Impact of Social Media on Children’s Emotional Well-Being – PediaCast CME 104
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Show Notes
Description
- Drs Megan Schaefer, Anne Dawson, and Jennie David visit the studio as we consider the impact of social media on children’s emotional well-being. We explore risks and benefits, offer recommendations for families, schools, and communities… and dig into the research that supports our discussion. We hope you can join us!
Instructions to obtain CME/CE Credit
- Read this information page.
- Listen to the podcast.
- Complete the post-test at Nationwide Children’s CloudCME.
- Please Note: CME credit expires 3 years from this episode’s release date
- You can view your transcript and print a certificate of completion at Cloud CME.
- Need help creating a Cloud CME account? Click Here.
- Still have questions? Contact CMEOffice@nationwidechildrens.org
Topic
- Impact of Social Media on Children’s Emotional Well-Being
Presenters
Learning Objectives
At the end of this activity, participants should be able to:
- Describe the psychological impact of social media use on teenagers, including its influence on self-esteem, self-worth, and overall emotional well-being.
- Analyze how social media use affects teenagers’ relationships, communication skills, attention span, and cognitive development.
- Identify positive and negative impact of social media use on teenagers with chronic conditions.
- Evaluate the influence of family dynamics, parenting styles, and school in shaping teenagers’ social media behaviors.
- Outline practical recommendations for parents, healthcare providers, and schools in assessing and supporting healthy social media use.
Links
Warnings/Recommendations/Policy
- Surgeon General: Why I’m Calling for a Warning Label on Social Media Platforms
- Social Media and Youth Mental Health
- Health Advisory on Social Media Use in Adolescence
- Biden-Harris Administration
- Media and Young Minds
- Media Use in School-Aged Children and Adolescents
- Driven into Darkness
- Healthy Digital Boundaries for Kids
General Educational Resources
- The Kids Mental Health Foundation: Resources for Technology and Social Media
- The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness
- After Babel
Resources for Parents
- Wait Until 8thFamily’s Phone Plan
- Family Social Media Plan
- Screen Time Action NetworkSTAN Resource Library
- Smartphone Alternatives
- Mattell & Nokia- Barbie Phone
- Bark
- Tech Parenting 101
Research Related to Social Media and Children with Health Concerns
- Clinical and ethical considerations of maladaptive social media use in pediatric patients with disorders of gut-brain interaction
- Tics and TikTok: Functional tics spread through social media
- Social media use among parents of food allergic children
- Social media to promote treatment adherence among adolescents and young adults with chronic health conditions: A topical review and TikTok application
Disclosure Statement
- No one in a position to control content has any relationships with commercial interests.
Commercial Support
- Nationwide Children’s has not received any commercial support for this activity.
CME/CE Information
- In support of improving patient care, Nationwide Children’s Hospital is jointly accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for the healthcare team. (1.0 ANCC contact hours; 1.0 ACPE hours; 1.0 CME hours)
- Nationwide Children's Hospital has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid for 2 years from the date of the activity. PAs should only claim credit commensurate with the extent of their participation.
- As a Jointly Accredited Organization, Nationwide Children's Hospital is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Nationwide Children's Hospital maintains responsibility for this course. Social workers completing this course receive 1.0 continuing education credits.
- Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs.
Contact Us
- CMEOffice@nationwidechildrens.org
Episode Transcript
[Dr Mike Patrick]
This episode of PediaCast CME is brought to you by Pediatric Psychology at Nationwide Children's Hospital.
Hello, everyone, and welcome once again to PediaCast CME. It is a continuing medical education podcast for healthcare providers.
This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is episode 104.
We're calling this one Impact of social media on Children's Emotional Wellbeing. I want to welcome all of you to the program. So, we have a topic today that will impact the vast majority of US families in 2025.
And it's a topic that pediatric providers have a terrific opportunity to shape through conversations in the exam room. It's also a complicated topic with research showing plenty of risk posed by social media exposure, and other research showing the beneficial impact that social media can have on kids and teenagers. The truth lies somewhere in the middle with both risks and benefits present together, which makes things tricky for parents as they seek best practices for social media participation by their children and teenagers.
We're going to take a deep dive today as we consider the impact of social media on children's emotional well-being, including the risks and benefits, of course, but also warnings, recommendations for families, policy ideas for schools and communities, educational resources, and a look into the research that supports all of these ideas. Of course, in our usual PediaCast fashion, we have some terrific guests joining us this week in the studio. Dr. Anne Dawson and Dr. Jennie David are both pediatric psychologists at Nationwide Children's Hospital. And we have a guest host leading the conversation this week. Dr. Megan Schaefer is back. She is also a pediatric psychologist at Nationwide Children's.
Don't forget, after listening to this episode, you can claim free Category 1 CME or CE credit. Really easy to do. Just head over to the show notes for this episode at PDACastCME.org.
Again, it's episode 104. And there you will find a link to a post-test in the show notes. Follow that link to Cloud CME, click on the materials tab, take and pass the post-test, and the Category 1 credit is yours.
And we do offer credit not only for physicians, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And since Nationwide Children's is jointly accredited by many professional organizations, it's likely we offer the exact credits you need to fulfill your state's continuing medical education requirements. Of course, you want to be sure the content of the episode matches your scope of practice.
And you know, as we think about conversations around the benefits and risks of social media, really anyone who takes care of kids and families can have that conversation with them during the course of a visit. So, this is one of those episodes that really is going to be important for just about everybody out there. Complete details on the CME credit are available over at PediaCastCME.org.
Also, I want to remind you the information presented in our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. Also, your use of this audio program is subject to the PediaCast CME Terms of Use Agreement, which you can find at PediaCastCME.org.
So, let's take a quick break. We'll get our expert panel settled into the studio. And then we will be back to talk about the impact of social media on children's emotional well-being.
It's coming up right after this. Dr. Ann Dawson and Dr. Jennie David are pediatric psychologists at Nationwide Children's Hospital and assistant professors of pediatrics at the Ohio State University College of Medicine. They both have a passion for helping children, teens, parents, and families navigate the many complexities of social media, including the impact of social media on children's emotional well-being, which happens to be our topic today.
But before we dive in, let's offer a warm PediaCast welcome to our guests, Dr. Ann Dawson and Dr. Jennie David. Thank you both for visiting us today.
