A 13-year-old male came to clinic for wart treatment. When the physician entered the room, the mother and teen were both upset, as apparently the mother had just found out that the teen had lied and setup a social media account online. The physician diffused the situation by talking with the family about overall family communication. The pertinent physical exam showed a healthy teen with normal growth parameters. Two plantar warts 3-5 mm in size were found on the right great toe. The diagnosis of plantar warts was confirmed and while treating the wart the physician emphasized the priviledge the teen had of using a cellphone and Internet, but that there were responsibilities too, especially that the parent could trust the teen. The teen reluctantly agreed that he had broken the social media rule and that the consequence of not using the cellphone and Internet for a week was appropriate. In the meantime, the teen and mother agreed to set up written rules about using the cellphone and Internet.
Social networking is an extension of normal healthy adolescent development and their off line lives. “…[S]ocial networking sites allow teenagers to explore their identities, make new friends and continue to develop long-standing relationships, explore their sexuality, voice their opinions, and be creative.”
According to the Pew Internet and American Life Project:
Online teens (44%) admit to lying about their age at some point to gain access to a website or sign up for an online account, with younger teens more likely to do so than older ones (49% for 12-13 year olds versus 30% for 17 year olds), and teens that use social networking sites also more likely than non-users (49% vs 26%) to do so.
Online teens (30%) have shared passwords with a friend with online girls more likely than online boys ( 38% v 23%) and older teens more likely than younger teens to share passwords (36% for 14+ years vs. 17% for < 14 years).
Teens who have set their social networking profiles to private so that only friends can see content is 62% and an additional 19% have set their profile so that it is semi-private (i.e. friends of friends or networks of individuals). At least half of teens (55%) have chosen to not post some type of content because of their concerns that it may reflect on them poorly in the future. Teens that use social networking sites are more likely to withhold content than teens that do not use social networking sites (60% vs. 30%).
Two percent of teens have sent a sexually suggestive picture or video (sexting) to another person, but 16% have received a similar picture or video.
Some potential risks of social media use include:
- Harassment (most common) and cyberbullying
- Using inaccurate health information
- Psychological problems including depression, anxiety, suicide, and Internet addiction. Depression includes possible “Facebook depression” or depression as the result of using Facebook a great deal of time and not measuring up as compared to peers (i.e. not as many friends or status updates)
- Security risks
- Stalking or grooming (establishing an emotional connection with a child for purposes of sex or other exploitation)
- Identity theft
- Monetary scams
- Social/Legal action – school suspensions, arrests
Parents and teenagers need to continue to talk and monitor the everchanging Internet environment so teens can learn to use social media and other technologies responsibly.
- Decide when their teen has the knowledge, attitude and judgment to be responsible enough to be given the privilege of using the computer/cellphone and can understand and follow though with this responsibility.
- Set clear rules about when, where and how their teen can use a computer/cellphone
- Computers/cellphone should be used in public spaces such as the kitchen
- Parent should emphasize what teens are allowed to do – text, chat, post pictures, open new accounts, change passwords etc.
- Limit friends to someone the teen has actually seen and knows well. Someone that the teen would invite to their home or introduce to their parents
- Don’t post identifying information online – address, phone, hometown, school, social security number – anything that can help someone else to identify the teen
- Never meet anyone face to face that they have met online
- Don’t give out passwords to anyone but parents – not even friends
- Go online and help the teen set up their accounts and set privacy settings.
- Monitor online activities just like they would any other activity
- Ask teens who are their friends, who are they talking to, what are they doing
- Ask to see the teen’s profile – give them time to remove something that shouldn’t be there but if others can already see it, then it is not invading privacy
- Be one of their teen’s friends to be able to monitor what their teen is doing. If the teen doesn’t want to be a friend, then this is a red flag.
- Talk with their teens. Tell and remind them often to:
- Talk with the parent if anything makes them feel uncomfortable, strange, weird, embarrassed, hurts or scares them
- If the teen sees any harassment or cyberbullying
- If the teen sees any sexting
- This can result in legal action including felony and misdemeanor arrest for pornography distribution and privacy issues. It can also include school/team suspension or dismissal.
- Don’t believe everything that the teen reads – teach them to be appropriately skeptical, and ask them if they can verify it
- Not write or post anything online that the teen wouldn’t be comfortable giving to a parent, coach or sending with their college, scholarship or job application
- Everything that is posted will be there forever and anyone can access everything.
- Be particularly careful about anything that could be construed as substance abuse (i.e. alcohol, tobacco or drugs), engaging in behavior that others may judge differently (i.e. sexual material) or even potentially extreme political or social views. Others may judge the information differently.
- Be a good citizen online and that parents will not act in a punitive way unless it is warranted by not following the agreed rules and the teen is not behaving in a way that shows they are responsible enough for the privilege.
- Parents should also model their own good citizenship
Questions for Further Discussion
1. What are potential legal penalties for Internet harassment and/or cyberbullying?
2. What are the major regulations in the Children’s Online Privacy Protection Act?
- Disease: Warts | Internet Safety | Safety Issues
- Symptom/Presentation: Mass or Swelling | Behavior Problems
- Specialty: General Pediatrics
- Age: Teenager
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: Warts and Internet Safety.
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Ybarra ML, Mitchell KJ, Finkelhor D, Wolak J. Internet prevention messages: targeting the right online behaviors. Arch Pediatr Adolesc Med. 2007 Feb;161(2):138-45.
Mitchell KJ, Ybarra M. Social networking sites: finding a balance between their risks and benefits. Arch Pediatr Adolesc Med. 2009 Jan;163(1):87-9.
O’Keeffe GS, Clarke-Pearson K; Council on Communications and Media. The impact of social media on children, adolescents, and families. Pediatrics. 2011 Apr;127(4):800-4.
Lenhart A, Madden M, Smith A, Purcell K, Zickuhr K, and Rainie L. Teens, kindness and cruelty on social network sites. Pew Internet and American Life. 11/9/2011
Available from the Internet at: http://pewinternet.org/Reports/2011/Teens-and-social-media.aspx
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
7. All medical and invasive procedures considered essential for the area of practice are competently performed.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
17. A therapeutic and ethically sound relationship with patients is created and sustained.
18. Using effective nonverbal, explanatory, questioning, and writing skills, the healthcare professional uses effective listening skills and elicits and provides information.
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital