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Diane Tanaka, MD, Solomon Behar, MD, and Mizuho Morrison, DO

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Tags adolescent · media · sex · youth

Understanding the dark side of social media is important to understand what risks our adolescent patients are exposed to. Cyber-bullying, sexting, and being vulnerable to sexual predators online are all very real and potentially silent risks. As caregivers to teens and their families it is vital we learn and understand the current trends of what our youth must face so that we can identify signs of victimization.



  • Cyberbullying is prevalent with an many as 35% of high school students experiencing cyberbullying.

  • Parents should make family policies around social media use and an online presence, computers should be kept in public areas in the house and parents should monitor their children’s behavior on social media and online.


  • How common are problems related to the internet in children and when does this start?  95% of US teenagers use the internet and 81% of those teens are on social media. It is illegal to collect data on internet users less than 13 years of age so most social media sites do not allow users under that age.

    • A 2013 survey by the CDC demonstrated that 20% of high school students reported being bullied electronically in the last year and as access has improved to devices this may have climbed to 35%.

  • What is cyberbullying? Cyber-bullying as any electronic aggression through email, a chat room, instant messaging, website, text messaging, videos or pictures posted on websites or sent through cell phones.

    • Cyber bullying can take many forms but typically is in the form of name calling like comments on a girl’s appearance or homophobic remarks directed at a boy.

    • Two important differences between cyberbullying and in person name calling is the large number of people who may see comments on line and the lack of immediate feedback from the perpetrator. In typical school yard name calling,  the perpetrator gets immediate feedback on the victim's reaction that is lacking online.

    • Children are more sensitive to bullying than adults and cyberbullying is associated with depression. Typically victims of cyberbullying will not tell anyone that they are being bullied.

  • How can we mitigate the risk of cyberbullying? For parents the recommendation is to have a family policy around social media use and an online presence, making it clear at what age children can be part of social media sites.  

    • Computers should be located in a public areas and parents should review the history on the computer. If kids have facebook accounts one prerequisite should be being friends with their parents so that their posts can be monitored.

    • Weekly meetings to discuss what is going on online can help. Parents can use prompts to open up discussion.

      • "I couldn't believe it on Facebook. One of my friends put up a picture of their daughter falling into a pool"

      • "What about you guys? What's the best thing you've seen on Facebook this week?”

      • “What's the most disturbing thing or the most upsetting thing you saw?"

  • What are the symptoms of cyberbullying? Warning signs include things like looking more sad or upset especially after using one of the devices. Other symptoms could include new avoidance of school or other settings which could be the source of the bullying. Children may be more secretive about their digital lives. Parents know their kids best and they may simply notice a change in mood. Kids will typically not report cyberbullying and may be afraid or retaliation so looking for these symptoms is important.

Editor’s note: More information about electronic aggression from the CDC can be found online here: Electronic Aggression. Information from the AAP for families can be found here: Cyberbullying: Important Information for Parents.

  • At what age should a child have access to their own phone? Eight to ten year olds may be a reasonable age for a child to have access to a phone but should not have access to the internet. 13 to 14 might be a reasonable age in a the right situation if appropriate ground rules are in place.

  • How do you ask questions about social media in your adolescent visits? This has not been standardized but Tanaka uses questions like:

    • "Have you experienced anybody calling you names or treating you inappropriately through social media?”

    • “Have you felt threatened?”

    • “Is somebody treating you badly through text or online?"

    • If they have a change in affect a question like "What is going on? You seem different. Tell me what's happening," might help.

  • How should adults deal with reports of cyberbullying? This concern should be taken seriously. Documenting the incidents with screenshots should be done and these incidents should be addressed with the school or the police as appropriate. 

Editor's note: Guidance on when to involve the police and other guidance for managing cyberbullying can be found on

  • Should parents worry about predators on multiplayer online games? Yes there are reports of this occurring both in the media and the literature. Parents should be warning their children to let them know if someone online is paying too much attention to them or is making them feel uncomfortable.

More information about security online  for parents from the AAP can be found at SafetyNet.


  • What is sexting? Sexting is defined most commonly as sending a sexually explicit image or message.

    • Estimates of prevalence vary but the 2013 Youth Risk Behavior Survey, which is funded through the CDC and looks at eighth, tenth, and twelfth graders, found a prevalence just under 15%.

    • Those who engage in sexting are more likely to engage in high risk sexual behaviors as well as substance use. There can be severe legal penalties in some states where offenders may be registered as sex offenders. Tanaka will warn her patients about this possible consequence.

  • What are the new applications that teens are using to communicate?

    • Kick and WhatsApp are new applications that allows teens to communicate without messages appearing on the phone bill.

    • Snapchat, iDelete and Frankly are all applications where the messages are only temporarily available.

    • The well known dating application Tinder is also being used by teens, with 7% of its users being between 13 and 17 years of age.

    • Also new are “vault” applications which are password protected messaging and file storage applications. Some like Calculator% (which looks like a calculator until a password is entered) are disguised so they do not look like messaging applications.

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