It's All About the Children

Just as caring for newborns and infants is a specialty in itself, the same can be said about approaching children who are nearing their adolescent years (from 11 years onward).  And for those of you with children nearing that age range (or even those who have reached or surpassed it), I thought it might be helpful to give a little bit of insight as to how we approach what can be a very sensitive area of the Adolescent History and Physical...the psychosocial history.  Such importance is placed upon this part of the visit as so many causes of adolescent morbidity and mortality are preventable and early indicators of potential problems (e.g. suicide risk, drug and alcohol use, risky sexual behavior) may be found during the psychosocial history of the exam. 

So with thanks to Drs. Eric Cohen and John Goldenring in their original design of the Adolescent HEADSS Assessment (and from which modifications have been made over the years), I share with you how I approach this part of the adolescent visit:

After a general conversation with both the parent(s) and child, I ask for a period alone with the adolescent in order to create an environment and relationship built on trust and respect for the adolescent's privacy.  I then continue on with the HEADSS Assessment:

H - Home: This focuses on who lives at home and of any recent developments in the household (parental discordance, running away, etc).  It's a perfect opportunity for the adolescent to vent about his/her parents with the confidence in knowing it will not leave the room. 

E - Education/Employment: This obviously includes grades and which subjects are being enjoyed, how things are going with the teachers, and, of course, any bullying that may be going on.

E - Eating/Exercise: You've heard me rant and rave about the obesity epidemic in the U.S...so this is where I focus in on appropriate dietary habits and routine exercise.  But just as important, this is also where I concentrate on any potential eating disorders and body image concerns.

A - Activities: This includes sports, dance, music, video game/computer/TV time.  And it is also very important to get a sense of who else is involved in these activities...both the peers and family.

D - Drugs/Cigarettes/Alcohol: I am very careful with this one as it is very easy for an adolescent to just deny or say "no" to any questions here.  I really feel I have to gain the trust of the adolescent first or I won't get a straight reply.  I should also note it is very easy for comments to be made first about friends and what they are doing before answering anything about oneself.

S - Sexuality: Again, very important to have the trust of the adolescent first before asking questions here.  During this discussion, it also is crucial to ask about any history of being touched inappropriately...the sexual/physical abuse question.  I also enjoy having questions being thrown my way as I feel it is an indicator the adolescent takes this topic seriously.

S - Suicide/Depression/Mood Screen: It is during this time I try to get a sense of how the child is feeling and ensure there is someone he/she can talk to.  This is also where I explore any self-harm issues...the potential risk of suicide.

So for all the parents who have been asked (or will be asked) out of the room during their adolescent's physical exam, I hope this gives a bit of insight and understanding of what occurs as it serves as the best opportunity to assess your child's overall well-being and safety.

Dr. Jeremy