In Children

  1. When evaluating children, generate a differential diagnosis that accounts for common medical problems, which may present differently in children (e.g., urinary tract infections, pneumonia, appendicitis, depression).
  2. As children, especially adolescents, generally present infrequently for medical care, take advantage of visits to ask about:
    • unverbalized problems (e.g., school performance).
    • social well-being (e.g., relationships, home, friends).
    • modifiable risk factors (e.g., exercise, diet).
    • risk behaviours (e.g., use of bike helmets and seatbelts).
  3. At every opportunity, directly ask questions about risk behaviours (e.g., drug use, sex, smoking, driving) to promote harm reduction.
  4. In adolescents, ensure the confidentiality of the visit, and, when appropriate, encourage open discussion with their caregivers about specific problems (e.g., pregnancy, depression and suicide, bullying, drug abuse).
  5. In assessing and treating children, use age-appropriate language.
  6. In assessing and treating children, obtain and share information with them directly (i.e., don’t just talk to the parents).
  7. When investigation is appropriate, do not limit it because it may be unpleasant for those involved (the child, parents, or health care providers).

Approach to Young Patients/Adolescents

  • Ensure confidentiality
    • "During this visit, I'll ask you some very personal questions to best help you - I promise that whatever you say will be kept in private between us. The only exception would be in a circumstance in which disclosure to someone is required by law (eg. someone's life is at risk)"
  • Use age-appropriate language
    • Assess ability to understand (eg. consequences of risky behaviour)
  • Assess role of parent
  • Consider meeting privately for sensitive topics
    • Obtain and share information with young patients directly (don't just talk to parents)
    • Encourage open discussion with their caregivers (eg. pregnancy, depression, suicide, bullying, drug abuse)
    • Invite adolescents to independently access physician's office
  • Consider Greig Health Record for 6-17yo


  • Home "Where do you live? Who lives with you? Do you get along with your parents/siblings? Smokers in house?"
  • Education/Employment "Are you in school? What are you good at in school? What is hard for you? What grades do you get?"
  • Eating "What do you like to eat? Changes in weight? Does your weight or body shape cause you any stress?"
  • Activities "What do you do for fun? What things do you do with friends? What do you do with your free time? "
  • Drugs "Many young people experiment with drugs, alcohol, or cigarettes. Have you or your friends ever tried them? What have your tried? "
  • Depression/Suicide "How have you been feeling? Recent stress or anxious or sad more than usual? Have you thought about hurting yourself/others?
  • Sex/Sexuality "Have you ever been in a romantic relationship? How was that experience for you? How would you describe your feeling towards guys or girls? How do you see yourself in terms of sexual preference, eg. gay, straight, bisexual, other?"
  • Safety (injury/violence) "Have you ever been seriously injured? How? Do you wear a seatbelt? Text while driving? Violence at home, school, neighbourhood?"
  • Social Media (internet, cyberbullying, sexting)

Modifiable Risk Factors

  • Exercise/Diet - Obesity
  • Safety - Driving/bike/helmets/seatbelts
  • Drugs - Alcohol/smoking/drugs
  • Sex - Contraception/STI/pregnancy
  • Vaccines - Hep B/HPV

Different Presentations in Children

  • Depression - somatic complaints
  • Appendicitis - vague abdominal pain, N/V, stool changes , anorexia
  • Infection (UTI/Pneumonia) - irritability, fever, lethargy, poor feeding.