Scott Webb (Host): There's no doubt that pediatricians are the best. But eventually, our kids need to transition to adult care. And my guest today has some suggestions for when and how to make that transition. I'm joined today by Ruthie Crapps. She's a family nurse practitioner with PRISMA Health.

 This is Flourish, the podcast brought to you by PRISMA Health. I'm Scott Webb. Ruthie, it's so nice to have you here today. We're going to talk about, you know, how to transition from pediatric to adult care. And I have a son who's 21, who's in the midst of transitioning from pediatric to adult care. So, I have some experience in this realm. So, let's start there. When should a young person transition from pediatric to adult care?

Ruthie Crapps: I guess the short answer is around 18, 19 years of age is when the actual transition typically will occur. But typically, you should try to start that transition process early, like between the ages of 12 and 16 years old. I think it's important to begin considering the transition from pediatric to adult care around 16. That's a good time for teens to start managing their own health conditions a little more independently. Allowing them to take ownership of their health care prepares them for adult care where they will sort of take the lead, discussing their, you know, personal health history. So, they need to be able to advocate for themselves without necessarily having a parent there. So, essentially, starting like between 12 to 16 years old gives a nice window to allow them to assume more responsibility of their health, so that they're more confidently prepared for that.

Host: Yeah. And that's what we've been doing, kind of doing that with our 16-year-old now. Like when we do go to the doctor, like last week, it was like, "Okay. Well, you're a big girl. You know what's ailing you, you talk to the doctor. Don't look at dad." And we've been trying to do that with our son to transition. And maybe you can emphasize why it's important for teens, and young adults to have their own primary care doctor.

Ruthie Crapps: Yeah, for sure. So, establishing care with a primary care provider kind of lets you get to know your provider over time. So, you know, if you start, say, transitioning between pediatric to adult care at say 19 years old, well, you may be doing very well health-wise. But as the years go on, things will sort of creep in. And so, it's easier to see trends and lab values. It's easier to kind of see what medications affect patients certain ways, so we know like if you don't respond to certain antibiotics, we kind of already know that. It just gives us a better idea of who the person is as a whole and as they age. And so, it's just nice to have somebody who can consistently see you and provide that care.

Host: Yeah. And I love pediatricians. I mean, who doesn't love pediatricians? They're just the best. The pediatric office is the best, that has the toys and all, you know, fun things to look at. But at some point, when our kids become sort of people of their own, right? You say that around 16, maybe as late as 19, we're still working on it with our son, but he's also away at school, which presents some complications. And I'm just wondering, how can we help them manage their own care?

Ruthie Crapps: We can begin talking to our kids early on about their diagnoses, about what we're doing when we go to a doctor's office. You know, as they get older and start to assume more of their own care, it may be kind of necessary to kind of step out of the room at times and let kids have some time with the provider alone, more towards 16, 17, and that kind of thing. But letting them talk and kind of get to experience a little small slice of time where they're alone with their provider to talk about their health and then just getting them super involved in their health. So, you know, if they have any sort of issue arise, a lab value that may be awry or something that kind of needs more attention, having that open dialogue so that they understand it.

And then also, just casually kind of mentioning their family medical history and kind of like, "Mom and grandma and dad's dad all have high cholesterol." So, you know, just kind of get that in their mind so that they know when it's time for them to go see a provider, they can say, "Hey, my mom and her mom and my dad's mom, they all have high cholesterol." So, it's just kind of getting them to really understand their health history, their surgical history. And really kind of stepping back, and that's really difficult, I think, sometimes for parents. Especially if their kids have more health issues to deal with, it's kind of hard for parents to step back. But when appropriate, it's ideal to give them a little bit more control, a little bit more autonomy slowly.

Host: Yeah, there's no doubt, it is difficult to step back when you've been helicoptering for so long. And then, you're like, "Oh, hey, I made an appointment for you. Just head on over there and park and go in and use your debit card and pay the co-pay" and all of that. So, we've been working on that slowly, you know, because they're going to be taking care of themselves the rest of their lives. Mom and dad are not going to be there to answer those questions. So, as you say, family history, things like that. Ruthie, I have a nephew who has Down syndrome and he's in his 20s. So, it makes me wonder, what do we do if a child has special needs?

