Measles Outbreaks In The Pacific

Fever, rash, cough and congestion. These are the hallmarks of measles. Before the beginning of the measles vaccination program in the 1960s, there were 3-4 million cases of measles annually in the United States, almost 40,000 people were hospitalized, over 1000 people developed permanent disability from measles encephalopathy, and almost 500 people died. Every year. Most of these cases happened in children.

Now with vaccination rates falling, we are again seeing outbreaks of measles. Right now, there are measles outbreaks occurring in the South Pacific. It’s estimated that only 30% of the population of Samoa, for instance, have been vaccinated against measles, and they are in the midst of a terrible outbreak right now. Other countries are sending medical supplies, doses of vaccine and health care personnel to help deal with this outbreak.

Samoa is a country with about 200,000 people. 3,149 cases of measles have been reported, 197 people are hospitalized and 42 have died. To give some idea of the magnitude of this outbreak, we can compare to the United States, which has a population of 327.2 million people. This size of an outbreak in the US would result in 5.2 million cases, 322,000 people hospitalized, and 68,712 deaths. Most of Samoa’s deaths have been in children under 4 years of age.

Think about that. Imagine a United States in which almost 70,000 infants, toddlers and preschoolers were killed within a month’s time. Bearing in mind that those deaths are preventable, this outbreak in Samoa is a heartbreaking tragedy.

The good news for the USA is that vaccine coverage overall is still above 90%. However, there are 11 states in which coverage is under 90% and there are pockets where vaccine coverage is much, much lower. Amish people reject most modern medical innovations (including vaccines). Many California communities have vaccine coverage rates at about 50%. This is much lower than what is required to prevent outbreaks of measles.

Measles is the most contagious illness we know. It is a serious illness and potentially fatal. The vaccine is safe, so safe that in 1.5 million people vaccinated in Finland from 1982-1992 no deaths or serious permanent adverse reactions were reported.

If you are not immune to measles and are exposed, you have a 90% chance of getting sick. This is in comparison to influenza, which has about a 50% transmission rate. Parents who choose not to vaccinate their children are making a choice to leave them unprotected against a serious, possibly fatal, horribly contagious illness that is still endemic in parts of the world.

No vaccine is perfectly effective, but the MMR vaccine is pretty close. It eradicated measles, mumps and rubella in Finland in the 1980s with a 12-year, 2-dose vaccination schedule.

Measles is still present in the world. The MMR vaccine is the most effective weapon we have against this illness. Please be sure to vaccinate your children.

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Picky Eaters: Some Suggestions

“What should I do about my child, he is SUCH a picky eater!”

I hear this a lot in the office.  Parents are struggling to find foods that their child will eat.  Parents cooking several meals every night, one for their child(ren) and one for themselves.

Thanksgiving is a good time to reiterate:  this is a mistake.  Don’t go there.  Just don’t.

When I have a parent struggling with a picky eater, it is exactly that.  A struggle.  A battle.  A fight for control.  The parent trying to control what their child eats.  And the child fighting to control ANYTHING he or she can.

My absolute best suggestion for this situation is to take the fight out of it.  Give the child choices from the time the child can communicate.  Let your child control SOMETHING.  Do you want the red bowl or the blue bowl?  How about the Mickey Mouse plate or the Cars plate?  Do you want to try eating at the table like a big boy or do you want to stay in the high chair?  Straw cup or sippy cup?

As your child gets bigger let them take more control.  Ask for help with meal planning.  Should Daddy put the corn on the grill or should we cook it on the stove?  Do you think green peas or green beans sound better tonight?  Especially if it’s a special dinner like Thanksgiving, simple tasks give children a role to play and something to brag about over dinner (“Mommy let me stir the soup into the green beans AND I got to put the onions on top!”)  Let them say how much of each item they want on their plate.  Not WHETHER they want it, but how much:  a little or a lot.

Taking your children to a farmer’s market in the summer and exploring all the really cool and unusual foods is a way to trigger interest in food as well.  Ever had muskmelon?  I tried it for the first time at forty-two.  My six-year-old loved it.  We found it at the farmer’s market and it was love at first sample 🙂  Now both my kids (17 and 12 now) are pretty adventurous although my senior is still not a big fan of green things, LOL!

