Transitions can be difficult. Going from pediatrics to adult health care can intimidate young people who aren’t ready. But by knowing when and how to change, you can help your children get the health care they need.
When to Leave Pediatrics Behind
At age 18, children are considered adults. They can vote and enter the armed services. But they may not be ready to leave their pediatricians just yet. The American Academy of Pediatrics (AAP) warns against leaving a pediatrician just because your child reaches a certain age. Finding the right time to transition to adult care depends on a couple of factors:
- Your child’s specific physical and psychosocial health needs
- The pediatrician’s ability to meet those needs
Though the AAP previously stated that pediatric services should end at age 21, they updated their policy. Now, they put no upper age limit on pediatric care. That means kids can stay with their pediatricians through the college years if desired.
Timing the transition also depends on your child’s maturity level. Because transitioning out of pediatrics involves more than a new health provider: It puts children in charge of their health. If your child isn’t ready for such a responsibility, you may want to hold off on the transition.
Smoothing Out the Process
The National Alliance to Advance Adolescent Health created Got Transition to help children transition from pediatrics to adult care. This program provides free resources for parents and caregivers, children and providers alike.
Your children’s pediatrician is also a great resource. Start talking about the transition when your child is 12. When children transition to adult care, they have to schedule appointments, fill prescriptions, understand their personal and family medical histories and more.
To ensure your kids are ready, consider asking your children’s pediatrician questions that include:
- Do you have a list of skills my child needs to prepare for adult care?
- What should I know about health privacy and consent before my child turns 18?
- When do you think they should leave pediatrics and find an adult provider?
- Which adult providers do you recommend for my children?
You can also smooth the transition with a medical summary. Help your child navigate the following topics and have them write or discuss the summary with you and/or the pediatrician. Doing so is a small way to give them ownership over their health.
Within the summary, include important health information, such as:
- Allergies your child has (whether environmental, medication or food allergies) and the reaction
- Current or past history of drug, alcohol or tobacco use including THC, vapes, stimulants, performance-enhancing substances
- Hobbies, work and other activities your child engages in
- Illnesses your child has experienced and any hospitalizations or admissions requiring PICU level of care
- Medications your child takes or has taken (include dosage and frequency) and why
- Mental health history and current mental health status
- Sex-specific information, such as first and most recent menstruation, heavy versus light periods, dysfunctional uterine bleeding, birth control – oral contraceptive pills (OCPs), birth control shot or long-term reversible (IUD, implantable)
- Sexual history and/or habits, including sexually transmitted infections (STIs), contraception/STI prevention and frequency of use, and type and number of sexual partners (male, female, both). Many teens and young adults only consider HIV and Syphilis STIs; they may need to be directly asked about a history of Gonorrhea and Chlamydia. Regarding contraception/STI prevention, oral contraceptive pills may not be taken regularly, birth control shots may not be scheduled appropriately, and condoms may be used sometimes without fully understanding the consequences.
- Sexual and substance use history (alcohol, drug, tobacco, stimulants, performance enhancers, etc.) will likely need to be done in private without parental involvement to ensure accuracy. Also, inquire about feeling safe at home, school, work and in relationships.
- Surgeries your child has undergone and any complications (bleeding, etc.)
- Vaccines for kids taken in the past
Ideally, children should have this information readily available for their first adult care appointments. The summary provides a snapshot of your child’s health history and guides future care.
Transitioning out of Pediatrics with Chronic Conditions
According to the Agency for Healthcare Research and Quality, one out of five children have “special health care needs.” These needs increase the risk of chronic conditions affecting a child’s behavioral, developmental, emotional and physical health. For these children, leaving pediatrics for adult care requires special attention.
Give the process that attention by talking with your child’s pediatrician. Use the aforementioned prompts to start the conversation. Additionally, ask if the pediatrician is aware of the American College of Physicians’ Pediatric to Adult Care Transitions Toolkit. You’ll be doing your part to help your children enter the world of adult health care safely.
By using the toolkit, providers can determine when a child is ready for adult-level care. They’re given tools to determine how well young patients understand their health needs. The kit also includes a form to share with appropriate adult providers. This includes all information necessary for a smooth transition.
New specialty toolkits get added regularly and are currently available for the following areas:
- Cardiology (congenital heart defects)
- Endocrinology (Type 1 diabetes and other hormonal conditions)
- Gastroenterology (bowel issues)
- Hematology (blood disorders, such as sickle cell disease)
- Nephrology (end-stage kidney failure)
- Neurology (issues affecting the nerves, brain and spinal cord)
- Primary care (intellectual, developmental and physical disabilities)
- Rheumatology (juvenile arthritis and other autoimmune/inflammatory diseases)
Transitioning as a Team
No matter when your child moves on from pediatrics, a team approach increases the likelihood of success. People who help with the transition to adult care include:
- Pediatricians
- Other pediatric specialists
- Adult primary care providers
- Adult specialty providers
- Nurses
- Care coordinators
Communication between these providers leads to a smoother transition. A smoother transition gives your child confidence and a sense of belonging. At the same time, it ensures your child’s medical records get passed from pediatric to adult providers.
All University of Maryland Medical System hospitals use the same electronic health records system. As a result, your child’s health information is accessible to all UMMS providers, so our providers never have to guess at your child’s history if they were pediatric patients.
Where Parents Fit into the Transition
Parents also play a role in the transition to adult care. Before your children leave pediatrics, talk about the upcoming transition. Let your children ask questions and tell them what to expect. Once your children take charge of their health, encourage them to keep it up.
Start early. Encourage your children to talk to medical providers. Whenever possible, encourage your children to tell the provider what brings them in for a sick visit. Parents can fill in the blanks, but children should start providing information and becoming comfortable speaking to medical providers at a young age. Educate your children on their medical and surgical history. Make sure they are aware of any allergies and their reactions.
With medications, be sure your children know the correct frequency and dosage and understand why the medications are necessary. Empower your children to take personal responsibility for their medical health while still providing age and developmentally-appropriate support.
And remember—the goal is for your children to take control of their health. Once they begin moving away from pediatrics, back off. Let your children make their own care decisions. Show that you trust them, and only give advice when your children ask it. This independence helps them feel more confident to start making their own health decisions.
More to Read
- Should I Take My Child to the Emergency Room?
- Parenting and Mental Health: Building Your Toolkit
- Making Sense of Teens and Their Mood Swings
- Healthy Sleep Habits Mean a Happy Child
Medically reviewed by Megan Shimkaveg, MD.
