As your kids get older, you've probably considered whether it's time to move on from the pediatrician who's taken care of them all their lives.
And teens – coping with hormonal changes, or seeking treatment for a tattoo-related infection, or in need of counseling about birth control or an eating disorder – might be feeling out of place in a waiting room where toddlers clamber on the furniture and moms coo to babies on their laps.
If you're trying to figure out the right age or moment for your kid to move on from the pediatrician, "the answer is, that depends," says Cora Breuner,a professor of pediatrics and adolescent medicine at Seattle Children's Hospital and the University of Washington.
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Different Ages, Different Health Issues
One advantage of staying put is continuity of care. Pediatricians know all about developmental milestones and may be better equipped to deal with teens and their reproductive, mental health and sports-related issues than a doctor with an adult-oriented practice, says Breuner, who's on the Committee on Adolescence for the American Academy of Pediatrics.
"That being said, many children are not comfortable seeing their pediatrician for some issues like contraception, or STD screening or other issues around their health because they feel like it's a 'baby doctor,'" she says.
An adolescent-friendly practice should have at least one exam room that's tailored more for an older child, says pediatrician Damien Mitchell, with Forest Lane Pediatrics in Plano, Texas. His office, he says, is not covered in balloons and teddy bears, and other than toys, children's books and smaller tables, it resembles a regular physician's office.
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Mom, You Can Stay in the Waiting Room
If you stick with your pediatrician, you may be taken aback the first time you're excluded from your child's medical exam or some of the doctor-patient discussion.
By age 13, a child does need to see a pediatrician without the parent for some of the visit, Breuner says. This allows kids to develop a one-to-one rapport and simply learn how to speak directly to a health practitioner.
She says as a parent herself, she felt a twinge when her kids started going back into the exam room without her. While she knew it had to happen, she says, "even though I am an adolescent doc, I was like, 'Wow, really?'"
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Confidentiality Comes Into Play
In his practice, Mitchell says at age 13 they give the child the opportunity to have their exam in private. "They also have doctor-patient confidentiality," he says, "which means they can share something – whatever they like – with me, and I'm not allowed to share that with their parents unless they give me permission, or unless they tell me that they're thinking about hurting themselves or somebody else."
That separation, he says, creates a safe place for kids who are embarrassed to talk about an issue with their parents.
Parents should be present during at least part of the appointment, Breuner says, to make sure health issues get addressed. For example, she says, "A lot of time the kids say, 'Um, I don't know why I'm here,' and the parents say, 'You're here because you need a sports physical, and you need an HPV vaccine.'"
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From Cradle to College
Most practices will see children until they're 18, and some will attend to them up to age 21. In Mitchell's practice, children can stay through their first year of college, which makes a natural transition point into adulthood, he says.
"Preparing kids for college is a big part of what pediatricians should be doing both physically in terms of dealing with puberty and those transitions, and also emotionally – just dealing with the hormonal changes and transitions from a boy to a man or a girl to a woman," Mitchell says. Preparing teens for dorm life also means making sure they're up to date with vaccines, including one to prevent meningitis.
For children with complex medical issues, like a congenital heart condition, the transition to adult care may come at a later age as young patients stay with the specialists most familiar with their individual needs.
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Where Do You Go From Here?
If a child is ready to move on, the decision becomes where to go next for health care. An adolescent medical practice can be a good fit, but depending on where you live, there may not be one available.
Breuner recommends that children keep seeing their pediatricians as long as they're comfortable talking to them about important physical and mental health issues. But if the child feels ill at ease, she says, or if "the pediatrician isn't versed in providing guidance in areas like texting and driving, or HPV vaccination, then they should to go to an adult provider."
Breuner recommends family doctors as "excellent providers who can handle everything for 18- to whatever-year-olds." Some kids move on to an adult-oriented doctor, like an internist. Girls also may opt for a gynecologist; however, they only handle one aspect of a woman's health, Breuner points out.
Your pediatrician can help by giving you a referral to a practitioner who's comfortable seeing adolescents or teens, Mitchell says. He adds that it's "very appropriate for a parent to ask at any point during a visit: 'What can we expect as my child gets older? When should we transition to an adult physician?'"
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