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16 September, 2019 00:00 00 AM

How old is too old to go to the pediatrician?

Parents
How old is too old to go to the pediatrician?

For most parents, getting started with a pediatrician is the easy part. Chances are that even before you gave birth, you had researched doctors certified to treat children and chosen one for your baby on the way. The tougher part is realizing it's time to say goodbye to a doctor everyone has no doubt come to love.

Many parents, as well as children who are on their way to becoming adults, wonder at what age is it appropriate to stop seeing their pediatrician. In the same boat? We went to the experts to get the answer, plus answers to a few other questions you may be curious about when it comes knowing it's time to leave your family pediatrician.

Is there an age limit for seeing a pediatrician?

Back in 1938, the American Academy of Pediatrics (AAP) recommended that pediatric patients be no older than 18. Then, in 1969, they raised the recommended pediatric age to 21. This advice was based on conditions like sickle-cell disease that could claim the life of an adolescent as young as 20. But thanks to the improved outcomes that have resulted from the medical advancements of the past 40+ years, people are living longer and will ultimately need adult care.

At the same time, the AAP's position is a recommendation, as opposed to a set rule, so the age at which a patient will be advised to see adult care by their pediatrician varies from practice to practice. Dyan Hes, M.D., a pediatrician and medical director for Gramercy Pediatrics in New York explains, "Some pediatric offices have an arbitrary year when they stop seeing young adults, such as 18 years old or 21 years old.

Many pediatric emergency rooms automatically send anyone 18 years old and above to the adult emergency room. In some instances, the adolescent is force to transition to an adult doctor because of the insurance guidelines that mandate this to happen at age 18 years."

Why might a patient continue to see a pediatrician beyond childhood?

While it might seem like some adult patients continue on with their pediatrician out of sheer convenience or indolence, there are a couple of major reasons patients might postpone seeking an adult care provider:

College - When adolescents go away to pursue higher education, they might not have a chance or not want to deal with the stress of having to find a new doctor. They're content to go to the student health clinic on campus and and continue to see their pediatrician when they go home.

This is a practice that Daniel Ganjian, M.D., a pediatrician at Providence Saint John’s Health Center in Santa Monica, California approves of, explaining, "I encourage patients to continue seeing their pediatrician throughout college for check-ups during vacations and see the college doctor for any urgent or sick visits. The college years have so many changes associated with it. We do not have to add more onto our children's shoulders by making them look for a new practitioner."

Certain chronic conditions or disabilities - As a recent report from PBS points out, people who have developmental or intellectual disabilities might remain with their pediatricians into adulthood, because switching doctors might be traumatic, and people with conditions like congenital heart defects, sickle cell disease, or cystic fibrosis might find it especially challenging to transition.

How do pediatricians feel about seeing older patients?

Pediatricians' willingness to see older patients usually boils down to personal preference, Dr. Hes explains. "Some pediatricians feel that they were not trained to deal with the more adult issues facing a 21-year-old, although I believe this to be the rare case," she says. "Most pediatricians in the U.S. are exposed to adolescent medicine in training. In some offices, some physicians really enjoy seeing newborns, while others enjoy the psychosocial dynamics of adolescent health care."

Dr. Hes' personal belief is that turning a patient away based on their age does a disservice to the young adult. "In our office, we see the patients through college if they choose to stay will us," she notes.

She also points to young adults with chronic illnesses like chronic asthma, sickle cell disease, most congenital diseases, or intellectual disabilities as prime candidates for receiving "better care from their pediatric provider, who is more familiar with the illness and has known the patient for many years."

For example, Dr. Hes sees patients with autism well beyond the time they are 21. "I have one patient with autism who loves to watch baby cartoons on his phone, despite the fact that he is a young adult," she says. "Many special needs young adults function at a grade school level.

Their parents have a hard time taking them to adult specialists who do not understand the behaviors and have less patience. Many special needs young adults cannot sit in a waiting room for a long time either. Pediatric offices are much more accommodating to this. We are used to noise, music, games, and crying."

By comparison, Gina Posner, M.D., pediatrician at MemorialCare Orange Coast Medical Center in Fountain Valley, California says she encourages patients to see a family medicine physician or internal medicine physician starting at the age of 21. "For females, this is when they need to start pap tests, so they should be referred to an OB-GYN," she explains. "However, some start begin feeling uncomfortable being in a pediatric office before that, so I let them know that at age 18, it certainly is OK to make the switch."

What are the signs that your child might be ready to stop seeing their pediatrician?

If your adolescent isn't exactly a fan of hanging in a waiting room with a bunch of small kids, or they do not like sitting on the fire-truck exam table, or they just want to see an adult doctor, they're probably ready to transition away from pediatric care, notes Dr. Ganjian.

And if they're contending with specific adult health concerns, they'll do well to move on. "When they start having more complex problems like diabetes (type 2), hypertension, high cholesterol, these are telltale signs of when they are ready and should seek the medical advice and care of a general practitioner and/or specialist," says Dr. Posner.

The Bottom Line

The decision to transition to an adult doctor must be based on a combination of the doctor's comfort in treating young adults and the patient's desire to stay in that practice. And in most cases, once patients have adult medical issues, a "good pediatrician will recommend that it is time to transition," Dr. Hes explains. "We often have ties to adult practices to where our patients 'graduate.'"

Although she says it is bittersweet to see patients grow up, she finds it rewarding. In the end, that feeling should extend to the patient, too. After all, being provided with age-appropriate health care benefits them, as well.

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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