Understand | diagnose | change

Whether you are looking to learn more about paediatric musculoskeletal problems, or are involved in the care of children, then PMM and PMM-Nursing will help you change your clinical practice for the better.

Adolescent Issues

  • All health care professionals who see young people should take a developmentally appropriate psychosocial history as well as enquiry about generic health and disease specific issues. Health professionals often find it difficult discussing risk taking behaviours and sexual health with young people and specific training is advised.
  • Ideally the questions are asked when the young person is comfortable to answer frankly and openly - this often means without their parent / carer. The young persons’ right to confidentiality is important and they may need assurance. Questions should be open-ended and aimed at building rapport with the young person. 
  • The aim of HEADSS is to identify any issues that might need to be explored to ensure safe treatment and positive outcomes in terms of the young person’s health and well-being.  There are many other support agencies in the community that the young person can be signposted to for example sexual health or for support with drugs / alcohol or low mood. Ensure that there are leaflets available to give to the young person about outside agencies or websites.
HEADSS with examples of questions to ask
Issues to be explored 
Who lives at home with them? List all parents / siblings and additional household members.
If parents are separated then ask about any formal or informal custody arrangements. Ask about step-parents or siblings.
Parents may have separated / divorced / died / left the home. It is important to identify who is supporting the young person through diagnosis and treatment.
Education and employment
What year at school are they in?
Do they like school? (Favourite subjects / worst subjects)
What is their school attendance?
Future education/career/job plans?  Any current employment?
School attendance or poor school attendance may be an indicator of problems within the young person’s life or could be an indicator of poor disease control.
Plans for employment need discussion as some young people with chronic illness are excluded from certain careers e.g., armed forces and JIA.
What do they enjoy doing out of school?
Any hobbies / formal activities?
If they just “hang out” - who are they with and where do they go?
It is important to explore peer relationships and activities that may support positive mental health.
Are they safe? Think about cyber safety and bullying.
Smoking/alcohol/other drugs?
Ask about all medicines including complementary and over the counter medicines.
Many young people experiment with drugs and alcohol.
It is important to establish if this is a regular or an occasional activity.  Try to identify what they drink or what drugs they take and frequency.
This question can also include prescribed medications for treatment, contraceptive pill or others.
Are they involved in a relationship?
Are they using a form of contraception?
Ask girls about menarche and menstrual cycle (and last menstrual period) 
Do not assume that all young people are heterosexual.
Do they know about teratogen risk with some medicines e.g., methotrexate?
Discuss contraception with both boys and girls.
If they are in a relationship establish age of partner and how they met. Seek advice from designated health professional for safeguarding if there are concerns.
Suicide risk 
(mental health) 
Safeguarding Safety 
Social media 
Something Else
Is there anything else that is worrying the young person?
Do they have trouble with sleep / appetite/ eating behaviour?
Have they ever self-harmed?
Who can they talk to if they have worries?
Teenagers may feel anxious / depressed or have difficulty falling asleep.
Enquiring about eating habits may lead to identified disordered eating habits.