"Is my kid ready for a smartphone?"

“Mom/Dad, can I have a smartphone?” Children are posing this question to their parents at earlier and earlier ages. If parents wait until they are asked to consider how they will monitor technology and their children, they are already behind.

Children today know only a digital world, and technology is a part of that world from their earliest memories. With the advent of products such as LeapPad, children are beginning their electronic journey as early as age 1 year. Nintendo, iPads, and other electronic smart devices are not far behind. However, this is often far from the case for many parents in pediatric practices.

Because parents often do not have a long-standing personal history with smart devices, parent and child often experience this development at the same time-often spearheaded by the child. Parents may be at a much lower developmental level than their children related to technology. As a result, parents do not have an innate sense regarding the risks, where their children might get into trouble, or what risks they need to look for as they experience the digital world with their kids. Adolescents report that many of their own online activities are unmonitored.¹

“Mom/Dad, can I have a smartphone?” should be one of the anticipatory guidance topics for parents starting at age 5 years in order to generate a discussion surrounding technology, parenting, and monitoring. Whether pediatricians agree or not, children are getting phones, tablets, and other state-of-the-art technology at younger ages. Parents often fail to consider that this technology is often a small but powerful handheld computer. There are no right or wrong answers, but the pediatrician needs knowledge and education in order to have productive conversations with both parents and patients.

Smart devices often provide unfiltered access to the Internet as well as access to nearly any subject matter or thousands of applications. Often parents who have installed significant monitoring and protection of home computers have no idea what children can access on a handheld smart device. There are, however, a number of topics that pediatricians can discuss with parents to help keep children safe and still allow them age-appropriate freedom and responsibility.

Parents influence both online and offline behaviors

Luckily for parents and pediatricians, a developmental approach similar to “childproofing” the home is appropriate. In the early years, simple barriers in the form of filters and limited access are probably enough. As kids get older, supervision is the best way to prevent children and adolescents from accessing inappropriate or potentially harmful content on the Internet. Technology can help, but not replace, this essential parental responsibility.

Parents have a powerful influence on their children. In areas such as alcohol consumption, sex, and tobacco use, parental monitoring is an effective mechanism for preventing poor decisions by teenagers.^2-6 Additionally, clearly communicating expectations is important because adolescents who know their parents disapprove of specific behaviors are less likely to choose those behaviors.⁷

These concepts can be applied to a child’s online world as well. Children are less likely to get in trouble or display risky behavior online when parents:

• Actively monitor where children are going online.

• Actively monitor whom their children are interacting with online.

• Set clear expectations of acceptable online behaviors.

• Regularly check in to see that expectations are being met.

However, parents will never be able to monitor children and technology 24/7. A combination of proactive interaction with children and leveraging technology is likely the best approach.

When are kids ready?

There are currently no standards or recommendations for when children are ready to enter the digital world. Very little research has been done to see how digital information and technology impact children of different ages. Although common questions from parents include “What is the best time/age to allow my child to begin online activity?” and “How much time can my child spend online?”, few evidenced-based answers exist. Some practical questions to guide a conversation with parents may include:

• Does the parent believe his or her child is currently responsible enough?

• Can the child be trusted to follow rules such as not texting during class?

• Do parents want children to be able to directly reach the parent for specific emergency or social situations?

• Is the child able to understand parental limits similar to those that might be placed for television viewing or video game playing?

• Does the child understand acceptable content and behaviors when using smart devices?

• Does the child know with whom it’s appropriate to communicate and with whom it is not?

Because evidence-based answers to these questions do not currently exist, common sense dictates that younger children need more supervision than older children, and monitoring gets more difficult as children get older.

Online activities with offline networks affect behavior

Although parents often believe they need to monitor online activities to help protect their children from predators or exposure to objectionable content, a child’s health is influenced by the online activities of his or her offline social groups. These associations are an important reason for pediatricians to discuss online topics with parents.

Just as parents may have been given a first cigarette or drink by a friend, a child’s online social networking activities impact face-to-face behaviors and risk taking. Peers increasingly impact children’s behavior as they enter adolescence, and social networking sites and online communities can powerfully impact adolescents through modeling and peer norming. Exposure to a friend’s photos of risky behaviors such as smoking or drinking is associated with increased risk of adolescents participating in those same behaviors.^8,9

Have a family discussion about technology

Parents often have dual fears about smartphones and similar technology. Commonly, parents justify the decision as one of safety. In a world where parents see all sorts of school shootings and other risks, smart technology provides open communication and the ability to reach out to the parent or call 911 if needed. On the other hand, the same technology puts children at risk for overuse, contact by strangers, and exposure to content and messages parents may believe are inappropriate.

Parents have a great opportunity to collaborate with their children related to smart technology, and each parent will need to decide how long a rope they want to extend to their child. Most adolescents consider smart devices their personal property and do not want parents being intrusive. However, parents may tell their adolescent that this technology is a privilege and that, just as they monitor other aspects of their child’s life, the parents are going to ensure their son or daughter is utilizing smart technology responsibly. This may include periodically looking at texts, e-mails, photos, and other aspects of the child’s online life. I encourage parents to lay groundwork for use of smart technology and set limits very early on so that this does not become a battle in adolescence, but just a routine part of child/parent monitoring.

Limits and a clear understanding of the consequences are especially important. What happens if a child goes over time or data limits? What Internet sites are acceptable? Are the parents going to block certain numbers or sites? Designating acceptable and unacceptable times (eg, not after 10 pm) and behaviors (eg, not during dinner; no devices in bedroom at night; always answer calls/texts from parents immediately) are all part of the discussion that should take place between parent and child.

