Online trends are leaving children hospitalized. Where do physicians fit in?

The dangers posed by social media trends have sparked renewed attention among the healthcare community in recent months — but risky online challenges are nothing new. 

A decade ago, it was the "Cinnamon Challenge" that sparked a surge in calls to poison control centers and emergency room visits. In 2012, the challenge — which involves swallowing a spoonful of the spice without water — left some children and teens needing ventilator support for collapsed lungs. At the time, YouTube was the platform where the trend gained popularity, with a single video garnering more than 29 million views, according to The New York Times. 

Fast-forward to 2023 and dozens of children and young adults have been hospitalized for partaking in risky trends on TikTok and Instagram. The latest to make headlines was the "Flamethrower Challenge," which left a 16-year-old boy hospitalized in North Carolina with burns covering most of his body. 

This history goes to show there will always be a new viral trend on the horizon with potential implications for children's health and hospitals. Becker's spoke to four physicians about how clinicians can play a role in preventing patient harm from risky online trends.

"Involved parents and aware pediatricians can help set a framework for guidance about these issues, which is going to be a lot more important in the short- and long-term than trying to play whack-a-mole with every new online challenge that comes up," Nusheen Ameenuddin, MD, chair of the American Academy of Pediatrics council on communications and media, and assistant professor of pediatrics at Mayo Clinic Children's Center in Rochester, Minn., told Becker's

Beyond the medium 

Dr. Ameenuddin has been talking to patients' families about social media use for "well over a decade," and those conversations involve much more than blame or focus on the platform of the moment.

"It's rarely the medium that is the problem, but the way it's used, and it's important for pediatricians to understand and be able to effectively provide anticipatory guidance about what kids might be seeing and how to preemptively educate families about how to redirect impulsive behavior that could cause harm," she said. 

A key theme several physicians mentioned is the proactive nature of such discussions. They aren't waiting for the latest new risk to pop up to engage patients' parents and family members in these conversations. Rather, informative dialogue should happen more on a proactive and routine basis, physicians said. 

"It doesn't really matter what the platform is," because there will always be a new one that emerges, said Mike Patrick, MD, an emergency medicine physician at Nationwide Children's Hospital in Columbus, Ohio. "It's really more that we have to raise awareness about the dangers, and hopefully kids and parents will hear that and think twice before they do it."

These discussions should also happen, "even in the absence of signs that a child may be vulnerable to these 'health challenges,'" said Aakash Shah, MD, chief of addiction medicine at Edison, N.J.-based Hackensack Meridian Health. 

Social media as a tool 

While platforms like TikTok may contribute to dangerous challenges going viral, they can also be used as a tool by physicians and health systems to educate and combat misinformation — meeting kids where they're at most: through their phone screens. 

An April 27 webinar featuring several physician leaders from children's hospitals across the U.S. suggested that medical professionals using social media to extend important conversations beyond exam room walls can positively influence children's understanding of what they might come across. 

Dr. Patrick often uses his own social media to share important information in his own sphere. "I do think, to some degree, that we have a responsibility to be active on social media and to lend a voice to evidence and to advocate for kids' safety," he said. 

Before the internet's time, physicians stayed in touch and supported their community by visiting schools and other community centers. In many ways, today's version of that community presence means staying in tune with what's circulating on social media and having a presence, Dr. Patrick said. "In that space as professionals, it can be really an extension of our practice and professionalism."

Nationwide Children's Hospital has been actively educating residents on that practice, he said, underscoring that it doesn't need to be an additional time-consuming task for overburdened physicians. 

"Even if you only spend 10 minutes to a half an hour per day finding something good and sharing it to your feed at least the people in your state, in your sphere of influence, will see that helpful, evidence-based information," Dr. Patrick said. "It may not be a huge number of people, you can make the difference in a handful of people's lives. In the exam room, we make a difference one family at a time, and on social media you can certainly make a difference for a lot more people in a short period of time."

In addition to being able to reach patients, having a presence on social media is also the best way for physicians to keep "an ear on the ground," for any risks on the horizon, said Jonathan Miller, MD, medical director of value-based care and chief of primary care at Nemours Children's Health in Delaware Valley. 

"Social media platforms like TikTok can be like a double-edged sword. On one hand, they can be a great way to reach hard-to-reach audiences like teens to promote health. On the other hand, they can circulate a lot of misinformation. I believe that there should be some degree of fact-checking so that consumers of social media know what is legitimate and what is misinformation." 

TikTok has previously disclosed it is working to combat misinformation. Rather than homing in on the platform of the moment, physicians are maintaining focus on elevating their interactions with patients and their own social media use to have a positive effect wherever possible.

For  Dr. Shah, it all comes down to "how do we amplify what is healthy, and how do we minimize what is harmful." 

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