[Dr Anne Dawson]
Thank you. It's great to be here.
[Dr Jennie David]
Thank you so much. Thrilled to be here.
[Dr Mike Patrick]
Yeah, we are really glad you guys are here as well. We also have a guest host leading the conversation this week, Dr. Megan Schaefer. She is a pediatric psychologist at Nationwide Children's and an assistant professor of pediatrics at Ohio State.
Great to see you again, Megan. And thanks for putting this episode together for us.
[Dr Megan Schaefer]
Absolutely. We're excited to talk about this topic together.
[Dr Mike Patrick]
Yeah, it is definitely an important one. And with that, I will hand the episode reins over to you.
[Dr Megan Schaefer]
All right. Thank you, Dr. Mike. We're going to kick off with a question to Dr. Dawson. So, to kick us off, can you tell us a little bit about how you would define social media and screen time?
[Dr Anne Dawson]
Sure, Megan. Thanks. That's a good question, because it is hard to disentangle when we're talking about risks or just behaviors that kids participate in.
We often talk about both social media and screen time. I know today we'll be focusing mostly on social media, but to define screen time, that's really just any time that kids spend in front of a screen. So, TV, computer, anything with a screen.
When we're talking specifically about social media, we're talking about really any form of electronic communication where there's an online community, you can share information and connect socially.
[Dr Megan Schaefer]
I think that'll be a helpful clarification as we as we move forward. And if you want to go next to also talk about how common social media use in teenagers is. I know a lot of us, we see teenagers all the time on their phones, but what do the statistics say about how common frequency is?
[Dr Anne Dawson]
Yeah, and that's a tough thing to pin down because social media statistics are always changing as they're evolving. There are new apps coming to the forefront all the time. In the recent 2023 CDC report about youth risk behavior survey, they found about 77% of high school students reported frequent social media use.
And we know about over 90% of kids have access to the internet. So, if over 90% of teenagers are accessing the internet, 77% of them are using the internet frequently for social media. And then when we think about how common it is, we're also thinking about those apps.
So, the Pew Research Center found YouTube is the most common social media app, not always thought of social media, but with the ad of YouTube shorts, it is with 93% of kids using that almost constantly. So that's daily, almost constant use, followed by TikTok, Snapchat, and Instagram. Many of us think of kind of the original social media that hit the scene of Facebook.
And that's largely dwindled in use for teens with probably less than 20% using Facebook now. It's probably interesting to note the most common social media use by teens is those with infinite video scroll, which I think is something we are concerned about. And so, what that means is something like YouTube shorts or TikTok's For You page or Instagram's Reels, is that once you start watching one video, it goes to the next and goes to the next with really little interaction from the user.
[Dr Megan Schaefer]
Thank you. That is very helpful facts to start our discussion. So, I know a lot of the conversations that people are talking about is what are the broad concerns that teens are facing when they're using social media?
So, could you speak to what those conversations are looking like now?
[Dr Anne Dawson]
Sure. And I think it's important to say the broad concerns because I think we'll keep talking about the more specific ones as we go. But I think more recently, it's really been acknowledged as a concern.
And we see that from a number of institutions putting out, whether it's policy briefs or recommendations. And so maybe we'll kind of think the fact that the American Psychological Association, so our home, as well as the American Academy of Pediatrics, the Surgeon General, Amnesty International, at this point have all put out recommendations or warnings. And so, I think that alone is telling us that there's some broad risks associated with social media.
When we're thinking about kind of what those are, broadly, social landscape has changed. So, I think a lot of times for us as providers, or for us as parents, the landscape that our kids are growing up in is different now that there's social media. So, when we're thinking about the broad risks, we're thinking about kind of a complete change in what social development looks like now in the digital age, and how that's impacting kids growing up, to the point where now we're putting maybe pumping the brakes with countries like Australia saying, social media is illegal for kids under 16.
So, when we're thinking about the big risks for kids with social media, we're thinking about the internet is permanent. So, whatever you put when, while your brain is developing, is there forever. So, privacy is also a concern.
So, what kid information they're giving out, there's research that shows all of us adults and kids are more likely to give out private information on the internet than in face-to-face conversations or on the phone. So that's pretty scary given the permanency of the internet. How we also respond to boredom, I think, has changed.
There's interesting research about the potential benefits of being able to manage boredom, but children now struggle. We're seeing increased struggle with managing boredom due to the almost constant use of applications like YouTube or TikTok. So, when we're thinking about broad risks, really just thinking about how it's affecting social development for kids.
[Dr Megan Schaefer]
Thank you. I think that'll be very helpful, as you said, giving us a good idea of the broad concerns. And then we're going to get more specific as the podcast goes today.
So now I'm going to send it over to Dr. David. And can you talk a little bit more about how social media use is specifically affecting self-esteem and self-worth in teenagers today?
[Dr Jennie David]
Absolutely. This is a big topic, and I think one that many, many of us see clinically and in our own personal lives. In many ways, it depends on what someone is using, why someone is using it, how often.
And really going back to everything Dr. Dawson was talking about, there's just so many complexities and nuances with social media. And depending on what rules or not rules exist within a young person's home, that might really depend, or impact rather, their self-worth, especially with things like likes and followers and comments. There's just so much content online.
I think many of us, even as adults, can think about a time we posted a photo, and it just feels good to get lots of people that we know and care about us giving us likes. And just as Dr. Dawson was talking about a moment ago with the developing brain, if you think about a developing brain getting all of that input, that probably feels really, really good and maybe a little bit harder with that emerging executive functioning to then think about, gosh, maybe I shouldn't post today. Maybe I should take a break.
Maybe these posts don't represent a direct correlation of this many people like me versus some people don't like me. There's some concerning research that within seven minutes of using Instagram, young women have an increase in their body image dissatisfaction. That's probably for various reasons.
There's also social comparison. There's lots of content and really all of the content is curated. Even if it doesn't seem immediately curated, it might seem very real.
And yet everything that we post is very select. There might be filters or other things that are added on, especially now with generative AI. There's just so much that is happening for these young folks.
