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NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice

      Creation of exclusive age limits for the provision of health care in pediatric, adolescent, and young adult patients may unnecessarily create barriers and limit access to care continuity for this population (
      American Nurses Association, National Association of Pediatric Nurse Practitioners, & Society of Pediatric Nurses
      Pediatric nursing: Scope and standards of practice.
      ,
      • Hardin A.P.
      • Hackell J.M.
      Committee on Practice and Ambulatory Medicine
      Age limit of pediatrics.
      , ). Pediatric nurse practitioners (PNPs) have the education, certification, and licensure to provide comprehensive care to all children from birth through young adulthood. This includes providing screening, evaluation, and diagnosis for patients in both primary and acute care settings (
      American Nurses Credentialing Center
      Test content outline: Pediatric primary care nurse practitioner board certification examination.
      Pediatric Nursing Certification Board
      Primary Care Pediatric Nurse Practitioner—Primary Care Exam: Detailed content outline.
      ). NAPNAP historically defined the age population cared for by PNPs as all children from birth through 21 years of age. In specific situations, individuals older than 21 years can continue to receive health care from PNPs until care can be successfully transitioned to adult health care providers. Adolescents with complex health care needs can face limited access to appropriate adult care and require additional coordination and guidance to ensure an optimal care transition (
      • Hardin A.P.
      • Hackell J.M.
      Committee on Practice and Ambulatory Medicine
      Age limit of pediatrics.
      ). The PNP is educated to meet the psychosocial and physical care needs of these patients, participate in health promotion, deliver preventive care, and provide medical continuity to all children as they transition into young adulthood (
      American Nurses Association, National Association of Pediatric Nurse Practitioners, & Society of Pediatric Nurses
      Pediatric nursing: Scope and standards of practice.
      ).
      Pediatric providers are uniquely qualified to manage developmental and physical health care needs into young adulthood. The importance of transition planning for adolescents to adult health care services has been widely acknowledged (
      • Betz C.
      SPN position statement: Transition of pediatric patients into adult care.
      ,
      • Linebarger J.
      • Ajayi T.
      • Jones B.
      Adolescents and adults with life-threatening illnesses: Special considerations, transitions in care, and the role of pediatric palliative care.
      ). Transition of care includes the use of comprehensive support processes to provide coordinated movement of adolescents and young adults with chronic health conditions from child-centered to adult-oriented health care systems (
      • Davis A.
      • Brown R.
      • Taylor J.
      • Epstein R.
      • McPheeters M.
      Transition care for children with special health care needs.
      ). Education, planning, and support are needed for all young people preparing to transition to adult systems of health care.
      The
      World Health Organization
      Adolescence: A period needing special attention.
      categorizes young people as individuals 10 through 24 years of age. The upper age limit of 24 years considers that there are higher rates of unemployment and high costs to establishing an independent household, leading to a prolonged period of dependency (
      United Nations Educational, Scientific and Cultural Organization
      Learning to live together: What do we mean by “youth”?.
      ). Gaps in insurance coverage and inconsistent adherence to care regimens for existing conditions and follow-up can lead to poorer health outcomes in young people (
      • Cuomo C.
      • Rome E.S.
      Translation of the six core elements of healthcare transition: A primary care approach.
      ).
      • Sawyer S.
      • Azzopardi P.
      • Wickremaranthne D.
      • Patton G.
      The age of adolescence.
      suggested that defining adolescence as ages 10 through 24 aligns more clearly with an improved understanding of adolescent growth patterns and social role transitions.
      Age parameters should not be the sole arbiter for optimal, safe, and quality care in pediatric practice. Multiple evidence-based publications underscore circumstances in which a patient falls outside the traditionally defined population focus of a pediatric health care provider (
      American Academy of Pediatrics, American Academy of Family Physicians, & American College of Physicians, Transitions Clinical Report Authoring Group
      Supporting the health care transition from adolescence to adulthood in the medical home.
      ,
      Society of Adolescent Health & Medicine
      Young adult health and well-being: A position statement of the Society for Adolescent Health and Medicine.
      ). In these circumstances, the PNP may manage the patient or provide expert consultation to ensure the provision of high-quality and evidence-based care to those patients ().
      PNPs provide developmentally appropriate, family-centered care to adolescent parents and their infants to meet their special health care needs (
      • Dumas S.A.
      • Terrell I.W.
      • Gustafson M.
      Health and social needs of young mothers.
      ). PNPs play a significant role in establishing a child's medical home by conducting pediatric prenatal visits and by continuing care delivery for term and preterm infant care across health care settings (
      • Yogman M.
      • Lavin A.
      • Cohen G.
      Committee on Psychosocial Aspects of Child and Family Health
      The prenatal visit.
      ). Preterm infants are a unique population with specialized health care needs that may continue across the lifespan, and PNPs are educated to care for these specialized needs.
      In the acute care setting, patients of all ages present with health care issues that originate in or that normally occur during childhood and adolescent years. Because of the unique health care needs of young persons with acute and/or chronic life-threatening illnesses, patients outside the traditionally defined pediatric age parameters may require ongoing pediatric health services and may be best served by acute care–certified PNPs (
      Pediatric Nursing Certification Board
      Acute Care Pediatric Nurse Practitioner Certification Exam: Detailed content outline.
      ).
      NAPNAP is an organization whose mission is to empower PNPs, pediatric-focused advanced practice registered nurses (APRNs) and their interprofessional partners to enhance child and family health through leadership, advocacy, professional practice, education, and research. NAPNAP firmly supports the scope of practice for PNPs to include prenatal consultations and care of newborns, infants, children, adolescents, and young adults. The American Academy of Pediatrics (
      • Hardin A.P.
      • Hackell J.M.
      Committee on Practice and Ambulatory Medicine
      Age limit of pediatrics.
      ) has recently left the decision about receiving pediatric-based care to individual patients, in concert with their provider, in consideration of the patient's physical and psychosocial needs. NAPNAP supports the PNP's role as a provider of health care for young adults with unique needs during the transition to adult health care providers, especially among those with limited access to health care (
      American Academy of Pediatrics, American Academy of Family Physicians, & American College of Physicians, Transitions Clinical Report Authoring Group
      Supporting the health care transition from adolescence to adulthood in the medical home.
      ,
      • Scher E.
      Transition: Changing old habits.
      ).

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