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REVIEW

CURRENTOPINION New age technology and social media: adolescent psychosocial implications and the need for protective measures

www.co-pediatrics.com

Jay Shah, Prithwijit Das, Nallammai Muthiah, and Ruth Milanaik

Purpose of review In recent years, breakthroughs and advancements in new age technology have revolutionized the way children communicate and interact with the world around them. As social media platforms such as Facebook, Instagram, and Snapchat continue to grow in popularity, their usage has raised concerns about their role and impact on adolescent development and behavior. This review examines the psychosocial implications of social media usage on youth outcomes related to body image, socialization, and adolescent development. It discusses ways that clinicians and parents can effectively safeguard their children from the potential threats posed by digital media while providing a fact sheet for parents that addresses these concerns and summarizes recommended strategies to combat them.

Recent findings While social media platforms continue to experience surges in popularity, mounting evidence suggests significant correlations between their usage and adolescent mental health and behavioral issues. Increased social media usage has been linked to diminished self-esteem and body satisfaction, elevated risk of cyber- bullying, heightened exposure to pornographic material, and risky sexual behaviors.

Summary Given how new age technology is steadily permeating everyday life, greater efforts are needed to inform adolescent users and their families about the negative consequences of social media usage. Pediatricians and parents must take cautionary measures to reduce psychosocial risks and ensure the online safety of children.

Keywords cyber-bullying, new age technology, online safety, pornography, social media

Division of Developmental and Behavioral Pediatrics, Steven and Alex- andra Cohen Children’s Medical Center of New York, Northwell Health System, Lake Success, New York, USA

Correspondence to Ruth Milanaik, DO, Division of Developmental and Behavioral, Pediatrics, Steven and Alexandra Cohen Children’s Medical Center of New York, 1983 Marcus, Ave, Suite 130, Lake Success, NY 11042, USA. Tel: +1 516 633 7416; e-mail: [email protected]

Curr Opin Pediatr 2019, 31:148–156

DOI:10.1097/MOP.0000000000000714

INTRODUCTION

The advent of modern technology has brought about unlimited internet access and introduced a plethora of downloadable media applications to a new generation of youth. Many of these applica- tions have revolutionized communication among digital-aged adolescents, who are some of the most prolific users of this technology. According to a recent survey conducted by the Pew Research Cen- ter, 91% of adolescents sampled use social media to maintain contact with peers, of whom, 94% use social media daily [1].

During adolescence, a time characterized by social and cognitive changes, peer interaction, and approval become more important as children develop a stronger capacity to interpret both their own emotions and those of their peers. Communi- cation becomes vital during this transitional stage

into adulthood [2]. Contemporary forms of commu- nication have allowed adolescents today to exist dually in a virtual and physical reality. While they have face-to-face interactions with peers in school and other social settings, technological advances allow teens to transcend the limits set by physical distance. As technology becomes a larger part of adolescents’ daily activities, the benefits and

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KEY POINTS

� New age technologies have given rise to novel forms of digital media and networking that have made communication and socialization faster and easier for children across the world.

� Online social media exposure and usage can have detrimental consequences on the psychosocial well being and development of adolescents ranging from body image issues and risky sexual behaviors to social anxiety and other mental health conditions.

� Clinicians, parents, and families can use the online safety fact sheet provided to address ways to ensure the safety of children on digital media such as Facebook, Instagram, and Snapchat.

New age technology and social media Shah et al.

drawbacks of new age digital devices and media platforms on adolescent psychosocial development are areas of concern. This review article is organized into three main sections. First, we explore the nega- tive psychosocial implications of social media usage on teenage users. Next, we discuss some of the most popular social media platforms and how they are, at present, used by adolescents. Finally, we offer sug- gestions for parents and pediatricians to better mon- itor adolescent social media usage to protect adolescent psychological health and encourage social well being.

NEGATIVE IMPLICATIONS OF SOCIAL MEDIA USAGE

Social media usage can lead to a number of negative psychosocial consequences on adolescent self- esteem, body image, and identity, and also raise issues such as cyber-bullying, easier access to por- nography, and sexting behaviors from a younger age.

