Quarantined families, who are off of regular schedules and missing outlets like sports, may find it challenging to ensure children are on healthy diets and getting enough physical activity.

One popular tool among adults and teens to track fitness, eating habits, sleep and even menstrual cycles is health apps –  but should tweens be using them?

Most parents of tweens in a new national poll say they have serious concerns about how health apps may impact children ages 8-12, especially surrounding privacy and self-body image issues.

But many also see potential benefits to their child's health, according to the C.S. Mott Children's Hospital National Poll on Children's Health at Michigan Medicine.

"Most health apps target adults and teens, but we are starting to see a few that are designed for the tween age group," says Susan Woolford, M.D. ,M.P.H., a child obesity expert and pediatrician at Michigan Medicine C.S. Mott Children's Hospital.

"As with any new tool, parents should be cautious about letting their children use apps, even those that promote healthy choices, particularly for younger kids. Before tweens use health apps, parents should research them to see if they have been tested and whether they are age-appropriate."

Health apps include games that teach about health, as well as devices that track health data, such as the amount of calories consumed or burned, exercise intensity and other habits. Many apps allow users to set goals and give feedback on progress, as well as motivational messages or tips to improve health behaviors.

Woolford recommends parents weigh several factors before allowing tweens to use health apps:

Consider the app's impact on body image.

Three fourths of parents polled worried that having children track calories and what they eat could lead them to become overly concerned about food and weight. And research shows that eating disorders can begin before age 12.

Parents should make sure that apps aren't promoting unrealistic goals, especially tied to having an "ideal" body type, Woolford says.

"Body image issues often emerge during tween years," she says. "It's important for efforts to improve fitness and nutrition to focus on health and physiologic benefits rather than emphasizing weight loss or appearance."

Consistent with many conventional pediatric weight management programs, Woolford says that when working with children ages 7-11, she doesn't recommend letting patients track their own weight and calorie intake. Even for older children ages 12-17, it's safer to focus on the ways in which lifestyle changes benefit their overall health, such as the impact on cholesterol, blood pressure and blood sugar."

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"Clinically, we use evidence-based approaches to keep the focus on health and not pounds lost or how you look," Woolford says. "We should equally consider the research behind strategies incorporated into health apps being used by tweens."

Before tweens begin using a health app that tracks food or calorie intake, parents should also encourage their child to talk about why they're interested in tracking their food or calorie intake, and have conversations about healthy ways to use this information.

"Parents should reinforce the idea that everyone grows at their own rate, and that being healthy does not mean the same weight or body shape for everyone," Woolford says.

Read the fine print on privacy and advertising.

Despite laws designed to protect children's privacy online, research has also shown that many apps contain advertising and collect and share personal information without verifying the age of the user or gaining parent consent.

Two in three parents polled worried that their tween might be targeted by ads. Since many apps are designed for teens or young adults, advertising – including content targeting older ages involving alcohol, sexual activity or other inappropriate content – a top concern was that this could reach younger children.

Parents should read the fine print on privacy policies when helping their tween choose a health app, and use settings that restrict data sharing.

"Parents should take steps to prevent apps from marketing products or services to kids within the app or collecting or selling personal health information," Woolford says. "If there's no opt-out option, that's a red flag."

Test-run the app – and then use it together.

Nearly half of parents polled have used a health app themselves, but only 1 in 20 say their tween is using health apps.

Parents who are considering letting their tween use one should test out apps themselves first to get the best sense of the approaches it uses.

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"If it's making parents anxious or overly consumed with weight, for example, they should definitely be concerned about how it might impact their tweens," Woolford says.

But if parents find an app or device they like, it's age appropriate and based on evidence-based research, they may then consider using it alongside their children, Woolford says. Tracking steps together or trying new family fitness activities, for example, may be a fun way to encourage family walks or getting outside.

"It's usually best if parents and tweens are involved in new healthy habits together rather than it just being focused on the child," Woolford says.

If you do use apps with tweens, make them supplemental tools.

Parents may consider talking to their child's health care provider about using health apps and should continue addressing health issues even during the pandemic when virtual care is an option. Providers can also help tweens set realistic health goals and emphasize the importance of a varied diet and regular exercise.

"It's important to see health apps as an adjunct to clinical care," Woolford says. "It doesn't replace the doctor and other steps we should take to keep tweens and teens healthy."

"Just like with any other media, we have to be sure the content apps are offering is appropriate for the child," she adds. "They should only be used when a number of other concerns, such as privacy, ad exposure and potential impact on body image have been considered and addressed."