Trust, but verify. -Ronald Reagan

Pediatricians’ advice to parents is that they need to trust their children, but nearly all children lie to their parents at some point. Parents need to make sure their children are safe and take a proactive monitoring stance.

Ultimately, the decision to tell children whether they are being monitored or not is up to the parents. Not telling children could be potentially detrimental to the parent/child relationship, and being honest about monitoring has some benefits.

When parents choose to lurk and then intervene, children and adolescents are often left with a “gotcha” feeling. This may lead to anger, resentment, and the child deciding to hide things from his or her parents. Being honest, on the other hand, will likely drive behaviors parents desire because the child knows they are watching.

Specific behaviors parents can implement

Whereas vendors and experts promote specific monitoring applications through software and services along with anecdotal evidence of their utility, empirical results through randomized controlled trials or other studies are much less common. Asking children what they are doing on the Internet and having discussions about online activities are effective for promoting safe and responsible Internet use. Additionally, keeping Internet-enabled devices out of children’s bedrooms is another tactic that decreases the risk of undesirable online behaviors.¹⁰

Other proactive parenting techniques may include:

• Consider a non–smartphone. Believe it or not, parents can get phones without cameras and Internet connections, or turn off these features in hand-me-down phones. Although children may complain, this can be an easier transition into technology, especially if the parents’ reason for the phone surrounds safety.

• Watch the phone bill. Some mobile providers provide itemized lists of numbers called and texted. Parents can look to see with whom their child is communicating and ask questions about unfamiliar numbers. Additionally, nearly all Internet and cell-phone providers allow some degree of parental control and monitoring that can be instituted at an account level. Tell parents to contact their Internet/cell-phone provider’s customer service representative for details.

• Control access. If a child or adolescent must ask a parent before downloading an application or service, the parent is in much greater control of their child’s experience. Parents can look up games and sites to see if they think the content is appropriate or if it places their child at risk. In order to accomplish this, parents will need to control passwords to accounts and not use passwords easily guessed by their child.

• Tell children they must “friend” their parent on social networks. In this manner, parents can monitor what their kids and their friends are doing. Additionally, parents can make rules around these accounts. For example, some parents tell children that the parent must know the passwords for these accounts and there are consequences (eg, losing computer privileges) for changing them without parental notification.

• Set alerts. If some of the previous strategies are too intrusive for parents, setting alerts for things such as data use or app downloads can give parents an idea of what their children are doing online.

Consider parental control apps for all devices

Parental control applications allow parents to monitor, limit, or block access, and track what their child is doing with their mobile device. Although parents can monitor significantly with the previously mentioned steps, parental control applications provide assistance in appropriate use of “smart” technology. These applications often make monitoring easier by bringing lots of information into 1 dashboard, but they also are associated with some sort of cost. Parents can easily monitor their child’s use to reward good decisions and step in when their child does something risky or views content that parents believe is inappropriate.

Generally, these applications are installed on the smart device or computer. They provide parents with remote monitoring features through an application or dashboard (Table). Different applications provide different features and have varied costs.

All the services have some reporting component and often allow real-time, historical, or online monitoring. Some services include:

• eBlaster;

• Lookout;

• My Mobile Watchdog;

• Net Nanny;

• TeenSafe; and

• WebWatcher.

Role of the pediatrician

Pediatricians are in a unique position to educate parents and patients about technology and online behaviors. Teaching parents how to develop proactive monitoring plans that encourage parent/child interaction as well as providing parents with strategies to keep children safe online are just part of how pediatricians can help patients and parents navigate an increasingly complex digital world.

REFERENCES

1. Reich SM, Subrahmanyam K, Espinoza G. Friending, IMing, and hanging out face-to-face: overlap in adolescents' online and offline social networks. Dev Psychol. 2012;48(2):356-368.

2. Li X, Feigelman S, Stanton B. Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents. J Adolesc Health. 2000;27(1):43-48.

3. Choquet M, Hassler C, Morin D, Falissard B, Chau N. Perceived parenting styles and tobacco, alcohol and cannabis use among French adolescents: gender and family structure differentials. Alcohol Alcohol. 2008;43(1):73-80.

4. Markham CM, Lormand D, Gloppen KM, et al. Connectedness as a predictor of sexual and reproductive health outcomes for youth. J Adolesc Health. 2010;46(3 suppl):S23-S41.

5. Cota-Robles S, Gamble W. Parent-adolescent processes and reduced risk for delinquency. The effect of gender for Mexican American adolescents. Youth Society. 2006;37(4):375-392.

6. Brendgen M, Vitaro R, Tremblay RE, Lavoie F. Reactive and proactive aggression: predictions to physical violence in different contexts and moderating effects of parental monitoring and caregiving behavior. J Abnorm Child Psychol. 2001;29(4):293-304.

7. Guilamo-Ramos V, Jaccard J, Dittus P. Parental Monitoring of Adolescents: Current Perspectives for Researchers and Practitioners. New York: Columbia University Press; 2013.

8. Huang GC, Soto D, Fujimoto K, Valente TW. The interplay of friendship networks and social networking sites: longitudinal analysis of selection and influence effects on adolescent smoking and alcohol use. Am J Public Health. 2014;104(8):e51-e59.

9. Huang GC, Unger JB, Soto D, et al. Peer influences: the impact of online and offline friendship networks on adolescent smoking and alcohol use. J Adolesc Health. 2014;54(5):508-514.

10. Law DM, Shapka JD, Olson BF. To control or not to control? Parenting behaviours and adolescent online aggression. Comput Hum Behav. 2010;26(6):1651-1656. 

Dr Bass is chief medical information officer and associate professor of medicine and pediatrics, Louisiana State University Health Science Center–Shreveport. The author has nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.