We were all once adolescents, and we can recall the unique challenges and complexities we experienced at that time. Yet in the UK, unlike in the USA, there is no recognised adolescent medicine speciality: general paediatricians see all patients under the aged of 16, from babies through to teenagers. As a medical student I was fascinated by adolescents but was never given any guidance or teaching as to how to engage and communicate with them effectively. It was this curiosity that set me on the path to learn more: I spent eight years working in New York where I became a Specialist in Adolescent health and medicine. I was determined to bring the skills and expertise that I learnt back to the UK, and in the ten years I have been a consultant in London, I have also worked nationally as an expert in the holistic care of adolescents. While many physical and hormonal changes occur in adolescence, many of the issues that I see directly relate to the changes that are occurring as their brains develop. During the teenage years the different areas of the brain do not develop all at the same time. The part that processes emotions (the amygdala) matures earlier than the part responsible for judgement (the pre-frontal cortex). And this is a period where the brain removes unnecessary connections and strengthens those that are important (synaptic pruning) to optimise efficiency. These changes in brain structure and function can influence adolescent behaviour, such as social interaction, emotional regulation, and decision-making. This in turn can lead to adolescents feeling things very intensely before they have developed the ability to process and manage these emotions in a rationale way. While the brain is developing and making these adjustments, the physical changes of puberty are taking place, there are transitions in education and friendships to navigate, public examinations to get through, and teenagers become aware of all the ‘unknowns’ that lie ahead. This combination can create a potentially perfect storm to have to weather. The COVID-19 pandemic has added another layer of complexity, with varying impacts depending on a young person’s age and stage of development at the time. This, coupled with the influence of social media, the spectre of global conflict, and anxiety over climate change, has placed an unprecedented strain on adolescent mental health. I view all adolescents as being vulnerable during this stage. It is as if they are treading the path along a tightrope — they need that odd ‘nudge’ to stay upright; and on occasions, when they fall, to be carried back to the wire. Eventually, in their late teens or early twenties, they have the cognitive, emotional, and physical attributes to step onto more stable ground. For parents watching this journey, deciding when to intervene and when to step back, can be confusing, destabilising and at times heart-wrenching. Any physical complaint will impact on mental health and wellbeing, and often poor mental health results in physical symptoms. My approach to treating adolescents, whatever the presenting complaint, is one of holistic care. For any consultation, I embed the concept of parity of esteem, acknowledging that both physical health and mental health may be contributing, and each may require tackling individually and in combination. In my consultations, I offer young people the opportunity to explore how their lifestyle influences their wellbeing and to reflect on what matters most to them—physically and emotionally. My goal is to educate and empower adolescents to take ownership of their health, to stay steady on that tightrope, and ultimately to step confidently into healthy adulthood.