2018-19 TOW #50: Social media

Social media is now at essentially ubiquitous levels of use among adults and adolescents. The new interns just discussed how to use it safely now that they are practicing doctors. Let’s review for youth as well.

Materials for this week:

Take-home points:

  1. How do we define social media? Social media can be defined as any online applications that allow for the creation and exchange of user-generated content. The collaborative approach is what separates “Web 1.0” functionality (i.e., static Internet pages) from “Web 2.0” where there is continuous modification and participation by users.
  2. How often are internet and social media used in children and adolescents? Even back in 2015, the Pew Internet and American Life Project found that 92% of teens went online daily. Nearly one quarter used the internet “almost constantly” via smartphones, with 73% of teens owning a mobile device and 91% using it to go online. We know the numbers have only increased! What I was surprised to learn is that even 50″% of 5 year olds and 70% of 8 year olds went online daily. By 4 years of age, nearly 75% of children had their own mobile device in a study of low-income urban minority children. A separate study found that by age 10, more than half of children had accessed an online social network site. We have truly entered a new digital age.
  3. What are some of the positives of social media use? (this is like an MI-style pro-con discussion!) There are 2 main categories: social connectedness and learning. Social media facilitates staying connected with friends and family, making new friends, and also creating social inclusion through community engagement. On the learning front, there are data that it helps with motivation to learn, and can be associated with higher test scores, especially for older youth. It also allows teens to access health information easily and anonymously. Additionally, it allows for self-expression, developing an individual identity, creativity, and exposure to ideas.
  4. What are some of the negatives? We now know there are quite a few: all of those positives seem to have their negative corollary. Risks of social media include cyberbullying, sexting, dissociating one’s online and offline life, and permanence of the digital footprint. Additional negative aspects include exposure to age-inappropriate and/or sexually explicit content, addiction to the Internet, and what’s been termed “Facebook depression”. By extension, these can negatively impact grades, relationships with family and friends, and physical and mental health (including sleep deprivation). Online exposure to alcohol and tobacco use, and sex is associated with earlier initiation of these high-risk behaviors.
  5. How can parents help youth navigate the Internet and social media? Parents should have open and honest discussions about Internet and social media use. Parents should evaluate sites their child wishes to participate in, discuss safe and appropriate usage, and routinely supervise and monitor usage. Though 94% of parents report ever talking with their teen about appropriate content to view and share online, only 40% do it frequently. At our house, our daughters need to use their devices in family areas (not in the bedroom). Even so, my daughter was trying to get on a Harry Potter website that required her to be 18 this weekend! It does take constant vigilance to be aware and support youth. The data are rapidly emerging on risks of depression with a lot of use. Adults need to model and encourage moderation. Avoid phone use during meals and before bed as a start. I like saying “the phone / device has it’s own bedtime and sleeping place.”

2018-19 TOW #41: Temperament in the pediatric visit

Temperament is a great topic to integrate discussion about parenting approaches, and recognizing child needs/preferences. This is a good time to review with colleagues how the Promoting First Relationships (PFR) approaches might help teach parents to recognize child needs, including temperament. Remember that PFR handouts are available for each of the well visits on the TOW blog page. I’ve found them really helpful in anticipatory guidance and addressing parents’ behavior/development concerns.


Take-home Points

  1. What is the definition of temperament and its underlying theory? Temperament is a little challenging conceptually, but can be generally thought of as the ways we self-regulate and react in different situations. Temperament is associated with both emotions and behavior. It emerges early in life, is largely influenced by genetics, and mostly stable over our lifetime. We know temperament can affect developmental pathways and be associated with future psychopathology, but it has been difficult to agree on a consistent definition and exactly how this influences children’s behavior and future.
  2. How many different temperament types are there? There are 10 main temperament traits generally assessed in childhood (adaptabillity, approach, sensory sensitivity, reactivity, distractibility, persistence, mood, regularity and emotional sensitivity). There are 3 main temperament clusters in childhood: “easy” children, “slow to warm up” and “difficult,” based on combinations of traits. Easy children are, well, easy. “Slow to warm up” kids tend to be more careful, to have low adaptability to new situations, and to have difficulty separating from parents. “Difficult” children may be more irritable or fearful, have low adaptability and short attention span, have disordered sleep-wake-eat cycles, and may respond more intensely. I really love framing this more positively as “spirited” to characterize the “difficult” temperament clusters. The book “Raising Your Spirited Child” by Mary Sheedy is a classic and so helpful when parenting a child that is more temperamentally challenging.
  3. How does parenting interact with temperament? We want to use labels carefully to help parents recognize that some children are more prone to having certain behavior/difficult reactions. This is not because they want to make life hard, but may just be how they are wired. Having parented a “slow to warm up” child through toddler years, I can say that it really did help me to learn about temperaments to be more empathic. We can help parents understand it’s not necessarily their fault when their child is easily upset, and also that sometimes a temperament mismatch between parents and children affects their interactions.
  4. How can we use concepts of temperament to discuss parental concerns? It’s helpful to use open-ended questions to explore concerns and give parents a “pause” moment to understand their child’s perspective, such as “What do you think may be going on with her/him when you see this behavior? How do you think s/he is feeling?” Also exploring how parents may be reacting/ feeling to help you understand their perspective / temperament. Simply pausing before offering advice may allow parents insight into their child’s and their own reactions, and help us provide better guidance and reflections.