There's been some interesting research that some of the trends we've seen on social media. So, one of the trends in particular of what I eat in a day, where influencers or other people online might post like, this is everything that I eat, which totally ignores the fact that we all have different bodies and might have different needs. Some might have a severe food allergy.
Somebody might have celiac and not be able to eat gluten products. And we just might have different nutritional needs for other diverse reasons or food preferences or religious components that impact what we're able to eat. And yet when we watch this content, the research has shown that it really reiterates this dichotomy of good food and bad food, which we know is a risk from a disordered eating perspective.
And there's a subtle implication of if I eat what that person is eating, I will look like that person is looking. I will have that kind of life, which is just not exactly how that works. And just as Dr. Dawson was talking about before with the infinite scroll, the algorithm will continue to feed this information time and time again. I've noticed even in my own use, especially because of this clinical interest, sometimes I'm looking online to see on social media to see what my patients are seeing or looking at public accounts that they have talked about that may be impacting their body image concerns. But my social media algorithm doesn't know that I'm doing that from a clinical research perspective, right? So, I on my own social media will then just get a flurry of like, here are more exercise videos, here are some supplements.
And I as an adult with a developed brain can be like, oh, that's silly and kind of like put it to the side and try to get my algorithm back on track of the dog content that I really am wanting to see online. But it's so confusing, especially to a young person, again, with that developing brain and when there's no stop versus like when you Google something and you have to click to the next page, there's no natural pause. And I think many of us have had the experience of being on social media scrolling and being like, oh, let me go back up.
That was just a moment ago. And then we have to scroll really far up to get back up to whatever we were thinking about. And again, these actions of the likes, the follows, the comments can be very reinforcing and hard to differentiate what it means in the social media context versus what it means in real life.
If you notice that a friend's prom picture has got a lot more likes than yours did, that is really hard. There's been some attempts by things like Instagram to change the likes. So now instead of like a total number, it'll just tell you all of the different names.
And yet there's other ways of kind of gauging how popular a post has been.
[Dr Megan Schaefer]
Thank you, Dr. David. I really appreciate you normalizing. I know we're specifically talking about children and teenagers today, but this is something we're all vulnerable to, right, because of the way the algorithms work.
And as you said, from a social emotional development and cognitive perspective, as adults, we have developed brains, and we can help set more boundaries. But for children and teenagers, that is a lot more challenging. And then as you said, that can result in these outcomes related to self-worth and self-esteem that can really be consequential for these kids, right?
And this is why we're talking about this, because it's important for us to figure out the best way to support social media use in kiddos and teenagers.
[Dr Jennie David]
Absolutely, because sometimes even a very small recommendation for a kiddo presenting with some body image concerns where it's not disordered eating, they're still safe, is even we talk about, can we curate your social media feed to have more body representation? Can we mute or unfollow the accounts that are increasing negative thoughts about one's body or food, that there's simple tweaks that don't fix it all, and yet can be really impactful when there's more thoughtful curation of what someone is seeing online? Definitely.
[Dr Megan Schaefer]
As you said, it's those small tips and tricks that can really have a big outcome if we kind of know how the algorithm is working. All right. Next to Dr. Dawson. So, we're starting to talk a little bit about consequences and risk. Can you tell us a little bit more about what are these other high risks that people are talking about when we're talking about social media use in children and teenagers?
[Dr Anne Dawson]
Sure, yeah. And I want to acknowledge there's this focus on high risk, and I think that is the risk of social media. If a risk exists, we're kind of accepting that when we're allowing our kids to go on social media.
And I know, hopefully, we can talk about potentially some of the positives too, because I think there needs to be a balanced conversation when we talk about social media. But I think when we talk about the risks, I really will echo everything Dr. David said, right? I think a lot of that social comparison algorithm, the impact on how you see yourself through the lens of others and the landscape you're cultivating for yourself on social media is part of those risks as you're learning to engage in social relationships.
So, speaking to that algorithm, Amnesty International actually recently put out a report about how the algorithm, specifically on TikTok, their report was talking about, can really quickly for a young child, young teen, can provide content related to self-harm pretty quickly. And so, I think that's a big concern for us is how quickly a kid maybe who's thinking depressed thoughts can be exposed content to something more that's not healing but rather harming on social media. And we have seen, unfortunately, things like suicide challenges that result in kids going to the emergency room or unfortunately ending their life due to challenges that they followed on social media.
So, I think when we're talking about risks, the obvious one is the premature death of kids. And that's scary. But even perhaps more common are concerns like cyberbullying.
The CDC found that about one in every six kids is bullied through texts or social media sites. And that's a lot. We also have concerns about early exposure to kind of mature or pseudo-mature content.
So, there's emerging research that sexting is now becoming almost considered a normal part of sexual development in teens because it is so common in teenagers. It's still not common to the point that 100% of teenagers are engaging it, but those teenagers that are engaging in pseudo-mature behaviors, perhaps the first one that they do is sexting at a younger age. And also, there's access to pornography on social media and through social media sites and a quicker way to get there that can really change the way that kids develop sexually.
And to kind of that point, there's also a lot of concerns for unsafe romantic relationships online. There's more pressure on kids to share their password with their romantic partners so that they can be monitored. Who's direct messaging you?
Who did you post on your story? And so, it's almost constant monitoring that's really creating concerning relationships to the point where the Green Flags campaign through Nationwide has really been promoting, you know, we need to show kids what are green flags rather than red flags so that they can really pursue a safe relationship. And part of the reason those campaigns are so important is a lot of us growing up didn't have that component in our romantic relationships, so it's hard for us to advise kids about those risks.
And so, I think those are some of the highlights for the high-risk behaviors, but there's certainly a lot more, unfortunately.
[Dr Megan Schaefer]
And hearing you talk, Dr. Dawson, as you were talking about earlier in the podcast about how much our social landscape has changed, like just as you're like reflecting on thinking about my childhood and growing up through adolescence, and these were things, as you said, that they just weren't a part of our exposure, right? And so, our ability to be able to coach children and adolescents, it's more challenging given that's not what we grew up on, but figuring out to learn more about these facts that we can best support that. And then as you said, with all the social media, how quickly these things can take off, right?
