Implications for patient care

Parents may not be aware of their teen’s attempts with any of these challenges. An acute care visit to an office or urgent care site may be scheduled for lip swelling, projectile vomiting, skin infection, burn, or respiratory symptoms, and unbeknown to the parent or provider, a “challenge” may be presenting. Any patient who may have attempted a “challenge” must be handled with the care and confidence as with any of the sensitive adolescent issues such as discussions about sexuality and drug or alcohol use. Speaking privately with the teen before discussion in front of the parents may be a helpful option to discuss the truth in what has occurred as part of a “challenge.” 

Taking a supportive team approach with the teen and parent can lead to open communication and appropriate treatment. Identification of the risk behavior should also be further explored to determine if this was a copycat prank or an attempt at self-harm or suicide. There are limited correlations between these online “challenges” and documentation of nonsuicidal self-injury in adolescents, but we must be aware of the risk that this can pose in our mental health assessments. There are no data on whether the Internet has increased the incidence of self-harm, but it has “normalized” the behaviors. Teens who are doing these challenges must be thoroughly screened for other self-harm behaviors, with the identification of depression, anxiety, stress, and bullying within the personal or online social arena. Any adolescent who has an identified plan for self-harm should be immediately referred to a mental health professional.

Additional considerations include collaboration between primary care providers, school nurses, and guidance counselors to acknowledge current trends in their geographic location to best determine these high-risk presentations within the school environment. Community awareness, as well as parents, children, and teens, can help in decreasing the inherent risk behaviors. Providers must remain astute to current trends and be nonbiased in discussing their concerns with the adolescent and parent to provide adequate treatment and support through these “challenging” adolescent years. 

Margaret Quinn, DNP, CPNP, CNE, is a clinical associate professor and specialty director of the Pediatric Nurse Practitioner Program, Rutgers University, in Newark, NJ.

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This article originally appeared on Clinical Advisor