By Susan Sugerman, MD, MPH | Contributor

Change is hard—and often confusing. The journey between childhood and adulthood might be the most monumental transformation any of us experience in our lives. The morphing of our body shape and size does not go unnoticed as we try to understand who we are and whether or not we are normal. In any generation, body image perception is heavily influenced by the prevailing culture. We blamed movies, magazines, music, radio, diet culture, etc. for our insecurities in the “way-back-when” days. But if you thought growing up in the (fill in the blank decade) was hard; can you imagine, in the new era of constant access to social media, what our kids are going through now?

Who am I? Am I normal? (a developmental perspective)

Children form their initial sense of self based on interaction with family. They hopefully find love and unconditional acceptance in their home environment. But much past 4^th grade, that won’t get you a friend group to sit with at lunch, let alone an invitation to homecoming. Even when grounded with strong family values, children look to the outside world to help understand and define themselves and cannot help but be influenced by the cultural factors that shape perceived norms.

Young children become aware of themselves in space and time during the toddler years, largely based on emerging understanding that they are separate beings from their parents and caregivers. By age 4, they assign value to physical appearance and make comparisons to others. Even before kindergarten, kids know that the good princess is always beautiful and the wicked stepmother is always ugly. 

Early adolescence is characterized by a shift in focus from family to peers as young teens look to the world around them to see where they fit in. They see that skinny girls and athletic boys hold the most popularity. Middle adolescence brings significant focus on peers, as teens attempt to separate from their families to try to find out who they are as individuals. Heavily influenced by perceived norms, they seek to create their identity in a way that makes them more “acceptable” to their friends. In a culture that prioritizes thinness and beauty, it is no surprise that we start to see disordered eating and eating disorders as teens have more ability to control when, where, and how they eat or exercise (often away from the watchful eye of parents). 

By later adolescence and young adulthood, most young people settle into more self-acceptance and typically return to their parents’ values (whether they like it or not!), becoming more confident in their sense of self and requiring less validation from the outside world. But damage to self-esteem may persist. They see that beautiful people get noticed more on campus; attractive job applicants get better jobs. 

We are only beginning to unpack the evolution of these trends on body image perception in the setting of ubiquitous access to hand-held devices.

Data from various studies document these effects. Even before social media captured the attention and the eyeballs of growing children everywhere:

• By the end of elementary school, we see development of body dissatisfaction and negative self-esteem in 40% of girls and 25% of boys. 
• In one study, 60% of fourth-graders said they would rather be dead than fat.
• By middle school, even prior to the rise of social media, 50% of girls are significantly unhappy with their appearance.
• In high school, 70% of normal weight girls have dieted. And they believe this is normal and perfectly fine.
• At least 80% of women over 18 are unhappy with what they see in the mirror.

So if that was then, what about now in the age of social media?

Kids are kids, from generation to generation, but the landscape they are growing up in is far more challenging. We are only beginning to unpack the effects of social media as a source of influence on body image and self-esteem. While any media can have harmful (or positive) impact, the pervasive, constant access to social media by teens sets them up for amplification of those effects and is borne out in a number of recent studies. 

Everyone (mostly)

A Pew Research Center survey of U.S. teens ages 13 to 17 conducted in late 2024 found that most teens use social media and have a smartphone. Nearly half say they’re online almost constantly. YouTube holds the top place in their survey, used by 90% of respondents, followed by TikTok and Instagram (about 60%), and Snapchat (55%). Facebook is used by 32% of teens, X (formerly Twitter) by 17% (notable declines compared to former surveys for both of these apps). Nearly one-quarter use What’sApp and 14% use Reddit. Almost all of them use the internet daily (96%). And despite most U.S. social media platforms requiring users to be at least 13 years old, about two-thirds (64%) of children ages 8 to 12 use YouTube and TikTok every day.

[Reference: Pew research study, https://www.pewresearch.org/internet/2024/12/12/teens-social-media-and-technology-2024/#:~:text=Nine%2Din%2Dten%20teens%20report,declined%20over%20the%20past%20decade]

Everywhere, all the time

These ubiquitous apps present a whole new way of interacting with media. It is everywhere and (mostly) unregulated, and insidiously curated to feed on our obsessions and insecurities. Even sophisticated adult consumers of information fall prey to these qualities. Imagine then how vulnerable a growing adolescent trying to understand their place in the world deals with media that 1) emphasizes visual appearance and social comparison while 2) being ever-present, almost entrapping, as it encourages scrolling from one algorithmically derived dopamine hit to the next, and 3) rewarding users with likes and comments, let alone the possibility of earning money for posting original content (often related to the appearance of the poster) (Choukas-Bradley et al., 2022).