What do you do if you have a bigger picky eater?  Suppose your child is twelve and still has only five or six foods on the approved list?  That’s a tough one.  One of the best suggestions I’ve ever read is to have your child take charge of one meal per week.  From meal planning (within limits) to making a list to shopping to cooking (with help), making one meal per week is a great way to expose children to new foods and encourage them to be more adventurous with food.

There are lots of recipe sites and apps out there but my favorite is allrecipes.com. It’s easy to pick an ingredient and search for options.  Sure it’s a lot of work to help a tween plan, shop for and cook an entire meal, but they have to learn this skill sometime!  After a few weeks I think Mom and Dad will enjoy a dinner “off” once a week, and your child will have a new skill they can be very proud of.

PS – I highly recommend the book French Kids Eat Everything and Jim and Charles Fay’s Love and Logic series of parenting books, which have many very helpful suggestions for curing picky eater syndrome.

QUESTION:  Can you add more suggestions for helping parents with their picky eaters?

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Screening Children For Cardiovascular Risk

I’m a family doctor. I take care of children. When I think of patients with high blood pressure, cholesterol and diabetes, I think of my ADULT patients, not my kids.

But there’s a good reason for screening children for cardiovascular risk. A new study published in Pediatrics showed up to 40% of children may have high blood pressure, high cholesterol, and even diabetes.

We’ve known for a long time that kids are having more and more problems with overweight and obesity. Poor food choices (and limited availability of fresh whole plant foods, in many cases), decreasing levels of physical activity and increasing time spent in front of computers both in school and at home have contributed to this trend.

Researchers went to Norwood, Ohio (very close to where I grew up, actually) and studied kids in middle school. With parental permission they checked height, weight, blood pressure, cholesterol and blood sugar. 42% of the children were overweight or obese, and 34% had blood sugar or cholesterol out of the normal range.

The American Academy of Pediatrics recommends screening children for blood pressure, blood sugar and cholesterol at age 9-11, and again at age 17-21. It is more urgent if children are overweight or obese, or if they have a family history of high cholesterol.

If you have children, make sure to model good habits for them. Don’t tell them to eat their veggies while you are eating pizza and wings. Don’t tell them to exercise while you sit on the couch. Make fitness a family affair by choosing activities all family members can enjoy. Some examples are hiking, cycling, swimming, martial arts, dance, sports, etc.

As your children are growing, ask their doctor whether they need to be screened for heart risk factors. Especially ask about screening if their doctor expresses concern about their weight. Also ask if there is a family history of high cholesterol or early heart attacks. “Early” means before age 55 in men and age 65 in women).

There is an epidemic of overweight and obesity happening in the US and around the world. We must be alert and start screening children for cardiovascular risk factors earlier than we might think.

QUESTION: Do you have kids? Have they had their cholesterol and blood sugar checked?

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Suicide Games And Social Media

If you have children, have you heard of the Momo challenge? This was a supposed series of social media posts targeting children and teens. The challenge asks children to perform an escalating series of dangerous actions ending by telling the child to hurt or kill themselves.

This is just the latest in a series of supposed “suicide games” making the rounds on social media. The Momo challenge itself turned out to be a hoax, but there definitely have been instances of kids and teens being challenged to do dangerous things (like eating Tide Pods) during social media suicide games.

We as adults see social media as a way to share information, keep up with what’s going on with our friends and families, raise awareness, argue about politics and engage in other activities. Sometimes these activities are very beneficial. Think of the ALS ice water challenge that raised awareness and funds for ALS research several years ago.

Our kids, however, are very vulnerable online. Even more than in person, children are susceptible to grooming by predators, bullying and other dangerous influences via social media.

It’s been said many times before but bears repeating. Our children need us to be vigilant in protecting them. They have a hard time knowing whether someone is trustworthy in the best of times. When you take away the body language clues, social media interactions are even harder for them to judge.

Kids are impulsive. Many times they don’t stop to think through the consequences of their actions. Couple that with kids’ natural risk-taking behavior and the anonymous nature of online interaction, and you make it very easy to coax a child or teen into doing something very dangerous.

