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JAMA Pediatrics Patient Page
July 2013

Transition of Care From Pediatric to Adult Clinics

JAMA Pediatr. 2013;167(7):684. doi:10.1001/jamapediatrics.2013.2657

Pediatrics is a branch of medicine that specializes in health care of children and adolescents. Pediatric physicians may include your child’s primary pediatrician, as well as subspecialists such as pediatric cardiologists or pediatric endocrinologists who provide care for particular illnesses.

As your child grows to be an adult, your child will transition his or her health care from pediatric physicians to adult physicians. Adult physicians may also include a primary physician, which may be an internal medicine physician or a family practice physician. There are some physicians, called med-peds, who provide primary care to both pediatric and adult patients. Children with chronic or ongoing illnesses will also need to transition their care from a pediatric subspecialist to an adult subspecialist.

The Society for Adolescent Health and Medicine calls transition: “the purposeful, planned movement from adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems.”

Changing from a pediatric-centered clinic to an adult-centered clinic can raise questions for children as well as their family. For patients with chronic disease that began in childhood and will continue into adulthood, transition to adult care is a very important process. This process may involve medical, psychological, and social support. Every clinic approaches transition in an individual way, and each child’s journey through transition is unique.

Transition Timing

Discussions about transition can begin at any time; however, it is best to begin this process by the time a child is 12 years old. Discussions about transition are best held during a checkup or routine chronic illness visit.

Transition to an adult-oriented clinic typically should occur within the 18- to 21-year age range. There are cases in which transition can occur earlier if the adult clinic accepts new patients at younger ages and cases in which transition can occur later if transition goals are not yet reached.

Who Is Involved in the Transition?

Successful transition involves the participation of the whole medical team, including physicians, nurses, and other care coordinators. The medical team works with the family and the child to create goals and a timeline for transition. It is important to identify each team member’s role in the transition to help the child to begin to take on a more independent role in his or her health care. Parents’ role is to be part of the process but to start to step back from making every decision so that the child gets increasing experience and independence making health care decisions.

What Parents Can Do

  • Ask your child’s pediatrician and other pediatric physicians at what age they typically transition patients to adult clinics.

  • Understand that transition can lead to feelings of nervousness, excitement, hope, and frustration for all family members involved. It is important to have patience and provide support to each other during this process.

  • Work with your pediatric clinic to develop a list of goals for transition, and check in on these goals at each routine visit.

  • Talk with your child early and often about his or her role as a patient and that he or she will take an increasing role in his or her own health care over time. Provide positive reinforcement when your child shows independence in his or her own health care.

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To find this and other Advice for Patients articles, go to the Advice for Patients link on the JAMA Pediatrics website at jamapediatrics.com.

The Advice for Patients feature is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Resource: American Academy of Pediatrics