Social Media Makes Me A Better Pediatrician

Heidi Roman, MD, FAAP

About two years ago I started writing more regularly- reflections on being a new mom, thoughts on my changing perspective as a pediatrician. I kept a notebook that quickly filled with musings that occurred to me during clinic, questions parents asked, things that came up with my son. I realized that a lot of other parents had the same kinds of questions I did. They too were Googling questions and looking for credible sources of information. So, I started actively creating and curating child health information via social media. I'm still a neophyte compared to many online pediatricians that I respect and follow. Nonetheless, I'm a relative veteran compared to most of my colleagues. I’m often asked about how and why I do this. When I answer that I think being online is making me a better pediatrician, I get some curious and quizzical looks. I admit that I  didn’t expect it when I started all of this, but being involved in social media is shifting the way I think about medicine and ultimately making me a better doctor. Here’s how.

•          I write more. I write, on average, a post a week. Writing has made me a better doctor and mom, in many ways. When a parent asks a question on a topic I’ve recently researched and written about I can direct them to useful resources without a moment’s hesitation. And, writing makes me read more too. I now have a set of go-to sources for quality child health information that I am well acquainted with and that I can use quickly in clinic or to research a topic.

•          I think more. Writing makes me think. Insightful comments from readers make me think. Listening to the amazing online community of patients makes me think. My point of view is challenged. My mind is opened. I’m a better doctor.

•          I make more connections. After I started blogging, I joined Twitter. I thought it might be a good way to share my work. But, I’ve found that, for me, Twitter is so much more. For me, Twitter is about the thoughtful, generous, intelligent community of people that I follow. Every day, they bring me the latest information in medicine, child health, parenting, and general news. They enable me to say to my patients’ parents, yes I did read that study on sleep that just came out and here are some thoughts. Or, there are some new car seat regulations and here’s what you need to know.

•          I am a more effective child advocate. By being more connected, I am both more aware of the current policy issues affecting kids and more effective at spreading the word.

•          I’ve started to become more “digitally literate.” There is no debating that this is where healthcare is going. It’s good to be in the thick of it.

•          I have more hope for healthcare. Thanks to social media I have met,people both online and in real life who are working every day to make healthcare better. People with innovative ideas and incredible drive who I am excited to join. People who give me hope that, with the help of new technology and hard work, we will improve our broken healthcare system.

Sure, there are limitations to social media. Nothing replaces face-to-face communication. I’ve also learned to take breaks now and then. Regain perspective. I’ve learned to dip in and out of the social media stream and not worry too much about missing something. If it’s important or compelling, it’ll come around again. I’m certain that the ways we share information will continue to change and evolve. Perhaps, this will all sound quaint in five years. But, for now, I think all of this communication and knowledge sharing is a good thing for patients, their families and for me.

Editor’s Note:  For AAP Members, the Academy has a wonderful webpage entitled, “Making the Most of SocialMedia” This resource is full of helpful tips and advice so login and check it out.

The Kids Are Doing It Right! For The Most Part

John E. Moore, MD, FAAP

Assistant Professor of Pediatrics, Virginia Tech-Carilion School of Medicine

Physicians, and especially young physicians, are becoming increasingly more active on social media. More than ninety percent of physicians younger than 30 have a social media presence. Twitter, Facebook, and Pinterest have become a part of modern medicine for residents, med students, and junior partners.  For them, a life and career without Facebook is inconceivable.

The rest of us are slowly catching up as well. According to recent surveys, almost half of the physicians in my demographic group (41-50) use social media. We are slowly embracing Facebook in our personal as well as professional lives. I am happy to see more and more pediatricians show up on my Twitter feed.  Slowly and painfully, physicians are entering the new digital world, and I think we are better off for it.

We still have a lot of work to do, though, to make this digital world as painless for all physicians as possible. Specifically, we media-savvy, wired-in pediatricians need to provide real leadership in the area of digital media. In countless surveys, new residents and med students say they want more guidance from their mentors about social media. They want recommendations on navigating social networks that go beyond, “Don’t friend your patients.”

