Age Limit of Pediatrics Pediatrics Is a Multifaceted Specialty That Encompasses Children’S Abstract Physical, Psychosocial, Developmental, and Mental Health

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POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children

Amy Peykoff Hardin, MD, FAAP,a Jesse M. Hackell, MD, FAAP,b COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE Age Limit of Pediatrics Pediatrics is a multifaceted specialty that encompasses children’s abstract physical, psychosocial, developmental, and mental health. Pediatric care may begin periconceptionally and continues through gestation, infancy, childhood, adolescence, and young adulthood. Although adolescence and young adulthood are recognizable phases of life, an upper age limit is not easily demarcated and varies depending on the individual patient. The aNorthside Pediatrics, Atlanta, Georgia; and bPomona Pediatrics, establishment of arbitrary age limits on pediatric care by health care Boston Children’s Health Physicians, Pomona, New York providers should be discouraged. The decision to continue care with a Drs Hardin and Hackell were equally responsible for developing and writing this policy statement. pediatrician or pediatric medical or surgical subspecialist should be made This document is copyrighted and is property of the American solely by the patient (and family, when appropriate) and the physician and Academy of Pediatrics and its Board of Directors. All authors have must take into account the physical and psychosocial needs of the patient filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process and the abilities of the pediatric provider to meet these needs. approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the Policy Statement organizations or government agencies that they represent. ’ The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. Pediatrics is a multifaceted specialty that encompasses children s physical, psychosocial, developmental, and mental health. Pediatric care All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, may begin periconceptionally and continues through gestation, infancy, revised, or retired at or before that time.

childhood, adolescence, and young adulthood. In the guidelines for DOI: https://doi.org/10.1542/peds.2017-2151 choosing pediatric experts for advisory panels, the US Department of Please address correspondence to Jesse M. Hackell, MD, FAAP. E-mail: Health and the Food and Drug Administration reference approximate age [email protected] ranges for these phases of life, which consist of the following: (1) infancy, Bright PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Futuresbetween birth and 2 years of age; (2) childhood, from1 2 to 12 years of age; and (3) adolescence, from 12 to 21 years of age. Additionally, Copyright © 2017 by the American Academy of Pediatrics guidelines from the American Academy of Pediatrics identify FINANCIAL DISCLOSURE: The authors have indicated they have no – –2 – adolescence as 11 to 21 years of age, dividing the group into early financial relationships relevant to this article to disclose. (ages 11 14 years), middle (ages 15 17 years), and late (ages 18 21 FUNDING: No external funding.

years) adolescence. The American Academy of Pediatrics has3 previously POTENTIAL CONFLICT OF INTEREST: The authors have indicated they published a statement on the age limit of pediatrics in 1988, which was have no potential conflicts of interest to disclose. reaffirmed in 2012 and identified the upper age limit as 21 years with a note that exceptions could be made when the pediatrician and family To cite: Hardin AP, Hackell JM, AAP COMMITTEE ON PRACTICE agree to an older age, particularly in the case of a child with special health AND AMBULATORY MEDICINE. Age Limit of Pediatrics. Pedi care needs. atrics. 2017;140(3):e20172151 Recent research has begun to shed more light on the progression of mental and emotional development as children progress through Downloaded from www.aappublications.org/news by guest on September 28, 2021 PEDIATRICS Volume 140, number 3, September 2017:e20172151 From the American Academy of Pediatrics

