Melanie Cole, MS (Host): What's happening with kids in the digital world? Is it making them smarter, more worldly? Is it positive? What kind of toll is it taking on their mental health?

Intro: It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie Cole, MS: Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is Dr. Neela Sethi. She's a pediatrician on the medical staff at Henry Mayo Newhall Hospital. She is a fan favorite on this show and she's here to talk to us about the effect of social media on teenagers' mental health.

Dr. Sethi, thank you so much for joining us. As always, it's great to talk to you. And if we were to think of social media, on average, and as my intro said, what is happening? Is it making them more worldly, smarter than we were? On average, how much time would you say adolescents spend on social media?

Neela Sethi, MD: Well, it's a joy and a pleasure to be here. Thank you for having me. I think the short answer to that question is far too long. They're spending too much time on it, and I think that's a big part of the issue here is just the fact that they're on it too much and that it's hard for them to have boundaries. It's frankly hard for adults to have boundaries with social media. So, imagine when you're a child and your brain is not fully developed, and just how addictive their nature is, it tends to affect them more, and the effect tends to be greater, because they are just more vulnerable given their age.

Melanie Cole, MS: You just used the word addicted and that they are potentially more easily drawn into things. Can they truly become addicted to social media? And does the evidence or studies speak about the potential harms of that sort of addiction and/or overuse?

Neela Sethi, MD: Absolutely. The answer is yes. They are addicted and it happens quicker than it should. And if you can imagine, you so quickly can scroll and you're so quickly getting that dopamine hit, and you're not watching videos for very long. And it's almost like a slot machine where you can just press and press and scroll and scroll and you're waiting to get that dopamine hit to find a video that you like, or to follow somebody that you love. And we've all been in that position, but especially with younger kids, hours will pass, and they don't even know it. And the studies have suggested that yes, in fact, they are more likely to get addicted. And once they are addicted, it's harder to get them off it because it becomes part, it's like almost like just part of their life and part of their nature, that weaning them off it is very, very difficult and takes a lot of work. Oftentimes even needs a healthcare professional like me to assist.

Melanie Cole, MS: Okay. Off the air you and I were talking, and because I like TikTok, and I realize the toxicity of things like Twitter, and even Facebook to me is completely toxic, and I can't stand it. But when I think of things like TikTok, I like it. But as we said, mine is not the same as my daughter's. I see recipes and fun things for women my age and movie clips and shows. But my kids, actually now we're starting to intersect and we'll send each other and share each other's TikToks, and a lot of them are kind of very similar. So, it's funny that way how it's coming together. But when we think of ones like TikTok, or Instagram or Snapchat, which really isn't really social media kind of, but not really. As parents, you said it gets harder and harder to pull the kids away, how do we know that it's too much? And are there signs? Because I spotted some signs in myself and said, "Oh, that's a little too much, and shut it down. What about our kids?

Neela Sethi, MD: There are definitely signs. And I think just being hyperaware and hypervigilant of your kids is always a great thing in their teenage years. But yes, you'll notice that they're not leaving their room as much. They're not eating as much. They're not as active. They may be gaining or losing weight. They have something called anhedonia where things that brought them joy, don't bring them joy as much. Their favorite restaurant, they don't want to go to. They don't want to see their favorite aunt or uncle. They don't even want to go for a walk with you to walk the dog. So, there are definitely warning signs.

You find that they're very, very irritable. And of course, I know that's difficult because most teens are difficult and irritable. I have one at home myself and I love her dearly, but she can be irritable. But I think more than usual, where there's changes in patterns, And if you're seeing that, that's a red flag. We're finding that there's a confounding variable here. And we use that term in medicine where there could be other players involved, right? We don't know if it's just social media equals depression. And what we find is that sleep deprivation continues to be a part of that, right? They're up late and they need a lot more sleep. And we've talked about this, Melanie, in the past, where teens need so much sleep and we're not giving them that because they're overscheduled and overcommitted. And in addition to that, they're on social media.

The second aspect of it is, what is their diet like? Are they spending so much time on that, that they're skipping meals? Or on the flip, are they overeating and they're filling themselves with junk and trash because they're just scrolling, scrolling, scrolling, and just popping whatever snacks they have in their mouth and not having proper nutrition? Those are things that are contributing to just this epidemic of teen mental health and its sort of relationship with social media. I do want to follow that up by saying we do know that kids that tend to have a predisposition to mental health disorders tend to be more affected negatively by social media. So if they have a history of depression or anxiety, social media can make that worse. Now, I don't want to sit here and trash social media completely and say that you shouldn't give it to your kids. I I've seen a lot of pediatricians do that and that's just not reasonable and not relatable, especially because I have a teen. And you don't want to just say like, "Nope, you can't have it and that's the end of it," because that's not realistic for our world. And there are positive aspects, just like you said.

