EXPLORING TRANSITIONS
GROWING UP AND MOVING ON
– MEDICAL TRANSITIONS
Growing up is hard enough, but for young people with chronic health conditions,
there is the added complication of medical issues that need to be addressed in the
transition from paediatric to adult care.
By Associate Professor Susan Towns
T
ransition is the planned and coordinated
move from paediatric care to the adult
healthcare system for those young people
with chronic health conditions who will
require ongoing medical care. Transition is
a process not an event, and preparation,
planning and good communication are key
to a successful and smooth transition.
Transition planning is integral to
coordinated care and begins at diagnosis
as part of the overall discussion of ongoing
management. As adolescence approaches,
with its inherent physical, pubertal and
neurocognitive developmental changes,
transition planning begins with increased
focus on preparation and developing
self-management skills. It is important that
your child understands that someday they
will move on to adult care, and that they
feel confident about making the move.
Most young people will start asking
questions related to their healthcare and
ongoing treatment when they begin high
school. This can be a challenging time for
parents as well as the young person, but a
cohesive communicative family environment
providing structure and support can help.
How can parents plan for it?
Talk to your healthcare team so you are
fully informed regarding the availability
of appropriate adult services. You can
then discuss planning for transition to
adult care with your healthcare team and
your child. Exploring the options together
and encouraging your son or daughter
to ask questions can be reassuring and
motivating. Some questions to ask are:
¡¡ At what age can an adolescent still be
admitted to a children’s hospital or ward?
¡¡ How do you choose an adult doctor/
healthcare team?
¡¡ What adult health services are available?
¡¡ How will I be referred on?
The timing of transition is flexible
according to your individual needs, but
planning for all young people to be ready
to move on around the time they turn 18
is optimal. This is a time of great change as
it usually coincides with teens completing
their education, making vocational choices
and other transitions to adulthood such
as driving, voting and legal consumption
of alcohol.
How can adolescents prepare?
Information, education, appropriate family
support and encouragement can all facilitate
emerging independence.
In the preparation phase (12 to 16 years),
the emphasis is on communication,
education and facilitating the development
of self-management skills and increasing
responsibility around treatment plans.
¡¡ Encourage young people to start
to talk to their doctors on their own.
Your adolescent might like to see the
doctor for part of each visit from about
the age of 12 years.
¡¡ Your doctor and healthcare team
will reassure the young person
regarding appropriate confidentiality
so that the impact of puberty can
be discussed in the context of the
developmental changes that happen
duringadolescence, and how these
changes can affect their condition.
Sexual and reproductive health issues
can also be discussed. These can
be even more important for young people
with chronic conditions. The pace of
puberty can be slowed or delayed by
some disorders or by medication effects.
¡¡ Young people can begin practising
independent healthcare skills, such as
taking responsibility for medications,
learning what to do and who to
contact in an emergency, and even
booking appointments.
¡¡ A trusted GP who is involved long
term can provide continuity at a time
of change, valuable support during