Self-esteem, body image, and identity

Social media platforms can act as powerful vehicles to promote certain standards and ideals regarding culture and beauty. Consequently, these platforms can influence adolescent perceptions of body image and contribute to self-esteem and body satisfaction issues.

Self-esteem

As technology plays an increasing role in adoles- cents’ daily lives, it is both pertinent and necessary for clinicians to assess the associated risks. Self- esteem – the perception of self-value – is a major predictor of psychological well being [3,4]. This

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decade’s social media revolution has played a sig- nificant role in influencing adolescent mental health [5,6], as important social markers of identity and ‘acceptable’ behaviors are now more easily com- municated between peers. As a result, both social acceptance and social rejection are facilitated by new age technologies [5,7]. Most adolescents derive positive experiences from communication via social media because the majority are not ‘addicted’ to electronic mobile devices [8]. Particularly, 76% of teens believe that using social media has no effect on their confidence, while 20% believe it makes them more confident.

It is, however, well established that the intro- duction of new age technology, such as television media, significantly impacts adolescent self-esteem and body image [5,9,10]. Moreover, greater time spent on social media has consistently been corre- lated to decreased body satisfaction [11]. However, the directionality of the relationships between body image and self-esteem and social media use is gen- erally unclear [11,12

,13 &&

]. Studies have suggested that social media may serve as a superficial method of increasing self-esteem in adolescents. In other words, teenagers who already have low self-esteem appear to be predisposed to finding validation or achieving positive social relations through social media [14,15]. It is also well established that those with protective personality traits (e.g. happiness, high purpose in life) are less likely to engage in negative social comparison through social media [4,6]. Other studies argue that increased social media use increases the risk of exposure to phenom- ena like cyber-bullying, which, in turn, can influ- ence an adolescent’s self-esteem [16]. Thus, selection bias likely influences the way adolescents use and respond to social media.

Identity validation

During the transition from childhood to adulthood, teenagers often seek to exert autonomy and to cul- tivate their personal identities [9]. For these reasons, adolescents use electronic media to experiment with their identities and receive feedback from peers. Even though the use of platforms such as Facebook appears to decline as adolescents get older, approxi- mately 50% of teens experiment with their identi- ties on the Internet, seeking their friends’ reactions to their posts [7,17]. Ultimately, social media use might serve to strengthen peer groups and validate identities. Thus, social media websites, like Face- book or Instagram, can be used by individuals of any sex to display qualities they believe their friends will perceive as ‘attractive.’ With the ease in upload- ing pictures depicting clothing style and person- alities online, adolescents appear to use social

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media to exaggerate their desired appearance. Nota- bly, without peers’ immediate responses to posts such as those on Instagram and Facebook, adoles- cents’ self-esteem tends to decrease [7,17].

Image enhancement and body image

Beauty trends are constantly reinforced through social media networks. Often, these social media outlets will utilize image editing tools such as Adobe Photoshop to alter images to fit beauty standards. Teenagers who, perhaps, are not consciously aware of the body alterations made in commercial photos may become more self-conscious of their body image. This in turn can decrease self-esteem and body satisfac- tion, especially among adolescent girls [8,18]. Ulti- mately, internalization of beauty standards places teenagers at increased risk for developing body image concerns, engaging in weight-modification behav- ior, and potentially developing eating disorders [8,19]. Many adolescents, especially girls, are pres- sured by society to fit certain beauty standards and turn to easily accessible image-editing software to alter their images before posting them on social media. In fact, 28% of girls between the age of 8 and 18 admit to editing their photos to make them- selves look more attractive prior to posting them online [8]. Furthermore, social media platforms such as Instagram facilitate editing by offering the option to apply filters – preset color-enhancing software that alter the appearance of original images.