And so being able to be on top of it, that some of these bigger concerns don't take off to some very serious consequences, as you just mentioned. So, the last question that we talked about was more of, you know, we're thinking about these high-risk factors, a lot of conversations that people are definitely having, but what are maybe some of the risks of social media that people are just starting to talk about? Maybe the things that haven't necessarily been the buzzwords with social media, but as we're exploring this more, we're starting to learn that there's other things we should be considering when it comes to social media use in children and adolescents.
[Dr Anne Dawson]
Yeah, that's a good question because I think, to your point, the buzzwords or the high risks are the things that are terrifying, have gotten the most kind of attention and are kind of those pop words. But when we're starting to sit back and think really how this is changing potentially or altering our kids' social development, cognitive development. So, us as psychologists, we've, you know, we're relying on decades and decades and decades of research on social development in child and teen as they develop.
And now we're putting a wrench in that system and saying, hey, social media is entering that. And so, these decades of research that we're familiar with potentially is changing. So, you know, we know that kids start and early adolescents really relying on their peers as they're engaging in social problem-solving to solve problems for their self and develop their moral reasoning and start saying, like, what's important to me?
What should I challenge? What do I believe? And we know for, you know, for decades we've known this, that it's important that kids are surrounded by their social group and that they start challenging what their parents believe and thinking about what their peers believe.
And now they're doing that online. And their peers are no longer necessarily just the kids that go to their school or the kids that are in their sports teams or the kids in their neighborhood or their cousins. Their peers are now potentially millions of people, billions of people that they can see quickly on a For You page or that they can see quickly through Instagram reels and then click on that and then go through the cyber world, kind of like Dr. David was talking about. You click on a couple of things and realize, wait, the original thing I came for is, hold on, let me scroll and find that. Wow, you've gone deep. And so, the things we're really starting to talk about is, like, has this affected our kids' attention?
Has this affected the way that they can focus? Has this affected their ability to use critical thinking skills? So, as they're starting to have their peers be a greater influence, are they able to still step back and use critical thinking skills?
Are they at greater risk of being fed misinformation or disinformation and buying it? Are they more likely to perpetuate that themselves and potentially deal with guilt or shame? And how is this really affecting their development of independence?
So, you know, kind of just driving into, like, did everything we learn, how can we adapt that and know how it's affecting kids' cognitive and social development? And to what Dr. David said, their physical development and perception of that as well.
[Dr Megan Schaefer]
Yeah, as you're highlighting, we think about, like, quality of life, all these domains of functioning, there's a lot of impact, as you said, physical functioning, emotional functioning, social functioning, school, right? It's really pervasive in that way. And so, we've talked a lot about these different risks and concerns and, you know, what people in society are talking about when we're thinking about social media use in children and adolescents.
And as psychologists, our goal is to promote the emotional well-being of children and adolescents, right? So, it's our goal to be those advocates for kids on this topic. So, Dr. Dawson, as psychologists, should we be sounding the alarm about the risk of social media on teenagers' mental health based on some of the information we've just shared?
[Dr Anne Dawson]
Yes, I think that's the easy answer. And I think we have, right? Like, so we talked about the American Psychological Association put out a policy about the concerning use of social media for teenagers.
So yes, I think we should. And I think that we need to also take a step back and make sure that we get the education about social media so that we can. Because I do think that we owe it to our patients and our research to really understand how this is affecting the kids that we see.
You know, I think it's been discussed a lot that the Surgeon General made an op-ed saying that, you know, just like at one point decades ago, the Surgeon General said that cigarettes need a warning label, that social media now needs a warning label, too. So that is the easiest way to say we need to be sounding the alarm. I think, again, like we'll talk about potentially the benefits of social media and if we should consider not throwing the baby out with the bathwater.
But when we know that there's a risk and we know that there's a fire that kids can step into and that they definitely need to have protection, I think we can't sound the alarm and say you can kind of walk into the forest alone. We believe in you. I think we have to say we have to protect you as you're walking into that forest because a fire can get you at any time.
And so, the other thing we know is like the kids at greater risk for struggling with social media are the kids that we're also worried about in real life relationships. So, there's some research that finds it's called kind of the poor get poorer hypothesis, which means the kids that are struggling offline are going to struggle even more online. And so, while they tell us, you know, all my friends are online, they're supportive, even if I don't have friends in real life, I have this community.
Well, we find research that shows that those relationships aren't as deep as meaning or as meaningful online. And while there might be some benefits, there's more risk. And that's as a psychologist, we're often seeing the kids who need a little bit additional support.
And those are the kids who need to really be sounding the alarm off, but it affects all of our kids.
[Dr Megan Schaefer]
Thank you. I think again, I know we're all psychologists here on this call, but it's important for us to all hear about the risk and the types of things we should be advocating for. And again, I know we're going to talk about recommendations later for parents, schools and providers.
But as Dr. Dotson was saying, it's not all bad, right? And we don't want to have people leave hearing this and thinking that social media is all bad and there's no positives to it. So, we also want to designate some space to talk about what are the positives and benefits of social media, Dr. David?
[Dr Jennie David]
Yeah, so just like you were sharing, Dr. Schaefer, there's many things to be considerate of and things that might be really positive and beneficial to social media. Based on the research at this moment, the positives and benefits are somewhat inconclusive. And so, we likely will learn more about that in the time ahead.
And yet I think many of us, if we reflect in our own lived experience or for our patients or other young people in our lives, there are probably benefits that we do see from the lived experience perspective. So, for example, as a GI psychologist that primarily sees young people that have inflammatory bowel disease, who sometimes need to undergo surgery and may need to have an ostomy as part of their surgical treatment, that is something that despite many people having and living well with ostomies, we don't see representation. There's tremendous stigma around.
That's a podcast for a different day. And so, all of that to say, though, when I'm meeting with these young people, I have a list of reputable, based on my own clinical judgment, different types of accounts that have different types of ostomies. So that might be an ostomy for someone who has inflammatory bowel disease, an ostomy because of someone who had a traumatic injury, and trying to have as much representation as possible across gender, across racial and ethnic identities.
And in that way, it can be a way that we have representation so that young people considering ostomy surgery may see, hey, there's other people who are living typical lives, who are fashion models, who are parents, who are business people, who are athletes, who are just doing their own thing, and they're okay. Maybe I'll be okay, too. So, there can certainly be positives clinically and for someone's individual life experience.
