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AAP policy: What doctors need to consider when caring for 11- to 21-year-olds :

November 18, 2019

Adolescence is the transitional bridge from childhood to adulthood in so many ways. It’s a pivotal time in physical development, starting with puberty. Healthy cognitive, sexual and psychosocial development all are crucial in the journey in becoming a productive and self-fulfilled adult.

In recent years, international and national organizations have issued statements on the imperative for health care professionals and policymakers to consider the special transitions that need to occur during adolescence and advocate for optimal health of teens.

A new AAP policy statement, Unique Needs of the Adolescent from the Committee on Adolescence, discusses the seminal changes that take place and puts forth recommendations based on the unique biological and psychosocial transitions that occur for this age group. The policy is available at https://doi.org/10.1542/peds.2019-3150 and will be published in the December issue of Pediatrics.

Considerations in practice

The biggest health risks to adolescents are not a result of physical illness. Mortality in this age group is due to unintentional injury, homicide and suicide, all of which have their underpinnings in behavior. These causes of death greatly surpass medical etiologies such as cancer, HIV and heart disease in the U.S. and other industrialized nations.

The policy highlights the need for ongoing health screening, including confidential screening for mental health, sexual health and use of tobacco, alcohol and illicit substances. Some risk-taking behavior is normative in adolescence. However, high-risk sexual activity and alcohol and illicit substance abuse are known to lead not only to substantial morbidity and mortality in teens but could influence physical and mental health during adulthood.

The policy reviews a wide range of issues taking place during adolescence and what the pediatric professional needs to consider when caring for this age group, including the following:

  • the physical changes of puberty and what may influence this progression;
  • research on adolescent brain development, a relatively new arena that will continue to impact how we view adolescent cognitive and psychosocial development and behavior;
  • the crucial task of the development and affirmation of gender identity and sexual orientation;
  • how the legal status of adolescents under age 18 years is an important consideration in the context of rights related to reproductive and mental health, but complicated by challenges to confidential care due to billing and the electronic medical record; and
  • how mental health and emotional well-being are crucial to teens’ overall health and educational/vocational success. Anxiety, depression, eating disorders and other mental illnesses often have their onset during adolescence. Mental health challenges, if unrecognized or under-treated, may result in poor school performance, school failure, difficult family relationships, substance abuse, high-risk sexual behaviors and suicide.

When considering the health challenges teens face, it is imperative to take into account the ethnic and racial diversity of the U.S. adolescent population, as well as their socioeconomic status, family composition, and neighborhood and school environments.

Children with chronic illness are surviving to adolescence, and pediatric health professionals need to assure their healthy journey to adulthood.

The policy also emphasizes the importance of maximizing adolescents’ strengths and capitalizing on their resiliency. Pediatric health care providers are poised to partner with adolescents, and their families when appropriate, in the medical home, schools and their communities to help them face these challenges.


The policy supports the following:

  • Continued recognition of the need for policies and advocacy related to teen health and well-being, such as improved access to medical homes for all adolescents to help ensure preventive care.
  • Sustained funding for research on the biologic basis of growth and development of adolescents and how these changes affect behavior.
  • Educational programs and adequate compensation for pediatric health care professionals in providing evidence-based, quality primary care.
  • Strategies to improve financing for health care of adolescents.
  • Training of pediatric health professionals in creating a “safe space”:  providing confidential care, especially when working with LGBTQ teens and other vulnerable youths.

With this policy, the AAP adds its voice to the call for recognition of adolescence as a crucial time in an individual’s life. Optimizing the journey through adolescence will help assure the development of a healthy, productive, independent adult.

Dr. Alderman is a lead author of the policy statement and chair of the Committee on Adolescence. 

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