In a world where people project their best (often doctored) selves, users get the message that beauty and perfection is not just desirable but a minimum standard.

Without quality controls

In a world where people project their best (often doctored) selves, users get the message that beauty and perfection is not just desirable but a minimum standard. The media literacy of their parents’ generation warned about photoshopped images; but the days of filters and artificial intelligence make it hard for even mature audiences to understand whether what they are seeing is real. Even warning kids about this doesn’t necessarily protect them from being influenced by what they see. 

Without limit

Unlike traditional media exposure, which may have been easier to “turn off” from time-to-time, social media bombards us in frequency with content that is immediate and engaging in its nature all the time. It amplifies experiences by feeding us more of the same content, reinforcing often dysfunctional perspectives. But unlike the “good-old-days,” when teens could take a break and walk away, it is far too easy to never leave, to come back to toxic content, and even to transition to new venues and behaviors that reinforce the same messages. With the touch of a screen, teens can “like” a post that guarantees similar content keeps coming or link to a site to head deeper down the rabbit hole. They are recruited by advertising that reinforces stereotypes and sells them on the idea that, while they are “less-than,” they could be so much better if only they purchased this celebrity’s supplement or subscribed to an influencer’s program. Even accidentally clicking in the wrong section of a small screen makes them vulnerable to new, potentially more harmful content.

With what results?

It is not surprising then that nearly half of American teens (46%) say social media makes them feel a little or a lot worse about their body, while only 14% say it makes them feel a little or a lot better (Bickham et al, 2022). Self-comparison to highly curated images from influencers can be damaging to body image, with particular effects noted on younger girls and those with a higher body mass index (BMI).  Beyond body image, researchers have concerns about the linkage of targeted advertising and sponsored content in social media posts impacting food choice preferences in younger children and teens. Nutritionally focused posts in the guise of “health” often translate into guides for disordered eating behaviors, and anecdotal evidence suggests promotions for dieting supplements and steroids may have notable negative influence on body image. Researchers studying female teen dancers in the US and Canada found that a three-day break from social media decreased body surveillance and shame while increasing self-esteem and self-compassion (Roberts et al., 2022). Yet another study of adolescents taking one-day breaks found limited benefits and potential decrease in wellbeing (Przybylski et al., 2021). Designing your own “digital detox” requires a bit of thought and collaboration to find the balance that works for your child and your family. But some basic concepts can get you on your way.

Now what?

We are only beginning to unpack the evolution of these trends on body image perception in the setting of ubiquitous access to hand-held devices. In the meantime, how do we protect our kids? In the same way we don’t give twelve-year-olds keys to the car or even take a sixteen-year-old to the DMV without driving lessons, we need a plan that is thoughtful, intentional, and not just passive helpless parenting by default. The obvious but impossible choice would be to turn it off and just take it all away. But that cat is out of the bag for young people all around the planet; it’s hard to imagine how we can wish it gone. Most likely, social media is something our children will have to learn to understand, let alone navigate, at some point or another in their lives.

In the end, social media has a ying and a yang. We learn, and even thrive, from meaningful social connections as we grow into adolescents and young adults. Positive interactions nurture our ability to become confident, self-sufficient adults. Negative ones, especially if we do not learn from them, can destroy us. Find ways to help your kids help themselves, starting offline in your own home!

Use your self-media as a weapon against the influence of the ever-present screen. 

• Arm yourself and your family by being mindful of what your kids are seeing generally and on social media specifically. Be ready to counter messages that reinforce negative stereotypes. If you don’t say something, chances are no one else is either.
• Promote body positivity in your own house by celebrating your own body and those of the people you love regardless of their shape and size. 
• Everyone deserves to feel comfortable in their own skin. Buy clothing that fits well and makes you (your child) feel good regardless of the size. Is it wrong to have three of the same t-shirt in different colors if we feel like we rock it? 
• Teach your family how to eat well, from all food groups, in appropriate portions, by doing it yourself when they can see you. Avoid shaming the cookie (but teach that we don’t need the whole package at one time).
• Celebrate the beauty in people around you by expressing positive comments when you see someone out in the world looking amazing, especially based on their attitude and energy, not just their body shape or size.

