Taking a full digital history in every consultation is impractical, therefore recognition of common digital harm outcomes should prompt further questioning.

In preadolescents, it’s important to start open conversations with parents determining their child’s screen time and online activities, making possible links to the presenting complaint.

In adolescent consultations, it’s important to ask sensitive questions one-to-one as parental presence may limit disclosure. Digital history can be explored using the HEADSSS assessment (box 1), for example, asking about device access and supervision in ‘home’, privacy settings in ‘safety’, screen time in ‘activities’ and potential inappropriate interactions and exposure in the sexual history.26

Home: Does the child neglect family activities for their device? Does their mood change if the device is removed from them?

Education: Do they get told off for using their device at school? Is screen time interfering with homework? Is there evidence of cyberbullying at school?

Activities: Do they have a healthy range of non-digital activities and exercise?

Drugs: Have they been approached online by a drug dealer, or shared or received inappropriate drug-related content online?

Sexual relationships: Have there been inappropriate contacts online that may have been sexual in nature? Has the child sent or received explicit content? Is there a possibility of online sexual abuse, grooming or exploitation?

Social care: Is there any social care history as a direct result of a digital harm event?

Safety: Has a child’s physical safety ever been at risk due to events that initiated online? Do they have adequate privacy settings?

Social media: Has social media ever caused you to have a low mood? Do you think social media has a positive or negative impact on your life?

If concerns are apparent, the Social Media Disorder Scale may be used to further define the problem. There is both a 9-step screening version and a 27-step in-depth version that may be used to understand trends in behaviour and focus on specific problems.27

Different concerns may be discussed which warrant a more urgent response (table 2).

Sophia, aged 14.

History: Recurrent abdominal pain with nausea resulting in poor school attendance.

Normal bowel habits. 4 lb weight loss in 3–6 months.

Nil medical or family history. Lives at home with mother and brother (6 years). No social care involvement.

Examination and blood tests are normal.

She struggles with anxiety, low mood and panic attacks. History of previous self-harm, cutting. No suicidal ideation.

You enquire if she spends a lot of time on digital devices…

Sophia reports using Instagram and TikTok for many hours every day and finds it distracts her from schoolwork.

You ask how her online use makes her feel…

Seeing social media posts of her friends having fun makes her feel lonely and isolated. She has received some negative messages online, causing her to ‘dread’ school.

You ask if there is any other content online that makes her feel unhappy…or anything that doesn’t feel safe…

She says social media makes her feel negative about her body image resulting in her trying several diets. A boy from school recently gave her compliments about her figure and asked for indecent images. Sophia becomes tearful and says she sent him explicit images which he then threatened to post on social media. She feels embarrassed and blames herself.

You have clearly identified digital harm and emotional health needs which could be presenting with physical symptoms.