As administrators, thought leaders and program directors, we need to do more to educate our learners. In a survey from 2010, Terry Kind et al. found that only 10 percent of medical schools even have social media policies in place for their students. Of those that address social networks, many only offered statements about what was forbidden, discouraged, or frowned upon. Sadly, only 7 out of 132 medical schools encouraged thoughtful and responsible social media use.  It’s  2012; we need to do better.

Specifically, we need to provide guidance in the proper use of social media. While our learners honestly understand the technology better than we do, we “older” physicians have a much better understanding of risk management and medical ethics. We need to instruct our learners about why they should be extremely cautious in “friending” their patients. We need to show them why they need to think about the photos they post and exactly how they word their status updates. We need to demonstrate to them why they should never talk about their patients online.

We also need to highlight the positive features of social media as well. We need to emphasize the patient education that we can provide over Facebook. We need to express how physicians need to take part in the medical discussions that occur on Twitter every day. We can explain the value of a timely blog post.  We can show the power of social media in advocating for our patients and our profession.

Over the last two years, we have made huge strides. In 2009, very few physicians were active in social media and ever fewer saw the value in it. Now, most doctors will agree that social networks have a role in modern life and in modern medicine even if they are not actively engaged themselves. We have done a good job convincing physicians to join the social media age; now we need to make sure we are all doing it correctly.

Editor's Note

AAP & COCM RELEASES NEW MEMBER GUIDE TO SOCIAL MEDIA:

The AAP Council on Communications and Media, the Council on Clinical Information Technology and the Department of Communications have teamed up to create a new resource: the AAP Member Guide to Social Media.

This interactive, web-based document offers a look at the ways pediatricians can engage in social media, whether that means following the AAP “feeds” that interest them, sharing Facebook and Twitter posts, or blogging as individual pediatricians.

The guide includes links to AAP platforms, including the main news feeds on Facebook and Twitter; the Healthychildren.org feeds offering parenting content; and numerous feeds serving readers of publications such as AAP News, Pediatrics and the AAP Red Book. Tips and resources are provided to help pediatricians contribute to the burgeoning but tricky world of online social conversation, including advice on how to comply with the Health Insurance Portability and Accountability Act; the Healthcare Blogger Code of Ethics; and tips on how to vet blogs and comments with their practice or institution.

The guide offers links to exemplary social media sites of AAP members and includes a list of popular parenting blogs that AAP members can explore and join the conversation.

For more information about AAP social media or the guide, contact Gina Steiner, in the AAP Department of Communications, at 800-433-9016, ext. 7945, or gsteiner@aap.org.

Media, Technology & Children: How to Guide Learning

By Ricky Y. Choi MD, MPH, FAAP
follow him on twitter.

The tech revolution is transforming my life.  I have reconnected with long lost friends on Facebook.  I consistently find excellent places to dine within a short walking distance when I travel to a new place (or get lost).  I can find obscure information in seconds or blast my latest blog post to millions of people with just a click.  As a parent and a pediatrician, I wonder about the ways that these technologies can benefit children and the use parameters we should have to minimize harm.

In my house, my children engage in imaginary play with dolls, make elaborate crafts with colored paper, and read books.  They also use my iPad.  Through this amazing piece of interactive technology, my children have practiced the correct stroke order for Korean characters, learned where milk comes from via YouTube videos, and came to the researched conclusion that no satellites orbiting the earth are the color pink.  Because my parents live 2700 miles away, most of my children’s interactions with their grandparents are over Skype video chats.  So much so, in fact, calling them “grandma Skype” and “grandfather Skype” is no longer funny, it's a reality.  While a second best to actually being together, the weekly video calls have supported a relationship that hand written letters and phone calls never could.

The AAP has policy positions on screen time and social media, as they relate to health, highlighting the link between excess television viewing and obesity, poor sleep, and decreased activity.  In today’s world, discussions about media use are no longer talking about passive media consumption.  We must now include interactive technologies such as touchscreens and body sensors.  Watching TV on the couch is not the same as playing tennis with a Wii remote.  And beyond setting boundaries, how should children actually use technology, and how should we as parents and health care professionals guide its use for learning?