We learn, and even thrive, from meaningful social connections as we grow into adolescents and young adults. Positive interactions nurture our ability to become confident, self-sufficient adults. Negative ones, especially if we do not learn from them, can destroy us.

Some additional resources:

Family Media Use Plan

Check the following link from the American Academy of Pediatrics to create your own interactive Family Media Use Plan.  www.HealthyChildren.org/MediaUsePlan. https://www.healthychildren.org/English/fmp/Pages/MediaPlan.aspx

• Set limits
• Address what type of and how much media are used and what media behaviors are appropriate for each child or teenager, and for parents. Place consistent limits on hours per day of media use as well as types of media used.
• Promote that children and adolescents get the recommended amount of daily physical activity (1 hour) and adequate sleep (8–12 hours, depending on age).
• Recommend that children not sleep with devices in their bedrooms, including TVs, computers, and smartphones. Avoid exposure to devices or screens for 1 hour before bedtime.
• Discourage entertainment media while doing homework.
• Designate media-free times together (e.g., family dinner) and media-free locations (e.g., bedrooms) in homes. Promote activities that are likely to facilitate development and health, including positive parenting activities, such as reading, teaching, talking, and playing together.
• Communicate guidelines to other caregivers, such as babysitters or grandparents, so that media rules are followed consistently.

• Have ongoing communication with children about online citizenship and safety, including treating others with respect online and offline, avoiding cyberbullying and sexting, being wary of online solicitation, and avoiding communications that can compromise personal privacy and safety.
• Actively develop a network of trusted adults (e.g., aunts, uncles, coaches, etc.) who can engage with children through social media and to whom children can turn when they encounter challenges.
• Engage in selecting and co-viewing media with your child, through which your child can use media to learn and be creative, and share these experiences with your family and your community.

5 M’s of Digital Wellness — Model, Mentor, Monitor, Mastery, and Meaning 

Model: Set a Good Example

Set a good example of what healthy and responsible technology and digital media use looks like by being mindful of your own habits and consistently modeling the positive behaviors you want your child to follow.

• Create device-free zones: Putting devices away at mealtimes and in bedrooms fosters healthier habits and stronger family connections, encouraging face-to-face interactions, ensuring better sleep, and promoting mindfulness for everyone in the family. 
• Promote respectful communication: Speak with kindness and respect online. Avoid posting content that may have embarrassing, hurtful, or harmful consequences for others now or in the future. And check the accuracy of information before re-sharing. 
• Be mindful of sharing: Take caution when sharing information about yourself and your family online. Ask yourself why you’re sharing it and what you hope to gain from the exposure. Ask others, including your children, for permission to post about them on social media. If they ask for posts or images about them to be removed, respect their wishes.

Mentor: Advise and Guide

Teach your child to use technology and digital media in a healthy, purposeful, and responsible way by creating space for open and non-judgmental conversations about what they see and do — and who they interact with —  online.

• Introduce early digital awareness: Even if your child is too young for cell phones and social media, start talking about privacy, respect for self and others, and safety online. Share how you make decisions and choose to engage in the digital sphere and what makes you feel good and, on the flip side, bad, online.
• Promote safe media use: Work with your child to use their favorite digital media safely. Have them show you how to set up privacy settings, how to block or report someone, and how to recognize the difference between what is real and what is mis- or disinformation.
• Maintain open communication: Create an ongoing dialogue with your child about online activities. Don’t wait until they are “in trouble” to have conversations about what they see and do online. You can share something about your experiences and ask about theirs. 
• Recognize online threats: Discuss how to identify “tricky people” online and what to do if they are being contacted by someone with bad intentions. These could include people who may ask them to keep a secret that could be harmful to them or others, request private or personal details, share uncomfortable comments, ask them to lie, or threaten them.
• Identify trusted adults: Talk about who in your family’s circle is a trusted adult who your child can turn to for help or guidance, especially when they are uncomfortable speaking to their parent or guardian.

