Special article Arch Argent Pediatr 2023;121(4):e202202674

Hyperconnected: children and adolescents on social

media. The TikTok phenomenon

Silvina B. Pedrouzoa , Laura Krynskia

ABSTRACT
Network communication digital platforms have revolutionized the way we communicate, get information,
and entertain ourselves; they have had a major impact on the new generations.
The pandemic has increased consumption patterns at all ages and its consequences: a sedentary
lifestyle, obesity, sleep, psychological, cognitive, memory/attention, and academic performance disorders,
problematic behaviors, and risks of cyberbullying.
The activity of the new generations on TikTok –a platform that allows them to create, view, share videos
and viral challenges– has affected their behavior. Their posts lead to likes, comments, and followers;
this stimulates the dopaminergic reward system, which is the basis of addictive behaviors. Pediatricians
should be aware of these behaviors in order to recommend good practices.
The objective of this narrative review, based on the bibliography from PubMed Central, SciELO, national
and international recommendations, is to provide information and an update to health care providers on
TikTok, its characteristics, and the recommendations for safe use.
Key words: social media; adolescent; behavior problem; addictive behavior.

doi: http://dx.doi.org/10.5546/aap.2022-02674.eng

To cite: Pedrouzo SB, Krynski L. Hyperconnected: children and adolescents on social media. The TikTok phenomenon. Arch Argent Pediatr
2023;121(4):e202202674.

a
Sociedad Argentina de Pediatría. City of Buenos Aires, Argentina.

Correspondece to Silvina B. Pedrouzo: [email protected]

Funding: None.

Conflict of interest: None.

Received: 4-4-2022
Accepted: 6-16-2022

2This is an open access article under the Creative Commons Attribution–Noncommercial–Noderivatives license 4.0 International.
Attribution - Allows reusers to copy and distribute the material in any medium or format so long as attribution is given to the
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 Special article / Arch Argent Pediatr 2023;121(4):e202202674

INTRODUCTION profile or digital footprint, with their images posted

From birth, human beings are part of a network online, and 25% of them start their footprint with
or group called society. Within this structure, the prenatal ultrasound image uploaded by their
humans communicate and share bonds; and parents.4
in these relationships with others, they become In times of the pandemic, digital tools and
nourished and develop. Socialization is in human social media have allowed us to maintain
nature: humans form networks, seek groups of communications, entertainment, education, and
belonging according to their emotions, needs, and work. This has definitely changed consumption
interests. patterns across all ages.5
In 1997, with the emergence of Six Degrees In turn, excessive screen use may have
–considered the world’s first social networking important side effects: digital sedentary leisure
site–, a transcendental change occurred in the or physical inactivity, overweight or obesity
way people related to each other. Through a (exposure to unhealthy food advertising), sleep
list of friends, Six Degrees made it possible to disturbances (due to the negative effects of
locate other members of the network, based on blue light on melatonin secretion), impairment of
the theory of the six degrees of separation, which cognition, memory, attention, and poor academic
affirms the possibility of connecting with any other performance in relation to sleep deprivation
person in the world in just six steps. and multitasking.6 In addition, cyberbullying and
Since their inception, network communication problematic behaviors may be facilitated.7 This
digital platforms (social networking services) have has a strong impact on daily tasks with a marked
revolutionized the way we communicate, relate, deterioration in the personal, family, social, and
get information, and entertain ourselves, from academic settings.
family ties to social and work relationships. Pediatricians play a privileged role in the
Although each platform has its characteristics, periodic contact with families, which represents a
all of them are based on the distribution great opportunity to intervene and prevent harmful
of information through contact networks and effects.
interaction through digital identities, where The activity of the new generations on TikTok
the user is at the center of the creation and –a platform that allows them to create, view, share
dissemination of content in different formats.¹ videos and viral challenges– has affected their
The emergence of Web 2.0 in 2004 introduced behavior. Their posts lead to likes, comments, and
the possibility of interacting, creating content followers; this stimulates the dopaminergic reward
and, above all, being part of virtual communities, system, which is the basis of addictive behaviors.
making the user an active member and the lead Pediatricians should be aware of these behaviors
character for the first time. This phenomenon had in order to recommend good practices.
an impact on the new generations, especially The objective of this narrative review is to
on the most recent ones, called Gen Z and provide information and an update to health care
Gen Alpha (purely digital natives).² providers on TikTok, its characteristics, and the
Digital natives can develop their technological recommendations for safe use among children,
competencies as well as their analog skills. For adolescents, and adult caregivers.
them, it is difficult to establish a boundary between The methodology consisted in searching the
the physical and virtual worlds. Children play PubMed Central and SciELO databases, national
online, whereas adolescents entertain themselves, and international recommendations, and the
express themselves, and interact in the virtual statistics of social media use and tendencies for
world. In this way, they define and reinforce the past 5 years. The search key words included
their identity, exchange information (personal tiktok, adolescents, social media, addictive
data, images, news, comments, preferences, behaviors, effects.
friendships, opinions, and sensitive data), and
leave an indelible digital footprint that outlines their SOCIAL MEDIA USE AT PRESENT:
reputation.³ A PARADIGM SHIFT
A survey conducted in several countries by According to the Digital Report 2022, there are
AVG Internet Security (2010) to 2000 mothers 4620 million social media users worldwide (58%
showed that the “digital birth” of babies occurs at of the population), which accounts for a growth
approximately 6 months of age; it found that 81% of more than 10% compared to the year before
of children under 2 years old have some kind of the pandemic. 8 Social media took up most of

