In the Fall of 2021, a whistleblower testified before the United States Congress that Instagram can be particularly harmful to teenage girls and called for congressional action to regulate the social media platform more aggressively. Testimony focused on specific negative effects on body image that include feelings of jealousy, sadness, insecurity, unworthiness, and depression (Gollum, 2021). According to research conducted by Facebook, which owns Instagram, one in three teens who voiced concerns with body image reported that the pictures generated by the image-focused Instagram may lead to worsening of body image issues (Washington Post, 2021). Although this testimony was riveting and compelling, it is not new news.

Researchers have long been concerned about detrimental effects of social media on the more vulnerable members of society, including adolescents. A 2018 survey of 750 teens between ages 13 and 17 found 45% were online almost constantly and 97% typically access YouTube, Facebook, Instagram, or Snapchat (Anderson & Jiang, 2018). Harmful effects include exposure to bullying, rumor spreading, unrealistic views of other people's lives, and peer pressure (Mayo Clinic, 2019). In 2011, the American Academy of Pediatrics (AAP) published a clinical report on the impact of social media on children, adolescents, and families that reviewed positive and negative effects of social media including Facebook, MYSpace, Twitter, a variety of gaming sites, video games, and blogs (O'Keeffe et al., 2011). With the well-documented increase in use, these sites offer teens opportunities for entertainment, networking, communication, and enhanced learning. But as the authors stated, "because of their limited capacity for self-regulation and susceptibility to peer pressure, children and adolescents are at some risk as they navigate and experiment with social media" (p. 800). Per AAP, risks include bullying, clique-formation, sexual experimentation, privacy issues, internet addiction, sleep deprivation, sexting, and depression (O'Keeffe et al.).

McHugh et al. (2018) asked 75 teens to report on their online experiences with social media over a 2-month period and their coping strategies if they experienced symptoms of posttraumatic stress disorder (PTSD) following exposures to explicit content, cyber-bullying, and sexual exploitation. McHugh et al. present a thorough review of research on the impact of social media on teens dating back to 1998 that documented excessive use has been tied to depression, anxiety, aggression, addictive behaviors, sexual exploitation, breeches in privacy, and poorer mental health. The researchers found that most online risks can lead to symptoms of PTSD and that coping behaviors were more related to the stress response to the exposure than to the symptoms of PTSD. They concluded that rather than focusing on preventing teens from using social media and getting exposed to online adverse content, we should help teens to develop more effective ways of coping with the associated risks, such as reporting perpetrators to the authorities and changing privacy filters.

The role of the pediatric nurse is critical in working with teens and their parents in encouraging responsible use of social media, while limiting some of the negative effects of exposure to harmful content. Strategies include setting limits so social media does not interfere with sleep, schoolwork, and other activities; parental monitoring and control of social media accounts; discouraging inappropriate behaviors including gossiping, spreading rumors, bullying, and making reputational damaging comments; encouraging face-to face over online interactions; and, encouraging conversations about what is shared online and how that makes one feel. Pediatric nurses need to be vigilant in assessing for depression and anxiety and the potential for a relationship to social media use.

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