What Pediatric Rheumatologists Can Do
For pediatric rheumatologist Lauren Henderson, MD, MMSc, developmentally appropriate care is integral to the care she provides her pediatric rheumatology patients at Boston Children’s Hospital. Depending on the patient, she prefers to continue as their primary provider to support stability in their care as they deal with major life changes between ages 17–22 before transitioning to adult rheumatology care.
“This [stage] is a time of great anxiety for these young adults, so taking time with the transition is something I focus on to make sure they are prepared for adult care,” Dr. Henderson explains.
She also says there is no magic age a patient reaches when it’s time to start talking about transition. To test a patient’s readiness, she will work with patients in their early teens to start taking the lead in making their appointments and managing their medication. “I spend a lot of time talking to my patients about social choices, healthy eating, exercise and sleep, because building healthy habits can prevent stresses that affect their autoimmune condition,” Dr. Henderson says.
The mental health of her young patients is also an important focus for Dr. Henderson. Often, she sees young adolescents begin to realize they are different from their peers because of their chronic illness, which can be difficult for them to process and accept. “This [aspect] can take open and honest discussion with my patients to emphasize how the choices they make, even social choices to use drugs or alcohol, can be dangerous with their condition and medications,” she shares. “If the patient and/or the family is struggling, additional support with therapy that focuses on coping skills can be very helpful and is something I strongly recommend in appropriate cases.”
To initiate transition to adult care, Dr. Henderson tries to choose a physician who will be a good match for the patient. Many of her patients go through a pre-clinic with the Brigham and Women’s Hospital Center for Adults with Pediatric Rheumatic Illness, which helps guide young adults through this transition process. Direct communication between the pediatric and adult provider is essential to ensure all relevant clinical information is shared. After the transition occurs, it’s important that the adult rheumatologist assumes the role of primary care provider so that no confusion occurs about who is managing the patient’s care.
Dr. Henderson’s one piece of advice to adult rheumatologists preparing to take on young adult patients is to remember that each young adult handles the transition differently and every patient will be at their own phase in the process. “Take time to assess where the young adult is in the transition process. It’s also important to set expectations about care in the adult setting, so young adults can navigate this transition successfully.”