We all want to find community in person or online, and so there can be lots of benefits depending on what kind of community you are looking for, potentially, and some considerations that we'll talk about in a little bit when it comes to community finding. But related to ostomies and social media, there was a really interesting paper that came out last year that found that representation of ostomies on TikTok was found to be very positive and nonjudgmental, and that may be, again, really beneficial for young people or families looking at that content. And so, things that can be quite positive, but this, I think, as a clinical nugget, this is a great time to ask young people and their families throughout care, not just a singular time, what are the benefits for you?
What do you think is positive about your use? And perhaps in the flip, what are the drawbacks? What are the things that make you pause?
Getting an understanding of what someone finds positive may also tell us what that is filling for them. That may be that social need, information need, but these are great conversations to begin to have and continue to have throughout clinical care.
[Dr Megan Schaefer]
Thank you for highlighting some of those positives, Dr. David. And as you said, I think our goal is we want to really create a balanced view of the pros and cons of social media use. And as you said, a lot of the things about community and finding people who are similar to you, there can be a lot of benefits.
And then knowing that each patient that we come across as individual and the benefits that they find. And so, exploring that as providers can be particularly helpful. And I know throughout some of our questions, Dr. David, you've kind of highlighted the impact on those with chronic conditions, but can you speak more to how social media use impacts teenagers with chronic conditions, whether that's medical or a mental health condition?
[Dr Jennie David]
Absolutely. So, the things I'm going to be presenting today are primarily related to the chronic medical conditions. There's lots of research about some of the chronic mental health conditions, be it anxiety, ADHD.
And we wanted to make sure on a pediatric podcast to highlight when it comes to the medical piece, because I think many of us when we think about social media, our initial gut instinct might be anxiety, body image, depression, but we don't necessarily think about how is this impacting my young person in front of me who has a chronic GI condition, who has food allergies, who has diabetes. And yeah, there's some really fascinating and very concerning research on pediatric medical conditions and social media. Just like we've been talking about before, it is normal and valid to want to find a community of others who understand you.
And so especially for people that have medical conditions that may not have strong representation, may have stigmatizing perceptions kind of in everyday media, or where they might be things that are just not well understood or seem relatively rare statistically, many young people and families are looking online. And I think as clinicians, it is beneficial to us to make the gentle assumption that people are looking online on social media for these types of health-related communities. Better to make the gentle assumption and for a family to say, nope, that's not how we use social media, then to think that it's more of the exception versus the rule.
The goal of young people with medical conditions using social media can be really multifaceted. So, some folks may be trying to find a community, some may be trying to find information, some may feel like they're not moving forward in their care and want information about other treatments, other doctors or providers that I can go to, and some might be more interested in advocacy or fundraising. Lots of different reasons why somebody might come to social media, which again is important to ask about and understand as a clinician.
We as healthcare professionals know that when it comes to chronic medical conditions, there's so much heterogeneity. So, I know before I was talking about inflammatory bowel disease as my primary population that I work with, if you meet one kid with IBD, you've met one kid with IBD. And yet all of the nuances get very flattened on social media.
Like Dr. Dawson was talking about with emerging cognitive development, it's going to be harder for a young person whose let's say 16 thinking about a new IBD treatment to go on social media and see someone in a different treatment and not understand that might fit for their body, they might be on a different treatment for another reason. And so, some of that limited information can be quite impactful or just not understand that there's differences. Of the research that's been published when it comes to social media and pediatric medical conditions, there's been some concerning findings that it can impact adherence to treatment.
So, if you are in a treatment from your provider, but then you go on social media and you see someone is not doing that, is doing something else, using that medicine in a different way, perhaps prescribed differently by their own provider, there's research that suggests that that young person may alter what they are doing. So, concerns for non-adherence are going to be a little bit higher and just something that again we have to think about and it's okay to ask about and continue to ask about throughout care. We also know that things like functional tics and tick-tock are things that were heavily connected.
There's been some fascinating research in that area. There's also some research here by one of our fellow colleagues at Nationwide that showed that parents of kids who had severe food allergies, they were more likely to feel hesitant and not certain about a doctor's recommendations if it contradicted what the parent had seen on social media. And so, this really emphasizes that what we see on social media, we take for fact, requires more of that critical thinking that may not be happening or is rapidly developing for our young people.
But a good way of talking about how what happens online with those social media impacts what happens in our clinical spaces. And that again, these are important things to talk about. In 2023, we published a paper talking about the different maladaptive social media usages amongst our young people that have disorders of gut-brain interaction.
So, these are things like animal bowel syndrome, cyclic vomiting, functional dyspepsia, to name a few. And these, for listeners who may be less familiar, are real conditions. There's tremendous pathophysiology to these conditions and ones that we treat in a multidisciplinary fashion.
And in the paper, we highlight two de-identified case examples, one where a young teen was using social media in a very maladaptive way that was impacting her quality of life and functioning tremendously. She, and we would talk about it often in clinical care, she really wanted to find a community of others who understood her healthcare condition. She felt very connected to her healthcare condition and described that it was very important to her to give advice and receive advice online of the people that she was talking about with her healthcare condition on social media.
None of these people were people that she knew in person. In clinical care, we continued to notice that she would use highly specific medical terms that were really not congruent with her age or life experience or familial experience within the healthcare field. And they asked for very specific medical interventions were increasing and were not at all aligned with what was happening medically for this patient.
So, asking for TVN, wanting to have other types of feeding tubes or other types of mobility aids, and it just was not aligned with what was happening medically for her. And upon exploration and asking her, many people use social media. Do you use social media when it comes to your health?
She was able to, in clinical care, show me like, yeah, here's my social media. We looked at it together and really reminiscent of all the highly specific medical terminology that she was using and people who had the types of medical interventions that she was seeking. And she showed me some very highly produced videos of herself that really were emphasizing the experiences that she was having within her illness, which is really counter to the recommendation for kids that have disordered gut-brain interaction.
We want to treat that. And we want them, if anything, to really engage in life and not engage as much in the health aspects of what's happening. We also, in the paper, talk about caregivers' maladaptive social media use.
