Pediatric patients will ultimately require adult health care. Successful transition programs are responsive to the various needs of patients, their families, and potential health care providers. Transitioning a child with no medical issues versus a child with significant medical problems or chronic illness presents a wide range of challenges.
Switching from a pediatrician who a child (oftentimes) has seen from birth is a big adjustment for any patient. Transitioning to adult care for patients with special health care needs can be extremely difficult. Certain diagnoses will require that pediatric patients transition to an adult medical home. For special-needs pediatric patients, transition planning should include information about specific responsibilities of the primary care physician and specialists. For these reasons, many years ago, the American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians advocated for advancement of planning and documenting processes for children who are approaching a transition age.
It is important for pediatricians to help adolescent patients be more informed and aware of self-care behaviors. Pediatric practices should compile a transition chart that includes a summary of all relevant medical information, including history of immunizations, medical issues, medications, hospitalizations, tests, and medical insurance. When patients are between the ages of 14 and 17, discussions need to begin (including parents) about your office transition policy. Engage the patient as appropriate in discussions regarding adult care. The pediatrician can help identify individual preferences such as gender and special-needs issues and can offer referrals to family practitioners with whom they are comfortable and familiar. A good rule of thumb is to refer your patients to physicians whom you would use yourself. Between the ages of 18 and 21, the patient should have a plan for successfully transitioning to adult care.
It’s interesting to note that female adolescents who are transitioning generally establish solidified medical relationships earlier than their male counterparts. Gynecological examinations are often recommended by pediatricians between the ages of 16 and 18. They are encouraged to follow up by scheduling annual gynecological office visits. Once males “graduate” from the pediatrician’s office, they often feel that there is no longer a need for annual care, and they disconnect, only going to see a doctor when they are ill. If male patients miss regular health examinations, they are missing the opportunity to deal with problems that may exist but that they don’t know about. Also, they aren’t able to address issues such as diet, exercise, stress, weight management, alcohol consumption, family history of disease, and insomnia. Male patients who are transitioning may need some extra education as to why taking their health care seriously is essential. The overall goal is to provide health care that is uninterrupted, coordinated, and appropriate from childhood through adulthood.
- Superheroes? Think again…men’s health. The Medical Bag website. October 12, 2012. http://www.themedicalbag.com/vitalsign/superheroes-think-again-mens-health.
- Transitioning to adult care: what can pediatricians do? John Hopkins Children’s Center website. October 28, 2009. http://www.hopkinschildrens.org/Transitioning-to-Adult-Care.aspx.