Melanie Cole, MS: There are.

Neela Sethi, MD: There are. There is a social sort of interconnectedness that we've seen for the first time in this last decade that we've never seen before. There is a global sort of thinking that we've sort of shown these children where they've gotten more involved with politics. They've understand global sort of issues and concerns. They become very well aware of global warming and the world wars that we're experiencing and they have empathy and kindness. It is bringing this aspect to them that they weren't exposed to or seen before. They also are able to connect and, like you said, if we could control their feed and we could say, "Hey, you have a predisposition to depression and we're noticing that you are quite depressed. You should have your filters be all teens that have recovered from depression and the things they did to recover from that, i. e. they increased their vitamin D, they started going for a walk, they started sleeping 12 hours a night, they started really focusing on their protein intake and making sure they were adequately hydrated, and they had boundaries with toxic individuals in their life." that'd be great. But that's not what's happening. We're finding that they're more depressed and they're having more body dysmorphia. And guess what their feed looks like? Teens that have the perfect life, teens that have the perfect body, teens that have all of the things like the material possessions that make them compare themselves to each other.

So, I think that's one of the bigger issues here is that we can't control what's on their feed. We can empower them to make good decisions. But if there was a way for us to say, "Hey, this is what would work for your feed and this is what these filters would help you to do and this is how we can help you to improve," great. But that's not what's happening.

That being said, that is something that parents can get involved with. That is something that parents can have a conversation with their teen and say, "Who are you following? What are you watching?" Just like, "What are you eating?" That's important. This is part of that. What are you watching? What are you passively getting? And what information are you receiving? And what messaging are you hearing from that? Are you getting the message that you're confident about your body? You're confident about yourself? You feel good in your surroundings? Or are you leaving feeling empty and less than? If so, it's time to do a digital detox and sort of set digital boundaries of "I'm not following this person anymore. I'm not going to listen to this person. I'm going to unfollow these people with these reels, and I'm going to follow people that make me feel better about myself." And I think that's a really good take home point from today's messaging, that we need to empower our teens. Treat social media just like anything else. Is it good for your body? Is it making you feel good? Or is it making you feel bad? Because if it is, it's not good. It's not good for you. And you have the power to change that.

Melanie Cole, MS: Wow. Very well said. And I like that you said you're not completely trashing it. Because if we went to our kids and said, "Okay, no more social media," they're going to rebel against us. And then, they're going to hide it just like they would any other addiction. And then, it's going to become even more of a problem.

So, you've given us some things we can talk about with our kids. And I think communication is key and digital detox. You used those words, Dr. Sethi. So, I'd like you to speak to parents about real world. So if we could look at their social media and say, "This one is not healthy for you. This is not healthy for you. This one is fine. This one is really upbeat." And yes, I agree with you that it is giving them a global picture that we never had. And I'm a lot older than you are, but we didn't know anything that was going on outside of our neighborhood, really. We really didn't. And these kids are so much smarter than we were. But how, as parents, do we say to them, "Okay, enough is enough"? Because there comes a point when our kids, you have a 14-year-old, it's nearly impossible at this point. So, how do we give them that digital detox and/or shift the narrative of what they're seeing? As I said, my daughter and I see a lot of the same things. So that means she's liking videos that I send her, which means that the algorithm is then going to send her more recipes and more things. And we're both kind of going back and forth. And that's what she's seeing now is her mother's TikTok. And you're a perfect example of this, because you're right in the thick of it. How do we get them to switch that narrative? What can we say?

Neela Sethi, MD: I think we say how do you feel when you're done with scrolling through reels? How do you feel when you're done with TikTok? And also, use your maternal and paternal instinct. If they put their phone down and they seem grumpy, that's a huge red flag versus when they put their phone down and they're giggling and laughing, then you're like, "Okay," that's where you lean in and say, "What did you just see? What did you just see?" I do that with my daughter all the time when she's scrawling and she giggles. I'm like, "Let me see that video." Now, she's a dog lover like me. So just as you love recipes, I'm on social media, I have way too much time on social media as well. I'm not some sort of perfect person that sleeps eight hours and Gets all my fruits and vegetables in and never, you know, is on social media. That's not true. I'm a human. But when she has a funny video and she shows it to me and it's a funny dog doing a funny trick, I'm like, "Yep, that's me. I have dog videos on mine as well." And so in my mind, I'm like, "Check. That's a good sign that in her algorithm are funny dog videos." I love the anything pediatric. So, I get the funny baby videos.