Cyber-bullying

New age technology has also provided a new medium for bullying. Cyber-bullying is defined as the willful and repeated harm inflicted through the use of computers, cell phones, and other electronic devices [20]. This type of bullying can take place on various technological platforms, such as text mes- sages, chats, and social media sites. Examples of cyber-bullying include: sending messages to harass and threaten victims, spreading rumors with the intent to humiliate, and impersonating a victim in an attempt to damage their reputation [21]. Vic- tims of bullying were most often targeted for looks (55%), body shape (37%), and race (16%) [22].

The anonymity of cyber-bullying starkly distin- guishes it from more traditional forms of bullying. Using technology as the medium to harass an indi- vidual grants the perpetrator greater protection because they can easily conceal their identity [21]. Furthermore, the lack of direct personal contact in cyber-communication mitigates the degree of guilt or remorse that perpetrator feel as a result of engag- ing in such activity. [23]. Whereas traditional bully- ing was previously restricted to classrooms,

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playgrounds, parks and spaces that permit in-person contact, cyber-bullying broadens the plausible geo- graphic range of bullying, perhaps even into the ‘safe spaces’ of adolescents’ homes [24].

According to a 2016 nationally representative survey distributed by the Cyber-bullying Research Center, 33.8% of adolescents reported being cyber- bullied once in their lifetime and 16.9% reported being a victim of recent cyber-bullying [25]. When compared with rates in 2010, in which 20.8% of adolescents reported being cyber-bullied once in their life and 7.5% reported being a recent victim of cyber-bullying, it is evident that cyber-bullying is a growing concern.

Cyber-bullying rates are, however, not equal across the demographic spectrum. One study found that 25.8% girls, as opposed to only 16.8% of boys, reported being cyber-bullied [26]. Another study by Llorent et al. [27] revealed an increased rate of vic- timization among minorities, especially among sex- ual minorities. According to the National School Climate Survey of 2015, 48.6% of LGBTQ students have experienced cyber-bullying in the past year [28].

As growing access to new age technology raises the threat of cyber-bullying, examining the impact of cyber-bullying on mental health becomes increas- ingly important [29]. Cyber-bullying has been asso- ciated with heightened risks of depression, paranoia, anxiety, and suicide [30]. According to a meta-analy- sisof 34 studies, traditionalbullying increased suicide ideation by a factor of 2.16, whereas cyber-bullying increased it by a factor of 3.12 [31]. It is well docu- mented that cyber-bullying also increases risk of substance abuse among adolescents, suggesting that they are abusing drugs as a coping mechanism to their bullying experience [30,32,33].

Pornography

Pornography includes material containing explicit depictions of sexual activity and behaviors. Although pornographic material was formerly con- fined to print media forms and videotapes, the Internet has allowed pornography to expand into the digital realm and reach a significantly wider population. Today, the majority of adolescents are exposed to Internet pornography before the age of 18 [34]. According to one study, 93.2% of boys and 62.1% of girls surveyed had viewed pornographic media before age 18 [34]. Greater technological capabilities, greater internet access, and rapid mar- keting strategies by pornographic companies have all contributed to the rise in exposure to pornogra- phy [35,36

]. Online pornography is often the first source of sex education for many sexually maturing adolescents [37,38].

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Adolescence is a period during which children begin to explore and understand sexuality. As the adolescent brain is still developing, making them increasingly susceptible to external influences, exposure to pornography during this time can have negative impacts on psychological development [39]. Viewing pornography during adolescence may involuntarily result in teenagers internalizing unrealistic expectations about their own physical body appearance [40

,41], which, when unmet, can decrease self-esteem and confidence [41]. The odds of sexually aggressive behavior increase with expo- sure to violent pornography: one study even cited a six-fold increase [42,43]. Studies also suggest that frequent pornography viewing is associated with higher incidences of depressive symptoms, reduced emotional bonding with caregivers, increased aggression at school, and lower levels of social inte- gration [44].