If you allow your child or teen to have a smartphone or online access, make sure you supervise them. Privacy online should NOT exist when it comes to children. You are not their friend – you are there to protect them, whether they like it or not. You should have all their passwords and the right to inspect their accounts at any time, with no warning, or they are not online.

Many of our children do have access online while at school. Make sure to check with your child’s school to understand their security procedures. Children shouldn’t be able to access forbidden content while at school.

So-called suicide games are only one of the dangers our kids face online. If your child’s behavior changes or they act secretive, be suspicious and investigate their online accounts. Our kids need us to protect us online the way we protect them offline. You insist your child buckle up in the car and wear a helmet when riding their bike, right? You should be as vigilant to make sure they are safe when they are online.

QUESTION: What steps do you take to monitor your child’s online activity?

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Eating Out With Food Allergies

As someone who has multiple food allergies/intolerances, I know from personal experience that restaurants can be tricky.  When you have to avoid a number of common ingredients, eating out makes one anxious

Parents of children with food allergies are understandably more comfortable eating their meals at home.  When they control the ingredients they can be sure their kids are safe.  However, there are a number of strategies that can make eating out safer for both children and adults with food allergies.

There was a poster presented at the American College of Allergy, Asthma and Immunology annual meeting this week in Washington State.  Researchers at University Hospitals Rainbow Babies’ and Children’s Hospital explored strategies used to avoid allergic reactions in restaurants.

They found that those who had never had a reaction used more safety strategies than those who had had reactions.  Once a person had an allergic reaction, they tended to increase their use of safety strategies.  This makes sense, right?  Anyone who has had an allergic reaction is pretty motivated to avoid another one!

The allergens people reported included the most common ones like peanuts, tree nuts, dairy, wheat, eggs and soy.  85% of the participants were children, they were split evenly male-female, and most were white.

Safety strategies varied widely.  The most common strategies included

  • Talking to wait staff, manager and chef about allergies
  • Checking menus and ingredients on the restaurant website, if possible
  • Choosing restaurants that are allergy-friendly or have a low chance of contamination
  • Ordering meals with simple ingredients
  • Double checking with wait staff after food arrives

The researchers found that the more different strategies were used, the less likely reactions were.  They also advised that whenever eating out, those who have food allergies should always bring an EpiPen or similar treatment with them in case of a reaction.

I know from my own experience that eating out with food allergies can be tough.  However, if you or your family member has food allergies, you don’t have to give up restaurant foods.  Simple strategies can make eating at restaurants safer and more enjoyable!

QUESTION:  Do you or a family member have a food allergy?  What strategies do you use to make eating out safer?

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Back To School Health Concerns

It’s that time of year again!  Have you got kids going to school this fall?  Me too!  We’re shopping for school supplies and clothes and shoes just like everybody else.

Are your kids ready to go back?  There are a number of things you can do to set your kids up for success this school year!

Good Sleep

Did your kids get off their school sleep schedule this summer?  Don’t worry, if they did you should have plenty of time to get them back on-track before school starts.

Elementary school children need about 10 hours of sleep per night.  For instance, our kids’ bus came at 7:30 AM last year.  Since they got up between 6:30 and 7:00, that made our bedtime about 8:30 so that they were asleep by 9.

You will want to give plenty of time to adjust a child’s sleep schedule.  Move bedtime by no more than a half-hour per night, every few nights, to let your child adjust.  If they’ve become accustomed to sleeping in, start instituting a set wake-up time.  In the adjustment period if they seem tired let them take a short nap.

There are plenty of things to adjust to in the first few weeks of school.  Fatigue and sleepiness and battles over going to bed and waking up are things you just don’t need to deal with.

Doctor’s Visits

Are your kids playing sports this school year?  Summertime is a good time to get their sports physicals out of the way.  Don’t worry, the physical is good for a year and is covered by health insurance.  Make sure to bring along any medication administration forms (for asthma or other meds your child will need to take at school).

If your child will be heading into kindergarten or 7th grade, they will need vaccines prior to starting school.  You should have gotten paperwork from the school already if your child is affected.  Remember that although your rising 7th grader is required to have the DTaP, the meningitis and HPV vaccines are also recommended at this age.

I get a lot of questions about the HPV vaccine and dove a little deeper into that topic in this post.  Please discuss the vaccine recommendations with your child’s doctor in detail.