And briefly, this was a caregiver who dearly, dearly loved their young person, initially was on board with this sort of gut-brain interaction diagnosis. And then as the admission, this was a person who had been in the hospital for quite some time, continued, the caregiver continued to express hesitancy and brought up a different GI condition that this young person had already been evaluated for. There was no evidence to suggest that this person had.
And the caregiver just continued to be very, very concerned that the person had this other organic condition that, again, the patient did not have. And as we explored it, the caregiver had shared that she was in a social media group for that organic health care condition. And that was a very, very big part of her social network.
There weren’t many other people within their social network. And again, one of her big values was to be a part of this community. And that really contributed to many, many communication challenges between the family and the team.
In the end, the young person was able to meet discharge requirements to go home, and family was going to pursue other testing and evaluation for the condition that, unfortunately, there was no evidence that she had. And these two cases really, for me as a clinician, emphasize that had we talked about social media proactively versus that Spidey sense that kind of developed as those clinical cases were happening, we might have been able to, and we would have been able to provide better psychoeducation, anticipatory guidance, clearer recommendations about what might be adaptive and maladaptive for those particular young people and their families. And it also really emphasizes when it comes to multidisciplinary collaboration, which many of us do and really pride ourselves on, it's so important if one provider taking care of a kid with a medical condition is aware that that young person is engaging in social media for things that might be very positive or things that might be more neutral or potentially more harmful, to have that documented in a nonjudgmental way in the note.
That way, it allows for better understanding amongst the other multidisciplinary care providers of what is happening and what types of questions to perhaps ask or follow up on. And again, these are conversations that should happen throughout care. We'll talk about this a little bit later on as we chat because the paper that I am referencing that we wrote in 2023 will be linked in the show notes.
But there's a great table in there, in table one. I think it's great because I helped to write it, but table one that has lots of good recommendations about some of the clinical questions that providers could consider asking in assessing social media use in young people and families with chronic medical conditions.
[Dr Megan Schaefer]
Thank you, Dr. David. That was extraordinarily helpful. And as you were highlighting when you were summarizing, if we're not asking these questions about social media as providers, there could be critical pieces of information that we're missing.
It could totally change the treatment plan or as you said, how we give information or maybe understand some of our patients' health behaviors. And again, I think it speaks as Dr. Dawson was saying, with the changing social landscape, it does change the way that we ask questions as providers and what types of things we're learning. Now we're going to move a little bit more towards recommendations.
We know that kids and teens do not operate in silos, right? So, there's a lot of systems in which kids operate. And so, thinking about how these other systems and supports can help them with social media use.
So now I'm going to turn it over to Dr. Dawson. What roles do family and parenting styles play in protecting and supporting child's behavior online?
[Dr Anne Dawson]
Yeah, I think that's a fundamental question right now. And I think a lot of parents are starting to ask that same question. How can I support my child and what am I doing?
And I think it's important that although we're highlighting the concerns and we're sounding the alarms, that we take a step back and take away judgment at this point. Social media is changing exponentially. It is introducing new features and buttons and apps.
It seems daily, but every year it's different. So, I think we have to be gentle with ourselves when we talk about how families can be influencing or supporting or protecting kids. Because the fact is as psychologists, we're still learning too about how to support kids.
And parents largely rely on or turn to their pediatricians, their child psychologists for this advice. And so, kind of a long way of saying this is all still hot on the press and not quite out. But I think to kind of highlight a lot of what Dr. David was just reviewing, one of the biggest recommendations we can make is being aware. So, I think when we're talking about this changing social landscape and reflecting on our own childhoods, a lot of times we might just say like, I don't know what these kids are talking about. I don't know what they're talking about with TikTok. We probably talk a lot about just how quickly language is changing for our kids and trying to keep up with all the new language like Riz or whatnot.
And sometimes we kind of just dismiss that as kids these days. And I think the biggest takeaway is just being aware of what our kids are doing. And so, in the same way that parents, when I was growing up, my parents would say, why do you want to go to the mall?
What are you going to do at the mall? And I think in the same way, we need to ask like, why do you want to go on Instagram? What did you do on Instagram?
And then we need to take the time to understand what they're talking about. I think maybe as we've kind of alluded to throughout, it's the first step is being aware of your own use of technology and how using your phones or using screens in general has entered family life. So, you know, we're seeing social media influencers emerging for our littlest children, right?
So, we have the Blips and the Miss Rachels for our little kids. And then we have social media users from there on out. A lot of us turn to social media influencers.
So, Dr. David talked about being aware of a lot of positive social media influencers for kids with IBD or for adults with IBD. And so, I think we have to take a second to just think about first how social media influenced my life. How has my child seen me engaging on my phone?
Have I been able to step away from my phone? Or is my attention fragmented too? When my iWatch goes off, or not to call out a brand, my smartwatch goes off, or my phone goes off, do I look at it?
Do I interrupt my interaction with my child to look at it? Or am I able to set good boundaries for myself? So, I think the first thing parents can do is first self-assess.
Dr. David alluded to earlier that our mature brains are able to maybe take in this information and process it out. And I think that we're weak and we're not able to do it either. And social media has been able to design these algorithms that also get us, right?
Like we're vulnerable to addiction too. And so, I think the first thing that parents and parenting styles can do is self-assess their own use and see if they can put limits on their self. I'm going to recommend that we're putting limits on kids.
I'm going to throw my support behind the Australian ban on social media for kids younger than 16, which is generally recommended. 16 is kind of the age, the minimum age that we're hearing about recommendations for social media due to cognitive development. So, I think before we can say, hey kids, I want your phones in the basket before 7 p.m. I only want you to have access to your iMessage or your whatever group message app that you use. We have to see if we can withstand limits ourselves and challenge ourselves. So, this isn't a do what I say, not what I do situation. I think this has to be a do what I say and do situation.
And from talking to lots of kids, they can't put limits on themselves when it comes to their phone. They can try for brief periods of time, but they crave structure. And as psychologists, we're always talking about behavioral management, structure, limits, supporting parents, and doing this in many ways and in many facets.
Just helping kids sleep at night requires structure and limits. And kids crave it. There's very few toddlers or infants putting themselves to sleep and saying, all right, I'm tired now.
I don't want to play anymore. And I think we all can accept that we have to help kids put themselves to sleep and set up good sleep hygiene. And that's the same when it comes to social media.
