In today’s society, social media is a major part of life for all age groups. While some use the platforms to keep up with family and friends, others use the sites for networking and job hunting. For those 18 and younger, social media has changed the way young people communicate with each other, often leading to inappropriate use, and bullying among other things.

As part of Cook Children’s Joy Campaign, which aims to reduce the number of children and teens attempting suicide, we’re looking at the role social media plays in the mental well-being of young people.

Kristen Pyrc, M.D., medical director of Psychiatry Outpatient Services and the Partial Hospitalization Program at Cook Children’s, says the number of her patients dealing with anxiety and depression has significantly increased over the past year. She’s concerned that social media is playing a role, especially during the pandemic when young people are online more than ever.

“I have seen an increase in depression symptoms in teenagers who had not had them before,” Dr.Pyrc said. “So maybe I regularly see them for something like ADHD, and now they are showing symptoms of depression on top of that.”

Dr. Pyrc said she often hears complaints from parents that their children are ‘tied’ to their phones. She believes a major problem with that is a lack of exposure to seeing friends in person, and the opportunity for kids to feel left out when they see peers online having fun without them.

“I think online culture can worsen students’ feelings of loneliness and rejection because they see their friends doing things together without them in real time,” she explained. “Also we tend to post things that highlight what’s going well in our lives, but may not tell the full story of the times that we feel sad or inadequate. When teens are feeling down, seeing everyone else having fun without them can make them feel worse.”

Katie Greer, an internet safety expert, has spent the past 15+ years educating students, parents, law enforcement, and large companies across the country about the importance of online safety.

“I have seen social media used to bring out the best in humanity, but I have also seen it rip families apart in a matter of minutes,” she said.

Greer, who began her work as the director of Internet Safety with the Massachusetts Attorney General’s Office, believes social media has evolved in ways no one was ready for. Not so long ago, bullying was something that happened mostly at school. Now, young people are bullied online, in front of countless people. Even worse, a bully’s comments can be liked and shared by others.

“Kids were already spending a lot of time on their phones and online, then came a global pandemic. Now, they’re attending school online and relying on things like gaming online and social media platforms to connect,” Greer said. “There’s a lot more opportunity for cyberbullying and while it can start with one person, it can be a matter of seconds for others to jump in with a like or a comment and gang up on the victim.”

Situations like this increase a child’s chances of dealing with anxiety, depression, and self-harm.

“We know that developmentally, children’s brains aren’t fully formed,” she said. “When we put something in front of them as complex as social media, it’s almost as if we are asking for trouble.”

Greer also warns parents about the newfound TikTok culture.

“TikTok is a platform that has created unrealistic expectations about everyday life,” she explained.

She said children and teens see their peers or influencers having “perfect” lives and begin to feel as if they’re inadequate, or aren’t enough or worth it.

“Children have a desire to fit in and they want to have as much or more than their friends,” Greer said. “When children see their friends flaunt material things, or lavish experiences, that can make them spiral.”

Another issue putting kids’ mental health in danger is ‘sexting’ or the exchange of nude photos and videos, which has become quite prevalent.

“I recently was made aware of an incident where a girl sent a guy nude photos and he leaked them. Once they were leaked, so many people saw them, the young girl was humiliated,” Greer recalled. “The family reported that this led to the young girl untimely killing herself out of embarrassment and humiliation that her photos were leaked.”

Greer said, in cases like these, it is vital to remember that not only does suicide hurt a family, it also tears apart the people who loved and supported the victim.

Cook Children’s launched the Joy Campaign, which this story is a part of, to bring awareness to the increase in suicides and suicide attempts being seen at the medical center. In 2020, seven Cook Children’s patients died of suicide, making suicide the leading cause of traumatic death for the first time ever. The hospital has also seen record numbers of patients being admitted for suicide attempts month after month, most recently in March when 43 children and teens were treated for injuries. While the increase in suicide attempts cannot directly be tied to the pandemic, Dr. Pyrc said children need certain things to properly function in day-to-day life.

