Recent news stories have brought attention to the Tide pod challenge. Teenagers are ingesting laundry pods, which can cause severe burns to the mouth, respiratory tract, or esophagus, vomiting, diarrhea, and seizure, and can lead to death.1 In 2017, more than 10,500 calls to US poison control centers were made due to ingestion of laundry pods in children younger than 5 years of age. In the first month of 2018, there were 86 cases of adolescents ingesting a pod, a significant increase from the 53 reported cases among adolescents in 2017.

The Tide pod challenge is not unique to social media influences affecting teenagers. Social media, online videos, and the Internet are a major influence on this generation. Platforms such as chat rooms, blogging web sites (ie, BlogSpot), video sites (ie, YouTube), social networking sites (ie, Facebook, Twitter, Google+), and picture sites (ie, Snap chat, Instagram) have changed communication by allowing an interactive sharing of information.3 Social media can be very useful to explore trends, but it can also lead to copycats without moral concerns and social warnings.4 This presents numerous challenges for parents, including the norm of social media being a part of their teen’s life. It allows for communication between friends, but it can also lead to cyberbullying and at-risk behaviors such as selfies and sexting, as well as learning and repeating the numerous Internet “challenges.”5 A primary concern with suicide or self-harm videos is that they may normalize and reinforce self-injurious behaviors or cause disinhibition.6 

An Internet challenge is a cultural phenomenon defined as “Internet users recording themselves taking a challenge and then distributing the resulting video through social media sites, often inspiring or daring others to repeat the challenge.”3 Due to these online influences and seeking attention by “liking” a behavior with global encouragement, there are no boundaries or limits to whom you can reach. Many challenges are from prior years, but with the immortalization of the Internet, these challenges tend to resurface with each season and varied cohorts of teens. Acceptance in school and within peer groups is paramount, regardless of the choices or risk of injury, and the acceptance and attempt of the challenge can have grave consequences. 

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There is actually scientific reasoning within the developing teenage brain that causes the teen to accept and perform these challenges. The teen brain is programmed to seek out new and pleasurable experiences that help the brain learn, but they have not yet developed the tools to make rational decisions or choices.4 Dopamine, the pleasure-seeking hormone, is increased during adolescence. This causes adolescents to seek acceptance as a pleasurable experience to feel good. Rewards can include money, food, sex, and within an Internet-influenced environment may include sharing of the video or posting, known as “retweets,” “followers,” and “likes.”7

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A 2011 American Academy of Pediatrics statement relevant to social media encouraged all pediatric primary care providers to “increase their knowledge of digital technology to have a more educated frame of reference of the tools their patients and families are using and providing timely and relevant anticipatory media guidance as well as diagnosing media-related issues should they arise.”8 Accurate history taking and complete physical assessments are routine in our everyday care of patients. But what happens when the providers are not abreast of current “challenges” that can mimic other diagnosis? Primary care providers must identify correct diagnosis and treatments plans for these patients. This article will describe some of the current online “challenges” and risks identified for clinical practice.