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All Grown Up?

When should teens transition from pediatric to adult care?

You're by your teen's side in the pediatrician's waiting room — one filled with babies, toddlers, toys and children's books. And you wonder: Should your child start seeing an adult primary care provider?

"There's no definitive answer — it really depends on your child," says Sherald R. Leonard, MD, a pediatrician at Rush University Children’s Hospital.

While most pediatricians treat kids until they're 18 or 21, your teen may balk at still seeing a doctor who deals with diaper rash. On the other hand, your teen may want the continued comfort of a familiar physician, especially if that doctor has known them since childhood.

Your best bet: Respect your child's preferences when possible. "But also factor in your child's maturity,” Leonard says. "A teen who still counts on you to do all the communicating at medical appointments probably isn't ready for the switch."

The next step

If it's time for your teen to move on to a new provider, ask friends, family and your child's pediatrician for recommendations. And be sure to line up the new provider before your child says goodbye to the old one — even if your child is healthy. 

After all, you won't want to scramble to find a provider when your child is sick.

"You also wouldn’t want your child to miss out on important opportunities for the early detection and screening of medical conditions — from diabetes to cancer — because of a gap in health care," cautions Beth Marshall-Bergman, DO, an internist at Rush Oak Park Hospital.

Smoothing the way

To help make the transition from a pediatrician to an adult provider as smooth as possible, Leonard and Marshall-Bergman suggest the following: 

1. Step away.

Starting when a child is 13 years old, many pediatricians want to see a teen alone — without a parent present — for at least part of an appointment.

It's natural to want to stay with your child the entire time. But a graceful exit during the visit helps your child practice talking to a doctor about anything — even difficult or embarrassing topics.

2. Hand off responsibility.

Encourage your child to make their own medical appointments and to show up at visits with a list of questions about any health concerns.

3. Be a historian.

Make sure your child knows their personal and family medical history — your child's new provider will want to talk about both.

Encourage your child to make their own medical appointments and to show up at visits with a list of questions about any health concerns.

Care transitions for kids with complex conditions

Children with a serious health problem — such as cancer, a chronic digestive disease or a neurological disorder — typically are treated by pediatric specialists until they're in their late teens or early 20s. As those kids become adults, it's important that they seamlessly transition to a specialist who treats adults — without having any interruption in their care.

"That’s true even if a child's condition is well-controlled or cured,” says Leonard.

Here's why: It's common for a child with a complex or chronic medical condition to have serious, sometimes even life-threatening, side effects from treatment years later as an adult. For example, some children treated with chemotherapy for leukemia are at higher risk of developing other cancers later in life.

Also, even if a person's condition is stable as they begin adulthood, their symptoms can reappear or worsen — and require immediate treatment. That is true for teens with Crohn's disease, for example. The disease typically varies between periods of remission (few or no symptoms) and flaring up (symptoms return suddenly or are intense).

As your child gets older, it's a good idea for you and your child to work with their pediatric specialist to create a transition plan. That includes getting recommendations for adult providers who specialize in your child's condition.

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