Summary
The epidemiological transition towards non-communicable diseases is characterised by an upward shift in age of disease burden across the lifecourse. One response, within a suite of wider actions, would be to extend the upper age limit of paediatric practice to embrace adolescent health. We did an online survey to explore the upper age limit of paediatric care, obtaining responses from 1372 paediatricians in 115 countries. Marked variation in the upper age limit was apparent. Among high-income countries, a higher upper age limit was associated with greater disease burden in adolescents relative to young children (<5 years). Although paediatricians reported the mean upper age limit of paediatrics had risen over the past 20 years, the mean preferred age of 18·7 (SD 2·6) years was higher than the mean current age of 17·4 (SD 2·5) years (p<0·0001). Paediatricians reported the main reasons for the rising age over time was their greater awareness of adolescent health and leadership by professional associations. Reports of the quality of adolescent health education within national paediatric training suggest that this education is largely inadequate. A greater focus on adolescent health is required within paediatrics to ensure that the future paediatric workforce is appropriately equipped to respond to the changing disease burden across childhood and adolescence.
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Article info
Publication history
Published: September 18, 2019
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© 2019 Elsevier Ltd. All rights reserved.
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- Avoiding a rigid age of paediatrics – Authors' reply
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We thank Michael J Rigby for his reflections on our paper. We agree that shifts in the relative burden of disease across the life course have relevance for different disciplines across the health-care system and how they work together, including mental health services. We also agree that beyond the health-care system, it takes a village to raise a healthy adolescent.1 However, we urge care in assuming that countries with a lower proportion of older adults will naturally give more attention to adolescents.
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- Avoiding a rigid age of paediatrics
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The comprehensive Health Policy paper by Susan M Sawyer and colleagues1 on the age of paediatrics gives much food for thought. However, it has a medical-driven view and other professions get scant mention, even though a harmonised health infrastructure is essential. Worryingly, mental health services are not addressed, implying a continuation of the current divide in service.
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