Frequent pornographic viewing might also lead to false perceptions and distorted views of sexual intercourse and relationship dynamics. Researchers in Sweden found that adolescents who sought sex- ually explicit material were more likely to act out porn in their relationships by emulating extreme sexual behaviors portrayed in porn [45]. In fact, a study by Owens et al. [44] found that repeated pornographic exposure was linked to a recreational and casual attitude towards sex, much like eating and drinking. Similarly, other studies have found that men who visit porn sites frequently are more likely to view sex as a mere physical act and perceive women as sex objects [46].

Studies have also suggested that increased expo- sure to pornography among adolescents may be associated with riskier sexual behaviors [36

]. In a 2009 cross-sectional study of New York City adoles- cents aged 12–22, those who reported visiting sexu- ally explicit websites were more likely to have had multiple lifetime sexual partners, have had more than one sexual partner in the past 3 months, have engaged in anal sex, or have used alcohol or other drugs during their last sexual encounter [47]. In agreement with this finding, exposure to pornogra- phy has a greater influence on an adolescent’s deci- sion to have sex than do parents, religion, or schools combined [48].

Sexting

Sexting is a phenomenon that has risen with the advent of texting. By definition, sexting is sending or receiving images or videos that are sexually sug- gestive in nature [49]. Some definitions also include text messages that are sexually explicit. Adolescents are now obtaining smartphones earlier in life,

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allowing them to use smartphones both at their own discretion and often without the knowledge of parents. Among adolescents 10–19 years of age, the rate of sexting ranges from 17 to 22% [41]. Moreover, 54% of students know someone who has sexted before, and these students were also 17 times more likely to send a sext [50]. Although causation cannot be concluded, sexting is strongly correlated to depression and engagement in risky health behaviors including marijuana use, cigarette smoking, alcohol consumption, and suicidal idea- tion/attempt [51,52].

RECENT ADVANCEMENTS IN SOCIAL MEDIA

The growth of social media has been explosive throughout the contemporary digital age. Yet, while platforms continue to evolve and design new fea- tures for their user bases, these advancements may also pose significant risks to adolescent users.

Facebook

In 2004, Facebook – an online social networking platform accessible on mobile phones, laptops, desktops, and other electronic devices with Internet access – began this decade’s social media revolu- tion. Facebook allows users to create their own individual ‘profiles’ characterizing their personal information and interests. Users can connect to other users via these profiles through a process called ‘friending.’ Facebook friends can share pic- tures, updates on activities, and locations, which are organized by the platform into a scrollable page of information (‘news feed’). Users can ‘like’ or share their friends’ statuses and even react to them with icons called ‘emojis’ (short for emoticons), which are small digital and visual representations of ideas and emotions, varying from happy faces to images of food.

Because online material is now often presented concisely and simply, adolescents can easily culti- vate a general understanding of the latest political, social, and scientific news through platforms like Facebook. Interacting with information-disseminat- ing platforms, which often dually function as social media tools, can encourage adolescents to critically reflect on the discrete events unfolding in the world around them [53].

Social media platforms, such as Facebook, also allow individuals with specific physical conditions, such as diabetes, to form support groups and collective forums as an outlet for emotional, moral, financial, and informational support. Evidence from a diabetes group on Facebook with 30 000

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international users demonstrated the prowess of social media to connect people regardless of lan- guage and cultural barriers [54].

Despite these benefits, it remains crucial for parents to be aware of how Facebook could nega- tively impact children. In 1998, the Children’s Online Privacy Protection Rule (COPPA) was issued to protect the privacy and personal information of children under the age of 13 [55]. However, reports reveal that more than half of children use social media by the age of 10 [56]. Although Facebook complies with COPPA by setting the minimum age to create a profile at 13, in 2011, it was reported that 7.5 million Facebook users were under the age of 13 [57]. As a result, children are becoming more vulnerable to threats including exposure to inappro- priate graphic and sexual content, increased contact with strangers, and cyber-bullying.

Additionally, studies have suggested that post- ing images or status updates to Facebook is associ- ated with an increased perception of social support [58–62]. The ability of Facebook ‘friends’ to ‘like’ and comment on their friends’ activities and posts via text or emojis results in this perceived social support. Although these responses can yield the impression of robust social support, a lack of response can have a detrimental effect on adolescent self-esteem [17].

