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Berita MPA Newsletter November 2016 - In Time With Transition

28 November 2016

From the President 

In Time With Transition

Dear friends,

Issues related to child health; as always, were highlighted prominently in the media.

Zika and microcephaly, mortality from child abuse and neglect, road traffic injuries and obesity in children. Nothing new except Zika. All of which are however, preventable.

There are programmes, laws and regulations in place. Sadly we continue to lose precious lives due to abysmal human behaviour. The same people entrusted to protect the children seem to fail miserably in protecting children from road traffic injuries. Worse still, many neglect and abuse had led to loss of precious lives.

Non Communicable Diseases...

Obesity remains in the “big picture” of MOH. However, it is time MOH invest more in prevention of obesity in childhood and adolescents. Studies have shown that the war against obesity in population must start during childhood and adolescence. If we fail to prevent obesity in these age groups, handling adult obesity is a lost war. 

Even World Health Organisation (WHO) is in the process of drafting a document on obesity prevention. The prevention and control of noncommunicable diseases is identified as one of the major health challenges under the Sustainable Development Goals, established by the United Nations in 2015.

The WHO Global action plan for the prevention and control of noncommunicable diseases 2013-2025 calls for a halt in the rise in obesity among adolescents and sets a target of no increase in childhood overweight by 2025.

Writing about childhood origin of adult NCDs bring us to the issues of smooth and effective transition of care from paediatric to adult health care systems.

Transition time...

“A painful passage or a restless flood”
- William Cowper (1731–1800)

As paediatricians we care for our patients right from the time they were born. Sometimes even earlier (in utero) when we counsel pregnant mothers in anticipation of a stormy neonatal period for the unborn baby e.g premature delivery and congenital anomaly.

We care for them till the age of 12 years and nowadays a vast majority of us will contiue to care for them till the adolescents are 18 years old. Unfortunately paediatricians are likened to children; difficult to “give away” patients (discharge patients). Some continue to care for them beyond even 25 years of age. Most paediatricians will claim, rather delusionally that adult physicians are never capable of managing these patients well. We must realise that caring for patients beyond the paediatric age group has medicolegal implications too.

In our current generation, more than 80-90% of children with chronic illnesses and conditions survive to adulthood.

Adolescence is a period of significant change. More so when they have ongoing health problems, which requires continuity of care within the adult health care setting. The manner in which this care is transferred to the adult health care setting is crucial to the continuing wellbeing of the adolescent patients and their willingness to continue and comply with treatment.

In the past, the moment patients reach the age of 18 years they are often abruptly refered to adult physician. Transition is a process; not an event.

Transition is defined as “A purposeful, planned process that addresses the medical, psychosocial and educational/vocational needs of adolescents and young adults with chronic physical and medical conditions as they move from child centred to adult-oriented health care systems” (Society of Adolescent Medicine 2003)

The transition from family-oriented, developmentally focussed paediatric health services to more independently oriented adult services can be challenging for adolescents and their families, as well as for the paediatricians.

Transition should be well coordinated without break in continuity of care. Timing of transition is crucial. Often the process begins when the adolescent reaches 14-16 years old.

The teenager and his/her family are briefed and prepared for transition. By the time they are 18-19 years old, they should be transferred to the adult system. However the actual event of transfer to adult care should not occur during any major event such as school exams etc.

Every paediatrician, in particular those in public sector should consider a smooth and coordinated transition from adolescent to adult health care setting to ensure continuity of optimal care.

Finally to all Hindu colleagues, wishing you a joyous Deepavali.

President 2015-2017

Please click here to download the latest BMPA November 2016 Newsletter.

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