“One thing to keep in mind is that while the stewardship focuses on our opioid utilization and prescribing habits and aiming to keep children safe, we can’t ignore the fact that kids will have pain—either acute or chronic. So, it has to be addressed,” says Artee Gandhi, M.D., medical director of Pain Management at Cook Children’s, who also oversees the stewardship program. “It’s not a matter of getting rid of one thing and not replacing it with anything else, or not using it sparingly in conjunction with other ways to treat pain. We recognize both sides of the coin.”

The goal of Safe and Sound is to use other methods of managing pain, she says. It aims “to improve patient safety, reduce the risk for potential child addiction, ingestion, misuse, overdose and death, while promoting best practices through the safe and sound management of pain,” according to its mission statement.

From 1999 to 2019, overdose deaths involving prescription opioids more than quadrupled in the United States—leaving about 247,000 dead, according to the Center for Disease Control and Prevention.

The trend has hit locally, as well. As of May, Cook Children’s admitted 17 patients for opioid-related overdoses, representing a significant jump from 2020 when 16 patients were admitted for the same condition for the entire year. In March, at least four area teens died from overdosing on fentanyl, a synthetic opioid that is 100 times stronger than morphine and 50 times stronger than heroin. The teens purchased the pills thinking they were Percocet, but they were laced with fentanyl, according to reports. Drug dealers often package and sell fentanyl on the streets disguised in forms of other popular medications, such as OxyContin, Percocet or Xanax.

Opioids, which “bind to or activate opioid receptors on cells located in the brain, spinal cord and other organs in the body,” block pain signals and release large amounts of dopamine throughout the body, according to the National Institute on Drug Abuse (NIDA), the leading federal agency supporting scientific research on drug use and its consequences. That flooding of dopamine can reinforce using the drug and make users want to repeat the experience, the agency reports. NIDA lists the most common drugs containing opioids as hydrocone (Vicodin), oxycodone (OxyContin, Percocet), oxymorphone (Opana), morphine (Kadian, Avinza), codeine and fentanyl.

In the late 1990s, the medical community was given the green light to prescribe opioid pain relievers after pharmaceutical companies assured them patients wouldn’t become addicted, according to the U.S. Department of Health and Human Services. Increased prescriptions of opioid meds led to widespread misuse of both prescription and nonprescription opioids before their highly addictive nature became clear. The department declared a public health emergency in 2017 and announced a 5-Point Strategy to Combat the Opioid Crisis.

Despite these efforts, 10.1 million Americans reportedly misused prescribed opioids last year, according to department data released in December.

At first, physicians and prescribers thought opioid medications were a safe, long-term way to manage acute pain and chronic pain—“not recognizing the effects opioids have on the pleasure-seeking parts of our brain,” Dr. Gandhi says. “Opioids not only helped control pain, but they also helped reduce anxiety and depression. By stimulating endorphins, one would feel more outgoing, confident and increase motivation. This property, along with the chemical changes in the brain, alters our biological or physiological set point. Now we need more to achieve the same effect. And if we don’t get the drug, we have withdrawal, which is a horrible feeling. So, now one becomes addicted and seeks ways to get the medication that may not be safe or legal.”

In the 2000s, opioid substance misuse, abuse and overdose deaths continue to climb, she says, adding, “Physician prescriptions have definitely decreased, but unfortunately substance abuse, opioid use and overdose has not. Those numbers are still increasing and are still in the hundreds of thousands of people who die each year from an overdose.”

The increase in opioid overdoses and deaths has trickled over into the younger population, bringing attention to what opioids can do to children and adolescents brains. Research studies show that the earlier children are exposed to opioid substances, the higher the risk of long-term addiction, Dr. Gandhi says.

“What we’re recognizing in the pediatric population is the adolescent brain is set up for risk-taking behaviors. The brain is changing in a way that the prefrontal cortex is the last to develop—it’s developing from the back to the front,” she says. “The front is the part that regulates. But the back is the part that’s about risk-taking, asking questions, wanting to rebel, wanting to find answers for themselves, not wanting to listen to what other people say.