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online time during 2021; on average 2 hours and The platform’s dynamics, its vertical swipe
27 minutes more per day than the previous year.8 navigation, is a curiosity trap and, then, tiktokers
Facebook is the most used social platform scroll down to find the successive but not
worldwide, followed by YouTube (growing twice automatic reproduction of short videos adjusted to
as fast as Facebook) and WhatsApp in the third their interests by AI.9,13 In this way, TikTok retains
place. They are followed by Instagram, WeChat, users, who interact actively and passively with
and TikTok (fifth with 1 billion users worldwide), an algorithmized version of themselves and in
45% more than in 2021.8 turn with other users, which makes it increasingly
TikTok is the international version of the attractive.
Douyin app created in 2016 in China and TikTok’s interface offers 2 options: the For You
launched for iOS and Android in 2017. After feed, with videos posted by strangers (selected by
Musical.ly merged with Douyin in 2018, TikTok AI according to the user’s activity), available for
is now available in more than 150 countries. 9 people older than 16 years, and the section with
According to Cocktail Marketing, 20% of users a feed of videos posted by followers.
are under 19 years, and mainly young people In turn, the AI contributes to marketing by
between 13 and 18 years are the most active continuously providing information according to
on this platform. 10 According to a forecast by the user’s interests.9
eMarketer and Insider Intelligence, during 2022, It is common for children and adolescents to
TikTok will position itself as the third social media set up their public profiles as older than 16 years
behind Facebook and Instagram.¹¹ (the account for minors is private by default) in
order to gain unrestricted access to all content on
THE TIKTOK PHENOMENON the platform.15 In this way, they may be exposed
The reasons for using this rapidly growing to inappropriate content and language and, in
app include entertainment, communication, and turn, display their privacy, which increases the risk
self-expression. It allows people to view, create, of cyberbullying.
and share videos about any topic with a short It is a common practice to share unverified
duration (from 15 seconds to 3 minutes), which or unedited content in order to get more
has recently been extended to 10 minutes. It also followers. 7 User may also expose themselves
allows designing viral challenges (dances, songs, to dangerous challenges, such as the “blackout
challenges, pranks), which are shared with other challenge” (holding their breath until they lose
users.8 consciousness), the “Benadryl challenge”
These posts generate a large number of (uploading a video under the effects of this
likes, comments, and followers that help users, antihistamine), or the “coronavirus challenge”
or tiktokers, feel valued and accepted.¹² For (licking a public toilet).
example, a 19-year-old Filipina girl lip-syncing to
a Jvke song surpassed 52 million likes. ARTIFICIAL INTELLIGENCE, MECHANISMS,
Such social recognition stimulates the EFFECTS, AND HIGH ADDICTIVE POWER
dopaminergic reward (pleasure) system, which TikTok delivers personalized content to users,
is the basis of addictive behaviors and is what retains them and thus provides feedback to
creates a strong incentive to repeat these its recommendation engine; this contributes to
actions.12,13 problematic behavior.18
As a distinctive feature of its development, The notion of addiction cannot be restricted
TikTok contents can be downloaded and/or only to chemical substances, since there are
shared throughout the digital ecosystem. behavioral habits that may generate dependence
Its artificial intelligence (AI) algorithm is and seriously interfere with people’s daily lives:
specially developed to be addictive because it these are called behavioral addictions.12,13
is able to obtain more information than other A study conducted in China in
apps in a very short time according to the user’s 3036 adolescents revealed that excessive TikTok
activity and thus effectively recommend content use may lead to memory impairment, increased
and personalize ads.14 The device permissions symptoms of depression, and anxiety. Among
required by TikTok include access to the camera, young people with problematic use, a poorer
microphone, Wi-Fi connection, contact list, and performance in remembering sequences of
user location, so it can obtain information from numbers and deficit in working memory were
multiple sources and apps. recorded.17