After the 7th grade shots, your child will be done with tetanus shots until after college (unless she hurts herself, gets bit by a dog, etc) but she will need a meningitis shot booster at age 16.  Other than annual flu shots those are all the shots your child will need.

Nutrition

My younger son participates in a summer day program every year that does not provide lunch.  We were a little concerned at the beginning that packing lunches would be a big hassle.  To our pleased surprise, it has been a very positive experience.

Our lunch planning guidelines have been that our child needs a sandwich (with deli meat and cheese) and a fruit, a vegetable, and a starch for his lunch.  We read labels and used a food scale to explore portions for the starch (often pretzels, corn chips or a granola bar).  Here’s a website with interesting school lunch ideas.

Now after several summers he makes his own lunches like a pro.  Even better, when we go to the market and our kids want to try a different food (like barbecue potato chips) we can look at ingredients and talk about what’s in there, portion sizes and how they’re manipulated, price versus value, and other good topics.  We’ve even gotten them to try some new vegetables!

From a health standpoint, heading back to school can be stressful from a health standpoint.  With a little planning your youngsters can transition into the school year happy and healthy.

QUESTION:  What back to school health concerns do you have that I didn’t discuss?  I can always talk about them next week, LOL!

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Teen Smoking And Alcohol Use Decreasing

When you talk to the teenagers in your life, do you feel like they don’t listen?  That your words go in one ear and out the other (or straight over their head altogether)? Don’t give up – there are positive signs that some kinds of substance use among our teens are on the decline.

FINALLY some good news about our teens!  There is evidence we are seeing teen smoking and alcohol use DECREASE in the USA!

There was a research article published last week in Pediatrics that found that high school seniors in 2014 were five times more likely to report they had never tried cigarettes or alcohol than they were in the mid-1970s.  Similar trends were seen for younger adolescents as well.

Why is this happening?  There are likely a lot of reasons.  First of all, it’s illegal for teens under 18 to buy or use tobacco products.  Granted, whether something is illegal isn’t a great deterrent for either teens or adults, but it does make it more difficult for teens to smoke cigarettes than it was in the 70s.

Same with alcohol.  Penalties for teenage drinking are increasing, as well as for parents who host parties where teens are drinking.

I’m seeing in my office that fewer and fewer teenagers report smoking cigarettes.  Even better, they will often tell me that cigarettes are “gross.”  I love hearing that!  Cigarettes ARE gross!  The social pressure to smoke cigarettes is definitely decreasing among teens.

The downside to this is that smoking hookah (tobacco in a water pipe) and vaping are hugely on the rise.  Both of these are also illegal to sell or provide to minors, but the social pressure seems to favor these behaviors over smoking cigarettes.

What really concerns me is the recent sharp increase in marijuana smoking.  More and more of my teenage patients tell me they smoke pot, and they often don’t see any problem with it.  It seems like high school social pressures have moved away from cigarettes and towards behaviors that seem safer but really aren’t.

Those of us who are parenting or have leadership roles with teens need to be aware of these trends and continue to work to educate our kids.  There is danger in ALL tobacco products, marijuana, alcohol, other recreational drugs, and electronic cigarettes.

QUESTION: Do you spend time with teens?  Would you agree that drinking and smoking are decreasing?

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Injury Deaths Rise For Kids And Teens

What is the leading cause of death for children and teens?

If you said accidents, you’re right.  Injury is the leading cause of death for children over 1 year of age.  This includes accidents, homicide and suicide.  A recent troubling report from the CDC states that injury deaths are now on the rise among our kids and teens.

It used to be that kids mostly died from infections.  Pneumonia, measles, polio, influenza, strep throat, the list goes on.  As we got better at preventing and treating these illnesses, injury deaths became the leading killer of kids and teenagers.

We’ve been doing better with injury prevention.  Better automobile safety measures like seat belts and air bags have helped tremendously.  Injury deaths fell by 35% between 1999 and 2013.

Then they started to trend up again.  Injury deaths rose by over 15% from 2013 to 2016 (the last year for which data is available).

Why is this on the rise again?  All injury causes of death rose, including accidents, suicides and homicides.  Suicides are typically underreported and may be mistaken for accidental poisonings (especially opiate overdoses).