“It’s kind of like they’re a high-speed car without any brakes,” Dr. Gandhi says. “We can prescribe opioids in a safe way to kids, but we really need to be conscientious of how many doses we’re giving them, whether there are other ways to control their pain, making sure parents are the ones giving them their medications and that the medication is locked and secured in a safe place.”

Educating physicians, parents and patients on alternative ways to manage pain is one of the most important goals of Safe and Sound. For instance, under the program, guidelines to manage acute pain have been created, using a multimodal analgesia regimen of acetaminophen and ibuprofen as the primary medications for post-surgical pain management.

“There are studies that show when those medications are used together and scheduled for the first 72 hours after surgery, you need less narcotics, if any at all,” she says. “And that they’re more effective than even an oxycodone.”

During surgeries, physicians may use local anesthetics or nerve blocks as a proactive way to minimize postoperative pain. Families also are educated ahead of time on what to expect during post-op and what the plan will be for medications.

“Every patient goes home with a handout and discharge instructions on how to manage pain, including things like ice and heat, rest, utilizing relaxation and breathing apps, ways to help cope with distraction,” she says. “We tell parents that it’s OK for them to have a little bit of pain after surgery. As long as they can function, they can eat, do the things they need to do to recover, that’s the focus, as opposed to saying, we’re just going to give you these pills and this will be it.”

There’s a natural course for acute pain, Dr. Gandhi says, and if a patient is not healing accordingly, the individual needs to be reevaluated. “If someone’s not following that natural course, we want to assess why that is the case. It’s important because pain can always be a sign of something else. We want to be able to address it before blankly prescribing a pill,” she says.

The Safe and Sound approach appears to be working, says Lorrainea Williams, Cook Children’s Patient/Medication Safety Officer. In the past, surgical patients were usually sent home with a medication that contained both an opioid and acetaminophen. Now, they’re sent home with a medication plan that uses alternating acetaminophen and ibuprofen doses as the primary method to control pain. Patients also may receive a small amount of low-dosage medication that contains only an opioid to be used as a “rescue” in case their pain intensifies, she says.

In 2018, patients who needed pain relief were sent home with an average of 25 doses of medication that contained an opioid. That number has steadily decreased since the program began, and now the average is 12 doses for patients who need additional pain relief, she says.

The number of post-surgical patients who returned to the emergency room or had to be readmitted because of severe pain also has lowered since the hospital decreased the amount of opioids prescribed, Williams says, adding the number of return patients from 2018 to present dropped by 34 percent.

“Based on the numbers, we can determine that we are effectively managing our patients’ pain with less opioids,” Williams says.

The Safe and Sound program also established guidelines on prescribing opioids, and all opioids are prescribed electronically through our system, which tracks them, Williams says. Under the law, physicians can still write paper prescriptions for opioids if special circumstances exist.

But there are exceptions for prescribing opioids under the guidelines developed for Safe and Sound. Opioid therapy is to be considered only if the physician expects the benefit for pain and function to outweigh the risks and is reserved for moderate to severe pain in patients with conditions such as post-operative pain, trauma, sickle cell disease, palliative or end-of-life care.

As for patients dealing with chronic pain, the preferred first-line treatments under the Safe and Sound program include using more beneficial non-opioid medications, making positive lifestyle changes (such as getting enough sleep) and trying complementary therapies, depending on each individual’s condition. The non-pharmacological therapies include acupuncture, aromatherapy, biofeedback, cognitive behavioral therapy, massage, positioning, and Transcutaneous Electrical Nerve Stimulation (TENS).

It all comes back to an evidence-based approach.

“For example, there are some wonderful studies that show the benefits of acupuncture for chronic headaches and the benefits of massage for chronic back pain,” Dr. Gandhi says. “There also are studies that show the benefits of Tai-Chi for insomnia, fatigue and other chronic conditions.”