Instagram

Instagram is a photo-sharing platform launched in 2010 that allows users to share pictures with friends. Much like with Facebook, Instagram users can choose to ‘follow’ other users, and Instagram’s soft- ware will organize friends’ pictures into a scrollable ‘feed’ of posts. Friends have the option to ‘like’ posted pictures. Each ‘like’ adds to a visible, quanti- fied ‘like-count’ at the bottom of each picture. Recently, Instagram created a feature referred to as ‘stories,’ which are pictures or short videos for a user’s followers to see that disappear after 24 h. Users can also post ‘live stories’ – video posts that stream live and in real-time directly on the social media platform.

Much like Facebook, Instagram can be a benefi- cial conduit for individuals to stay connected with each other, but it can also affect adolescent devel- opment. According to a survey of 1500 young adults, Instagram was ranked as the worst social media app for mental health and well being, partic- ularly for its impacts on anxiety and depression [63]. Many teenagers correlate the number of likes their posts receive to their social status, which can be strongly tied to self-esteem, perceived popularity, and confidence. To attain more likes, many teens

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consciously post at ‘ideal’ times-points in the day when other users are statistically most active (e.g. during lunchtime or after dinner). Many adoles- cents are also conscious about their follower-to-fol- lowing ratio – the ratio between the number of users following an individual to the number of users that an individual follows [64]. A high follower-to-fol- lowing ratio might indicate that the user is an influential figure and someone worth following. On the contrary, a low ratio might indicate a lack of popularity. Both of these concepts further high- light how the perceived status symbol associated with garnering a particular number of likes on posts can lead teenagers to view their bodies in a negative light. Additionally, carefully hand-picked and digi- tally-altered pictures paint an unrealistic represen- tation of one’s lifestyle, putting additional pressure on friends to match that lifestyle. This might con- tribute to a phenomenon referred to as a ‘fear of missing out,’ or FOMO, where individuals feel regret because they feel others are having more positive experiences from which they are absent [65

]. Ulti- mately, FOMO may contribute to feelings of anxiety and depression among teenage users of the platform [66].

With the pressure to post perfect pictures on Instagram, there has been a recent rise in the ‘Fin- sta,’ a ‘fake’ Instagram. These are alternative accounts on the same platform that users create for a smaller circle of friends, where the user is less concerned about which pictures they post and how many likes they receive [67]. In other words, Insta- gram represents the life users want to show the world while ‘Finsta’ depicts their real lives.

Snapchat

Snapchat is a unique photo-sharing app in which users can take pictures and short videos, referred to as ‘snapshots’ or ‘snaps,’ and send them to people on their friend lists. Users can preset a view time rang- ing from 1 to 10 s on each snap. Snapchat will notify a user when he/she receives a snap; once that user clicks the notification, the picture will expire after the preset time.

Snapchat, like Instagram, offers a ‘story’ feature, which allows users to share snaps with not just selected individuals, but rather every individual on their friend list. Although the pictures have a finite time limit, the receiver can use their smart- phone’s features to screenshot the picture and save the image to their phone’s photo library. Users will receive notifications when others take screenshots of their snaps, but it is also possible to evade sending this notification. Additionally, it may be possible that others are present when a user opens a received

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‘snap,’ allowing unintended viewers to see the snap. Along with providing real-time updates, Snapchat allows friends to identify a user’s location through geotags, special location-based borders and images, or the newer ‘snap map’ that displays users’ loca- tions on a physical map. The user’s location appears on the snap map by default unless ‘ghost mode’ in enabled. Through ghost mode, a user can mask his or her location and prevent Snapchat friends from locating them on the map. For these reasons, parents should be cautious about how their children interact with Snapchat. Any snap that is sent can be saved, sent to others, and potentially compromise the location of an adolescent.

