Pediatric Institutions' Instagram Response to the 2025 Acetaminophen-Autism Controversy

ABSTRACT Objective: To describe the timing, frequency, and accessibility of Instagram posts from pediatric health institutions during the 2025 acetaminophen-autism controversy. Methods: Cross-sectional audit of public Instagram accounts of 62 pediatric health institutions from September 22 to November 15, 2025. The a priori sampling frame comprised the top 50 US children's hospitals for pediatric behavioral health, the top 10 Honor Roll children's hospitals (US News and World Report), 5 national medical societies, and health departments of the 10 states with the largest pediatric populations. Posts were extracted with a web-scraping tool and manually verified. Two reviewers independently coded relevant posts for prespecified content and accessibility features. Readability was assessed with two validated measures. Results: Twelve of 62 institutions (19%) posted relevant content. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists posted on day 0, while hospital time to first post ranged from 3 to 51 days. No state health department posted. Nonresponding institutions remained active: 1 hospital published 108 unrelated posts. The 26 relevant posts had a mean Flesch-Kincaid Grade Level of 11.4 and SMOG Index of 10.2. Among coded features, 88% included resource links, 73% directed audiences to a health care provider, 46% featured a named clinician, 42% discussed risks and benefits, and none were multilingual. Conclusions: Most sampled institutions published no relevant content during an active health controversy despite remaining active. Readability of relevant posts exceeded recommended targets, and none were multilingual. These gaps in institutional communication infrastructure could be addressed.