When it comes to treating chronic pain conditions, physicians must rely heavily on functional ability, such as how difficult is it for patients to walk to the bathroom, meet with friends, sit in a car or go to school, she says. The goal is to improve functional ability because that improves patients’ lifestyles, relationships and healthy routines.

“Trying to keep that routine is what we talk about when it comes to chronic pain, and then maximizing the appropriate types of medications,” Dr. Gandhi says. “All pain medicines are not the same. I would not throw opioids on top of opioids for chronic pain because that would be like trying to treat an ear infection with an antibiotic that treats urinary tract infections. Opioids have a limited role in chronic pain. They can actually induce a hyperalgesia response, where the sensitivity of those pain receptors increases. So, you actually could experience more pain with longer exposure to those opiates.”

For patients who are prescribed opioid medications for acute pain, it’s important to return unused pills once the pain has been managed, she says. The pharmacy at Cook Children’s has become a take-back location, where families can drop off unused meds. Other area pharmacies also have been designated as take-back locations.

“They don’t have to talk to anyone. There’s a little slot, you put your bag in there and walk away,” Dr. Gandhi says. Patients sent home with opioid prescriptions get a text message within a week reminding them to dispose of their unused medications and providing a website link that shows them the nearest take-back pharmacy location.

The program’s success hinges on physicians and parents working together and, so far, they have responded favorably, Dr. Gandhi says, adding the evidence-based approach is much more proactive than in the past. It focuses on pain management for each individual rather than a generalized approach, she says.

“Where it comes back to is all of us working together and being really consistent in our messaging,” she says. “We’ve done a lot of education for our staff as well, learning modules, training modules, continuing education opportunities. Parents are hearing the same message from the beginning, and not just when their children are in the throes of a situation.”

Dr. Kirk Pinto, M.D., a Cook Children’s urologist, says he has found the stewardship program to be helpful for his patients.

“I was skeptical at first, but I learned from my colleagues, who do essentially the same things I do, that these patients could be adequately managed with fewer or less opioids,” Dr. Pinto says. “I have always promoted the use of Motrin and Tylenol as first-line therapies. With all the bad publicity that opioids have gotten lately, parents are much more receptive to nonnarcotic pain management after surgery.”

Dr. Gandhi says she has been pleased by the overall response to the stewardship program.

“I have to say our surgeons and providers have been very open and receptive to this information because everything that we’ve brought forward has been evidenced-based,” she says. “Once we’re able to give them factual information, they’re very willing to change their culture or their prescribing habits, knowing that there’s literature that supports this change.

“We also monitor readmissions for pain or emergency room visits for pain. So we’re able to give them the data that shows kids are not coming back in with more pain, even though we’re prescribing less opioids,” Dr. Gandhi says.

Overall, families also have been on board with the Safe and Sound approach. They get a lot of education through media and commercials, she says, so they’re more aware of concerns surrounding opioid medications.

“They don’t necessarily want their kids to be on them long-term or to get high doses or go home with a lot of medications,” Dr. Gandhi says. “Obviously, you still get into situations where maybe there’s a little bit more stress around it, but I think everyone’s done a great job rallying around parents and supporting them. We’re not letting their kids suffer—they’re still getting the relief they need, just in different ways.”

When we hear the word ‘addiction,’ we often think of drugs and alcohol, but in the 21^st century, addiction has taken on a new meaning. Lisa Elliott, Ph.D., psychologist and clinic manager of the Behavioral Health Clinic at Cook Children’s in Denton, says children are becoming addicted to their phones and gaming systems, driving parents to seek help through licensed therapists.

“We have the research that shows there is a chemical addiction as well as a behavioral addiction,” Dr. Elliott said.

“I think the thing that makes it even more dangerous for me is this is happening with young children, very young children, as much as it is with teens and young adults.”

In 2019, the World Health Organization (WHO), voted to include ‘gaming disorder’ as an official condition in the International Classification of Diseases, akin to anxiety, depression, etc. This paved the way for psychologists such as Dr. Elliott to bill insurance providers, making access to care more affordable for many families with health insurance. However, aside from video gaming, adolescents and teens are also glued to their electronic devices. She says remote learning due to the global pandemic has also played a major role in this addiction.