From reading this report, I have 3 takeaway points.

MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES ARE CRITICAL

We have to help our kids cope with stress better.  I’ve written before about kids’ mental health issues.  Adolescence is hard no matter who you are or where you live, but some teens struggle more with it than others.

I’ve talked with more than one terrified parent desperate to protect their child and help them get and stay well.  I’ve wondered more than once if letting a teenager walk out of my office meant an unacceptable risk that I’d never see their face again except in an obituary photo.

It is critically important that we develop effective, easily accessed, and affordable mental health and substance abuse services that are designed for children and teenagers.  Our kids are killing themselves and each other, and we have to help them!

TEENAGE DRIVERS ARE A MENACE

My son is learning to drive right now, so I KNOW just how hair-raising it is to have an impulse-control-challenged video game player with a serious social media addiction behind the wheel!  (Just kidding, my son doesn’t do social media accounts.  Texting, yes.  Instagram or Snapchat, no.)

The death rate from motor vehicle accidents for teens 15-19 is almost 6 times that of kids 10-14.  In Ohio teens learning to drive must not only participate in extensive driver training but they must also spend 50 hours behind the wheel driving with their parent or guardian.

We very sadly had a traffic accident locally within the last few years where a teen driver had her car overloaded such that not every passenger had access to a seatbelt.  She was driving unsafely, lost control of the car and a teenage passenger was killed.  More laws would not have prevented this needless death, but it serves to illustrate that teens don’t always make the best decisions when it comes to behavior behind the wheel.

THOSE WHO OWN GUNS MUST KEEP THEM SECURE

Homicide and suicide by firearms are both on the rise.  Homicides of male children and teens increased by 25% from 2013 to 2016.  Homicides of female children and teens increased by a whopping 72%.  Suicides by firearms are overwhelmingly more common with boys, but rising in girls too.

Adults who own guns must keep them locked up and secure.  This is both a legal and moral responsibility and makes intuitive sense, but I think adults sometimes are as prone to impulse control problems and delusions of immortality as their teenage counterparts.

As a parent myself, and as a physician that cares for children and teens, the rise in injury deaths over the last few years is very concerning to me.  I will be keeping an eye on future reports and passing on recommendations to help keep my and your kids as safe as possible!

QUESTION:  Why do you think the injury deaths are on the rise for kids and teens over the last few years?

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Is It Love? Or Is It Limerence?

As the mother of a teenager, I think I speak for most parents when I say I worry about my child completely losing his head over a girl.  Whether your teen is male or female really isn’t relevant to this intensely visceral worry that keeps parents up at night.

Part of what steals parents’ peace of mind when their teen starts dating is that most of us have been there.  We’ve said and done things that make us cringe in thinking back, while praying desperately that our children will have more sense than we did.

A friend recently pointed me in the direction of an entirely new (to me) concept called limerence.  In reading about it, I immediately recognized elements of my teenaged patients’ first experiences with dating and, if I’m completely honest, with my own first dating experiences back when the dinosaurs roamed the Earth 😉

What is limerence?  The dictionary defines this word as “the state of being infatuated or obsessed with another person.”  Sounds like a crush, right?  There’s actually a bit more to it than that.

The concept of limerence was first explored by psychologist Dorothy Tennov in her book “Love And Limerence: The Experience Of Being In Love,” which was published in 1979.  She believed limerence was a disordered form of romantic love, closer to obsession.

Tennov’s limerence was characterized by

  • Idealization of the person – to the point that negative characteristics are minimized or not recognized at all.
  • Uncontrollable and intrusive thoughts about the person
  • Extreme shyness and awkwardness, nervousness and confusion around the person
  • Euphoria in response to real or imagined signs the person returns your feelings
  • Fantasizing about or searching for signs of reciprocation
  • Arranging one’s schedule to maximize encounters with the person
  • Being reminded of the person by everything around you
  • Fear of rejection and despair or thoughts of suicide if rejection occurs

Sounds very much like a teenage crush, right?  There’s actually something to that.  There is evidence that limerence, or infatuation if you like that word better, activates the same parts of the brain that addicts activate by using their drug of choice.  The intense euphoria and deep despair, the amount of time spent thinking about the person and the inability to think of anything else strikes a chord with those of us who treat addicts.  Substitute “heroin” for “Judy” and you would instantly recognize your lovesick teenage boy as an addict.