Ruthie Crapps: That's a super great question. So, you know, when we talk about that window of when to start that transition for kids with special needs, we want to start that process even earlier. So really, that younger end of that spectrum, like 12 years, really get them involved. It's going to be a different transition for people who have special needs, right? They're going to need more specialists potentially. Sometimes they have to even change specialists when they're transitioning from pediatric to adult care. And so, there's a little bit more involved there. They need to know their resources. I think what's super important for kids with special needs or just even more complicated medical histories is having like a plan. So, having some type of document that you can keep, you know, who your providers are, who your specialists are, their contact information, plans for sick days, if kids have diabetes, all of that kind of in one place so that they can access that and keep that when they're sort of transitioning into the adult care.

Host: You know, when we think about the turning 18, that's such a milestone, obviously 16, 18, 21, right? But 18 is such a milestone. Are there any changes, you know, when kids turn 18 and they're, you know, essentially no longer kids? And what should they be able to do? And we talk about them managing their own care. What do they really need to be able to do?

Ruthie Crapps: So, they need to be able to relay their health history, their family health history. They need to be able to simply call and schedule the appointment. They need to be able to access their medical records if that's through some kind of online portal. They need to be able to do those kinds of things. They also really need to understand the basics of insurance coverage, because they may have a co-pay to pay. And they may be used to mom and dad paying that co-pay or they show up and they don't have it, and that can cause some unnecessary anxiety leading up to an appointment. So, they need to know that kind of stuff. They need to have a little bit of an idea of maybe their deductible and what they could be faced with financially. But the basics I think would be making sure that they understand how to schedule an appointment, the responsibility of showing up to those appointments, how to describe their past treatments and really be able to kind of stand firm in their desire for their own health so they can speak up for themselves. So, giving them that push to speak up for, you know, whatever they are concerned with or, you know, they may have different healthcare goals than the general community. So, they need to be able to kind of express that to a provider.

Host: Let's talk about adult care versus pediatric care. Besides the fact that there may not be as many toys, you know, at the adult office or, you know, lollipops and stickers and those types of things, what are the real differences between adult care and pediatric care?

Ruthie Crapps: Well, there are a couple of differences I think that are pretty significant. I think I should have touched on this a little bit earlier. But, you know, when you go into adult care, once you've reached that legal age of 18, now your health information is your health information. So if you want somebody else to be involved, do you need to sign a release of that information. You have to kind of give that person permission essentially. So, mom and dad can't necessarily call up and be like, "Hey, you know, Johnny was in there the other week. What was he sick with? What's going on with him?" That's not information that can be shared at that point. And so, that's kind of important, I think, to just mention.

But aside from that, pediatric care is very much focused on assessing development and intervening when necessary, right? But once you get into adult care, you're looking to maintain good health. And not only that, but to prevent disease progression. So, what we're really focused on from an adult perspective is different, because we do now really need to know more about family history and, as things sort of crop up, like what we need to kind of look out for. So, we're trying to maintain that high level of functioning, that high level of health, rather than assessing development and intervening in that kind of way.

Host: So, let's finish up here today. And we've been trying to help our son find the right doctor, the right fit and try some on, so to speak, but what should a young person keep in mind when they're choosing an adult doctor for the first time?

Ruthie Crapps: I think it's important to know that if you're going from a pediatrician that you've had for your entire childhood, school age kind of years, you're going to be meeting with somebody new. And so, it may take a little time to get to know that provider and to be trusting of that provider, right? So, you got to make sure it's a good fit. There are options available. Like I know that you can click on links of different providers and watch little videos and kind of see if you think it might be a good fit. and then just giving it a little bit of time. So, the first appointment, it's a lot of information gathering. And then, as time goes on, we get to know the patient's a lot better and start to talk about less mundane things when we have our visits and more like, "Well, how did this go? How did this event go?" You know, whatever. So if you've got a good fit, that tends to go a little smoother and honestly a little faster. And so, it's important to find somebody that you really felt comfortable with. And if you don't off the bat, maybe give it a little bit of time. And then also, if it just doesn't work out, if it's not a good fit, then it's not a good fit, you know, and it's okay to find another provider that you're more comfortable with.

Host: Yeah, good stuff to help kids transition, whether it's somewhere between 16 and 19 or, in the case of our son, roughly 21 or so. Yeah, really, at some point, it's got to happen. And I appreciate your advice, just all the great information today. So, thank you so much.

Ruthie Crapps: Sure. Thank you for having me.

Host: For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by PRISMA Health. I'm Scott Webb. Stay well.