Hardin et al Age Limit of Pediatrics 3 140 Pediatrics 2017 ROUGH GALLEY PROOF https://doi.org/10.1542/peds.2017-2151 September 2017 Lead Authors Amy Peykoff Hardin, MD, FAAP the adolescent years into young health care needs and if pediatricians Jesse M. Hackell, MD, FAAP adulthood. It is increasingly clear that have previously cared for them. the age of 21 years is an arbitrary Committee on Practice and demarcation line for adolescence Just as the health care needs of Ambulatory Medicine, 2015–2016 because there is increasing evidence each individual patient are unique, Geoffrey R. Simon, MD, FAAP, Chairperson Alexy Darlyn Arauz Boudreau, MD, FAAP that brain development has not the age of transition to adult6, care7 is also unique. This transition, ‍ Cynthia N. Baker, MD, FAAP reliably reached adult levels of Graham Arthur Barden III, MD, FAAP functioning until well into the third which should be part of health Jesse M. Hackell, MD, FAAP decade of life. Students remain in care discussions well before such Amy Peykoff Hardin, MD, FAAP college until their early 20s, and a transition becomes necessary, Kelley E. Meade, MD, FAAP many continue to reside with their should be based on many factors. Scot Benton Moore, MD, FAAP Julia Richerson, MD, FAAP parents after graduation for financial Primary consideration must reside as well as developmental reasons. with the needs of the individual Former Committee Members In addition, because the number of patient and the family situation. Oscar W. “Skip” Brown III, MD, FAAP children with special health care The training, abilities, and interests Chad Rodgers, MD, FAAP needs surviving into adulthood of the physicians involved must continues to grow, these patients are also be factors in these decisions. Staff faced with limited access to health In particular, pediatric medical Elizabeth Sobczyk, MSW, MPH care services once the availability and surgical subspecialists could consider their purviews to be specific of specialized, supportive services References terminates at age 21. Young adults conditions, rather than a specific with disabilities often have limited age range, and continue to provide 1. US Department of Health and Human Services; Food and Drug Administration. access to physicians who are trained care into adulthood in conjunction Guidance for Industry and FDA Staff: to care for adults and also have with adult primary8,9 care and surgical Pediatric Expertise for Advisory the required knowledge of these colleagues. ‍ In many instances, well- integrated, multispecialty groups are Panels. Rockville, MD: US Department problems originating in childhood. able to provide a seamless transition of Health and Human Services, Food and Drug Administration, Center for from pediatric to adult-oriented care Arbitrary restrictions on where Devices and Radiological Health; 2003. and may thus set their own standards Available at: www.fda.gov/downloads/ patients in this transitional age range for this transition based on the may seek care exist in many parts MedicalDevices/DeviceRegulationa competence, capacity, and availability ndGuidance/GuidanceDocuments/ of the health care system. Insurers of providers with the requisite ucm082188.pdf. Accessed September 21, may set arbitrary limits on the age expertise. 2016 range for which a pediatrician may 2. Hagan JF Jr, Shaw JS, Duncan P, eds. provide care, and these age limits The establishment of arbitrary age Bright Futures: Guidelines for the Health may sometimes range as low as 18 limits on pediatric care by health care Supervision of Infants, Children, and years. Prehospital emergency care providers should be discouraged. Adolescents. 3rd ed. Elk Grove Village, IL: providers are generally equipped Health care insurers and other American Academy of Pediatrics; 2008 to provide care for all age ranges ’ 4 payers should not place limits that 3. American Academy of Pediatrics, of patients. However, emergency affect a patient s choice of care Council on Child and Adolescent Health. departments, especially those with provider solely on theBright basis Futures of age. American Academy of Pediatrics, Council separate pediatric and adult facilities, An extension of the guidelines, such on Child and Adolescent Health: age limit may have policies directing patients ’ as those put forth in , of pediatrics. Pediatrics. 1988;81(5):736 to a particular unit solely on the basis to cover recommended health care 4. American Academy of Pediatrics; of the patient s chronological age, services for patients in their 20s American College of Emergency and the same often5 occurs in hospital should be developed. The decision Physicians; American College of inpatient settings. Even pediatric to continue care with a pediatrician Surgeons Committee on Trauma; practices may set an arbitrary age or pediatric medical or surgical Emergency Medical Services for at which patients will be required subspecialist should be made solely Children; Emergency Nurses Association; National Association of EMS Physicians; to transition to adult medicine. by the patient (and family, when National Association of State EMS Yet, pediatricians may be better appropriate) and the physician and Officials. Equipment for ground suited than their adult-oriented must take into account the physical ambulances. Prehosp Emerg Care. colleagues to provide care for many and psychosocial needs of the patient 2014;18(1):92–97 patients outside of these age ranges, and the abilities of the pediatric especially if patients have special provider to meet these needs. Downloaded from www.aappublications.org/news by guest on September 28, 2021 2 FROM THE AMERICAN ACADEMY OF PEDIATRICS

Hardin et al Age Limit of Pediatrics 3 140 Pediatrics 2017 ROUGH GALLEY PROOF https://doi.org/10.1542/peds.2017-2151 September 2017 5. Sacks D; Canadian Paediatric young adults with special health care in the medical home. Pediatrics. Society. Age limits and adolescents. needs. Pediatrics. 2002;110(6, pt 2011;128(1):182–200 Paediatr Child Health. 2003; 2):1304–1306 8. Schor EL. Transition: changing old habits. 8(9):577 7. Cooley WC, Sagerman PJ; Pediatrics. 2015;135(6):958–960 6. American Academy of Pediatrics; American Academy of Pediatrics; American Academy of Family American Academy of Family Physicians; 9. Rothstein DH, Dasgupta R; Delivery of Physicians; American College of American College of Physicians; Surgical Care Committee of the American Physicians-American Society of Transition Clinical Authoring Group. Academy of Pediatrics Section on Surgery. Internal Medicine. A consensus Supporting the health care transition Transition of care from pediatric to adult statement on health care transitions for from adolescence to adulthood surgery. Pediatrics. 2016;138(3):e20161303

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Hardin et al Age Limit of Pediatrics 3 140 Pediatrics 2017 ROUGH GALLEY PROOF https://doi.org/10.1542/peds.2017-2151 September 2017 Age Limit of Pediatrics Amy Peykoff Hardin, Jesse M. Hackell and COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE Pediatrics 2017;140; DOI: 10.1542/peds.2017-2151 originally published online August 21, 2017;

Updated Information & including high resolution figures, can be found at: Services http://pediatrics.aappublications.org/content/140/3/e20172151 References This article cites 7 articles, 5 of which you can access for free at: http://pediatrics.aappublications.org/content/140/3/e20172151#BIBL Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Committee on Practice & Ambulatory Medicine http://www.aappublications.org/cgi/collection/committee_on_practic e_-_ambulatory_medicine Administration/Practice Management http://www.aappublications.org/cgi/collection/administration:practice _management_sub Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.aappublications.org/site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: http://www.aappublications.org/site/misc/reprints.xhtml

Downloaded from www.aappublications.org/news by guest on September 28, 2021 Age Limit of Pediatrics Amy Peykoff Hardin, Jesse M. Hackell and COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE Pediatrics 2017;140; DOI: 10.1542/peds.2017-2151 originally published online August 21, 2017;

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Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2017 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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