The National Association for the Education of Young Children and the Fred Rogers Center for Early Learning and Children’s Media at Saint Vincent College have released a position statement that it is worth reviewing.  They take the position that “when used wisely, technology and media can support learning and relationships.”  While this position statement was directed towards educators, I find their recommendations to be easily applicable to parents - who are, after all, a child’s first teachers. They offer a thorough evidence based discussion on the range of ways that these new technologies can enhance learning.  It is more than consent to “pass back” the iPad to your child in the back seat.  Their guidelines are specific and inline with the AAP’s policy statements:

•   No screen time for children under 2 years of age

•   Technology should be developmentally appropriate

•   Technology should be used to support specific educational goals

•   It should be used with specific intentionality not for the sake of using the technology itself

•   Parents/Teachers should seek to link on and off screen activities

•   Technology should augment, not impede, or be a substitute for social activity, play, and learning.

I was also pleased to find their report included a discussion on the role of technology for children with autism and developmental delay.  In fact they seek the “Intentional leveraging [of] the potential of technology and media for the benefit of every child”.

This report even makes an important equity argument.  Lower income families own fewer media devices and so can get left behind.  Drawing an interesting parallel between “technology handling” and the importance of teaching “book handling” skills, the report argues the value of exposure of these technologies in a structured classroom environment to low income children so they learn how to both use these technologies and benefit from them.  Furthermore, they suggest that together with good teaching, this could “accelerate learning and narrow the achievement gap”.

Technology has, and will continue to have, a growing role in our lives.  Parents, pediatricians, and educators are clamoring for guidance on how to maximize the benefits of technology while minimizing the harm for children.  This position statement is an important contribution to this discussion. 

Teens, Multi-Tasking and Attention Span: The New Normal

Susan Buttross, MD, FAAP
Professor of Pediatrics
Developmental and Behavioral Pediatrics
University of Mississippi Medical Center

Have you ever thought about what’s really happening when teens are watching television, waiting for an appointment in an exam room, sitting in a classroom or talking to you? Most likely, it’s not just that one thing. Look carefully and you’ll see that our preteens and teens are absolute masters at multi-tasking.

Watching television exclusively rarely happens, nor does talking to you directly. Typically, while watching a movie on the TV (which by the way is becoming almost extinct for many) that same guy may be on his laptop or iPad and also texting or checking texts. Just when you think there is no way that the teen can be listening to you, he proves you wrong by answering a question that you didn’t think he heard, right? Amazing how they possess the ability to move back and forth from one type of task to another. Seems great; but, many of us, who did not grow up in the tech era, have distinct difficulty wrapping our heads around what is really happening and what possible ripple effects this may have on our previously accepted behavioral and societal norms.

So let’s take this a little further. If someone is not looking at us, can they really be paying attention? To learn something, must a child stay on task for 25 minutes at a time? At 5 years, we expect a child’s attention span to be about 10-15 minutes (that’s the basic standard of about 2 to 3 minutes of attention per year of age), by 12 years that length has doubled. For most individuals, there seems to be little real growth in the length after that, even into adulthood. However, with rapidly moving and exciting programs available electronically, the needed attention span may be only a few seconds because of the “machine gun-like” rapid-fire movement of the tasks.

Over the last 20 plus years, Adele Diamond, Russell Barkley, Doug Cantwell and other researchers in attention deficit hyperactivity disorder (ADHD) have spoken about executive function and working memory as the major deficits in the disorder. As Dr. Diamond hypothesizes, individuals with ADHD-I (the inattentive type of ADHD) have sluggish “cognitive tempo.” Thus, they are easily bored. Perhaps, changing the tempo of presentations may prevent that boredom and improve the performance of the child. Something that can keep the adrenaline (or dopamine) going improves the attention span in those with ADHD. Maybe that is true of all children. Perhaps children, in general, are better able to engage when their adrenaline is peaked. This would explain the incredible success and even addiction that many children and adults, for that matter, have for video games. The tempo is rapid fire; risks are there; adrenaline is up and so the hook is there that makes one able to stay with something for hours without boredom.

Sitting, talking and watching TV, individually are typically slow paced tasks. Multi-tasking is a way for someone to stay engaged without boredom. This phenomenon of multi-tasking when faced with conventionally slow placed tasks seems pervasive in much of the teen population and may increase their ability to have sustained attention to the task at hand.

