We are constantly bombarded with terrifying stories about the internet. Recently, Instagram was implicated in the suicide of a 14 year old girl—her father believes that her death was in part triggered by graphic images of self harm and suicide that she had viewed on the social media platform. 
One in three internet users are children, and one in four 8-11 year olds have a social media profile. 
Pro self harm sites, pro anorexia sites, and even the common practice of air brushing images have been causes of concern for the mental health of young people since the current generation of children were born. Even access to some regular news content (for example about celebrity suicide or terrorism) can provoke anxiety in young people. Particularly so for those who are more vulnerable, such as those on the autism spectrum or those who have developed maladaptive forms of coping due to abuse/other.
Games such as the Blue Whale Game and the Momo Challenge which were eventually revealed as hoaxes, have nevertheless caused widespread concern, and highlight the challenges/complexities that the internet presents. Add to this our concerns that the internet is a breeding ground for terrorist and sexual grooming, and it is no wonder that many parents are worried about their children’s use of devices.
In the setting of child and adolescent psychiatry, we often work with vulnerable young people where exposure to harmful internet content can, understandably, have an even more destructive effect. As recently as March 2019, the RCPsych advised psychiatrists for the first time to consider the impact of social media on all children that they assess.  For instance, when considering relentless bullying (something that was in the past seen mainly at school) remember that this now happens anywhere that a phone can travel. In fact, all difficult content that children may subscribe to is available to them throughout the day, every day, and can cause a degree of constant anxiety. We should also consider that children who are already subject to abuse may be susceptible to further grooming online.
For already vulnerable young people, something experienced online may be the last straw, tipping them into crisis. All clinicians assessing young people at risk, must ask themselves, “are we sending a child home to a safe place,” and this has become more than simply considering their immediate home environment.
Let’s remember that there are many amazing things about the internet, and being computer savvy is essential for all children as very few jobs do not involve a level of computer literacy. For people who are socially isolated—for example, those with autism spectrum disorder who find socialising difficult, those with agoraphobia, and those with physical health problems who may be limited in their time away from home—the internet can also be a revelation in terms of encouraging social engagement, educational development, and employment opportunities.
As clinicians we must start to adapt our practice to routinely ask questions and encourage open dialogue about internet use. As with most things, we need to remember that there are positives and negatives but ultimately we all need to adapt to the fact that the internet is a big part of most patients’ lives.
So, how can we advise parents on allowing their children to build resilience and develop tools for navigating both good and bad on the internet?
The NSPCC encourages parents to allow their children exposure to the internet in a developmentally appropriate way,allowing for some inevitable mistakes. For example, while most parents would not take their five year old to a nightclub, they probably would allow their 18 year old to go with some ground rules, and would expect their 30 year old to make sensible decisions for themselves. The internet is no different and needs to be used in an age appropriate way. Parents can ask themselves, is what the children are looking at online developmentally appropriate? By exposing children to what parents consider appropriate material, children can prepare for the next stage of their internet development. In the same way that an eight year old may be able to walk to the corner shop, they may be able to use the internet to do some homework research or watch cartoons. We would not, however, expect this child to travel 100 miles alone by train where they may encounter a host of strangers and be confronted with complex tasks, so we should not expect them to manage a social media account where they will encounter virtual events that may have similar impacts.
The charity Young Minds advises parents to stay well informed about the internet, model appropriate behaviour, and attempt open dialogue about what is going on online. 
Understandably, no clinician or parent can be expected to keep up to date with all internet developments, and we must accept that the child is often the expert. However, through mutual respect and collaboration with young people, we can hopefully help them to navigate these tricky waters.
Hollie Hearfield is a Child and Adolescent Mental Health Services (CAMHS) ST4 in Liverpool.
Competing interests: None declared
Jennie Collier is a Child and Adolescent Mental Health Services (CAMHS) ST4 in Liverpool.
Competing interests: None declared
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