Monitor: Create Agreements & Enforce Consistently

To establish healthy boundaries and make it easier to help your child manage their technology and digital media use, work with them to develop “shared media use agreements” that optimally support your child’s success at every age and stage. Customizing your approach to fit your child’s unique needs and motivations (whether it’s gold stars, post-it notes, a contract, or praise and encouragement) will lead to the best outcomes — healthy and balanced media use for your child, and less frustration and worry for you.

• Require login access: For minors, make giving you login access a condition for setting up social media and gaming accounts. Discuss what you will use that access for and even log in together regularly.
• Set expectations together: Involve your child in setting expectations, boundaries, and rules for family media and technology use. Make clear that you are the decision-maker but their input is valued, even if the decisions don’t always go their way.
• Update and enforce agreements regularly: Create “agreements” and engage with your child to update them when their circumstances change, such as when your child grows older and demonstrates greater proficiency with healthy media use. Also adjust when school gives way to summer break, when they lack the structure provided by school, homework, and other activities. Observe behaviors and enforce agreements consistently.
• Connect on social media: “Friend” your child on their interactive media accounts. This allows you to see what they are posting but it also allows them to see what you are posting online, enabling you to indirectly model positive, healthy behaviors.
• Seek professional help: If you believe your child is experiencing challenges related to their digital media use, take action by consulting with your pediatrician or a mental health professional. 

Mastery: Empower Agency and Independence

To enable your child to achieve agency and independence, prioritize helping them to take control of their technology and digital media use, rather than instituting mandates or bans. And assist them in learning how to recover from mistakes by not judging, catastrophizing, or shaming.

• Understand their preferences: Discuss with your child how they prefer to spend their free time and what they want to get out of their time spent online. Support their planning for how they will spend their time online and off.
• Create safety strategies: Develop a game plan together about what your child will do when they see or experience unsafe or concerning behaviors and content online. Consider what types of content they may encounter, how they will identify it, and what they can do when/if they see these types of content.
• Emphasize privacy protection: Talk about why it’s important to protect individual privacy and data online, and how your child can protect their own personal information when creating online accounts and engaging with digital platforms and apps.
• Build executive functioning skills: Support your child in developing their executive functioning skills — planning ahead, self-regulation and self-control, and ability to focus. Help them to practice these skills when they are offline and when they are engaging online.

Meaning: Encourage Authentic, Intentional, Balanced Use

Interactive media is an integral part of all of our daily lives, including kids. So, instead of thinking about your child’s screen use in terms of time limits, strict rules, or bans, we recommend encouraging your child to use technology and digital media in an authentic, intentional, and balanced way.

• Encourage Educational Content: Guide your child towards using screens for educational purposes, such as learning apps, documentaries, and educational games that promote critical thinking and creativity.
• Promote Active Use: Encourage activities that require interaction and creativity, like coding, digital art, or video creation, rather than passive consumption of content.
• Foster Social Connections: Encourage your child to use screens to maintain and build relationships through video calls, online study groups, and collaborative projects, rather than just for solitary activities.
• Balance Screen Time with Physical Activity: Integrate screen use with physical activities, such as using fitness apps, online dance classes, or interactive games that require movement.

ABOUT THE AUTHOR Susan Sugerman, MD, MPH, FAAP

Dr. Susan Sugerman is the president and co-founder of Girls to Women Health and Wellness, a multidisciplinary medical practice in north Dallas dedicated to the physical and emotional needs of girls and young women ages 10-25. She is a graduate of Stanford University, Baylor College of Medicine and the University of Texas School of Public Health in Houston. She did her residency training in Pediatrics in Cincinnati, Ohio, and a Robert Wood Johnson Fellowship in Health Services Research at UCLA with an emphasis on confidentiality and access to care for adolescent and young adult women.

She is Board Certified in Pediatrics and is a Fellow of the American Academy of Pediatrics. She holds memberships in the Society for Adolescent Medicine and the North American Society of Pediatric and Adolescent Gynecology.

Dr. Sugerman speaks to parent and professional audiences on subjects such as parenting, adolescent development, dating safety, sexuality, nutrition and body image, bullying, and preparing for college.

“Being able to have someone with whom to communicate comfortably and accurately about sensitive subjects is crucial to successfully navigating through adolescence,” says Dr. Sugerman.