What age do children typically change over to adult hospital services?

[Madsometimes]

My dd1 is nearly 12, so not for a while I'm sure.

I was wondering about this because she is seen by an outreach team from the Evelina. Looking at their website, they say they children are prepared for the transition at age 12/13, which seems very young. Most make the transition at 16, with a few staying to 18.

I remember when I was a teenager, hating being the youngest person in the waiting room at the hospital. It must be even worse if they are admitted onto an adult ward where most people are over 60.

If you have a teenager that has made the transition, did it go smoothly?

Dh had to take 13 yo dd to A&E yesterday and she was still told to go to the children's waiting room and seen by the children's team.

Not really sure that answers your question though.

I think it's a bit of a grey area; depends on the area, and the condition. THere is a huge issue with mental health services, for instance, where there's a gap between 16 and 18. I think your best option is to ask at her next appointment....

I'm 34 now so it was a while ago but at 15 I was admitted to an adult ward.

The area is cardiology, but i think the general principle of how teenagers cope in adult services is not dependant on condition - I can see that mental health services are different. I think that she will make the transition at 16, but I do think that hospitals should think about dedicated clinics for 16-25 year olds.

In the hospital near us it's paediatrics up to 18.
Although I think there is a little leeway in this either way.

DD2 was in hospital recently, there were sometimes 17 year olds on the ward with her.

IMO I would want my DC to be on paediatrics for as long as possible because the standard of care is so high.

My DD2 is under the paediatric team at Grantham Hospital & they're fab.

They see all kids up to 16 on the ward, not OP dept & even sometimes older if they're frequent visitors "known" to the team. Thay have a seperate "teens room" with age appropriate games, books TV etc & a big squishy sofa & a pinball machine!

It varies area to area. Some services have got very good cross over clinics/teams, so young diabetic, cardiology, cystic fibrosis etc. others are I'm sorry to say poor. 17 year olds who previously would have everything carefully explained and talked through are put in adult clinics and expected to cope. Diabetes services, in particular, have had to deal with the fall out this can create. But others are brilliant and the fact that your team starts to broach this issue early to prepare your child, bit by bit, for the time when they take control is a really good sign.

In general whether a 17 yr old goes to a paeds ward varies too. It used to be if 17/18 but in full time education, then paeds. Now anyone 17 or over adult ward, which I don't think is right. I have worked in some sensible places which did it on the basis of the child, so if you had a strapping 17 yr old lad who would die of embarrassment being in paeds then he got to go to an adult ward, whereas an immature 17 yr old who'd barely hit puberty would go to paeds.

Madsometimes - My dd's transition (cardiology) started at about 14 1/2 I think - she had a hospital stay/procedure around that time and we started to discuss it then. She certainly felt she'd outgrown children's at that time. As an inpatient stressed teens and screaming toddlers are not a good mix.

We finally had the physical transfer (it's a different hospital/team) just before her 17th birthday though had she not been ready or clinically well they would have kept her longer.

It's been a bit of an eyeopener TBH. Transition to adult cardiology is a well worn path but I feel they're a bit less organised and can see why some young people get lost to the service at this point. We've had a year of random visits to clinic and she's been the youngest person there everytime - I sort of imagined there'd be a specific GUCH clinic but it appears not. Also we had an issue with drs who need a lesson in person skills and manners and who need to learn that a nervous 18 year old female with a long term medical condition needs different handling to a 50 year-old.

I remember back to when I was a teenager (in sixth form), and a friend needed a gynae admission. She spent the whole time terrified because she was on a ward with all "old ladies" and thought that she had been put there because she was about to die. I do understand that gynae doesn't come under routine paediatrics, and my friend was 17. Perhaps teenagers should routinely be given side rooms. It's tricky.

Yeah - It's good to know that dd's clinic is doing the right kind of things for transition. I don't anticipate her needing any admissions as a teenager, but knowing my child, she doesn't like change, and isn't too keen on hospitals either.

One thing that the clinic does that I wish they didn't, is to use an electronic cuff to take bp. It always pumps up too tightly, whereas when a human does it, they are normally more gentle (dd has low bp). Would I be unreasonable to ask them to take it manually, given that the electronic cuff upsets her? She has to have bp taken and frets about it

she doesn't like change, and isn't too keen on hospitals either.

No nor mine I think she's learned quite quickly this past year to speak up and say if there's something she doesn't like or would like done differently. Like them being a bit more considerate at echo and ecg with regard to covering up. It's a shame it has to be like that She had a stress echo and I couldn't be in the room - too many people - and they were completely disrespectful; didn't introduce themselves, explain what they were doing or how she would get the results. I was bloody furious and wrote to her consultant about it. She was most apologetic but really it shouldn't have happened in the first place.

How horrible for your dd .

My dd has suddenly become a lot more body conscious. She doesn't want me to see her naked even though I wander about in the nod. I think she will find the echo this year a lot more distressing. I also need to broach with her the subject of joining a drug trial. I think she will flatly refuse, which is her choice in my view, because she is old enough to make decisions like this now.

There is a lot of work being done on transition at the moment across the board. In the area I work in - renal - there was a piece of research recently which confirmed the bleeding obvious - that if they dealt with teenagers emotional needs better (or at all) then those teenagers were able to manage their own care much better and this translated to better survival of transplanted kidneys. Until very recently a hideously high number of young people lost function in their transplanted kidney within a year or two of moving in to adult care. So it is now appreciated that transition is a critical time and it should start young so that the patient has plenty of time to get to know the new team.
Re the BP cuff - yes she can ask for a manual cuff. In fact I will shortly be ordering a load for use in our area as our hospital is moving back to manual across the board. There may be chuntering because the staff will have to go and find one for her but it's not an unreasonable request. So support her in asking for it because that's what transition is all about - her learning to manage her own condition and advocate for herself.