Child and adolescent mental-health nursing: approach, family, school and ADHD medicine monitoring
- Safe practice
The nurse builds trust at the child's level, works with family and school, uses behavioural methods and checks ADHD medicines' effects on growth, heart, mood.
What it is
Children and adolescents usually come for care someone else sought, and their communication depends on their development. The nurse starts with a therapeutic relationship, gathers information from both the young person and the carers, and speaks with adolescents alone under conditional confidentiality. Care combines behavioural strategies, play and expressive activities, family education and contact with the school. For ADHD, behaviour therapy comes first in preschool children and medicine may be added from school age; stimulants and atomoxetine need monitoring of growth, heart, sleep, appetite, mood and misuse.
What it requires
- A child-friendly space, play material and developmentally suitable language.
- Growth charts and repeated measurements of height and weight.
- Information from the school, with the family's consent.
- In Colombia, methylphenidate is among the medicines of State monopoly («Monopolio del Estado») in Res. 1478 de 2006: it follows the controlled-medicine route.
Components
- Relationship and assessment with the child, adolescent and carers.
- Behavioural management and therapeutic activities (play, art, books, journaling, music).
- Family education, school collaboration and referral.
- ADHD medicine monitoring and safety.
How it is applied (and why)
- Begin with a neutral topic or an observation about the child — young people open up when they feel noticed, heard and valued.
- Gather the carers' account, then invite the adolescent to talk alone, explaining the limits of confidentiality — answers are more honest one to one.
- Assess development, school, family relationships, bullying, abuse, self-harm, sleep, eating and substance use — many problems look like ADHD or mood disorders.
- Report signs of abuse or neglect through the institutional route — protecting the child comes first.
- Use consistent limits, praise and a points system agreed with the team and family — rewarding desired behaviour reduces disruptive behaviour.
- Measure height, weight, pulse and blood pressure before ADHD medicine and at each visit, and plot growth — stimulants can slow growth and raise pressure.
- Ask about sleep, appetite, headaches, stomach pain, tics, mood and unusual thoughts after starting — these effects can need a dose change.
- Teach carers to store stimulants locked, never share them and report missing doses; ask teens about pressure to sell or share — misuse and diversion happen.
- With atomoxetine, watch closely for suicidal thinking and mood change — it carries a warning of increased suicidal thoughts in young people.
- Teach carers that finding the right medicine and dose can take one to three months, with regular check-ups — realistic expectations support adherence.
In nursing practice
- Seclusion or restraint of a child is a last resort, by trained staff, with continuous monitoring and a debriefing with the child afterwards.
- Report exertional chest pain, fainting or a racing heart on stimulants at once: serious heart events have been reported.
- Stimulants are not combined with MAOIs, including in the two weeks after stopping one.
- Anxious children can be quiet and eager to please, so their distress is easily missed.
Common mistakes
- Interviewing an adolescent only with the parents in the room.
- Promising absolute confidentiality.
- Starting a stimulant without baseline height, weight, pulse and blood pressure.
- Measuring growth only once a year.
Test yourself
Think of the answer, then tap the question to see it.
Why speak with an adolescent alone after hearing the carers?
A one-to-one talk under conditional confidentiality builds trust and gives more honest answers; the adolescent's concern may differ from the parents'.
What is measured before a child starts a stimulant for ADHD?
Height, weight, blood pressure, heart rate and cardiac history, plus baseline appetite, sleep, headaches and abdominal pain.
Which common effects of stimulants does the nurse watch for?
Difficulty sleeping, loss of appetite and weight, slower growth, raised pulse and blood pressure; also tics and mood or psychotic symptoms.
How should a family store stimulant medicines at home?
Locked away, never shared, with doses counted so any missing medicine is noticed: stimulants can be misused and diverted.
Elsewhere in DurgiPedia
Connections
In Pharmacology3
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing: Mental Health and Community Concepts, 12.5: Applying the nursing process to mental health disorders in children and adolescents (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Nursing: Mental Health and Community Concepts, 12.2: Common disorders and disabilities in children and adolescents (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); Methylphenidate (drug information) (MedlinePlus, U.S. National Library of Medicine, 2026); Resolución 1478 de 2006: control, seguimiento y vigilancia de sustancias sometidas a fiscalización y medicamentos de control especial (Ministerio de la Protección Social, Colombia (texto alojado por el INVIMA), 2006).
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Representative model, for educational purposes only.