We know in the past the “normal and respectful” way to be was to look a person in the eye and certainly NOT to do something else when you are talking to that person. Fast-forward to now…really fast, and perhaps the norm is changing.

The diagnosis of ADHD is on the rise. There has been an explosion of medication use and alternative therapies created for the treatment of this disorder.

Don’t misconstrue my comments to mean that I don’t agree with using medication for the treatment of ADHD. ADHD is a real disorder and often individuals need medication to help in its treatment. But understand that, with the growing use of technology occupying the majority of our children’s waking lives, if our society continues to try to educate children in the same manner that we have in the past, we may be facing an ever-increasing number of children who meet the criteria for ADHD. Perhaps, we need to consider incorporating learning into different formats and look more closely at how we can really hold the attention span of our children. As we change as a society, we may need to take a hard look at the way we teach and the way we define what is really ADHD.

Adjusting to the new digital reality: why pediatricians may need to rethink—or at least refine—their messaging.

Claire McCarthy, MD, FAAP


A couple of weeks ago I went to a Verizon store to upgrade my phone (to an iPhone!). I had my 10-year-old and 5-year-old with me, as my big kids weren’t available for babysitting; this will be quick, I told them.

Of course (in that Murphy’s Law kind of way) it wasn’t quick at all; I had to wait more than twenty minutes for someone to help me. But Natasha and Liam didn’t mind. They went straight to the iPads on display, and navigated them without any help from me. Natasha found a puzzle application and started putting puzzles together. Liam found a drum set application and started making up songs, adding his own lyrics and dance moves.

As I watched them so fully and happily engaged in activities that required concentration and creativity, I thought (as I have so many times): there’s a lot that’s good about digital media.

We pediatricians tend to be very negative about “screens” when we talk with families. We stress the 2-hour limit to help prevent obesity. We warn about Facebook depression, exposure to violence and sex, cyberbullying and online predators. We talk about how texting can keep kids up at night and how video games can contribute to ADHD.

Don’t get me wrong: these are important messages. There are very real risks associated with the Internet and media. We need to keep kids healthy and safe; that’s our job as pediatricians.

But if we are just negative, we miss two important points:
• It’s not all bad. Children these days literally have the world at their fingertips. In our house, questions don’t go unanswered; when something comes up in a conversation, we Google it (often on someone’s smart phone at the dinner table). They have the ability to connect within seconds with people all over the world and to learn about lives that are very different from theirs. There are thousands of websites and applications that can teach them anything and everything, from science to writing to sign language.
• For better or worse, digital media is here to stay. This is the reality of our patients’ lives. Whether we like it or not, they are surfing the web (including for health information), communicating via text and Facebook and Twitter, reading and writing blogs, watching and creating videos. We can’t turn back the clock.

It’s not unlike when cars were invented. We didn’t insist that everyone keep riding horses. Instead, we created seatbelts and car seats and stoplights and traffic laws. And while it’s true, cars still bring risks and pollution they also make our lives better and easier in so many ways. We can’t imagine life without them. Already, it’s hard to imagine life without the Internet and digital media. They have incredible potential to improve our lives, if managed well.

If we are just negative, we may miss the opportunity to inform the discussion. We may miss the opportunity to guide children and families on the best uses of technology. Someone else will step in and do it, someone who doesn’t understand child health and development the way we do.

It’s hard to teach what you don’t know. So explore the Web. See what’s out there. Do the health searches your patients might do—and see what pops up. Find sites and applications that you like and can recommend. Talk to your patients and their families about how they use technology at home—learn from them. Check out Facebook and Twitter and YouTube. Consider using social media yourself.

Really, this is about meeting patients where they are, about being relevant in their changing world. It’s about making a difference in the lives of youth today.

And that is undeniably our job as pediatricians.


Dr. McCarthy is member of the American Academy of Pediatrics’ Council on Communications and Media. For more information regarding social media and its impact, please see The Council on Communications and Media’s full clinical report, “The Impact of Social Media on Children, Adolescents and Families.”

