leahparentWhen our kids are little, we take them to their well child exams in order to ensure they remain healthy. This preventive visit reassures us that they are growing well, meeting development milestones, and offers the opportunity to have our (and our child’s) questions about health answered. As kids enter the teen years, these visits occur less and less often. A friend recently asked my opinion as a pediatrician and adolescent specialist about when teens are too old to go see the pediatrician? This excellent question prompted me to post about the topic.

A little known fact is that pediatricians are caring people. Ok, this is a well known characteristic of pediatricians! We have the privilege of watching babies grow into toddlers, toddlers grow into kids, and kids grow into teens. Due to our ongoing relationship with our patients and families, we sometimes have trouble being able to ‘graduate’ our patients to a new adult provider. We miss the families and want to make sure they continue to receive excellent care. Parents also come with concerns about transition.  Some of the concerns that arise when both parents and pediatricians consider transitioning teens include: Will the new provider understand their history? Will the teen connect with the new provider? Will insurance coverage be a concern? Will the teen understand how to navigate our complex medical system alone?

However, as pediatricians, our medical training is focused on the care of people who are not adults. As teens age, medical concerns that arise may be out of our scope of expertise. A transition to a medical provider with training in adult health care is going to be warranted eventually.

From the perspective of the teen, they may ask for a change sooner that we (as pediatricians) or parents are ready to let go. One step into the waiting room of a pediatrician and you’re transported to a child friendly place, often complete with toys, children’s books, and a fish tank. This environment is set up to entertain young children as they wait, but adolescents may find it boring, inappropriate, or too young for them to feel comfortable.

The American Academy of Pediatrics, together with the American College of Physicians, and the American Academy of Family Medicine provided recommendations on transition from pediatric to adult providers in 2011. The article in journal of Pediatrics can be found here. They recommend the following schedule:

  1. Initiate the discussion of transition with parents around age 12 or 13.
  2. At age 14 or 15, begin developing a plan with teens and parents (this may include giving the teen more responsibility for knowing medications, spending time with the teen alone, or scheduling their own appointments).
  3. By age 16 or 17 review and update the earlier plan.
  4. Around age 18 or so, plan to proceed with the transition. Before actually transitioning to a different provider, the teen and family can visit adult medicine practices, meet new providers, and decide who will be the best fit for their needs. If a teen is going to move for college, this may include visiting the college health services.

This is a general timeline and some teens may be ready to transition sooner than age 18, while others may transition around age 21. If your teen has complex medical concerns and is followed by multiple providers the transition process may be more complicated, so talk with your team early. Next time you meet with your pediatrician, bring up the idea of transition and get the conversation started!

Resources on transition to adult care include:

GotTransition.org
Adolescent Health Transition Project