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April 7, 2010

When do children become adults?

In my first blog entry almost two years ago, I tackled the prevailing notion that children are not small adults and therefore deserve special treatment by pediatric hospitalists. But recent events have me thinking about when exactly do children become adults, and when should we transfer care of a pediatric patient to an adult hospitalist?

The question comes up with not-unexpected frequency in certain patients: the pregnant adolescent; the 25-year-old patient with a congenital heart defect or cystic fibrosis who is still followed by pediatric subspecialists; or the teenager who attempts suicide and needs to be medically cleared before a psychiatric evaluation.

In my new job, I have the luck and luxury to have a dedicated adolescent unit with nurses who welcome the challenge of taking care of these patients. As a result, my colleagues and I have become necessarily familiar with adult specialists and adult med dosages and therapies. After all, if a fifteen-year-old weighs more than I do, he is an adult in pharmacological terms. And as one of my nurses mentioned the other day, at some point, you have to cut the cord.

So when is the right time to send a man-child to the adult ward? Here are my criteria for when a child becomes an adult (in homage to my colleague Dr. DeLue and his Foxworthy-like recent post):

● You might be an adult if you take five or more medicines on a chronic basis and you donít know what they are for.

● You might be an adult if on discharge youíre already thinking about your next hospitalization, what pillow to bring and whether theyíll finally allow you to smoke in the doctorís lounge with your doc.

● You might be an adult if your diapers donít have cartoons on them.

● You might be an adult if I see your medicines advertised in the pages of JAMA, on the hood of a NASCAR vehicle or during a baseball telecast.

● You might be an adult if you donít know who Swiper the Fox, Diego or Hannah Montana are.

● You might be an adult if you think a Wii is something you smoke.

● And you are definitely an adult if you have more body hair than I do!

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About Ruben J. Nazario, MD
Ruben J. Nazario, MD, is now medical director at Inovalon, a health care data analytics company, and is medical editor for Elsevier's First Consult. A pediatric hospitalist, Dr. Nazario is a veteran of both community and academic pediatric hospitalist programs. All material represents his own views and does not reflect the views of his employer.
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