Anne Walters, PhD (Host 1): Hello and welcome back to Mindcast: Healthy Mind, Healthy Child, a podcast from the children's mental health experts at Bradley Hospital. I'm your host, Anne Walters, along with my colleague, Greg Fritz. And today, we're diving deep into the dynamic world of social media, from its potential benefits to the critical risks it poses and how we can strike a balance.

Greg Fritz, MD (Host 2): Social media has revolutionized the way we connect, communicate and share our lives. From fostering global friendships to supporting social causes, it has undeniably brought numerous benefits to our fingertips. But, as with any powerful tool, there are potential risks as well. From privacy concerns to the addictive nature of scrolling, we must be aware of the pitfalls that social media can present.

Host 1: Today, we're thrilled to have Dr. Tanuja Gandhi, a psychiatrist at Bradley Hospital, join us on the podcast. We'll be discussing practical guidelines to help you monitor your social media use and the content that you consume. We'll also explore how parents can set boundaries and effectively monitor their children's online activities, ensuring their safety in this digital age. Welcome, Dr. Gandhi.

Tanuja Gandhi, MD: Thank you for having me.

Host 1: We'd love to hear just a little bit about your background and your specialties and role at Bradley Hospital.

Tanuja Gandhi, MD: I'm one of the doctors in the Children's Inpatient Unit at Bradley Hospital, where we have kids anywhere from four to 12 years of age. I'm trained in both child and forensic psychiatry, and I'm doing the work that I love doing the most.

Host 2: Let's start with sort of a general overview of how do you see the role of social media in a child's life and their development today.

Tanuja Gandhi, MD: Growing up, I never thought this was a question we'll need to discuss, because I didn't have access to social media as a child. But now, when you think about it, The Pew Research Center has like a lot of data and papers on a lot of things, including social media use, and they say that about 95% of U.S. teens now have access to a smartphone. So, I think, as you rightfully asked, the best way to think about social media is how does it impact development, because it's here to stay. In the life of a child or a teenager, social media can have both positive and negative or concerning influences.

Host 1: Well, what do you think the potential benefits of social media might be for children's mental health?

Tanuja Gandhi, MD: So, most children have access to some kind of a device or a screen nowadays. And the older the child is, they probably have access to more complicated versions of screen time or social media access. Most kids are using it to spend time, make friends, connect with the world, socialize, become a part of a larger community, learn new skills, or even do projects together.

So, I think some of the benefits of social media are providing a connection to the world, keeping up with a new form of communication and a way of living for children in today's time, learning new skills, and also contributing to their growth in terms of educational content that's being developed over complex multimedia platforms available through social media.

Host 1: What are the common challenges or risks, on the other hand, that are associated with social media use in children, particularly from a mental health standpoint?

Tanuja Gandhi, MD: I think anything that comes up as a new technology, or a new device, or even social media platforms, there's a balance to how much it benefits a person versus how much it can be influencing negatively. So from a mental health standpoint, some of the risks associated with social media use have been the kind of social peer pressure that children and teenagers feel to look a certain way, behave a certain way or form friendships and communicate in ways that are apparently acceptable on social media. And that might not even be the truth in their real life, but there's this unfit pressure that's created by social media seeming perfection.

The other things could be, if the child is very young and is exposed to content which is not appropriate for age or development, they don't know what to make of it, so you could see problematic digital behaviors and problematic behaviors in real life coming from that sort of exposure.

The more concerning things that you hear commonly are bullying that happens in social media. People feel comfortable saying things that they might not actually say in real life to other people. And the whole concept of think before you act kind of works, seems to work in the reverse manner on social media where something's posted, then you're like, "Oh, I shouldn't have said that," but then once posted, it's there forever. So, I think it exposes people to both being part of the process of bullying or harassment and being targeted themselves. And then, the common risks is in a platform where you don't know who's at the other end, children could be exposed to people who are trying to take advantage of younger kids, find out their details and just a lot of activities that a child should not be exposed to.

Host 1: I think certainly those of us working with children hear regularly about some of the struggles that parents have with sending kids off, for them to come to dinner, things that somewhat innocuous as that. But in general, what would you say are some ways that parents can recognize signs that children might be struggling with the effects of social media use?

Tanuja Gandhi, MD: Commonly, every parent knows what their child's baseline pattern of functioning or interaction is in daily life at home with them, their siblings and friends. So as the rule of thumb, if there's any change in the child's behavior or way of living or functioning, be it change in appetite, sleep, avoiding things that they previously enjoyed, avoiding school, avoiding certain friends, being on social media more sparsely or excessively and looking much more frustrated after that point, or even making like overt statements such as dying or wanting to die or saying things like feels worthless and hopeless might be signs that you need to watch out for, and then wonder if it has something to do with social media.

Host 2: You mentioned cyberbullying or other kinds of online harassment. What about what are the signs that a child might be experiencing those sorts of problems?

Tanuja Gandhi, MD: In addition to the usual signs, you know, that indicate decline in daily functioning, certain things to look out for would be school avoidance if the people who are harassing the child are also present in their school or in their social or friend circles, so avoiding certain social activities, or generally a decline in academic performance might be some signs that kind of tell you something's wrong in that domain of their life.

Host 1: Can we share some strategies with our listeners for how we might monitor use or content?