Social Media and Public Health

Jacqueline R. Dougé, MD, MPH, FAAP

Social media has become an important public health tool. It is inexpensive; it reaches millions, and can positively affect behavioral change. However, for the busy pediatrician it can be hard to stay abreast of all the new and beneficial tools out there. Below are a few that I have found particularly helpful and innovative.

Healthychildren.org is a website developed by the American Academy of Pediatrics to provide health information to parents. Parents can search for pediatric providers, get answers to health questions or look up health topics. It is a great resource to link to your practice’s website and to share with your parents.

Text4Baby recently celebrated its one year anniversary. It is a project of the National Healthy Mothers, Healthy Babies Coalition; the American Academy of Pediatrics is among its many partners. Text4baby provides free health information to pregnant and new mothers via free text messages. The messages coincide with a woman's due date or the baby's date of birth. Moms receive information on topics such as breastfeeding, immunizations, safe sleep, nutrition and smoking cessation. Mothers are also connected to community services. This is a great resource to refer new parents.

The National Association of County and City Health Officials (NACCHO) recently developed a campaign to promote the Vaccine for Children’s Program (VFC). VFC is a federal program that provides free immunizations to millions of children enrolled in Medicaid or who are uninsured. The campaign promotes the program and educates parents as to how they can access vaccinations for their children.

Health and Human Services (HHS) launched a website, InsureKidsNow.gov. This site increases awareness about what programs are available across the country for uninsured children and helps parents enroll their children into affordable health insurance plans.

Lastly, the First Lady’s Let’s Move Campaign uses social media to prevent childhood obesity. The site is bringing together health care providers, parents, children and industry to find ways to promote healthy eating and physical activity.

These social media campaigns not only promote but improve the public’s health. They illustrate how the field of medicine and public health are changing. It is an exciting time to be both a pediatrician and public health professional. Personally, I like to think all pediatricians are also public health professionals and as such it behoves us to familiarize ourselves with the tools and campaigns out there and to share this information with our patients. Social media is a great tool to promote health and improve health behaviors.

To learn more about current social media campaigns and about social media in general, check out the The Centers for Disease Control (CDC) website or the May issue of AAP News.

Social Media and the Private Practice

By John Moore, MD FAAP

Over the past ten years, Americans’ usage of electronic media has exploded. The Internet has gone from a novelty to an essential part of our personal and professional lives. I check my email and Facebook wall before I finish my first cup of coffee in the morning, and I know I’m not the only one! A recent survey of pediatricians (2009 Periodic Survey of Fellows) found that over 85 percent of us use the internet for news and CME. Over 60 percent of younger pediatricians also use social networking sites like Facebook or Sermo.

A small but growing number of practices are starting to use social networking sites as marketing tools as well, communicating directly with patients and families. As I began to investigate starting our own practice Facebook page, however, I quickly realized this is a very complicated issue with a lot of pros and cons.

There are many positive aspects to social media. It is a free way to communicate directly and instantly with a highly receptive audience. The sites are easy to construct, free to establish, and require minimal time to maintain - all of which are in stark contrast to conventional websites. In addition, the communication between administrator and patients is instant. Finally, you are able to communicate your message directly to patients and families who register with you - targeting the most interested audience. Facebook pages can provide a convenient portal to correspond with patients and families, transmitting not only office information and policies but also overall pediatric news.

However, social networking pages are not without risks for physicians. Pediatricians need to keep some basic rules in mind before opening their pages for business. Patient privacy is a real and major concern. Posts on walls that contain specific identifiers and privileged information may run afoul of federal law and thus may constitute a HIPAA violation.

Pediatricians who maintain a social media presence also need to monitor their pages regularly. Patients may treat those portals as an extension of our offices and expect the same level of communication they receive through more conventional methods. While no legal precedents have been set, it is reasonable to assume that we are as liable for social media communications as we are for all other platforms. Finally, pediatricians need to keep copyright, libel and slander laws in mind - social media are not immune from conventional legal standards and violations are more public and more permanent!