Cheryl, a North Texas mother, says her 12-year-old daughter is obsessed with YouTube. The family is now seeking guidance from a Cook Children’s family therapist.

Cheryl and her husband didn’t allow their daughter to have a cellphone until they believed she needed it for safety purposes. She wasn’t allowed to have any social media accounts, but her parents did allow her to watch TikTok videos.

“She has a cellphone and iPad, but we made sure everything had parental controls and restrictions,” Cheryl said.

When they later deleted the TikTok account out of concern for privacy issues, they allowed her to watch YouTube videos.

“She watches kids playing innocent pranks on each other, and she gets invested in that. She consistently talks about who is dating who and is always looking forward to the next update like she knows the people in the videos,” Cheryl explained.

Cheryl added that her daughter knew exactly when the episodes were coming out and had a fear of missing out on what was next in the lives of her favorite YouTubers.

When the Cheryl and her husband realized their daughter was going behind their back to find ways to watch YouTube, after she’d been instructed otherwise, they decided to reach out for help.

“For me, it was really about correcting that behavior because right now she has this temptation in front of her and she's making bad choices,” Cheryl explained.

Why are young people becoming obsessed with a reality outside of their own? Dr. Elliott believes the global pandemic has a lot to do with this rising trend.

“I think it's pervasive, so it's not just from an academic setting, but it's also how kids are filling their downtime. It's how they're maintaining social relationships, whether they're healthy or not,” Dr. Elliott said.

Cheryl and her husband couldn’t agree more. They don’t have any issues with their daughter’s choice of content. The issue is her actions and what these minor actions could lead to in the future when bigger temptation is put in front of her.

Cheryl’s daughter sees Stephanie Golden, LPC, a therapist at Cook Children’s Alliance. Golden has been working as a mental health professional for 20+ years but says phone and social media addiction is something she has seen more in the last three to four years in her practice. While phone addiction isn’t healthy, Golden believes it is treatable.

“It’s certainly a widespread problem, but I believe one that can be improved upon with boundaries,” Golden said.

Boundaries are exactly what Cheryl believes would be beneficial for her daughter when it comes to her desire to watch YouTube videos.

In a 2019 study released by the Child Mind Institute, 1% to 10% of children and adolescents have excessive and impairing online behavior. This behavior impacts a child’s ability to focus, the hours of sleep they get at night, and their social behavior with others when they aren’t behind a screen.

Cheryl says having a daughter that’s addicted to YouTube and going behind her parent’s back to find ways to watch it is hard because there aren’t resources for this problem specifically.

“It was really hard to figure out what to do and how to handle this,” Cheryl said. “We tried every single thing we could, from taking away her devices and even sitting down with her and asking her what she needed and how we could help.”

Cheryl and her husband struggled even more because they felt their daughter’s actions were ‘minor’ and ‘innocent’ because she wasn’t struggling with substance addiction. However, Dr. Elliot says addiction is handled the same whether it’s social media or something severe like drug use and gambling. She also notes until more research is done, therapists have to continue to rely on coping mechanisms and techniques they’ve used for adults who’ve struggled with addiction for many years. However, she says that it is scary because she doesn’t want to see adolescents fall into deeper temptation in the future.

“My concern is, if children are creating this addictive response, which we know happens, what kind of addictions does this lead into later?” Dr. Elliott asked. “So I'm concerned about the potential risk they might have for other addictions down the road.”

Cheryl and her husband also struggled with the guilt of putting their daughter in therapy because they didn’t want to take a seat of a child who might’ve needed the resources more.

“She isn’t suicidal and she isn’t depressed,” Cheryl said. “But I had to remind myself that we are putting her into counseling so she can learn skills and those skills can be applied to other areas of her life as well.”

Golden agrees with that sentiment and says in situations like this, she also gives guidance to families/parents.

