Easing the Transition from Pediatric Care to Adult Primary Care

From a baby’s first steps to high school graduation, the journey from childhood and adolescence to young adulthood is filled with change. Just as your child outgrows their toys, so too will they outgrow their pediatrician.

When should your child switch from a pediatrician to an adult primary care physician? And as a parent, how can you make this transition go as smoothly as possible for your son or daughter?

When to Make the Transition

According to Donald Hackenberg, MD, FAAP, a pediatrician at UH Rainbow Children's Medical Group in Hudson, Ohio, most pediatric patients switch from a pediatrician to an adult primary care doctor between the ages of 18 and 21. Young adults with more complex health histories may stay under the care of a pediatrician slightly longer than other patients.

Dr. Hackenberg says it’s a good idea for pediatricians and parents to help prepare children for the transition early on.

“Usually by the time a child reaches middle school,” he says, “I’ve already begun to encourage them to tell me why they’ve come in to see me rather than have a parent explain the reasons. At this age, I want the child to become more mindful and introspective about his or her healthcare. At well visits and other appointments, I urge older children to be more open to me about what is going on with them physically, emotionally and socially. The ultimate goal is to make them the primary participant in their healthcare visits, with the parent moving more into the background.”

As his pediatric patients grow older, Dr. Hackenberg eventually introduces the subject of switching to adult primary care into his conversations with them.

“Often these conversations are very practical in nature,” he says. “For example, if a patient tells me he’s moving out of state to attend college next year, I’ll ask him if he expects to be able to visit home frequently enough to schedule well visits with me. If not, it may make sense to begin talking about establishing care with a new doctor in the town where he’ll be attending school.”

Internal Medicine vs. Family Medicine: What’s the Difference?

A patient leaving a pediatrician’s care has two primary care options: a family medicine doctor or an internal medicine doctor. Dr. Hackenberg makes sure his patients and their parents understand the differences between these two types of doctors.

Internal medicine doctors

Also called internists, internal medicine doctors specialize in the diagnosis, treatment and prevention of disease in adult patients. However, internal medicine doctors with dual training in internal medicine and pediatrics will also see children.

Internal medicine doctors are trained to provide care for a wide variety of medical conditions and to counsel patients on disease prevention and overall wellness. Some internal medicine doctors have additional training in subspecialties such as neurology, endocrinology, oncology, psychiatry, dermatology, cardiology, rheumatology and geriatrics.

Dr. Hackenberg says, “Certainly if a patient has special healthcare needs, I’ll likely steer them towards an internal medicine doctor whose specialization will benefit them. But for patients without specialized needs, selecting a new primary care doctor is often just a matter of finding the right personality you want in a doctor.”

Family medicine doctors

Family medicine doctors care for patients of all ages — from infants to the elderly. They are trained to diagnose and treat a very broad range of diseases and conditions and typically have less specialized training than internal medicine doctors.

Kelly Raj, DO, a family medicine doctor at University Hospitals, says, “Family medicine doctors often care for the same patient throughout much of their life, and, in many cases, care for multiple generations from the same family at the same time. As a result, patients who stay under our care from childhood to young adulthood experience less of a transition as they grow from adolescents into young adults, at least in terms of the familiar faces they see at their healthcare appointments.”

A Natural Transition

Dr. Raj has taken new patients of all ages, including older children who have moved away from pediatric care. For any parents who may be concerned that the transition from pediatric care to adult primary care could be difficult or stressful for their growing son or daughter, both Dr. Raj and Dr. Hackenberg agree there’s usually no cause for concern.

Dr. Raj says, “The transition from pediatric care to adult primary care occurs at a time in a young person’s life when many other changes are taking place. So, in that sense, this change is just another part of the natural order of things. And for most teenagers, the change in doctors is welcomed as a positive thing, since most young people at this age want to embrace their autonomy more and more.”

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