Behind the Screens-Social Media and Psychosocial Outcomes in Adolescents With Cleft Lip/Palate

Social media influences adolescent self-image and confidence, yet its impact on psychosocial outcomes in adolescents with cleft lip and/or palate remains poorly defined. This population may be particularly vulnerable given the importance of craniofacial features to self-perception during adolescence. Negative self-perceptions have been linked to psychosocial distress and interest in revisional surgery, whereas social media may also provide peer support and cleft-related information. This study examined social media use patterns and their association with psychosocial functioning in adolescents with cleft lip and/or palate.

A cross-sectional online survey adapted from the CLEFT-Q and Pediatric Quality of Life Inventory (PedsQL) was distributed via REDCap to adolescents aged 10-18 years with cleft lip and/or palate. A parallel survey assessed parental perceptions of their child's psychosocial functioning. Recruitment occurred at the Lancaster Cleft Palate Clinic between 2023 and 2025. The approximately 10-minute survey assessed demographics, social media use, and psychosocial outcomes across well-being, social functioning, school functioning, and self-perception domains using 5-point Likert scales.

Thirty-one adolescents completed the teen survey (mean [SD] age, 15.2 [2.1] years). Daily social media use was reported as <1 hour by 5/31 (16.1%), 1-3 hours by 14/31 (45.2%), 3-5 hours by 9/31 (29.0%), and ≥5 hours by 3/31 (9.7%). The most commonly used platforms were YouTube 24/31 (77.4%), TikTok 21/31 (67.7%), Snapchat 21/31 (67.7%), and Instagram 16/31 (51.6%). Palate surgery was reported by 29/31 (93.5%), and 17/31 (54.8%) had undergone combined lip, palate, and nasal surgery. Adolescents reporting ≥5 h/d of use demonstrated lower psychosocial functioning scores across domains, including teasing, appearance concerns, and happiness, although differences were not statistically significant. No significant differences were observed between adolescents reporting 1-3 versus 3-5 h/d of use. Surgical history and platform choice were not associated with psychosocial outcomes.

This pilot study provides preliminary descriptive insight into social media use and psychosocial functioning among adolescents with cleft lip and/or palate. Although no statistically significant associations were identified, consistent directional trends suggested lower psychosocial scores among adolescents reporting heavy social media use. These findings support cautious consideration of social media-based interventions and highlight the need for larger, adequately powered studies.