“Set boundaries around cell phone usage and be consistent with the rules,” Golden said. “Following suggestions from experts can help protect a child’s mental health.”

Dr. Elliott adds another reason boundaries are important is that peer pressure and the need to fit in as at an all-time high. The Child Mind Institute reports 81% of teens say social media makes them feel more connected to their friends.

Cheryl agrees her daughter fits into that category.

“When we ask her why she wants it so bad or feels the need to sneak around to get what she wants, she tells us all of her friends in class are on YouTube all the time on their devices,” she said.

Dr. Elliott urges all parents to keep a very close eye on children’s social media and device use. She says not only can addiction to devices impact schoolwork, it can affect social relationships with others. When a child’s brain is still developing, she says children need healthy and appropriate social interactions to learn empathy, how to relate and communicate, as opposed to learning unhealthy social skills through a device/gaming system.

Cheryl understands the importance of limited screen time and says adolescents don’t fully understand phone etiquette, and how to properly interact with their peers and it is important to set an example and put boundaries into place at an early age.

As Chery’s daughter continues to see Golden, and the family works through this issue, Golden says it’s important to “face the issue with compassion, understanding and firm kindness.” She goes on to add “We don’t always like to have rules, but it’s often healthy and good for us when we follow them.”

Find more technology guidelines from Dr. Elliott shares with her patients from the American Association of Pediatrics below.

• Birth to Pre-School Years
  • There should be no technology from birth to 3 years.
  • Any screen time at this age impairs social communication, development, and attachment to family members.
  • This age should be devoted to social development, sensory-motor skills, and reading skills.
  • Limited exposure may be introduced at 4 years with only high-quality programming.
  • American Academy of Pediatrics (AAP) cautions that all technology programs should be watched with their children.
  • Parents have to lead by example: Do not check messages at the dinner table, do not become absorbed by devices, look at people when they are talking – children notice and mimic everything!
  • Never undervalue unstructured “free play.”
  • Parents should not give their children a tech device as a reward for good behavior. Children must learn to self-soothe.
  • Appropriate activities for 4 year olds
    • Periodically use eReader for storytime.
    • Allow limited access to electronic toys that educate and teach numbers, letters, and vowel sounds.
    • Utilize mobile apps/tech devices for sorting shapes and finding objects.
  • It is critical children engage in physical play, have social engagements and read books!

• Grade School Age Years
  • Create a balance between technology, along with social and physical play.
  • AAP recommends no more than two hours of screen time per day with close parental supervision! And that should be less during the younger grade school ages.
  • It is critical to watch alongside your kids to point out messages that are not congruent to your values.
  • Parents need to designate media-free spaces, including bedrooms, meal times, and playtimes.
  • Screen time should be quality; age-appropriate, share your values, and engage your child’s imagination.
  • Never make screens a reward or consequence.
  • Encourage other activities such as free play outside, playing sports, creating hobbies, arts and crafts, and social activities.
  • Appropriate activities for grade school
    • The goal is to teach responsible use.
    • Use internet under supervision only.
    • Create tech-free talk each day.
    • Institute strict time limit restrictions and rules for use.
    • Monitor computer homework; eliminate all technology when screen time rules are broken.
    • Children need to stay involved with school activities and friends.
    • Model appropriate technology behavior

• Preteen and Teen Years
  • It is critical parents model appropriate technology behavior – they have to practice what they preach.
  • Parents need to establish the rule that their children will agree to “friending” them on social media platforms.
  • Parents should have access to passwords.
  • Maintain open dialogue about what is and is not appropriate sharing on social media platforms.
  • Parents and their tween/teens should develop a social media contract that includes expectations, violations as well as discipline for violations. Try out this great free tool from @AmerAcadPeds: http://www.healthychildren.org/MediaUsePlan
  • Bedrooms should be tech-free, all devices should be removed from bedrooms at night.
  • Snapchat is the most difficult platform to monitor – may be wise not to allow this platform.
  • It is imperative to teach your children about the potential consequences of their postings on social media platforms.

