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Pediatrics

Adolescent medicine

Part of every adolescent visit happens without the parent, with the limits of confidentiality stated before the questions start. The psychosocial history is the examination.

HEEADSSS

The psychosocial interview, in the order that builds trust: easy domains first.

  1. HHomeWho lives at home? How do you get along? Is there somewhere you feel safe?
  2. EEducation and employmentWhat is school like? Grades changing? Bullying? Working?
  3. EEatingHow do you feel about your body? Any changes in what or how you eat? Dieting, skipping meals, purging?
  4. AActivitiesWhat do you do for fun? Friends, sport, screens, sleep?
  5. DDrugsDo any of your friends use alcohol, cannabis, vaping, other drugs? Do you?
  6. SSexualityAre you in a relationship? Have you been sexually active? Contraception, protection, consent?
  7. SSuicide and depressionHow is your mood? Sleep? Have you had thoughts of hurting yourself or that life is not worth living?
  8. SSafetyDo you feel safe at home, at school, online? Seatbelts, helmets, weapons, violence?

Confidentiality, in principle

  • Introduce the private part of the visit as routine for everyone this age, at the start, with the parent present, so nobody is singled out
  • State the limits before the questions: what is shared stays confidential unless there is a risk of serious harm to the adolescent or to others, or where the law requires disclosure
  • Assess capacity to consent to the specific decision; the mature minor concept means capacity, not a birthday, in much of Canada, and the details are jurisdictional
  • Document what was discussed and what was agreed; involve the adolescent in decisions about what to share with the parent and how
  • Return the parent to the room for the plan; adolescents usually want their parents involved once they control what is said

Educational framing after the Canadian Paediatric Society; the law on consent and confidentiality is jurisdictional and is checked locally.

Transition to adult care

  • Start early (around 12 to 14) and make the adolescent the primary historian: they will be the one telling their story in adult clinics
  • Teach the condition, the medications, the reasons, and how to refill, book and ask; a written summary they own helps
  • Name the adult team, arrange a joint or handover visit, and check it happened; the years around transfer are the risky ones for chronic disease
  • Address the adolescent tasks alongside the disease: school, work, relationships, mental health, substances, and independence

The confidential interview

A 15-year-old, a parent present

Moment 1 of 3

A 15-year-old with three months of tiredness, headaches and weight loss. Her mother has brought her and is answering the questions.

How do you set up the interview?

Adolescent cases

Thirsty for weeks, vomiting since this morning12 years old · A 12-year-old has been drinking litres, wetting the bed again, and losing weight. Today he cannot keep water down and is breathing strangely.Collapsed during the 400 metres15 years old · A 15-year-old runner collapsed mid-race and came round within a minute. Her coach says she 'just fainted'. She has fainted once before, in a swimming pool.