We also need to consider which features make social networking sites effective. Marketing and business leaders have identified several key components of successful platforms. Sites should be interactive, drawing readers in and soliciting their comments. People like to feel included - successful sites encourage interactions between patients and the moderators. The more “viral” the site becomes, the more effective it is. Furthermore, sites should be updated frequently with interesting, entertaining and useful content, practice information and changes, links to pediatric or community-specific events, or even commercially available data (as copyright-applicable!).

The decision to open a practice-specific social networking page is a difficult one. For many of us who are “quick adapters”, these pages are a natural extension of our personalities. We are more than willing to embrace the unknowns in order to engage our patients in conversations. For others, however, the concerns more than outweigh any perceived benefits. Whatever your personal opinion on social networks, however, they are inescapable part of modern life and a growing part of many pediatricians’ daily practice.

When Can a Child Use Facebook?

By Bryan Vartabedian, MD FAAP
Assistant Professor of Pediatrics at Texas Children's Hospital/Baylor College of Medicine

This is a question parents are beginning to ask. If they don’t ask their pediatrician, it’s a question they will inevitably ask themselves and their friends. As the prevalence of social media increases, the issue of social media use by teens has become a legitimate concern and one that may not be on the radar of most practicing pediatricians.

Social networking is evolving at an extremely rapid pace. What’s popular today may not be in a year or two. As parents and pediatricians, we need to be less concerned with the particular method of communication and instead focus on instilling basic core values of privacy and personal boundaries in our children and patients. These same values will apply whether a child is using MySpace, Facebook or Twitter, whether they are texting or uploading photos of themselves.

Here are a few things to consider in our dialog with parents surrounding teen social media use:

A parent’s capacity to protect is limited
There are two basic truths that parents and pediatricians need to accept in this new digital age:
• Online social activity is inevitable.
• A parent’s ability to control what teens say and do is limited.

It’s important to recognize that as children get older, our ability to protect them, online or off, is greatly reduced. Digital socialization is not a fad or a gimmick. It represents a generational shift in how we engage one another. To suggest that our patients will grow and develop socially exactly as we did is fantasy. Digital culture is changing that.

Instead of trying to create an environment where online activity can be avoided, we need to help children develop a construct, or framework, for appropriate engagement in this new digital world.

Parents set an example
Perhaps the greatest framework for a child is the behavior of his or her parent. What parents do and how seriously they take their online engagement is noted and potentially adopted by tweens and teens. Modeling may be an important first-step in helping children identify what’s healthy and what isn’t.

Teens are digital and invincible
The trademark of teens is their ability to detach themselves from situations with the belief that they can’t get hurt. This narcissistic grandiosity affects the way teens evaluate risk and makes them more likely to engage in risky behavior. Unfortunately, just as what happens at a party or behind the wheel of a car can cause lasting damage, so too can online behavior.

Online engagement creates a trail that we call one’s digital footprint. This trail can follow teens into the college admission process and even into the workforce influencing how potential employers view them in their quest for jobs.

Parental monitoring of a child’s public ‘brand’ is evolving as a new responsibility in 2010. Parents can begin by impressing upon their children the emphasis that a digital footprint can have on their future. Although teens do view themselves as invincible, starting around 16 years of age they are also very concerned with the concept of a reputation and personal image. Once teens become aware of how online behavior can affect that image for years to come, they may be more apt to protect their online reputation.

The responsibility of pediatricians
If as pediatricians we don’t advise parents, they will turn to their own devices and their own networks for advice. Personal networks are part of parenting, but we should not surrender our role as child health advocates in the sphere of social engagement.

Helping parents navigate the territory of online socialization should fall under the responsibility of the pediatrician. Just as parents have to rethink the way they raise children, pediatricians collectively need to rethink anticipatory guidance. Our worldview of how we advise parents needs to evolve.

A Different Take on Social Media: Our patients...Today's YouTube Stars?

“Did you see, I made the news”, said my teenage patient a few hours after being shot twice in the legs.

“No”, I said, “I’ve been busy taking care of the other patients in the ED”.

“Too bad”, he replied. “It was pretty cool”.

I have never thought of having a gunshot wound as pretty cool. However, I am not part of this new generation that expects to be a part of social media, YouTube, Twitter, Facebook, etc.

