Pediatricians should start asking children, teens and their parents about internet use to look for any mental health problems that could be related to use of social media like Facebook, an influential U.S. medical group says.

Monday's issue of the journal Pediatrics includes a clinical report on "Facebook depression" and other pitfalls of heavy use of social media.

Researchers disagree on whether Facebook depression is an extension of clinical symptoms of depression some kids feel in other circumstances, or a distinct condition.

There are unique aspects of Facebook that can make it a particularly tough social landscape to navigate for kids already dealing with poor self-esteem, said Dr. Gwenn O'Keeffe, a Boston-area pediatrician and lead author of new American Academy of Pediatrics social media guidelines.

Tips for parents

  • Tweens are likely to be using more instant messaging and texting, while teens use those technologies and also networking sites such as Facebook. Ask daily how your family used those tools with questions such as: "What did you write on Facebook today?"
  • Share a bit about your daily social media use to encourage daily conversation. 
  • Keep the computer in a public part of your home, such as the family room or kitchen, so that you can check on what your kids are doing online and how much time they are spending there.
  • For all ages, emphasize that everything sent over the internet or a cell phone can be shared with the entire world, so it is important they use good judgment in sending messages and pictures and set privacy settings on social media sites appropriately.
  • Have a policy requiring that you and your child "friend" each other. This is one way of showing your child you are there, too, and will provide a check and balance system by having an adult within arm’s reach of their profile. This is important for kids of all ages, including teens.
  • Set time limits for internet and cell phone use. Learn the warning signs of trouble: skipping activities, meals and homework for social media; weight loss or gain; a drop in grades.
  • Check chat logs, emails, files and social networking profiles for inappropriate content and images periodically. Be transparent and let your kids know what you are doing.
  • Stress the importance of not texting, Facebooking, calling, listening to ear buds, or engaging in similarly distracting activities while driving.
  • Parents should be encouraged to ask their children, in a developmentally appropriate manner, what they know about sexting.
  • Text messages should never contain pictures of kids, teens or adults with their clothes off or kissing or touching each other in a manner that makes the child feel uncomfortable.

Sources: American Academy of Pediatrics, Canadian Paediatric Society

"The intensity of the online world is thought to be a factor that may trigger depression in some adolescents," the study's authors wrote.

The introduction of social media means parents need to supervise their kids' use of the technology though they may not know much about it themselves, O'Keeffe said. 

Outside a high school in Halifax , some students checked their Facebook accounts on their cellphones.

Student Leana Minera said she doesn't worry about the impact of social media, but admits it can be hard on some people.

"There's always mean people right so you never know what someone's going to say," Minera said.

Healthy use of social media

For Dr. Bruce Ballon, a a psychiatrist with the Centre for Addiction and Mental Health in Toronto, who specializes in problem gaming and internet use, labels like Facebook depression are simplistic and dangerous.

"If someone's on Facebook but it's become so powerful to them that it will affect their mood, we would say it's problematic," Ballon said.

How someone interacts with the tool, and factors like whether they are predisposed to depression or just faced a break up in a relationship, are also important, Ballon noted.

Parents can protect their kids by paying attention, noticing where and how often they're accessing sites, and how long they're spending online, Ballon said. He suggested families have a plan and standards for using social media, and that parents act as role models.

Like any technology that is potentially harmful, it is up to parents to set guidelines to reduce the risk, Ballon said.

The study's authors suggested parents and pediatricians be aware of Facebook depression, cyberbullying, sexting and other online risks.

Online harassment "can cause profound psychosocial outcomes," the researchers said, including suicide. The suicide of a 15-year-old Massachusetts girl last year received wide publicity. She'd been bullied and harassed, in person and on Facebook.

Some experts point out that Facebook and virtual worlds also have value.

Dr. Megan Moreno, a University of Wisconsin adolescent medicine specialist who has studied online social networking among college students, said using Facebook can even enhance feelings of social connectedness among well-adjusted kids.

With files from CBC's Pauline Dakin and The Associated Press