“Kids need in-person interactions. They need sunshine and exercise and all things encompassing,” Dr. Pyrc said. “Whenever your world is mostly virtual, it can hurt both your physical health and mental health.”

What does Greer suggest parents do? Stay alert and ask questions.

“A simple, “How was your day?” or “How are your friends doing?” can go a long way in opening the lines of communication,” she said.

She emphasizes knowing what your child is looking at online and know who they are talking to. If you are concerned about your child’s safety, there are measures you can take.

“While I am typically against this and wouldn’t always recommend it, there are ways parents can use apps that will mirror their children’s phone,” Greer said. “I do believe this could hurt the trust between a parent and a child, and isn’t the best way to go about typical monitoring, and I only recommend phone mirroring for dire situations.”

Before leaving any session, Greer reminds everyone she speaks with about the importance of a trusted adult.

“I tell parents and all adults it is important that children have a trusted adult they know they can come to at all times. Parents have to be okay with the fact that the adult may be someone other than them, it is all about a child feeling safe and opening up,” she said. “I also remind every child that I come in contact with that having an adult you trust is one of the most important things you can do to protect yourself and even help a friend.”

Both Greer and Dr. Pyrc see the issue and know there is a lot of work to be done to ensure we are helping our children with their new reality. Both professionals share their tips to help parents and families better support their children.

1. Take your child’s phone before they go to sleep at night. Disrupted sleep has a negative impact on adolescents.
2. Have an open dialogue with your child without judgment and give them the ability to freely express themselves to you. Given the amount of time kids are online, these conversations should happen every day.
3. Ask about their social media. Talk to your child about what they’re seeing, how it impacts them/makes them feel, and know who they’re communicating with.
4. Ensure your child can identify a trusted adult and make sure they understand that an adult can be their go-to person at all times.
5. Talk to your child about good social media etiquette. Remind them if they see something, say something and describe how that can help save someone’s life.
6. If you believe your child is in danger, there are apps available that can monitor their phone so you can see everything they see and get them the help they need immediately.
7. Reach out for help. Do not wait until your child is in a dire situation to reach out for help and get them the resources that could save their life.

Monitor your child’s social media, and make sure you have their usernames/passwords in case of an emergency situation.

Important to note:

Instagram has an anonymous reporting tool that allows users to report when they believe something could be wrong with a friend. The site sends the person resources depending on what was reported on their behalf. These resources could be vital in saving someone’s life by simply reporting.

“Just because it says crash tested doesn’t mean it’s been reviewed or approved by any regulatory agency,” said Sharon Evans, RN, trauma injury prevention coordinator at Cook Children’s.

Previously, non-regulated car seats were seen most in areas like California and New York. But according to Evans, these products are now showing up in North Texas.

Here’s what you need to know:

• To be approved by the National Highway Traffic Safety Administration (NHTSA), car seats must meet all the criteria to be able to state they meet or exceed FMVSS 213.
• Unregulated products may be found at well-known stores and online, so it is important for parents to check if the product is approved by the car seat manufacturer to be used with your specific car seat.

“The problem occurs when a parent buys a car seat that meets FMVSS 213, but adds accessories, which are not regulated. These products can alter the way the car seat works in a crash, or the accessory can become a flying missile, like a snap-on mirror,” explains Sharon Evans, trauma injury prevention coordinator at Cook Children’s. “I think parents feel that if it’s being sold by a big name retailer, it has to be safe, but often it isn’t.”

Evans big concern is that many car seat accessories claim to be “crash tested,” even though they are not regulated and do not meet the criteria by NHTSA.

The car seat manufacturers realize this is a problem and many now make non-regulated products such as seat protectors, water-resistant pads or covers for their specific car seats. If parents are going to add something to the car seat, it is important to verify the car seat manufacturer states the accessory is safe to use with the specific brand and model of the car seat.