Just because you don't know about it doesn't mean it can't have limits. And I've had teenagers come up to me and say, if my parent took away my phone or if my parent put limits on my app, that would help me. But there's too much social pressure for me to do that myself.
And so I think empowering parents to talk about it, what are you doing, how are you using it, to learn privacy and how apps function, to be empowered to put limits on their kids' phone use as well as their own phone use, social media use, and then also to do the same things that we've asked parents to do since parents existed. And I'm saying as a society that we've had parents do, which is teach their kids to be good citizens. And the same has to happen online.
We have to teach kids how to be good digital citizens. And so that's teaching them about the permanency of the internet. That's teaching them that we're nice to our friends.
If you don't have anything nice to say, don't say anything at all. We need to be working on how we can teach kids to be good digital citizens. And sometimes that takes parents figuring out how they can be good digital citizens too.
I think none of us want to be raising the keyboard warriors who have the maximum vitriol on comments that you would never say in real life. And I think we have to teach our kids how to resist that urge because this prevalence of social media has started to encourage people, I would say even adults more so than kids, to say whatever's on their mind. And without social media, we never encourage people to say whatever's on your mind.
We've encouraged people to say what's on your mind with respect. And I think that that's something we need to encourage online too. So, it's kind of a lot of broad recommendations when it comes to what parents and family styles can do.
And if we're going to narrow it down to one, it's learned.
[Dr Megan Schaefer]
Those are excellent points, Dr. Dawson. I really appreciate your sharing. And as you said, we're all in this together.
And as adults, it's our job to model and set those appropriate behaviors. And what we do online is what our kids and teenagers will follow. But those are all excellent points.
So, thank you for sharing that with our group. Dr. David, I know you were talking a little bit about providers. I'm going to talk about the table that will be referenced in the show note.
Were there any other key things that you wanted to highlight for recommendations for providers on how to best assess social media use in teenagers and children?
[Dr Jennie David]
I think a lot of it is echoing what we've already talked about. It is normal to want to use social media. It is normal to use social media for young people.
And so, making that gentle assumption and asking routinely in care, so similar to how we ask social drivers of health questions routinely in care. Many of us across our clinics have different depression screening or anxiety screening. These are also things that we could be doing much more consistently throughout care.
And asking with compassion and non-judgment and saying like, I use social media. Gee, like I like it for these reasons. Can you tell me more about how you use social media?
And then as we were talking before, asking when it comes to medical conditions, depending on what's relevant for the patient. And as I also alluded to, as I was rambling before about medical conditions and social media, documenting in a non-judgmental way when appropriate in the patient's chart, A is a really helpful thing to look back on of like, hey, I saw this patient six months ago. Let me refresh my memory.
Were they using social media when it comes to their medical condition? Maybe it's a new diagnosis. They were looking for information and would allow other providers that take care of them to have that information and to further follow up and explore.
And like I was mentioning with some of those identified case examples, it's totally okay to ask a young person in clinic, can you pull up your account? Can we look at this together? Can you show me the things that you're looking for?
As I was mentioning, when it comes to sharing ostomy resources, there's also some fantastic resources across medical populations that are reputable from organizations that I trust and that I want families to trust. And they try to teach some of that critical media literacy of like, hey, when you're looking for social media things online, this is what you could look for. Here are some of the buzzwords, the ways to know that it's legit.
So, all of that to say, assessing and asking and giving recommendations if there are reputable social media accounts that exist can be a fantastic way for providers to start.
[Dr Anne Dawson]
And I would echo what Dr. David said as well when it comes to recommendations for providers. Many of us don't have time to ask additional questions, especially our pediatrician colleagues. But I think if you're going to ask one question, it could just be, can you get on your phone right now and look up your screen time and tell me your average weekly use and your top three apps?
And that's what I routinely do. And it's usually in front of parents. So, parents know that one, you can check.
And two, kids know how to check and that's okay to check in on.
[Dr Megan Schaefer]
And what I'm hearing from both of you is normalization of these behaviors, right? Being nonjudgmental, knowing that we're all vulnerable to this. And it just makes these topics that can be heavy sometimes easier to talk about.
And again, back to that theme of we're all in this together. So those are all great, great points. We know that kids spend a lot of time in school, Dr. Dawson. So, what role do schools have in educating teens about social media's impact on their mental health and how can they help shape some of these behaviors as well?
[Dr Anne Dawson]
Man, that's tough, Dr. Schaefer. I will say because as the theme is, we're all in this together and it's an evolving and changing landscape. And sometimes I think we do have to hit a pause button and say, do we have to change the way we've been progressing?
Is this progress? There's a really popular book right now called The Anxious Generation by Dr. Jonathan Haidt. And I would recommend that book to all listeners.
I think they take a clear stance in the book about how social media has likely, more than likely, led to the mental health crisis. And they also make some recommendations for schools in that book. And the biggest recommendation that Dr. Haidt makes when it comes to schools is that all schools should be phone free. And I think, you know, I wouldn't endorse that. And I think beyond that, we have to look at how our schools have used the internet. It has been a wonderful thing when it comes to COVID, right?
The fact that kids could get Chromebooks and kids could get online and that they could learn and stay safe when we weren't really sure how to handle quarantine, right? Using screens has been wonderful. And there may have been some potential harms that came with that.
You know, our kids might have, I've had a patient tell me, yeah, my parents limit me. I can't use YouTube more than two hours a day. But on my school iPad, I can use it as much as I want because they can't limit that.
And I think as we're giving kids access to school iPads and school laptops, we have to consider what we're modeling for kids too. If our education is all on a screen, it's a little bit harder for parents to say, now that you're home from school, no more screen time or to figure out how to modify that. So, you know, I think we do have to continue to consider our reliance on computers and laptops and interactive internet-based learning.
Take what's good and be willing to kind of do a reanalysis of the potential harms. But I do think the biggest recommendation for schools would be that kids should not have access to their phone during school, because we do see it's interrupting their ability to pay attention. And it's difficult to ignore those notifications.
[Dr Megan Schaefer]
Thank you. And I know, Dr. Dalston, we were having these conversations in prep. We talked about the parents who say they want to have access to their child if there is an emergency at school.
What would you recommend to those parents?
