianWilcox, PhD–AmericanPsychological Association

STAFF Gina Ley Steiner Veronica LaudeNoland, [email protected]


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