Tanuja Gandhi, MD: So, some of the things I've heard parents do is by partnering with your child on what social media accounts they're on and basically having an open-minded communication with your child, depending on the age. So say if your child is much younger, you can watch the social media or educational content or YouTube videos, whatever they're watching, together. You can spend time screening what you would like to see together and have a conversation around safety.

And if the child is younger, the things you can do in addition to knowing what websites or accounts they're on is let them know that you might be friends with them on their account if they're okay, but have an open conversation." I'm not going to post on the content you post." It's just like, "I want to be there for you if you need me." You can become followers on their social media accounts. And if that doesn't feel too comfortable, you could definitely have, like, parental control. And that could be a discussion as to, you know, "You can't post identifying information as your home address, a telephone number, and you have to, like, turn off location settings," just, like, basic safety information discussed and agreed upon in the home.

And another way to monitor the child's social media activity could be by generally just checking their browsing history, which, again, some parents tend to do. So, I think what works in your family would depend on the age and level of development of your child and then the conversation between the parent and child as to what's comfortable for them all.

Host 1: And I know some of our professional organizations have come out with guidelines around sort of minimum age of youth. I wonder if you have thought about that.

Tanuja Gandhi, MD: I think ACAP in particular, which is the American Academy of Child and Adolescent Psychiatry, has a very simple one-page outline. The Academy of Pediatrics has eight specific outlines and what kind of screen time and how much screen time is recommended or somewhat acceptable, depending on the age group.

As a rule of thumb, I think we all understand that screens and devices and media have become a part of our lives. So, ideally, there is limits on how much a younger child should be exposed to and limited to content which is educational, certain times of the day and with certain screens only. But as the child grows older, there is a lot more flexibility with what you can and ideally would not do.

Host 2: You mentioned parents watching social media together with their child, which I think is, essential. But I'm not sure how common that is. Do you think that most parents do do that with their kids? Or do you think it's when you suggest that they're surprised?

Tanuja Gandhi, MD: It's actually come up from one of the parents, and I don't know how I would like watching Barney ten times over every day. But if the child is younger, it's much easier to do it. And some of the teenage shows that children are watching, which I'm assuming is older children, are much easier to watch, maybe once or twice together. But I think some parents have actually made time to dedicatedly watch, say, a certain movie or a certain series, which might have age-appropriate content according to the rating, but not according to the parent. Say, some of the movies have conversations or explicit material, which the parent doesn't think is okay for their child to watch. Then, you can sit and watch it together to make sure we know what they're watching and can have a discussion if they're concerned around this.

Host 2: So at some point, most teens will be exposed to social media one way or another. That's a given. We already said that it's not if, it's when and how. Maybe you could give our listeners some ideas on how they can effectively set time limits and monitor news for teenagers?

Tanuja Gandhi, MD: When I started thinking about this topic, which again has been discussed so many times with parents and families, I felt like every time I was making a suggestion, which the next time I found out had failed. So, I came upon this website, I can't remember the name, but they talked about creating a family social media safety plan, which basically tells you, you know, you need to have a conversation, you create spaces which are social media-free, you create times that are social media-free, to say you won't be looking at your phones or browsing your Instagram or Facebook at dinner time, when we are doing like a family activity, all the devices stay on the side.

But also, I realized that it's important for the adults and the parents to model the behavior they want the child to see. So, say at dinner time, all of us putting our devices away is a good practice. The safety plan applies to the children, but I think if you can have a family plan for what social media use in this home is going to look like, it might be a better way to partner with teenagers around the decision-making process. And then, this lends into the process of being a partner in safety, too. If something happens, the team would come and tell the parent, instead of finding themselves dealing with it alone.

Host 2: Excellent. Well, we need to go on for this. We have to come back and talk some more about this, because it's such an important topic. Do you have any final thoughts or words of wisdom for us?

Tanuja Gandhi, MD: I'm not sure these are words of wisdom, but I think increasingly the realization which comes back to children and adults again is we learn responsibility in communication when interactions are in person, but we don't have conversations around digital responsibility as much as we probably should. And imagine these conversations to be just as sensitive and responsibility-invoking as an in-person conversation would be. So, what you post stays online, what you say you can't take back. Those are kind of the basic principles, that I think it would be helpful to talk more about even in the digital context.

Host 2: Kind of digital politeness, I guess you'd call it, or digital etiquette.

Tanuja Gandhi, MD: Yeah, digital etiquette. Yeah.

Host 1: Yeah, that's a great point. Thank you all for tuning in to Mindcast today, and thank you Dr. Gandhi for providing a well-balanced overview of social media. On a personal note, I want to thank you for stepping in to be our new co-host as I'll be retiring at the end of this year. Mindcast is lucky to have you. I've so enjoyed the conversations that we've had with our colleagues on the platform and hope that you find them as interesting and informative as I have.

Host 2: That's for sure. We're really thrilled to continue with the podcast and welcome to you, Dr. Gandhi. We'll look forward to some continued, good discussions. And of course, we'll miss you, Anne. It's been a good run and we know you'll be enjoying retirement. That's not in question. Please share what you've learned today with your colleagues, friends and loved ones and share Mindcast with them. Thanks for tuning in today. We appreciate all our listeners. Until next time, this is Mindcast: Healthy Mind, Healthy Child.