[Dr Anne Dawson]
Yeah, I think that's common pushback. Like, I'm not, you can't take my kid's phone because if I need to reach them, I need to reach them. And I hear that, right?
We want to have; we want to be able to reach our kids. And I'm going to take from the Anxious Generations recommendation or at least point here that I thought was really salient. In an emergency, we don't want hundreds of kids on their phone contacting their parents and trying to figure out what to do.
We want our kids to listen to the teacher who's been trained how to handle emergency situations and have that teacher being the one that can contact emergency services. And I think that's a really good point. In an emergency, we don't want 300 kids calling 911.
We want the adults in the building calling 911 and for the emergency services to be handled by the adults that we should trust. I think it can be scary, but I think we have to reorient to that we're here to take care of our kids and that's our job and we're going to do that.
[Dr Megan Schaefer]
That makes a lot of sense. Thank you for answering that question, because I know that comes up a lot in these discussions. Well, today, I think we've talked a lot about great recommendations.
We've talked about risk factors. And so just to close out our podcast today, a final word on resources and recommendations of what we would give to parents, which Dr. Dawson is going to answer, and what we would give providers, which Dr. David is going to answer. But thinking about those general resources and recommendations to summarize those of the impact of social media use on children and teenagers' mental health.
So, Dr. Dawson, what would you say for parents? What are your take-home points?
[Dr Anne Dawson]
Sure. And I think that we're going to put a bunch of links in the show notes that can be helpful. My take-home points would be to learn.
So, I do think The Anxious Generation is a good book to start with, to learn about the safety features on the phone, to learn about apps and how they're used, to learn about who your kids can reach out to, and to consider setting limits on phones. There is a new thriving market for dumb phones for kids, which are those that aren't capable of getting on social networking sites and considering those. But then also, I think a lot of parents say, I can't be the only one that gets my kid a dumb phone.
When all of their friends have smartphones, they're going to be left out. And I think that's really fair. So, one thing that parents can do is join a community, create a community, where neighborhoods are kind of supporting each other in creating limits and taking pledges, such as the wait till eighth pledge, wait till eighth grade to have your kid have a phone, or following the recommendations of 16 together, working together to advocate as a community for the government to consider policy and limitations. Okay, I'll stop there.
[Dr Megan Schaefer]
Fantastic. Thank you for summarizing our recommendations for parents. Then I'll turn it over to you, Dr. David, for final words for our providers.
[Dr Jennie David]
Absolutely. So, I think overall, for providers, it's similar to for caregivers. We want to learn, we want to ask, and we want to document.
This is an evolving conversation for all of us. And just like Dr. Dawson was saying at the very beginning, I think there can often be the sense of like, oh, kids, they're so young, they're doing the hip things online. And yet we don't necessarily ask, what does it look like?
Can you show me? And so, asking those questions, creating that space of nonjudgment and compassion and normalizing that. We all want community, be that in person or on social media, and we want to be safe.
And we want our kids to be safe across in-person and online spaces. And again, lots of other resources linked in, in the show notes, including that table one from our 2023 paper that folks might find of interest.
[Dr Mike Patrick]
Well, this has been a really fascinating conversation. And I've just really enjoyed listening and fantastic recommendations. The phones in schools, really, I found particularly interesting because there's a long history of kids being at school without phones up until the last 10, 15 years.
There were no cell phones when I was in school. And of course, there also weren't as the number of school shootings and things that are really, can be scary for kids. And so, I do understand wanting to be able to get in touch with your kids right away, immediately.
But you've raised really good points. You don't want 300 kids all calling 911 at once. That actually is more harmful to the system working and protecting them.
So, fantastic conversations. And I know you kept mentioning resources in the show notes, and we are going to have a lot of those. So, if you head over to pediacastcme.org and click on the show notes for this episode 104, we have links on warnings, recommendations, and policy, general educational resources, resources for parents, and then all of the research that has been mentioned, we have links to those articles as well in the show notes. So, definitely check that out. Lots and lots of resources for you for this particular episode. So, once again, Dr. Anne Dawson and Dr. Jennie David, both with Pediatric Psychology at Nationwide Children's Hospital. Thank you both for being here today.
[Dr Anne Dawson]
Thank you for having us.
[Dr Jennie David]
Thank you so much.
[Dr Mike Patrick]
Yeah. And Megan, once again, Dr. Megan Schaefer with Pediatric Psychology. Thank you so much for all your hard work putting this together and leading the conversation for us.
[Dr Megan Schaefer]
Of course. Thank you. This was a really fun topic to talk about, one that I think will continue to be important throughout the year.
So, thank you.
[Dr Mike Patrick]
We are back with just enough time to say thanks, once again, to all of you for taking time out of your day and making PediaCast CME a part of it. Really do appreciate that. Also, thanks again to our guests this week, Dr. Anne Dawson, Dr. Jennie David, both with Pediatric Psychology, and we really appreciate Dr. Megan Schaefer, also a Pediatric Psychologist for leading the conversation today. Don't forget, you can find us wherever podcasts are found or in the Apple Podcast app, Spotify, iHeartRadio, SoundCloud, Amazon Music, YouTube, and most other podcast apps for iOS and Android. Our landing site is pediacastcme.org. You'll find our entire archive of past programs there, along with show notes for each of the episodes, our CME information, our terms of use agreement, and the handy contact page if you would like to suggest a future topic for the program.
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A couple other podcasts I want to share with you. PediaCast, so plain PediaCast without the CME. That is an evidence-based podcast for moms and dads.
Lots of pediatricians and other medical providers also tune in as we cover pediatric news, answer listener questions, interview pediatric and parenting experts. All those things. Shows are available at the landing site for that program, pediacast.org.
That's also available wherever podcasts are found. Simply search for PediaCast. And an additional podcast that I host is called FAMEcast.
This is a faculty development podcast from the Center for Faculty Advancement, Mentoring, and Engagement at The Ohio State University College of Medicine. So, if you're a teacher in academic medicine or a faculty member in any of the health sciences, then this podcast is for you. And you can find FAMEcast at famecast.org and wherever podcasts are found, simply search for FAMEcast. Once again, thanks to everyone for stopping by today. And until next time, this is Dr. Mike saying, stay informed, keep it evidence-based, and take care of those kids. So long, everybody.