March 2, 2009

Discussing On-Line Profiles - A New Addition To The Well-Child Exam

Through social networking sites, teens can now hangout with their friends without leaving their homes. But unlike sitting in a friend's basement, you're not always sure who else is there. There are unseen risks involved with virtual communities. Depending on the settings of one's web profile, personal information, photos, etc. may be open to anyone who wants to see them. Teens may be more lax about what they share on-line. They may say and do things on-line that they would shy away from in person. Teens may also feel pressured by their virtual community to post comments or pictures that may be inappropriate or illicit unwanted attention.

With how common these sites have become in everyday adolescent life, it would be wise for us as pediatricians to begin to include them in the teenage well-child exam. On-line activity and its risks can easily be worked into the "activities" part of a HEADSS exam. Incorporating it into the HEADSS exam can open the door to discussing the risks involved with putting personal information on-line as well as how to protect one's self and maintain one's privacy.

A recent study published in January's Archives of Adolescent and Pediatric Medicine has shown that adolescents may be open to advice regarding how and what they display about themselves on-line. In this study, a physician using MySpace sent an email to 18- to-20 year olds who displayed risky behavior in their on-line profiles. She informed them that the information they were sharing was open for anyone to see and advised that they take steps to maintain their privacy. 42% of the interventional group versus about 30% of the control group (P=0.7) made some sort of protective change whether it was reducing references to sex and substance use or changing their web profile setting to private.

These results were based on an unsolicited email from an unknown physician. It is likely that advise from one's own pediatrician with whom they have had a relationship for many years would be much more influential. Although there are many things to cover at the teenage well-child visit, given how much time teenagers spend on-line and in these virtual communities it is incumbent upon us to find the time and make the effort to discuss the risks involved.

Corinn Cross, MD, FAAP
COCM Website and Blog Editorial Advisory Group Member