A moment on the trends I have been seeing….

1. Teens with injuries sustained while doing some activity (likely not a safe or wise activity) that is being taped for production on YouTube. For example, with the warm weather brings the annual “what can we do to make a Slip-and-Slide more dangerous”? The last two teens with splenic lacerations opted to show me the injury as it was happening as depicted by video on YouTube. That is, before coming to the hospital, the patient (or the patient’s friend) took the time to post the video of the injury inducing event to YouTube.

2. Families videotaping injuries instead of helping the child being injured. I recently cared for a young man that was attacked in a local park. When I asked for a description of what happened, his older brother (of adult age) said he could show me the video if I wanted. When I asked why he chose to video the event instead of help his brother, he replied that he thought it would be better for the police and the news to have the video.

3. Victims of violence feeling a sense of accomplishment when their stories are covered on the local news. The gunshot victim provides a classic example.

Perhaps our entrance into social media is not best served by the medical professionals producing their own spots, but instead helping to prevent our young patients (and when necessary, their families) from being the star of these less than endearing media clips.

This is a new health crisis impacting the youth of today. I am at a loss as to the root of the problem. Is it due to the dramatic increase in reality TV? Are kids getting the message that since anyone can post a video on-line they are not worthy unless their video is the most dramatic, dangerous, outlandish, or destructive? What would cause a family member to choose allowing injury to a loved one over stopping an assault? Perhaps in addition to reviewing our patients’ charts prior to a visit, we need to Google them too…then discuss what we find when we see them in our offices!

By Elizabeth Murray DO MBA

Editor's Note:

Dr. Murray has offered us a bird's eye view into the real world of how kids are using social media. Our job is to figure out how to use this information clinically. Perhaps it's as simple as asking "been on YouTube recently?"

Sexting: dangerous but is it a crime?

“Come gather round people wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
Then you better start swimming
Or you’ll sink like a stone
For the times they are a changing”

Bob Dylan’s song of protest (voted #59 of the top 500 songs ever written by Rolling Stone) seems as prescient today as in 1964, especially as COCM members recognize the latest teen-technology on-line behavior:sexting. Research studies reflecting usage reveal that between 20-25% of all teens have sent or posted semi-naked or naked pictures. A higher percentage says that exchanging sexy content makes dating or hooking up more likely.

Teens have been recently charged with disseminating child pornography in 9 states, many have to then register as sex offenders. Meanwhile,the media (as usual) has sensationalized the issue by the way it has covered the topic, often confusing parents, teens and even pediatricians.

But the real question here is this: should laws made to protect children be used to prosecute them? I believe that misses the point. Pediatricians and parents should look beyond the headlines to the convergence of adolescence and these electronic devices that allow instant communication decisions from immature teen brains.

These kids are not threats to society.They’re reckless hormonal narcissists who are tasked with growing up in a sexualized society. Their previously private thoughts are now revealed all too publically. They often are the real victims here: assaulted by a desire and opportunity to get older-younger.

Parents need to become aware that the media has ensured that adolescence occurs well before Tanner stage II. The media has framed the issue, but not focused on real solutions. That's where we can help enormously with our pediatric knowledge and media skills!

So what is the Pediatrician’s role when it seems that teens are more connected to their devices, and each other, but disconnected from their parents? It doesn’t have to be complicated.

1) Don’t wait until a health maintenance appointment to frame the issue of texting/sexting. Rarely does a teen or tween appear in the office without a cell phone. (Or receive a call during the appointment).

2) Remind them that a text or sext, once sent, is out of their control permanently. Examples abound from the pictures of Vanessa Hudgins (HSM 1,2,3-oh google her) or Michael Phelps and his famous bong picture.

3) Ask about whether parent is concerned about texting as nauseum. Most will agree
about the numbers, but will be clueless as to potential solutions.

4) Advise visiting ThatsNotCool.com (go there yourself). A great site with tools and guidance, prime parenting directives actually, to buffer cyber-stalking and cyber-pressures. The site also has great posts that could be taken from the site to stimulate a discussion in your examination rooms, newsletters, websites.