Tracy Jensen often thinks about her son, Ethan. He was someone with an amazing aptitude for learning. “He was a boy who had eyes to notice others who, like him, were in pain and suffered silently, Tracy said. “He was a boy who had the heart to care.”

Ethan never stopped caring about life. It was just the pain became too frequent and too painful for him. Ethan suffered from muscle pain in his back and right leg. At 5 months old he had a fatty tumor removed from his spine. His spinal cord was unable to be untethered and the scar tissue that remained was also troublesome.

Tracy and her husband, Eric, wonder when their son’s suffering began. Was it before his birth? Was it at 5 months old when he had the surgery? Was it later as scar tissue tangled the cord?

As they became aware of their son’s pain, they tried to help but they weren’t sure how, other than with over-the-counter medications, massage therapies and hugs.

Ethan didn’t really know how to help his pain and neither did most adults in his life. When he asked for medication or begged to lie down or go home, his requests were typically met with scoldings for him at school. Most didn’t understand how such a usually active child could truly be suffering.

Over time, Ethan learned to mask his pain.

“A child in chronic pain who is continually misunderstood is going to have emotional struggles such as depression,” Tracy said. “It is not reasonable to expect a child to know how to understand these issues, and my son was no exception. He struggled to process the facts of his life and this caused him to be more and more frustrated.”

Before he entered middle school, Tracy found a book on healing a child’s chronic pain. She continued to research and found that Cook Children’s offered a pain management program. It was there that the family met Artee Gandhi, M.D., medical director of pain management.

“Dr. Gandhi and company were incredibly responsive and devoted to Ethan's needs,” Eric said. “He was enamored with her in particular because she took his interests seriously and treated him as a young man rather than a child. However, Ethan was not always honest with her about the severity of pain he was experiencing. He sometimes believed that the doctors would not believe him or that they would think he was exaggerating his pain level to get medications.”

All through high school and beyond, Ethan studied science online. He taught himself subjects such as organic chemistry, DNA and gene therapy, and pharmacology. He learned how drugs, and different doses, acted and interacted in the body. He thought he understood enough to be safe with whatever he used for pain. He thought he was in control of his pain as he learned to manage it himself. He bought over-the-counter meds and used them off-label. He found ways to obtain prescription pain medication without a prescription.

The pain management team knew Ethan's level of self- education made him a challenge. Dr. Gandhi warned him about self-medicating and the dangers. Unfortunately, like many in their late teens, Ethan believed he was indestructible.

Ethan never stopped coming to clinic, but as time progressed he began to cancel and reschedule appointments more frequently. His parents believe that by mid-2015, Ethan thought surgery was his only chance for relief. The surgeons were able to straighten a significant portion of his lower spine regarding the pain, and as he was tapered off of his pain medication he began to once again self-medicate.

Eventually, drugs, especially opioids, were the only things that made him feel better. It was only slightly better, but that was OK for him, at least for a while. After the realization that his surgery failed to entirely alleviate his pain, Ethan became increasingly afraid of how his pain would continue to impact his life. He was afraid of what others would say, or what they thought of him. He believed no one would understand. He ultimately decided that he would have to treat his pain himself.

According to the Medical Examiner, Ethan died of mixed drug toxicity.

“We are only now looking back and asking ourselves if we could've done much better,” Eric said. “That day, my son was freed from his pain, but our pain would just be beginning.”

About the source

Artee Gandhi, M.D., is a pediatric pain management specialist and anesthesiologist. She has trained across the country including residency at the University of Missouri and fellowship at Stanford Univeristy. Cook Children's Pain Management program cares for infants, children and adolescents with chronic and acute pain. C​ook Children's is one of a few children's hospitals in the U.S. providing a comprehensive pediatric pain management program.

About Pain Management

The Cook Children's Pain Management program uses a team approach in caring for infants, children and adolescents with chronic and acute pain. Cook Children's is one of a few children's hospitals in the United States providing a pediatric pain management program. 

