Is Your Teen Too Old for the Pediatrician?
New guidelines will help you decide when to make the big switch.
Last week my 16-year-old daughter needed a back-to-school checkup, so I scheduled a visit with the pediatrician who has taken care of her since the day she was born (the doc made her first well-baby visit in the hospital’s neonatal unit).
As my lanky teenager plopped down on a bench in the doctor’s waiting room, I realized she looked like Gulliver in the land of Lilliput. There were toddlers crawling around the floor and newborns mewling in their mother’s arms. Over by the reception desk, there were free samples of diaper cream and formula—two items I haven’t needed since the George W. Bush administration. I realized she looked closer in age to some of the parents in the office than to her fellow patients.
When I asked the doctor if perhaps my daughter was getting too old to see a pediatrician, she assured me that most of her patients stay with her until they turn 18. While it seemed strange to me that someone old enough to drive might still choose to see a provider who hands out Elmo stickers, it turns out that 18 is not only a standard time to transition, but it may actually be on the young side. In a policy paper released last week, the American Academy of Pediatrics (AAP) confirms that pediatricians are qualified to see patients until the end of “adolescence,” which can be as late as age 21. (They did not recommend any set cut-off date.)
“In the past, there have been recommendations to transition to an adult-focused doctor at 16 or 18 or 21, but we’ve found the dynamics have changed, and there are many patients who would benefit from staying with their pediatrician even later than that,” says Jesse M. Hackell, MD, a pediatrician in Pomona, New York, and co-author of the new AAP position paper. First of all, Hackell explains, many teens head off to college at 18 and rely on their campus health center for the majority of their needs. “They’re only home for a month here or a week there, so rather than force them to find another doctor for those four years, they can continue seeing their pediatrician over the summer, and then find a family doctor or internist once they graduate and move away from home.”
Hackell also points out that kids with special health needs such as congenital heart disease are surviving longer into adulthood than ever before, and adult-focused doctors may not be as well-trained in conditions that previously were considered only pediatric. “For them, the transition to a new doctor should be done very carefully over time,” he adds.
The most important question is: How comfortable is your kid with her doctor? “There are many 16-year-olds who don’t want to sit around screaming babies,” says Hackell. “But then there are 23- and 24-year-olds who I have to forcibly kick out of my practice! They know me, they trust me, they want to stay.” (Remember that episode of Friends when the gang discovers that 30-something Ross Geller still sees his pediatrician?)
Hackell adds that all pediatricians are trained and updated on adolescent concerns such as sexual health and substance abuse, but not all doctors may be comfortable addressing those issues—and your child may not feel comfortable talking about birth control with someone who’s known her and her family since she was a baby.
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In the end, my daughter and I decided to stay with her current doctor—someone who knows her entire history, from her food intolerances to her bout with chronic headaches. She may be the only person in the waiting room flipping through a physics textbook rather than a Dr. Seuss book, but that’s a small price to pay for a great doctor-patient relationship.