“Accessories and non-regulated products are designed, made and sold by car seat manufacturers and anyone else who wants to,” Evans explained. “Even though the product may say ‘crash tested’ or meets NHTSA standards or FMVSS 213, however, there are no standards for these products. The product may be crash tested but we don’t know how and we don’t know if the product was tested in specific car seats and/or what car seats.”

What to look for:

• Make sure car seats are labeled with FMVSS 213. This means the product is approved by the NHTSA.
• Non-regulated products often have a similar label of FMVSV 213. These products are not federally registered, and cannot claim to effectively restrain the child or claim to prevent injury.
• Regulated products and accessories will state: Meets or exceeds all federal standards for car seat safety (FMVSS 213 Federal Motor Safety Standard for USA).

“Parents need to be really careful with car seat accessories, because you run the risk of your child being injured due to something like a footrest or head strap,” Evans said. “Unfortunately, some companies are intentionally using confusing labels to sell their products, so it’s really important that parents know what to look out for.”

The National Highway Traffic Safety Administration provides child passenger safety that can be found here. 

The safety experts at Cook Children’s say kids can’t afford anything less than 100 percent adult supervision at the pool at all times. That means not taking your eyes off of a child while he or she is in the water.

Forgive the safety experts at Cook Children’s if they are coming across as bossy or even condemning, but they are at their wits’ end trying to find a message that will stop the tragic amounts of drownings over the past few summers. 

But they have come with a response: Lifeguard Your Child. And that starts with putting away perhaps the greatest competion for a grownup's attention - their smartphone.

“We understand the need for a phone at the pool, in case of emergencies, but those phones need to be put away until you leave the swimming area,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. “Parents should only be spending time watching their kids and not on the phone.”

Smartphones have changed the way we look at the world, but it’s also made it much easier to be distracted and not pay attention to what is happening right in front of us.

Nonfatal injuries to children under age 5 rose 12 percent between 2007 and 2010, after injury rates were steadily falling the previous decade. During that same time period, smartphone users increased from 9 million in mid-2007 to 63 million at the end of 2010.

The Centers for Disease Control and Prevention estimates more than 1,100 people a day are injured in car crashes that involved a distracted driver.

Sharon Evans, Trauma Injury Prevention/Outreach coordinator for Cook Children’s Medical Center says she would like to see similar research into distracted adults and drownings.

But she doesn’t need stats to know that it’s the adult’s responsibility to stay focused on the children, and nothing else, while they are swimming.

“Parents are distracted enough with people around them talking, eating and everything going on in their lives. After a hard day they may even zone out for a little while. But parents can’t afford to be distracted and that includes using their smart phones while their child is in the water,” Evans said. “I don’t think parents understand how quickly and quietly drowning occurs. There is no thrashing, no yelling for help. The drowning child is just trying to push down on the water to get their head above the surface to gasp a breath of air.”

Walraven reminds parents it takes only two seconds for a drowning to occur.

She encourages any adult watching children at the pool, including parents grandparents, family friends or babysitters, to use Water Watcher system if possible where the grownups at the pool take shifts with the sole responsibility of keeping an eye on the children swimming at all times.

They are expected to stay sober and focused during their 15 minute shift or if they are the only one out there, to stay alert the whole time. This isn't a job for kids, even older children. Walraven said this is a job solely for the adults. It shouldn’t be the responsibility of a teen. The younger person may be easily distracted, have trouble pulling the child out of the water and in case of a fatal drowning, the child could be scarred for life.

“This is definitely a job for a grownup, but that means acting like an adult,” Walraven said. “Many drownings occur when a caregiver is present. But being ‘present’ or being ‘there’ is not enough, you have to watch and be involved. Drowning is silent so keep your eyes on the water, not the phone. A text is not worth the risk and it’s certainly not worth your child losing his or her life.”