Melanie Cole, MS: I love the funny baby videos. I saw a baby race today. It was adorable.

Neela Sethi, MD: I love the baby videos. I love that kind of stuff and I love all kind of postpartum care. Now she's not going to be interested in that. But I think you can say to them when they giggle, "What is that?" And encourage them and say, "You know what, honey, that's great. You giggled with that. Now, we know that you should like that video." And then, that changes the algorithm versus them not touching it because when they click like, that helps with the algorithm. And it makes it a personalized experience. So, it empowers them to say, "Oh, I feel joy when I see this versus sadness. So if I click like, that's going to help me cater my social media experience versus the opposite." When they get off or you tell them to put their phone down and they look down or they look droopy or they look sad, it's the idea of "What did you just see?" What makes you feel bad? What's making you feel down?" And having them say, like my daughter says, "Gosh, she's so pretty. Gosh, she's so skinny. Gosh, she's always doing the most amazing things. Did you see, mom? She did a shopping spree in Mykonos," for example. This was one that popped up the other day, which it was a TikToker that had done a shopping spree in Mykonos. And it opens up the conversation of, "Well, did she pay for that? Well, do you think that that's filtered or not filtered? Do you think she keeps all those gifts?" And teaching them to have their own internal filter of, "Wow, what I'm seeing is not reality. And I am comparing myself to something that is not true and not real. And if I feel negatively after watching that, I am empowered enough to say, 'Unfollow.' And guess what? That then helps my own personal algorithm to not show me other people like this one individual.

Melanie Cole, MS: That's a really great point that you're making, because we can manipulate that algorithm if we do things just like you're saying. And then, those happier videos, the more fun or positive or healthy eating, because there's so much on there, whether it's Facebook or any of these others, where there's really good fitness people helping you eat healthy, helping get kids up, help with the childhood obesity epidemic, because these things that we're talking about, the mental health epidemic goes hand in hand with also the obesity epidemic we're seeing as well.

Neela Sethi, MD: Correct. I tend to follow a lot of people that do kindness projects or happiness projects where they'll give people-- I follow this one individual who will pretend he's hungry. And if somebody gives him their food, he gives them like a cash reward and it's always--

Melanie Cole, MS: I see him too. Beautiful.

Neela Sethi, MD: And it honestly is a serotonin boost for me of there are good people in this world and kind people in this world. And I tend to then get more videos like that. So, I think the Dr. Sethi that you meant a year ago where I was like, "Absolutely not. Take it away. Get them outside." Yes, that's true. You want to get them outside. You want to get them active. You want to follow your parental instincts when there's something wrong. And if there is something wrong, you need to come do someone like me that can help you.

That being said, and there is some room for having open communication and teaching these kids to cater their experience, because we know that they're going to be on it. We're on it. So, we know they're going to be on it. But really empowering them to be in their body and understanding what their physical symptoms are after seeing a video or after seeing a post, that raises healthy self-aware introspective people who are saying, "I am going to make a choice that is good for me. I am going to have a boundary here because this is not working. I'm going to choose me and my mental health, my physical health over anything else. And if it works for me and we are aligned energetically, I'm going to click follow. I'm going to click like. And if it doesn't, I'm going to click unfollow. And I'm going to be a boundaried individual, both in my personal life and digitally." And I do and truly believe that that's what's going to create better, more global, more empathetic, and just kinder teens to each other, and hopefully then lead to this next generation of leaders and not followers.

Melanie Cole, MS: Wow. You are just such a great guest, Dr. Sethi. Thank you so much for joining us because I really think this was an engaging conversation. And it gave parents like me and like you a lot to think about, because it isn't something we can just turn on and off in our kids, not at this point. Maybe we could have a few years ago, but now it's kind of, you know, the horse has left the den, so we can't exactly turn it off now. But we can get involved. We can communicate, we can see what they're doing and let them see what we're seeing and hopefully bring it together so that it is a positive message. And I just can't thank you enough for joining us today and come on back on anytime you want. And let's talk about so many things because you are just an excellent guest and a wealth of really, really great information. So, thank you again.

And you can always visit our website at henrymayo.com for more information. You can also visit the free health information library at library.henrymayo.Com. That concludes this episode of It's Your Health Radio with Henry Mayo New Hall Hospital. Please always remember to subscribe, rate, and review this podcast and all the other Henry Mayo New Hall Hospital podcasts and share this show, listeners, with your friends and family on your social channels, because that way we are all learning from the experts at Henry Mayo Newhall Hospital together, and we're sharing this quality information that you know you can trust. Thank you so much for being with us today. I'm Melanie Cole.