School-aged and young person’s health check (6–17 years)

Healthy childhood and teenage years are important in shaping brain development and future health, particularly reducing risk of chronic conditions
Key developmental stage with transition to independence
Before following this protocol you must make sure you understand issues of

Assessment of competency to make medical decisions
Limits of confidentiality
Mandatory reporting requirements
See Competency, consent and confidentiality.

Do first

Ask carer and young person about concerns, priorities and goals
Review previous medical and social history and gather information from other sources with consent (eg school) — attention to

Hearing — audiology reports, surgery
Vision — glasses, optometry reports
Respiratory — persistent wet cough, repeated chest infections especially if admitted to hospital
Acute rheumatic fever with/without heart disease
Growth concerns including overweight/obesity
Developmental or learning issues, school attendance, alcohol exposure in pregnancy
Involvement of other health care providers — child health nurse, paediatrician, psychologist or other agencies (educational, guardian, legal, child and family services)
Allergies and immunisations

See HEADSS framework for Psychosocial Health Assessment for examples of questions that can help engage young people

Check

School-aged health check — checklist

Age	Assessment — Check/Do/Refer	Discuss/Promote
5-17 years	Ask about Self care — toileting, bathing, brushing teeth Sleep — quality, how much, when (day/night) Nutrition — how much, what kind, food security Physical activity (sport, hunting, fishing), screen time Home — carer, living arrangements, overcrowding Domestic and family violence Education/training — school attendance, academic progress, behaviour issues Social group — friendships/peers/bullying Smoke exposure — cigarettes, camp fires Safety — seat belts, water safety, bike helmets	Talk about hygiene and dental health Encourage eating fruit and vegetables, water as the main drink, avoiding sugary drinks, avoiding highly processed foods Encourage regular physical activity — at least 1 hour every day Encourage limiting screen time (TV, phone, computer) to 2 hours a day Talk about protective behaviours — the right to feel safe, pay attention to feelings, tell someone if they feel unsafe, identify people they feel safe with Encourage carer engagement with school Encourage spending time with and talking to friends and family — talk about feelings, worries Talk about safety and injury prevention including seatbelts, water safety
5-17 years	Head-to-toe exam including BP — cuff needs to cover 2/3 of child’s upper arm Eyes — visual acuity at 6 years, 12 years and 15 years then every year, more often if symptoms or previous abnormality Ears Teeth and mouth Respiratory, cardiac and abdomen Skin (eg impetigo, scabies, acanthosis nigricans) Growth — weight, height, BMI, waist circumference to height ratio — plot on growth chart Hb Immunisation status. Give if due Check for development, behaviour, emotional concerns — see School aged child and youth behaviour or development concerns	Arrange time to follow-up and talk about results, treatment, management Offer copy of health check to carer
10 years and over	Diabetes risk factors check — 10 years and over (can be done for under 10 if pubertal or more than one risk factor) Mother, father or sibling with diabetes or mother had diabetes in pregnancy Overweight, obese or waist circumference to height ratio more than 0.5 Acanthosis nigricans (dark discolouration of skin folds and creases) Takes psychotropic medicine (antipsychotic) Other conditions linked to obesity or metabolic syndrome (high blood pressure, PCOS, high blood fats) Do if has risk factors U/A for protein — if protein 1+ or more send for ACR HbA1c (POC Test if available), FBC, UEC, eGFR, LFT, TFT, lipids Medical consult Dietitian referral
			12 years and over	Ask about puberty, menstruation Ask about sexual activity If non-consensual activity identified — see Child neglect, abuse and cumulative harm STI check if 14 years or over (consider for under 14 years if indicated) Discuss contraception needs Ask about smoking and smoke exposure Ask about gambling (young person or someone close to them) — how much, money owed, missing school Ask about concerns with mood, anxiety, self-harm Ask about behavioural concerns — school, friendships, police, youth justice	See Competency, consent and confidentiality Help the young person talk to you — Talk about healthy relationships, safe sex, consent protective behaviours and contraception — see STI checks for young people Talk about injury prevention including self-harm — see Competency, consent and confidentiality Brief intervention for tobacco, alcohol and other drugs Discuss and reinforce strengths, achievements and goals

Follow-up

If problems found — make sure person added to recall system and/or referrals completed
Team approach needed to manage complex problems — could include the young person, family, clinic staff, doctor, paediatrician, dentist, allied health, hearing/eye/mental health team, support services, council, housing associations, education system services

HEADSS interview for psychosocial health assessment

Young people are more likely to talk about sensitive issues and seek help if asked directly
Use HEADSS to help you to

Engage with young people
Identify vulnerabilities
Provide early intervention to manage high risk behaviours
Provide health promotion advice

HEADSS is best done with the young person alone

Ask carers if they have any worries before they leave the room and again when they return
Explain you will ask lots of questions about parts of their life that may affect their health and wellbeing — explain and stress confidentiality
You may not be able to cover all questions at one visit — focus on most relevant questions
Use general statements to be less intrusive (eg Some young people experiment with cigarettes, alcohol and drugs. Do people at your school use these, what about your friends, and you)

At end of HEADSS

Ask young person who they can trust and talk to if they have problems
Check preferred communication about results — what number to call, if anyone else you can talk to
Follow-up overdue recalls for health check items (eg blood tests, growth checks, vaccinations)
Treat any health issues and manage health risk behaviours — medical consult or other referrals if required

Table 3.4 HEADSS interview guide

General questions	Where are they from Where is their family from What do they like about their country/community
Home	Do they have somewhere to live Who lives at home, how many people are in the house Do they feel safe there
Education/employment	Do they attend school/VET If yes How often, how many days Do they enjoy school, what are they good at Do they have any issues with learning (concentration, hearing) Is there any bullying Do they have employment or know what they would like to do in the future
Eating/exercise	Do they think they eat well Are there times when there is not enough food Do they or anyone else worry about their weight Do they play sport/exercise Do they hunt/fish, eat bush tucker
Activities	Do they have good friendships and family support What do they do for fun Do they participate in cultural activities (carnival, hunting, ceremony) Any involvement with the justice system
Drugs	Do they smoke cigarettes/cannabis (what and how often) Do they use volatile substances Ask why they use drugs (eg to relieve stress, response to trauma)
Sexuality	Are they in a relationship Do they like males/females/both Are they having sexual intercourse, do they use contraception Do they need an STI screen Have they experienced non-consensual sex See STI checks for young people See Child neglect, abuse, sexual abuse
Safety/Self harm/Suicide	Do they feel happy/sad/angry. Do they worry a lot How is their sleep Have they ever tried to hurt themselves or had thought about hurting themselves Have things been so bad that they have thoughts they would rather not be here Are they currently suicidal. Do they have a plan Do they experience voices Is there any family history of mental illness Have they experienced or witnessed any violence recently Who can they talk to if they feel unsafe See mental health assessment See Domestic and family violence
Spirituality	Do they have any beliefs that are important (religious, spiritual) Who/what do they turn to if they need help or guidance