Limerence is much more likely to be seen in teenagers.  First of all, their brains aren’t done developing yet and they are much more susceptible to addictions of all sorts.  Smoking, alcohol, opiates and dating all light up the brain in similar ways, ways in which teenagers’ brains seem to be primed to behave.

If you’ve ever tried to tell a teenager they aren’t REALLY in love and the world won’t REALLY end if Judy doesn’t love him back, you know you might as well tell those things to the family dog for all the good it will do you.

It’s painful enough when one teen has a bad crush and the object of his crush doesn’t want anything to do with him.  What do you do when two teens experience the intensity of limerence for each other at the same time?

These times are when we earn our parenting badges.  Just like addicts, teens (and adults) in limerence are sneaky.  They lie to those who love them and take advantage of them.  Adults in limerence have extramarital affairs.  They do things that, were they in their right minds, they would never do.  Personalities change.  Formerly sensible people have sex in spite of knowing the risks and get pregnant and/or contract sexually transmitted diseases.  Good students ditch school or let their studies suffer.  Money that should be saved for college tuition or car insurance is spent impulsively on gifts and activities to impress the beloved person.

How do we keep our teens safe?  If your teen is dating and you notice a big change in behavior or personality, that should cause you to be very concerned.  Make sure you are talking to your teen about their activities and keep them appropriately chaperoned.

Remember my analogy about the lap bar on the roller coaster.  Everybody pushes the lap bar when they get into the seat on the roller coaster.  We are relieved when the restraint holds firm, NOT when it gives with a little pressure.  Our teens are the same way.  WE are their lap bar in the roller coaster of dating.  Expect them to push against us.  They will chafe against our restraint, but letting go, letting them get themselves in too deep, is not what they need from us.

Limerence, research has shown, does not last.  It generally does not deepen into an adult form of love that leads to happy marriages and families.  It is intense and overwhelming but does not stand the test of time and adversity.  Our teens need us to help them avoid making choices that will alter their life forever.

QUESTION:  Is this the first time you’ve heard of limerence?  Do you recognize the concept (if not the word) from your own adolescence or the experiences of friends and family?

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Social Media Makes Teen Girls Unhappy

There is a lot of controversy now about children’s access to electronic devices and, particularly, social media.  Many parents are understandably concerned about the effect social media may have on their kids.

Those of us adults who use Facebook, Twitter, Instagram and other social media know that people often choose to show only the happy, pretty, upbeat side of our lives.  Who wants to post about the fight you just had with your spouse, about the fact that you don’t like your daughter’s boyfriend, or the fear of losing your job that’s keeping you up at night?

Those whose only real exposure to others is through electronic media may not realize how inaccurate and misleading others’ social media profiles may be.

I know as a mom I worry that my teen is confining so much of his communication with peers to texting that he is not practicing valuable communication skills.  Gone are the days of teen girls spending hours holed up in their room chatting with friends on the phone.  Now they trade texts which are completely devoid of the tiny clues of tone of voice, facial expression, and uncomfortable pauses that can help interpret and layer meaning on spoken words.

Not to mention that it’s hard to create deep, long-lasting emotional relationships when all you can see is what another person purposely chooses to show.  It’s when things AREN’T pretty that you learn what someone is really like.  And tough times and real struggles build deep connections with others.

There was a study from the UK published recently that brought new focus to these pitfalls.  Researchers conducted a huge survey (almost 10,000 teens) which examined how much time the teens spent chatting on social media.  They also asked questions designed to evaluate the teens’ emotional and behavioral status and created a “happiness score.”

The researchers found that girls used social media more often than boys, although both genders’ use rose with age.  Also, use of social media in girls, particularly at a younger age, was associated with lower “happiness scores.  In boys it didn’t seem to have much if any effect.

Those of us who are parents of teens need to be careful to monitor our children’s use of social media.  Their happiness and well-being can be seriously impacted by spending too much time online, especially our daughters.

QUESTION: Do you have teens who use social media?  Do you notice it affecting their mood and well-being?

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