Table 3 Red Flags indicating a conversation about online activities may be particularly helpful

• Notable or changing patterns of device use

 Over-use, increase of notifications, device reliance, protectiveness of device, continually distracted by device (observed in session or concern reported by parent/carer)

• Secrecy over device and online activities (observed in session/ reported by parent/carer)

• Negative self-image

 Concern about appearance and body image, unfavourable comparison with others

• Signs of being isolated or withdrawn

 Withdrawing from friends/ family/ usual activities, spending more time alone

• Self-harm behaviours or suicidal thoughts

 Especially changing methods of harm

• Experience of bullying

• Sleep problems

 Changing pattern of sleep, excessive tiredness

• Disordered eating

• Sudden change in presentation, disturbance of mood or behaviour

 Including drug and alcohol use

• Signs of child sexual exploitation

 Including sexualised behaviours and past history of exploitation