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Do you know your BeReal from your B roll? Do you get laughed at when you ask a CYP if they use Facebook? Fear not, here is the definitive guide to social media for the paediatrician.

Social media is unavoidably a huge part of our personal and professional lives. We dedicate an entire ’S” of our HEADSSSS to it. But what are we really asking when we ask young people about social media use? Quoting Paracelsus – “the dose makes the poison.” We know that social media use can be healthy for many young people increasing their social connections and support in a time of lockdowns and isolation, but excessive use can create and exacerbate feelings of isolation, low mood, and anxiety. Our role as healthcare workers is not to keep tabs on young people’s handles and hashtags, but to elicit whether it is causing them harm.

The key is to start a conversation about social media and screen time with young people and their families and to support them to develop healthier relationships with them.

In the UK, Ofcom found that 62% of children between 3 and 17 had at least one profile on a social media app, increasing to 94% in the 16-17-year-old bracket.

Social media is an ever-changing landscape with new apps being released faster than we can keep up. Children have opened their first social media account by 11 years and 4 months old. Many of us wouldn’t have had mobile phones at this age. (Ed. They were still to be invented for some of us). So here is your guide to what’s currently out there, why it’s used, and where it could be harmful.

As of March 2022, these 5 applications were the top-ranking social media apps (quantified by self-reporting from children and their parents in the UK) in children aged 3- 17 years old. I’m going to make a special mention for BeReal which was released in 2020 but gained popularity earlier this year and is currently the number one downloaded app on the apple store.

BeReal

As of September 2022, BeReal has been downloaded over 28 million times. BeReal encourages the ethos of “being real”, unfiltered, and authentic. It sends a once-daily notification to users encouraging them to post a snapshot of their life at that exact moment of time daily using the front and rear-facing camera. It is largely used to share images with friends only, although it is possible to share your posts publicly. There is a 2-minute window to share your post from the allocated time. The positives of this include a potential reduction in time on the app, but the potential negatives include the anxiety that what you are doing in that time window is not photo-worthy. It is considered less intense than other platforms, less curated or filtered and therefore promotes a more realistic picture of your peers’ lives.

YouTube

YouTube is a popular video-sharing platform. It can be used to host and watch live streams of events.  YouTube for Kids allows parents to restrict the video content available to their children and is aimed at those 12 and under. The wealth of information available via YouTube is huge, from music videos to educational content and free access to entertainment. However, there is growing concern that many unregulated and inappropriate videos are being shared on the site. A study by Papadamou et al. found that you have a 45% chance of reaching an inappropriate video within 10 clicks from a YouTube Kids video.

WhatsApp

Whatsapp is a popular messaging app that prides itself on end-to-end encryption, meaning no one, other than the sender and recipient, can view the messages (including the WhatsApp team themselves). However, any message that is sent via WhatsApp can be forwarded to others without the original sender’s knowledge or consent. It is up to the young person what they share online. WhatsApp has been found to be the most popular platform for sexting among adolescents.

TikTok

TikTok allows users to create, share, and view short videos. They can be up to 10 minutes in length but most are between 15 seconds and 3 minutes. TikTok allows you to watch videos from your friends, but also celebrities and pop culture clips. Many claim TikTok to be feeding into “scroll culture” whereby young people consume huge amounts of content in short spaces of time contributing to a shift in attention spans. TikTok has been cited as the source of viral content encouraging dangerous practices including the “Benadryl challenge”, the ingestion of small magnets, and the “black-out” challenge which causes periods of hypoxia in children. As with many social media platforms, you can “react” to content with likes and emojis. This can contribute to anxiety about peer validation.

Snapchat

Snapchat is an app used to share photos, videos, and text; it can also be used to play interactive games and introduced the use of face-altering filters to the mainstream. The “snaps” are deleted by the app after being viewed by the recipient, but they can be added to your story so they can be viewed for up to 24 hours. Users can also message each other through the app, usually in response to shared content. The “Snap Map” shows your live geo location and is an opt-out system that requires users to switch this off in their privacy settings. Snapchat is the second most popular platform for sexting because messages disappear over time, although any image can be screenshotted and forwarded.

Instagram

Instagram is a photo and video-sharing app with an inbuilt messaging platform. Photos and videos can be filtered to enhance a sunset or, to the other extreme, alter skin colour, eye colour, face or body shape. Instagram has popularised Reels which allow users to create 15-minute videos of content. Filtered reality may be harmful to users. These images curate people’s lives and often showcase distorted images of landscapes and human bodies. Studies have found the dangers of “lying self-presentation” to fit these moulds of perceived perfection contribute to low mood and anxiety. There is a relationship between Instagram use and body dysmorphia.

I love social media. I can brighten up a dark day with a dog video or a meme from my best friends, but we must be aware of the harm it can cause to ourselves and our patients. When used well there is a huge amount of positive content out there, but when there are just clicks away from something harmful we need to talk to young people about whether social media use is still a healthy practice.

References

@andrewchen. andrewchen RSS. (n.d.). Retrieved April 22, 2022, from https://andrewchen.com/

Cristina Senín-Calderón, Salvador Perona-Garcelán, Juan F. Rodríguez-Testal, The dark side of Instagram: Predictor model of dysmorphic concerns, International Journal of Clinical and Health Psychology, Volume 20, Issue 3, 2020, Pages 253-261, ISSN 1697-2600, https://doi.org/10.1016/j.ijchp.2020.06.005.

Influence Central. Kids & tech: the evolution of today’s digital natives. 2016. Available at: http://influence-central.com/kids-tech-the-evolution-of-todays-digital-natives. Accessed October 7, 201

Mun IB, Kim H. Influence of False Self-Presentation on Mental Health and Deleting Behavior on Instagram: The Mediating Role of Perceived Popularity. Front Psychol. 2021 Apr 12;12:660484. doi 10.3389/fpsyg.2021.660484. PMID: 33912119; PMCID: PMC8071929.

Ofcom.org.uk. 2022. [online] Available at: <https://www.ofcom.org.uk/__data/assets/pdf_file/0024/234609/childrens-media-use-and-attitudes-report-2022.pdf> [Accessed 6 September 2022].

Ojeda, Mónica & Del Rey, Rosario & Walrave, Michel & Vandebosch, Heidi. (2020). Sexting in adolescents: Prevalence and behaviours [Sexting en adolescentes: Prevalencia y comportamientos]. Comunicar. 64. 10.3916/C64-2020-01.

Papadamou, K., Papasavva, A., Zannettou, S., Blackburn, J., Kourtellis, N., Leontiadis, I., Stringhini, G., & Sirivianos, M. (2020). Disturbed YouTube for Kids: Characterizing and Detecting Inappropriate Videos Targeting Young Children. Proceedings of the International AAAI Conference on Web and Social Media, 14(1), 522-533. Retrieved from https://ojs.aaai.org/index.php/ICWSM/article/view/7320

Reid Chassiakos YL, Radesky J, Christakis D, Moreno MA, Cross C; Council on Communications and Media. Children and adolescents and digital media. Pediatrics. 2016;138(5):e20162593 [PubMed]

About the authors

  • Nadia is a paediatric registrar in London. She is passionate about improving accessibility in medical education, emergency medicine, and finding the best flat white in South London.

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