Other resources:

• Drowning prevention page at Cook Children's
• 9 ways to protect your child from drowning
• Is your baby ready for swim lessons?
• This life-saving tip could prevent your child from drowning
• Life after drowning
• Be a water watcher. Adult supervisions saves lives.
• Drowning tragedy - 'I can't believe this happened to me.'
• The life-saving reason for Water Watchers

Over the past several years, I have been actively speaking to parents, children, tweens, teens, and young adults regarding the dangers of the Internet and social media. I discovered rather quickly that I could not prepare a single set of presentations to use over and over again. Rather, I need to conduct new and fresh research for every single presentation I do, regardless of how much time has passed from one to the next.

Why? Because that is how fast things change in the world of technology and online interactions.

I am not going to go on a long rant about immorality or express my true feelings about the class of a person it takes to create certain apps for monetary gain, all the while knowing full well that children can and will fall victim while using those apps; instead, I am going to stick with the matter at hand.

Parents, you need to be aware that truly dangerous apps exist and are readily available to your children. And, if you are reading this as a young person or young adult who thinks I am being condescending, tough. In order to write an article such as this that is intended to reach the parents of potential victims, I have to be general in my assumptions and sweeping in my aim. I would rather offend you than not get the message out to someone that could prevent a devastating, life altering event for a child.

In my presentations to parents, I list a handful of apps; however, you have to understand that there are literally millions of apps available and, even those apps where the intended purpose by the app’s creator may be innocent, can be used dangerously. The reverse is also applicable; however, with the apps I am about to showcase, it is unlikely that they would be used in a benign way. With that, let’s talk about them:

1. SeekingArrangement.com - Brandon Wade is the founder of this site and supporting apps are available on GooglePlay for Android devices as well as iTunes for all iOS devices. SeekingArrangement identifies itself as a “sugar daddy dating app”. While discussing SeekingArrangement, it is also important to note that Brandon Wade also created an app called CarrotDating. CarrotDating (no longer available at the time this article was written) was an app that was borderline prostitution in the same way backpage.com ads are also “borderline” prostitution. The “borderline” is fairly evident. Although CarrotDating has been nixed, the philosophy behind the trend is still evident… bribes for dates. Of course, “dates” can be defined in ways other than going out to dinner and a movie.

2. Yik Yak – This App is one of the most dangerous. It allows users to post text-only “Yaks,” or messages, of up to 200 characters. The messages have no filter and can be viewed by the 500 Yakkers who are closest to the person who wrote the Yak, as determined by GPS tracking. Users are exposed to – and contributing to – sexually explicit content, abusive language, and personal attacks so severe that schools are starting to block the App on their Wi-Fi. Although the posts are anonymous, kids start revealing personal information as they get more comfortable with other users. This app is a rumor machine and a perfect channel for the kinds of bullies who hide behind a screen, hurting other people behind a shield of anonymity.

3. Ask.fm – This app allows users to ask a specific person anonymous questions. Users can answer these questions and posts them to their personal page, truly leaving nothing to the imagination. This is especially dangerous because it allows any user to target a specific person anonymously. Bullies, predators, and more can send anonymous messages to a specific person, asking them inappropriate things or even simply making hurtful statements.

4. Kik Messenger – This is a private messenger app and is coveted by those under 18 for a number of reasons. The App allows kids to send private messages that their parents can’t see. This app also allows users to identify themselves by a made up username, posing the dangers of anonymity. To make matters even scarier, third party websites allow users to search for people based on things like age and gender. There is very little you can do to verify the identity of someone on Kik, which obviously poses the risk of sexual predators chatting with your child. And again, this is an easy tool for sexting. Just last month, a 13 year old girl was murdered by a man she presumably met on Kik Messenger. 

5. Omegle – This App has been around since 2008, with video chat added in 2009. When you use Omegle you do not identify yourself through the service – chat participants are only identified as “You” and “Stranger;” the app’s slogan is “Talk to Strangers!” You don't have to register for the App. However, you can connect Omegle to your Facebook account to find chat partners with similar interests. When choosing this feature, an Omegle Facebook App will receive your Facebook “likes” and try to match you with a stranger with similar likes. This is not okay for children. This app is the perfect channel for sexual predators. Experts say these predators blackmail young children, by starting inappropriate conversations with them, then threatening to send the messages, photos, or videos to their parents if they tell anybody, therefore trapping the child in a disgusting, dangerous situation. 

