The adolescent

Puberty to eighteen  ·  ten points

1. 1 An adult body, and not an adult. Every default around them is set for the body — the bed, the tube, the doses, the visiting rules. The consent, the confidentiality and the developmental needs are not, and nothing in the unit will remind you.
2. 2 Maturity decides, not the birthday. A young person who genuinely understands what is being proposed can consent to it themselves — a principle that came from the English Gillick case and now runs through most of the common-law world. What differs, country by country and even state by state, is the statute built around it: New South Wales sets no age at all, South Australia sets sixteen. Look up your own rather than trusting the number you were taught.
3. 3 Consent and refusal are not mirror images. A competent young person's consent generally stands; a refusal of life-saving treatment can be overridden by a court exercising its protective jurisdiction over children — and in New South Wales that happened as recently as 2024, in a case where the young person was found competent.
4. 4 See them alone for some part of the admission, and say what confidentiality does and does not cover before they tell you anything. Be concrete about where the line falls: what they smoke at the weekend stays within the treating team, a disclosure that somebody is hurting them does not, and either way they hear it from you before they hear it from anyone else. Never offer a promise of secrecy you will have to break. Their account of what happened is often not the parents' account.
5. 5 In Australia, injury causes around three-quarters of deaths at fifteen to twenty-four — 73% in 2017–2019, intentional and unintentional together — and suicide is the single leading cause, at about a third of all deaths in that band. Which single cause leads is not universal: in the United States it is unintentional injury, with suicide second. Deliberate self-harm accounts for 7.2% of Australian ICU admissions aged twelve to seventeen — the toxicology is the easy part, and the assessment and named follow-up before discharge are what change the outcome.
6. 6 Emergency front-of-neck access is the adult scalpel technique. The age at which that becomes true is genuinely disputed — five, eight, twelve or no number at all, depending whose guideline you hold — because the size of the cricothyroid membrane decides it, not the birthday.
7. 7 Dose by weight and do not exceed the adult maximum. That is the rule; there is no 50 kg or pubertal switch. Chemotherapy, heparins, insulin, vasoactives, relaxants and aminoglycosides never stop being size-dosed, and tidal volume comes from predicted body weight calculated from height — never from the scales.
8. 8 Non-adherence is the mechanism behind the two most predictable admissions. Insulin omission causes most ketoacidosis in established diabetes, and graft loss peaks between seventeen and twenty-four with no recipient group exempt. It is developmental, not moral.
9. 9 Meningococcal disease has a second peak at fifteen to twenty-four, highest at eighteen to twenty — and over 80% of Australian cases are now serogroup B, which the adolescent programme dose does not cover. A fully immunised adolescent is unprotected against the serogroup most likely to reach you.
10. 10 A seventeen-year-old may be competent to consent to their own chemotherapy and still cannot give legally effective consent to their own organ donation. For a deceased child it is the senior available next of kin who consents, and a sixteen- or seventeen-year-old on the donor register has recorded an intention, not a decision.