Our team includes a board certified anesthesiologist trained in pain management, a licensed clinical social worker specializing in psychophysiology, a dedicated physical therapist and pain management nurse coordinator.

Because of our team approach, patients will see their physician, physical therapist and psychophysiologist in one visit. 

Patients can make an appointment and physicians may refer a patient by calling our offices at: 682-885-PAIN (7246). New patients, for your convenience, please have your insurance information ready when you call.

But it’s the age when children began to look at pornography that may shock and concern you. Years ago, the accessibility to pornography was only on the home desktop computer that was monitored, but now, everyone in the house has a laptop, iPad and a smart phone. With children getting phones at a young age, they have access, away from the watchful eyes of their parents. So the temptation is now accessible.

Ernie Allen, former president and CEO of the International Center for Missing & Exploited Children, says the average age of U.S. children exposed to pornography is 12 years old and that one in three 10 year olds view porn.

Allen joined other health experts to speak in front of congressional staff members recently in Washington, D.C. to discuss children and Internet pornography, calling this issue a “public health crisis.”

Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, agrees with this assessment.

Elliott and her colleagues see children 10, and even younger struggle, with porn addiction. She says porn is so accessible with the Internet that it’s easy for children to view it with little preventing them from seeing it. She says some studies claim that pornography releases the same chemicals in the brain as cocaine addiction, making it one of the hardest to overcome.

“Kids can’t handle what they are seeing,” Elliott said. “It sends such a horrible message about the value of people and what a loving relationship truly is. Their frontal lobe has not developed enough to comprehend what they are viewing and it sends confusing messages on intimacy and what love truly is. Kids then have a hard time distinguishing what is healthy vs. what is not.”

Things have come a long way since the days of a son hiding his dad’s discarded Playboy under the bed or watching a teen flick on one of the movie channels. The Internet allows for quick and easy access to a whole new world of porn, including violent and dangerous acts that can do harm to a person.

“Kids are going to be curious,” Elliott said. “It’s important for parents to talk to their children about what’s healthy and developmentally appropriate for kids their age. It’s uncomfortable for some, but it’s a good idea to sit down with your children and talk to them about sex and healthy relationships. Parents should watch for the signs of what crosses boundaries and educate their kids too on what is out there and how harmful it can be. With my own children, I keep that dialogue going at all times and I’m not afraid to ask them very direct questions.”

So what are the symptoms of a child addicted to porn? Elliott said parents should watch for:

1. Children may isolate themselves from their parents and spend a lot of time in their bedroom or bathroom.
2. Evidence of pornography on their hard drive or web browser.
3. Clearing their history on their phone, tablet or computer.
4. Appears tearful, sullen.
5. Sleep disturbance with either falling asleep, staying asleep or exhaustion.

Elliott says the combination of children becoming desensitized to porn and the accessibility of social media can make for a scary combination, leading to a lack of inhibition and self-control. Elliott said the casual attitude about porn can lead some children to lack the ability to recognize long-term consequences with texting and sexting, Snap Chat, Vine, Facebook, Kik and ChatRoulette.

“Porn exposure can lead to desensitization just like exposure to violence has,” Elliott said. “When our children are exposed to these negative elements they begin to see that behavior is acceptable and normal. Frequent exposure to viewing violence has been shown to normalize that for kids as well as increasing trends in bullying and behaving violently as a way to solve problems. The concern is that children will grow up believing that pornography is normal, routine and that way relationships are, not to mention teaching them to exploit others.”

In a presentation she gives to parents, Elliott gives these numbers:

• Up to 39 percent of teens admit to sexting.
• Fifty-one percent of teen girls feel pressure to take and send explicit photos.
• Twenty-two percent of teen girls and 20 percent of teen boys send nude or semi-nude photos of themselves.

Resources for you:

• How pornography harms children
• Pornography's Progressive Pattern of Addiction
• The impact of pornography on children & youth
• So your kid is looking at porn. Now what?