When does Pediatrics End?

[Perrotfish]

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I'm curious, when do you consider a patient too be too old to be seen by a Pediatrician for a new acute issue? I've heard answers anywhere from 18-27, I'm curious what you guys use as a cutoff.

 

[Rumalum]

depends on the disease and length of care under the pediatric team

 

[michigangirl]

21+ unless it's a disease that is only known well to pediatricians.

 

[BigRedBeta]

I'd say disease specific. However for something entirely new in onset, I'm struggling to come up with a condition that makes sense once past the age of 21. Depending on the center, technical expertise in ECMO might be most concentrated in the PICU faculty and make it appropriate for a pediatric intensivist to be heavily, heavily involved.

Pediatric surgical subspecialists may have a greater extended age range than those of us who did a pediatric residency. I've seen a man in his 40's get diagnosed with a Aortic Coarctation after an episode of chest pain where the adult CT surgeons referred to the Peds CT surgeons. Obviously this is a chronic condition that got missed and wasn't a critical coarct, but again the technical expertise lies with the pediatric subspecialist.

 

[Stitch]

I'd get rid of everyone at at 18 if I could. The adult drama and social issues are a pain. The big ones we still see as adults are congenital heart disease (fontans and mustards or other ongoing thing that adult cardiologists and intensivists have little experience with) and CF. I know the adult docs are working to learn about these patients as they live longer now but they still come to us. Other sub specialists like oncology/hematology tend to hold onto their patients for a long time, and I've even seen some new diagnosis adult ALL patients referred to peds oncology.

Even ECMO is becoming bigger in the adult world, though it's still largely pediatric sub specialists that do it.

 

[Cuthbert]

As a general pediatrician, 18 is my cut off. There are always a few exceptions including some patient's with CP/MR who may stick with us a little longer.

However, I do make other exceptions: Any pregnant teenager has automatically graduated to adult medicine. I feel it is out of the scope of my training to try and take care of these children/soon to be parents.

 

[hmockingbird]

I'd get rid of everyone at at 18 if I could. The adult drama and social issues are a pain. The big ones we still see as adults are congenital heart disease (fontans and mustards or other ongoing thing that adult cardiologists and intensivists have little experience with) and CF. I know the adult docs are working to learn about these patients as they live longer now but they still come to us. Other sub specialists like oncology/hematology tend to hold onto their patients for a long time, and I've even seen some new diagnosis adult ALL patients referred to peds oncology.

Even ECMO is becoming bigger in the adult world, though it's still largely pediatric sub specialists that do it.

On my heme-inc rotation, they said they take young adult ALL patients because the biology of their disease is still more suited for pediatric chemotherapy regimens - which I guess are significantly different than adult ones? (Sorry if you already knew that, I just thought it was interesting.)

Most of the docs I've run into try to refer out around 18-20.

 

[DeadCactus]

In general, 21 seems to be the "we're padding our numbers" cut-off and 17 is the cut-off for actual pediatric care...

 

[13132]

I'm curious, when do you consider a patient too be too old to be seen by a Pediatrician for a new acute issue? I've heard answers anywhere from 18-27, I'm curious what you guys use as a cutoff.

I have a longitudinal clerkship type experience in peds endo and we routinely see patients >21.

 

[mvenus929]

I have a longitudinal clerkship type experience in peds endo and we routinely see patients >21.

But usually peds endo doesn't start seeing patients at >21. They continue to see their patients through to young adulthood, but won't generally see a patient who is over 21 if they were to develop, say, diabetes after that point.

 

[13132]

But usually peds endo doesn't start seeing patients at >21. They continue to see their patients through to young adulthood, but won't generally see a patient who is over 21 if they were to develop, say, diabetes after that point.

Maybe this is anomalous, but the MD I work with takes really old new patients. Tons of 18+ new patients and my last two times there I saw a 21 yo new patient and 24 yo new patient. Not sure what is going on, but Im thinking it is probably out of the ordinary.

This doc works in private practice with an adult endocrinologist and for some reason the adult endo gives the peds doc the stuff dealing with reproductive hormonal stuff.

 

[mvenus929]

Maybe this is anomalous, but the MD I work with takes really old new patients. Tons of 18+ new patients and my last two times there I saw a 21 yo new patient and 24 yo new patient. Not sure what is going on, but Im thinking it is probably out of the ordinary.

This doc works in private practice with an adult endocrinologist and for some reason the adult endo gives the peds doc the stuff dealing with reproductive hormonal stuff.

Yeah, in the two practices I've worked in, the only >18 patients I've seen are those with some reason to have continuity. We try to transition all of the patients to adult by 21 because that's when our children's hospital stops admitting patients routinely (they will allow admission older in certain cases, such as congenital heart disease, kidney transplants, and pediatric cancers, but it's pretty rare--all CF patients get kicked out of the system at 21).

 

[Stitch]

Maybe this is anomalous, but the MD I work with takes really old new patients. Tons of 18+ new patients and my last two times there I saw a 21 yo new patient and 24 yo new patient. Not sure what is going on, but Im thinking it is probably out of the ordinary.

This doc works in private practice with an adult endocrinologist and for some reason the adult endo gives the peds doc the stuff dealing with reproductive hormonal stuff.

Just curious where the patient goes if they need admission for endocrine related problems. The adult hospital or the pediatric one? I'd argue that when other subspecialists hold on to patients for too long, for whatever reason, they put their in patient colleagues and staff in a bad position. There are different pathologies that come up, different social issues that pediatric facilities aren't really experienced with. I'm very experienced taking care of congenital heart disease, but not so much with COPD or an older heart suffering from coronary artery disease.

 

[MEN2C]

I think AAP says up to 26. However, in terms of the subspecialists, particularly cardiology, genetics, neurology, etc, you may keep seeing people forever.

 

[dbeast]

Allergy/Immunology gets double-boarded in adults and pediatrics. So there's that.