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Another longitudinal study examined the in addition to the fact that it is the social media of
effects of excessive time using social media choice for the youngest users.
among adolescents and sleep quality; and this in In the midst of these controversies, TikTok
relation to the moderating role played by parents updated its privacy and security policies regarding
in limiting Internet use 1 hour before bedtime the protection of minors in June 2021.9
and the presence of devices in the bedroom. • Children under 13 years of age cannot post or
These rules contributed to improving sleep comment on videos, and content is selected
quality, mainly among youth who did not show a for this age group.9
problematic social media use.8 • Default privacy setting for accounts of children
Another study verified the onset of motor or aged 13-15 years. Only their friends can
vocal tics after watching videos of influencers comment and they cannot duet with other
suffering from or mimicking Tourette syndrome. users. The duet feature is only enabled for
These are the so-called TikTok tics, which could public accounts and allows users to post their
be a warning sign about its use and its effects video side-by-side with a video from another
on behavior, increasingly common among young user.9
tiktokers. Many of the adolescents diagnosed with • TikTok also offers parental controls, which
tics during the pandemic had a history of anxiety can be activated from the child’s account or
or depression, and isolation could have acted as from the adult’s account with the family pairing
a triggering factor.18 feature.9
The choice of TikTok may be explained by These are the current rules, although the
the use and rewards theory, where users seek to problem lies in the fact that, generally, children
satisfy their needs: entertainment, interpersonal younger than 16 years open their accounts
relationships (surrogate companionship), personal providing false data, such as date of birth,
identity, and surveillance of the environment, in because there is no system in place to verify
reference to keeping updated and informed and them. In this way, they access the adult account
the “fear of missing out.”12,19 option without asking for their parents’ consent
The TikTok search engines have a great and without restrictions.15
filtering and compiling capacity based on the As a relevant fact, Common Sense Media
platform’s own objectives and those of the recommends this application for teenagers as of
brands that advertise on it.16 Such information 15 years old due to privacy concerns and to avoid
filtering causes what are known as filter bubbles, adult content.15
where users see only content of interest to them
and lose the power of choice or autonomy; the RECOMMENDATIONS FOR
information they receive increasingly captures SAFE TIKTOK USE
their attention, generates more dopaminergic Although these recommendations are based
stimulation and, consequently, prevents them on TikTok, they may be extended to other social
from discontinuing the app use.16 As a result, an media for the purpose of safe browsing.
echo chamber is produced, where only a filtered • Avoid social media use before the age of
fraction of content is replicated and different views 13 years (terms and conditions).9
are not represented. Therefore, interactions and • Accompany children and adolescents in the
viralizations occur only among users with the setting of privacy and security (user settings
same preferences.16 and secure passwords).20
In relation to inappropriate content, the TikTok • Limit access to images and information to
engine can recognize and analyze it, but lacks the users closest to children.20
ability to justify its analysis.16 So, filtering failures • Avoid disclosing sensitive data in posts and
occur and extreme content of hate speech, comments, especially those concerning racial,
racism, discrimination, and promotion of anorexia ethnicity, religious and/or political opinions,
may be displayed.16 health information, and sexuality. In Argentina,
Regarding the issues of data protection, Law no. 25326 for the Protection of Personal
privacy, security, and content moderation, the Data recognizes and guarantees these rights.20
scope of the algorithms of this platform is not • Educate children about their digital footprint
clear. This has aroused suspicions in some in social media, since it shapes their digital
countries –including India, Australia, and the identity and is public and permanent.20
United States– due to the way TikTok uses data, • Help children develop a critical opinion about

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the information received through this platform essential to establish agreements until they reach
due to the circulation of misleading advertising autonomy so as to prevent them from opening
and avoid exposure to inappropriate content hidden accounts, which implies greater risks.
and cyberbullying.20 We must recognize the potential benefits
• Provide support, education, and tools to of TikTok: it can be used for educational and
protect them from these risks. Recognizing teaching purposes to reach a large number of
these situations may help with reporting and users in a short time. In the midst of the pandemic,
blocking malicious users or asking for help for example, videos on hand washing or mask use
from an adult.20 went viral to mitigate the spread of COVID-19.
• Activate the platform’s parental controls. In Lastly, the UNICEF’s report The State of the
this way, parents and legal guardians may World’s Children 2017: Children in a Digital World
open an account on TikTok and link it with that includes recommendations to protect children and
of children through the family safety mode, states that we must provide them with high-quality
which offers multiple options (within the Digital access, protect their privacy and identity, prevent
Wellbeing feature).9 online harm, provide digital literacy, and put them
Options include the possibility of establishing at the center of digital policy.
a maximum of 2 hours of use per day. At the
end of this period, the system requests a code CONCLUSIONS
to be able to restart it. This code must only This update provides pediatricians with tools to
be known by the responsible adult to allow help children and adolescents safely use TikTok,
access. one of the most widely used social media, with
• Explore other options for setting up controls a high addictive power and which, despite its
from your mobile device, such as Google privacy and child protection policies, still requires
Family Link. Its features allow to monitor adult supervision.
activity, manage apps, set time limits, We can conclude that exposure to certain
lock your device, and know your location content on social media and its consequences are
(https://families.google.com/intl/es-419_ALL/ part of a high-impact phenomenon in the pediatric
familylink/). population that requires further research. n
• Promote a balance between sleeping hours,
physical activity, and social media use Acknowledgments
according to the guidelines proposed by the We would like to thank Ariel Melamud, M.D.,
World Health Organization on physical activity and Paula Otero, M.D., for reading the manuscript
and sedentary habits (WHO guidelines on and their valuable suggestions.
physical activity and sedentary behavior: at a
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