Tinder

Social media has also transformed the realm of dating with the introduction of apps, such as Tinder. Tinder – an interactive dating app – allows individ- uals who are mutually interested in each other to connect. Until June 2016, adolescents aged 13–17 were allowed to create Tinder accounts; in fact, there were over a million users in that age range [68]. Although that age range is now banned from using Tinder, adolescents can falsify their age and can still be active on the app.

Tinder presents others’ profiles to the user based on perceived compatibility and location. The cen- tral feature of Tinder is ‘swiping’ on a user’s profile: swiping right indicates interest in that person, whereas swiping left indicates a desire to continue searching for users. One can also view users’ profiles to come to a better decision. If both users swipe right on each other, they ‘match’ and then can begin chatting.

GroupMe

Launched in 2010 by Microsoft, GroupMe is a group messaging app that allows users to send messages to large groups of people rather than sending individ- ual messages to friends. GroupMe is accessible both online and as an app on mobile devices. Because it relies on Internet connection to send and receive messages, GroupMe overcomes the limits of texting: users can communicate even in places without phone service and can maintain contact across international borders. However, while group mes- sages may make communication easier, they also pose a potential for groupthink – a set of psycho- logical effects associated with group decision-mak- ing which discourages nonconformity, creativity, and disagreement with the group – putting pressure on individuals to do things they might not be individually inclined to do [69].

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ADVICE FOR PEDIATRICIANS AND PARENTS As adolescents become more immersed in the tech- nological realm, parents and pediatricians must understand how they can best protect their children from the threats posed by social media. Although many social media companies impose age restric- tions on their platforms, adolescents can easily bypass these restrictions by creating fake profiles that inflate their ages. Therefore, even if a child is under the age of 13, parents should start conversa- tions to establish some ground rules of social media usage. Parents should strongly discourage the use of Facebook, Snapchat, Instagram, or any other social media site that may expose children to age-inappro- priate content. If the child is above the age require- ment, parents are encouraged to have their own social media accounts and be ‘friends’ with their children on these social media sites so they can regularly monitor the material that is posted online. It is essential for parents and pediatricians to discuss how to keep personal information private with ado- lescents, which may include adjusting the privacy settings on social media sites and never posting real names, addresses, or financial information. Parents also have the option of utilizing browsers that have parental controls, which allow them to filter inter- net content, including language, sex, and nudity, and also having disapproved sites. Adult content filtering software can be downloaded by parents to prevent accidental viewing of inappropriate con- tent or pop-up ads.

Parents are encouraged not only to monitor their children’s chats, but also to talk to their chil- dren about cyber-bullying and the dangers of keep- ing contact with strangers. It is important to emphasize that the Internet is written in ink and that once any material is posted online it can be shared, saved, distributed, and seen by anyone. Therefore, parents should be informed of any instances of cyber-bullying and engage in discus- sions with their children to prevent future incidents from happening.

Regarding body image and self-esteem, pediatri- cians are encouraged to discuss and help adolescents recognize that media images are often edited and enhanced and are not representative of the broad spectrum of body frames present in our population. Regarding pornography, pediatricians are encour- aged to talk to adolescents regarding the potential negative consequences of watching pornographic material on sexual behavior and experiences. Parents should also have honest discussions about these materials with their children to avoid stigma- tizing sex and to prevent skewed perceptions of sexual behavior from manifesting.

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In 2018, nearly 87 million people around the world had their personal information harvested from their Facebook profiles and shared via a third-party application known as ‘This Is Your Digi- tal Life’. The application allowed Cambridge Analy- tica – a political data firm – to exploit social media activity and identify voters whose behaviors they could influence [70]. In light of such a massive data breach, it has become apparent just how exposed user information is on Facebook and other social media platforms and how important it is to safe- guard personal data online, particularly that of ado- lescent users. With regard to Facebook, parents can take steps to protect their children’s privacy and control what information is visible online: they can check privacy settings on photos, restrict who can see old posts and status updates, and educate their children on the importance of avoiding inter- actions with users they do not know. Parents who use Facebook are encouraged to adjust the privacy settings on their own accounts, refrain from posting the full names and ages of their children, and avoid using third-party applications, which can have dif- ferent privacy policies and contain malware.

