Confidentiality. In order to allow the young person to feel comfortable in sharing information with you, it is helpful to remind them that any information they share with you will remain confidential (unless you have significant concerns for their own, or other people’s, safety in which case you will share the relevant information with only the necessary people). For more information about confidentiality, consent and consultation style, see Chapter 3 – Communication.

  Home. Where do they live? Who do they live with? How are things at home? Do they have any difficult relationships with people at home?

  Education. Are they still at school or at a college or working? What school/college do they go to or where do they work? Do they enjoy it? How are they finding the school work/exams/working environment? Who are their friends? Are they being bullied?

  Activities. What do they do when they are not at school or work? Are they part of a gang? Do they attend any youth groups or organisations?

  Drugs, smoking and alcohol. This can be a difficult one to ask about. You may find it helpful to ask about their friends first: ‘some people your age will drink alcohol, is that something that your friends do? Then after they have answered this, you can go on to ask if they also consume alcohol. You need to find out exactly what, how much and how frequently they consume drugs, alcohol or cigarettes. If you don’t know the slang name for a street drug, clarify with them what they mean but avoid using slang yourself if they are not. With alcohol, you can also ask if they feel that their drinking ever gets out of control or they think that they drink too much.

  Diet. Ask about eating habits and if they have any concerns about their weight or the way that their body looks?

  Sex. Do they have a boyfriend or girlfriend? Are they having sex? Are they using contraception and practising safe sex? Do they have any problems or worries about anything relating to sex? See the Sexual health section below for more details.

  Mental health. How are they feeling? Low mood? Anxious? How are they sleeping? Any suicidal thoughts or attempts at taking their own life? See the Mental health section below for more details.

 Top Tip

In most circumstances it is inappropriate to ask a young person about their sexual health or substance use in front of their parents. This can be extremely embarrassing for them, is very unlikely to yield any honest answers and may undermine their trust in you. Always allow time for a young person to see you on their own and bring up these topics at this stage. Reminding them that the consultation is confidential and that you will not share any information with anyone without asking the young person’s permission can be very helpful in encouraging them to talk to you.

---

Mental health problems

Much of the specialist management for children and young people with mental health problems is delivered or supervised by the Child and Adolescent Mental Health team. However, it is important for all doctors working with children and young people to know how to manage acute mental health problems and their accompanying medical signs and symptoms.

A useful website for young people and their parents about mental health issues is Young Minds (www.youngminds.org.uk).

Deliberate self-harm and suicide

Deliberate self-harm is common and frequently dealt with in the emergency department. Suicidal intent is not the only reason for self-harm, although a small proportion of those who self-harm will go on to commit suicide.

Self-harm is frequently an impulsive act that may follow an argument or upsetting situation. It can be a cry for help, a physical way of relieving emotional distress, a way to ‘get back at’ other people or a suicide attempt. All self-harm must be taken seriously as, even if the child does not appear at risk of suicide, it is an indication of severe emotional distress.

When caring for a child who is presenting following self-harm or attempted suicide:

 Top Tip

Many young people who self-harm will do so repeatedly and this can be frustrating for healthcare professionals who may see them on a number of different occasions under similar circumstances. However, impatience or exasperation from healthcare professionals is very unhelpful and can add to the distress of a young person who may be feeling similarly frustrated with themselves and out of control. Be aware of your own feelings and make a conscious decision never to make assumptions and to always treat them with sensitivity and respect, no matter how stressed or busy you are or how many times you have seen them previously.

---

  Deal with any medical problems. It is important to immediately establish any medical or surgical problems from a brief history and examination and to initiate appropriate treatment. You may need to involve the surgical team for help with suturing deep wounds (remembering to always use appropriate analgesia). For emergency management of overdose, drowning and Basic Life Support, see Chapter 5 – Common Paediatric Emergencies.

  Keep the child or young person safe. Until you have had time to take a history and establish any ongoing risk of self-harm, it is important not to leave the patient unsupervised.

  Assess ongoing risk. You need to establish the level of ongoing risk of the patient completing a further episode of self-harm. This will help to inform your decision about the most appropriate management plan. See Box 8.1 for risk and protective factors for ongoing risk of self-harm or suicide.

  Ask about suicidal thoughts. This can be difficult to ask about but starting with a generalised statement may help, such as: ‘Some young people tell me that they sometimes feel that life is not worth living; have you ever felt like that?’.

  Find out about plans. ‘Have you ever made plans about how you might end your life? Have you ever started trying to follow through with those plans?’

  Perform a brief mental state examination. This will be done in more detail by the mental health team but is important to undertake this at the time of presentation. Document:

– appearance and behaviour. Are they behaving normally and communicating with you? Do they appear unkempt or smartly dressed? How do you think they appear – sad, inappropriately cheerful, agitated?

– speech. Very quiet and withdrawn? Few words at all? Loud and pressured speech?

Stay updated, free articles. Join our Telegram channel

Join