---

title: "Adolescent Health"

Adolescent Health

Comprehensive guide to adolescent medicine including psychosocial assessment, developmental considerations, and common presentations.

Approach to Adolescents

Developmental Considerations

Adolescence stages:

Principles of Adolescent Care

1. Confidentiality: Explain limits clearly at start
2. Respect autonomy: Include them in decisions
3. Non-judgemental approach: Avoid lecturing
4. See alone: Part of consultation without parents
5. Explain process: What you're doing and why
6. Be honest: About what you can and can't keep confidential

Limits of Confidentiality

Must break confidentiality for:

• Risk to self (active suicidal intent)
• Risk to others
• Child abuse disclosure
• Reportable conditions

---

HEADSS Assessment

Home

• Who lives at home? Family structure
• Relationships with family members
• Recent changes (separation, new partners, moves)
• Where do you feel safe?
• Any conflict at home?

Education/Employment

• What school/year level?
• Favourite subjects? Subjects struggling with?
• Plans for the future?
• Part-time job?
• Any problems at school? Bullying?
• Absenteeism?

Activities

• What do you do for fun?
• Sports, hobbies, creative activities?
• Friends - how many, how close?
• Screen time - social media, gaming?
• Exercise frequency?

Drugs

• Have friends tried cigarettes, vaping, alcohol, drugs?
• Have you tried any? (normalise: "many young people experiment")
• What have you tried? How often?
• Any problems related to use?
• Driving after drinking?

Sexuality

• Are you in a relationship?
• Have you ever been in a relationship? Been sexual with anyone?
• Attracted to boys, girls, both, unsure?
• Any concerns about your body or gender?
• (If sexually active): Contraception? STI prevention?
• Ever felt pressured or unsafe?

Suicide/Depression/Safety

• How's your mood been lately?
• Ever felt so down that you thought life wasn't worth living?
• Ever hurt yourself on purpose?
• Ever thought about suicide? Made a plan?
• Do you feel safe at home? At school? Online?
• Has anyone ever hurt you or touched you inappropriately?

---

Eating Disorders in Adolescents

Warning Signs

• Weight loss or failure to gain weight during growth
• Preoccupation with food, calories, weight
• Excessive exercise
• Avoiding meals, eating alone
• Food restriction, food rules
• Purging behaviours (bathroom after meals, laxatives)
• Body image distortion

SCOFF Screening

One point for each "yes":

1. Do you make yourself Sick because you feel uncomfortably full?
2. Do you worry you've lost Control over how much you eat?
3. Have you recently lost more than One stone (6 kg) in 3 months?
4. Do you believe yourself to be Fat when others say you're thin?
5. Would you say Food dominates your life?

Score ≥2: High likelihood of eating disorder

Medical Complications

Management Principles

1. Medical stabilisation first
2. Family-Based Treatment (FBT) - first-line for adolescents
3. Nutritional rehabilitation
4. Psychological support
5. Monitor for refeeding syndrome

---

Substance Use in Adolescents

Patterns of Use

Common Substances

Alcohol: Most commonly used. Binge drinking pattern common.

Cannabis: Second most common. Associated with psychosis risk, amotivation.

Vaping/Nicotine: Rapidly increasing. Gateway concern. Lung injury risk (EVALI).

Other: Inhalants, pharmaceuticals, MDMA, stimulants.

Brief Intervention

ASSIST-Linked Brief Intervention:

1. Provide feedback on screening score
2. Discuss personal risks
3. Explore readiness to change
4. Advise on reducing harm
5. Provide resources
6. Arrange follow-up

---

Sexual Health

Confidentiality and Consent

• Adolescents can consent to sexual health services
• Confidential - parents do not need to be informed
• Exceptions: abuse, safety concerns, very young age

Contraception Options

STI Screening

Who to screen:

• Sexually active adolescents
• New partner in last 12 months
• Multiple partners
• Partner with STI
• Symptoms

What to test:

• Urine NAAT for chlamydia and gonorrhoea (first-void)
• Throat and rectal swabs if relevant exposures
• Blood for syphilis, HIV, Hepatitis B (serology)