Parents can also take steps to protect their child- ren’s information on Instagram by privatizing their accounts. By default, anyone signed into the Insta- gram application can view the photos or videos posted by a user. However, by switching a child’s Instagram account to private, parents can prevent unapproved users from viewing their child’s content and following posts. Parents can also help their children remove unwanted followers, block Insta- gram users from contacting them or searching for their accounts, and report inappropriate comments and photos that are being shared with them. Despite the existence of a location-sharing feature on the Instagram application, parents should encourage their children to avoid using this feature in order to prevent others from knowing where they are or when they are at certain places. Parents can even help their children remove locations on previously posted photos. Furthermore, to reduce mental health issues associated with making unrealistic comparisons to digitally-altered depictions of others, parents can establish rules and windows of time during which applications like Instagram are allowed to be used

Unlike Instagram and Facebook, the default set- tings for Snapchat are private, meaning that only friends will be able to view posted content. However, the central feature of Snapchat, the ability to send pictures, can be a major threat to privacy. Parents should have a discussion with their adolescents to discourage them from sending ‘snaps’ that they would not want to become public. More specifically,

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adolescents should not be sexting, or sending sexu- ally suggestive messages, with anyone because any picture that is sent can be screenshotted by the receiver, who can then circulate it publicly. Although the sender receives a notification when a picture is screenshotted, there are ways to circum- vent this notification from being received. Snap- chat’s geotags and map feature can also compromise the location of the individual. Adoles- cents should be encouraged to minimize the use of geotags and put themselves on ‘ghost mode’ on the map feature so their location cannot be tracked.

Tinder, an app at the forefront of online dating intended to help young adults meet new people, also poses a significant risk foradolescentsbecause itoften revolves around having conversations with strangers. Since adolescents can still create accounts by forging the age requirement, parents and pediatricians should ensure that their adolescents are not using the app, as they might engage in sexually-oriented conversations with strangers. Other risks include interacting with sexual predators, compromising location, and physically meeting strangers [71]. A supplementary fact sheet has been developed that provides additional information regarding these con- cerns as well as recommendations for families on strategies to address them and better protect their children; http://links.lww.com/MOP/A34.

CONCLUSION

The tremendous advancements in new age technol- ogy have redefined the way different groups of people, particularly young children and adoles- cents, communicate and interact with each other and the world. This study highlights social media advancements that augment experiences in online social networking, file sharing, and digital recrea- tional activities. Platforms such as Facebook, Snap- chat, GroupMe, Tinder, and Instagram have introduced new capabilities that connect users across physical boundaries. However, because these social media platforms facilitate social acceptance and rejection amongst peer groups, they can also detrimentally impact adolescent self-esteem, body image, and satisfaction. These new age technologies have allowed pornographic materials to be easily shared throughout large online communities and reach a greater number of adolescents. Ultimately, exposure to pornography may lead to more children internalizing unrealistic expectations about their bodies and partaking in riskier activities. The perva- siveness of traditional bullying has been increased with the advent of social media via the concept of ‘cyber-bullying.’ This form of bullying eliminates the idea of safe spaces for victims of bullying and

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can further influence social identities and percep- tions. By providing structure, supervision, and edu- cation, parents can play an integral role in monitoring and regulating their children’s interac- tions with social media platforms and devices Pedia- tricians should also be aware of the current trends in social media to better educate parents and their children on the associated risks of their usage. While posting information on these digital platforms poses potential risks to the health, safety, and overall well being of children, parents and pediatricians can take critical cautionary and preventive measures to better protect and ensure the safety of children.

Acknowledgements

None.

Financial support and sponsorship

The authors received no funding for this work from any of the following organizations: National Institutes of Health (NIH); Welcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

Conflicts of interest

There are no conflicts of interest.

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Volume 31 � Number 1 � February 2019

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