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Am Fam Physician. 2012;85(7):729

Guideline source: American Academy of Pediatrics

Evidence rating system used? No

Literature search described? No

Guideline developed by participants without relevant financial ties to industry? Not reported

Published source: Pediatrics, April 2011

The number of children and adolescents using social media Web sites (e.g., Facebook) has significantly increased in the past five years. Research has shown that social media improves communication, social interaction, and technical abilities. However, because children are limited in their ability to regulate themselves and are vulnerable to pressure from their peers, there also are risks associated with social media use, including online expression of offline behavior (e.g., bullying, experimenting with sex). Parents and their children also may have varying degrees of knowledge about social media, which can affect how they engage in online activities together.


Children and adolescents can use social media for activities that are important to them; for example, they can raise money for a charity organization; share art or music projects; create blogs, videos, or podcasts; or interact with others over shared interests. They can also use social media to get together with peers for homework or group projects, and to access health information easily and anonymously.



Cyberbullying, defined as using electronic media to communicate untrue, embarrassing, or hostile information about another person, is the most common online risk for teenagers. It can cause psychosocial outcomes, such as depression, anxiety, isolation, and suicide.


Sexting is defined as electronically sending, receiving, or forwarding messages or photographs that are sexually explicit. Some teenagers who have participated in sexting have been charged with felony child pornography; however, some states are now classifying sexting as a juvenile misdemeanor. Participation in sexting can also lead to suspension from school and emotional problems.


Facebook depression is depression that develops when a person spends a significant amount of time using social media and then exhibits depression symptoms. The intensity of the online environment is thought to possibly cause the depression. Facebook depression can increase the risk of social isolation, similar to offline depression.

Role of the Physician

Physicians are in a position to talk to families about the digital world and the social and health issues that children may experience. They should counsel parents to talk to their children about their Internet use and to learn more about the technologies their children are using. Physicians should also talk with parents about developing a plan for Internet use, which should include family meetings, reviews of privacy settings and online profiles, and a focus on healthy behavior. Parents should be reminded of the importance of supervising their children's activities through active participation and discussion. The American Academy of Pediatrics (AAP) also urges physicians to learn more about digital technology to improve their own understanding.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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