---

Mental Health in Adolescents

Prevalence

• 1 in 7 adolescents experience mental health disorder
• 50% of adult mental illness starts by age 14
• Depression and anxiety most common
• Self-harm increasingly prevalent

Depression in Adolescents

Presentation differs from adults:

• Irritability more common than sadness
• Somatic complaints
• Academic decline
• Social withdrawal
• Behavioural problems

Assessment:

• Screen with PHQ-A or similar
• Full HEADSS assessment
• Risk assessment (self-harm, suicide)
• Consider substance use
• Rule out medical causes

Management:

Anxiety Disorders

Common presentations:

• Social anxiety (fear of judgement)
• Generalised anxiety (worry about everything)
• Panic disorder
• School refusal

Management:

• CBT (exposure-based)
• Relaxation techniques
• SSRIs for moderate-severe

Self-Harm

Non-suicidal self-injury (NSSI):

• Cutting, burning, hitting, scratching
• Usually for emotional regulation
• Different from suicide attempt but a risk factor

Assessment:

• Non-judgemental approach
• Understand function (emotion regulation, communication)
• Assess suicide risk
• Safety planning
• Address underlying issues

---

Acne

Pathophysiology

1. Increased sebum production (androgens)
2. Follicular hyperkeratinisation
3. Cutibacterium acnes colonisation
4. Inflammation

Severity Classification

Management

---

Chronic Fatigue

Approach to Fatigue in Adolescents

Organic causes to exclude:

• Anaemia
• Thyroid dysfunction
• Infectious mononucleosis
• Diabetes
• Coeliac disease
• Inflammatory conditions

Lifestyle factors:

• Sleep (quantity, quality, schedule)
• Screen time and sleep hygiene
• Physical activity
• Diet and hydration

Psychosocial factors:

• Depression, anxiety
• School stress
• Social difficulties
• Family issues

Chronic Fatigue Syndrome (CFS/ME)

Criteria:

• Fatigue >6 months
• Post-exertional malaise
• Unrefreshing sleep
• Cognitive difficulties or orthostatic intolerance
• Significant functional impairment

Management:

• Education and validation
• Pacing (activity management)
• Sleep hygiene
• Gradual activity increase
• Psychological support
• Avoid complete rest

---

Sports Medicine Considerations

Pre-Participation Screening

Key questions:

• History of cardiac symptoms with exercise
• Family history of sudden cardiac death <50 years
• Previous musculoskeletal injuries
• History of concussion
• Menstrual history (females)

Relative Energy Deficiency in Sport (RED-S)

• Previously "Female Athlete Triad"
• Affects both sexes
• Low energy availability → hormonal disruption → bone stress injuries

Components:

• Low energy availability (inadequate intake for exercise)
• Menstrual dysfunction (females)
• Low bone density

Concussion

Recognition (SCAT5):

• Symptoms: Headache, dizziness, confusion, visual disturbance
• Signs: Disorientation, vacant look, balance problems
• Memory: Amnesia for event

Management:

1. Remove from play immediately
2. Medical assessment
3. Physical and cognitive rest (24-48 hours minimum)
4. Graduated return to learn, then return to sport
5. Medical clearance required before full contact

---

Obesity in Adolescents

Assessment

BMI percentile for age:

• Overweight: 85th-94th percentile
• Obese: ≥95th percentile

Investigations:

• Fasting glucose, HbA1c
• Lipid profile
• LFTs (NAFLD screening)
• Consider: thyroid function, insulin

Comorbidities to Screen

• Type 2 diabetes mellitus
• Dyslipidaemia
• Hypertension
• Obstructive sleep apnoea
• NAFLD
• PCOS (females)
• Depression

Management Approach

1. Family involvement essential
2. Dietary changes (not restrictive dieting)
3. Physical activity (aim for 60 min/day)
4. Reduce sedentary behaviour
5. Psychological support
6. Consider specialist referral for severe obesity

---

Sources

• RCH Clinical Practice Guidelines (adolescent health, eating disorders)
• Local adolescent medicine teaching