6. Whisper – This is a meeting App that encourages users to post secrets. You post anonymously, but it displays the area you are posting from. You can search for users posting within a mile from you. You are also able to communicate with users who post secrets. A quick look at the App and you can see that online relationships are forming constantly on this App, but you never know the person behind the computer or phone. One man in Washington was convicted of raping a 12-year-old girl he met on this App just last year. 

7. After School – This app is a message board that students can join by scanning their school I.D. or Facebook profile. While the scanning feature provides some security from outside users, once in the app, the user is anonymous. However, this app effortlessly creates drama and conflict among users because they all attend the same school. Students are able to freely post about anything. This year, a single school had problems with posts that included topless photos, alarmingly vulgar posts from males talking about fellow female students, and more. There is even a section where students can scan their driver’s license and enter a discussion only for students ages 17 and up, openly creating an environment for the discussion of more explicit material.

As with my presentations, articles such as this are a moving target as things get more troublesome by the minute. The biggest problem is that these apps make money. Because of this, more apps get developed that push the envelope of morality and safety. Look, if the developers could ensure the apps would only be used between consenting adults, I wouldn’t have a problem with all of this; however, the only way to ensure that to any reasonable level is to pretty much kill the app’s revenue streams. Because of this, we must remain diligent and be ever on the lookout for the next worst thing that could fall into the hands of our children. These apps make criminals out of cowards.

Please note: You can turn location services, or GPS, off on cell phones by going in to the device settings. This will keep the Apps and photos from posting the exact location or whereabouts of the phone user.

About the author

Jody S. Hawkins, Information Systems Security Officer, has been in technology for medical facilities since early 2000 and has been practicing for more than 20 years with his start in the United States Air Force. He is a part of Cook Children's Experts on Call Speakers Bureau. Hawkins specializes in privacy and technology safety and is a regular speaker at the National HIT/HIPAA Conference. He has been quoted and published in several national publications, including Health Information Management Magazine.

Hawkins' can speak on a variety of security topics facing our children & parents today, including:

• Social media
• Cyber bullying
• Sexting
• Safety online (Parents & Child)
• General home networking security
• Virtual Child (Parents)
• Internet Safety (Parents & Child)

"If it can accelerate your body, it can injure you," said Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children's. "Vehicular accidents, including boats, ATVs, cars, scooters and bikes are all too common on holiday weekends during the summer."

Another danger Dr. Warmink is concerned about this weekend: broken bones. No one wants to spend Labor Day weekend in the hospital. But Dr. Warmink says many families do, thanks to trampolines and monkey bars.

One of the scariest threats we see all too often is drowning. And yes, it can happen to you. In August alone, 14 children were admitted to Cook Children's Medical Center for drowning-related injuries. Two of those children died.

"We've seen many cases where children took their life preservers off and jumped back into the water," said Magdalena Santillan, Trauma Injury Prevention specialist at Cook Children’s. "Often, parents are getting ready to leave the pool and don't realize their kids have jumped back in."

One of the best ways to protect your child around the pool or lake is to become a Water Watcher. This means adults take turns supervising the water with undistracted attention. You can find more information about the program here, including 5 seldom used tips that could save a child's life.

And Labor Day may mark the unofficial end of summer, but that does not mean an end to the heat. According to Dr. Warmink, heat-related illness also tops the list of Labor Day dangers. "Heat exhaustion, heat stroke, hot cars and sunburns are among the common injuries we see over the Labor Day weekend," said Dr. Warmink. "Parents should make sure their kids drink plenty of water and wear sunscreen, and of course, never leave a child alone in a car."

With your help, we can cut the number of Emergency Department admissions this holiday weekend and ensure a safe celebration for everyone.