Mind the Gap

      See related article, p •••
      Before 1972, pediatricians generally relinquished the care of teenage patients to adult providers. That year, a forward-thinking American Academy of Pediatrics (AAP) Section on Child Health redefined pediatric care to encompass birth through age 21 years. Dedication to longitudinal care for teens and young adults was sealed through creation of certification in Adolescent Medicine through the American Board of Pediatrics in 1991. Decades later, it is clear that our AAP and American Board of Pediatrics leaders were prescient in this approach. Each subsequent decade brings increasing numbers of youth with chronic disease and medical complexity into adulthood. Recent insight into the impact of social determinants and adverse childhood events on longitudinal health has increased provider attention on the unequivocal impact of psychosocial variables on patient health. The mandate for this vigilance is not limited to primary and preventive care but also includes subspecialists managing pediatric chronic disease. The manuscript by Michel et al in this volume of The Journal further illuminates this challenge while revealing gaps in care among a subset of such youth and teens, ie, those living with inflammatory bowel disease (IBD).
      • Michel H.K.
      • Kim S.C.
      • Siripon N.
      • Noll R.B.
      Gaps exist in the comprehensive care of children with inflammatory bowel diseases.


      AAP ( American Academy of Pediatrics), IBD ( Inflammatory bowel disease), PCP ( Primary care provider)
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        • Michel H.K.
        • Kim S.C.
        • Siripon N.
        • Noll R.B.
        Gaps exist in the comprehensive care of children with inflammatory bowel diseases.
        J Pediatr. 2020; (in press)
        • Rand C.
        • Goldstein N.
        Patterns of primary care physician visits for US adolescents in 2014: implications for vaccination.
        Acad Pediatr. 2018; 18: S72-S78
        • Adams S.H.
        Association between adolescent preventive care and the role of the Affordable Care Act.
        JAMA Pediatr. 2018; 172: 43-48
      1. Hagan J.F. Shaw J.S. Duncan P.M. Bright Futures: guidelines for health supervision of infants, children, and adolescents. 4th ed. American Academy of Pediatrics, Elk Grove Village (IL)2017
        • Fuller-Thomson E.
        • Sulman J.
        Depression and inflammatory bowel disease: findings from two nationally representative Canadian surveys.
        Inflamm Bowel Dis. 2006; 12: 697-707
        • Lister B.
        • Bernstein C.
        • Graff L.
        Validation of the PHQ-9 for suicidal ideation in persons with inflammatory bowel disease.
        Inflamm Bowel Dis. 2018; 24: 1641-1648
        • Iturralde E.
        • Adams R.N.
        • Barley R.C.
        • Bensen R.
        • Christofferson M.
        • Hanes S.J.
        • et al.
        Implementation of depression screening and global health assessment in pediatric subspecialty clinics.
        J Adolesc Health. 2017; 61: 591-598
        • Abma I.
        • Martinez G.
        Sexual activity and contraceptive use among teenagers in the USA, 2011-2015.
        Natl Health Stat Report. 2017; 104: 1-23
        • Miller V.
        • Friedrich E.
        Adolescents spending time alone with pediatricians during routine visits: perspectives of parents in a primary care clinic.
        J Adolesc Health. 2018; 63: 280-285
        • Dykes D.
        • Williams E.
        • Margolis P.
        • Ruschman J.
        • Bick J.
        • Saeed S.
        • et al.
        Improving pediatric Inflammatory Bowel Disease (IBD) follow-up.
        BMJ Qual Improv Rep. 2016; 5 (u208961.w3675)
        • Gray W.
        • Resmini A.
        • Baker K.D.
        • Holbrook E.
        • Morgan P.J.
        • Ryan J.
        • et al.
        Concerns, barriers, and recommendations to improve transition from pediatric to adult IBD care: perspectives of patients, parents, and health professionals.
        Inflamm Bowel Dis. 2015; 21: 1641-1651
        • White P.H.
        • Cooley W.C.
        Transitions Clinical Report Authoring Group; American Academy of Pediatrics; American Academy of Family Physicians; American College of Physicians. Supporting the health care transition from adolescence to adulthood in the medical home.
        Pediatrics. 2018; 142: e20182587