Note that as the January archives article revealed, uncovering the problem does not imply you have to solve it. Expressing awareness and concern, could, hopefully, motivate parents to seek opportunities to learn and engage in collaborative conversations that would lead to constructive solutions.

“Come Mothers and fathers throughout the land
And don’t criticize what you don’t understand
Your sons and your daughters are beyond your command
Your old record is rapidly aging
Please get a new one
If you can’t lend a hand
For the times they are a changing”

By Don Shifrin, MD, FAAP

What if every pediatrician was on twitter?

Is the absence of pediatricians on social media platforms a public health issue for children? It might be. Misinformation predisposes children to risk. We all can identify instances where poor decisions for a child were made on corrupt information obtained online.

And as doctors we complain. We see ourselves as victims. Our patients are reading someone else’s information and opinion. And most of us handle matters by taking precious time to get the facts straight. Time that could be better spent on anticipatory guidance or counseling in other areas.

But to some extent the issue of bad information is our responsibility.

As pediatricians our response to online misinformation tends to be reactive. For some reason we never think that we should be the ones generating the information and dialogue. As the group charged with the well-being of the next generation we need to be proactive. We have a commitment to see to it that we are visible and vocal online.

So what can you as a fellow of the AAP do?

Contribute to a blog. It doesn’t have to be your own blog. There are many that would be happy to host you as a guest author. Offer practical input on the issues that you see creating confusion in your parent base. If every fellow of the AAP posted one blog post annually on the absent association between vaccines and autism, for example, there would be 60,000 online entries which would likely dominate search engines.

Comment regularly on news sites, blogs or anywhere there’s dialog on children’s health. With no input from those of us with the facts, discussion will be dominated by a vocal minority, many of whom have an agenda not representing the interests of the parental reader.

Begin a Twitter account. Just a few minutes a day cultivating relationships with peers, patients and ‘followers’, AAP fellows have the potential to change minds and influence thinking. Twitter is a platform for the dissemination of ideas, thoughts and information in ‘tweets’ of 140 characters. Assuming just 250 followers (I have 1,000), the news of a measles outbreak associated with undervaccination, for example, could instantly reach 15 million individuals with a single tweet from AAP members.

The battle for the health of our children and the sanity of our parents is now fought online. A commitment to online literacy through active involvement by AAP Fellows in social media should be seen as a critical advocacy role.

By Bryan Vartbedian, MD, FAAP

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.

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

Social Media Sites and Inauguration Coverage: A Glimpse Into Communication of Today and The Future

This week's Inauguration will not easily be forgotten. From the earliest moments to the First Couple's First Dance, it was a day filled with hope, memorable "tissue" moments, though-provoking music and words, and images of a gracious passing of the Presidential torch of power that will be carried with all of us for a very long time.

In addition to the usual TV coverage, a surprising twist to my day was how much more enhanced the experience became for me due to the power of my social media involvement on Twitter and Facebook. As the Inaugural events were unfolding, simultaneously, my virtual community of friends and colleagues were posting their impressions and images real-time from all 4 corners the United States. We even shared what we were snacking on! No longer sitting alone with our thoughts, we became a rich community of voices sharing our thoughts and impressions real-time.In the blink of an eye, a virtual living room of spectators for the biggest historical moment in most of our lives emerged.

And, we were not alone! JuJu Chang from ABC News had a flipcamera and her iPhone at the Inauguration. She not only posted videos on her ABC News blog but updated to Twitter and Facebook throughout the day. It was a cool way to give views another way to experience the Inauguration besides the more traditional TV coverage ABC was also doing, which was excellent.

We have yet to really tap into the full power of these communication tools but if Tuesday was any indication, a door has been opened that we have only just begun to walk through. It will be interesting to see how we all end up using social media in our media and communication lives and to learn from each other's experiences. We are likely to find we will only be bound by the limits of our own individual creativeness.

There was a true sense of unity and community this week that was visible and palpable on the Mall, parade route, the many evening balls, and in all our communities on and off line. While I had a bit of Inaugural media coverage brain burnout the following day, I woke up that morning hopeful about the future and looking forward to exploring more the power of the world of social networking.

Image: First Dance (FoxNews)

Republished with permission from Dr. Gwenn Is In