AAP Guidance Details ‘Unique and Essential Needs’ for Hospitalized Teens

Hospitalized adolescents have “unique and essential needs” that differ from those of younger pediatric inpatients, and it is critical that care teams have “knowledge, experience, and compassion” when it comes to addressing these specific needs, the American Academy of Pediatrics (AAP) said in a new policy statement.

This statement marks the first of its kind published in the U.S., noted Cora Breuner, MD, MPH, of the University of Washington and Seattle Children’s Hospital, and colleagues in Pediatrics. Overall, knowledge and understanding of adolescent growth and development, as well as the legal and ethical issues that affect this population, are essential to delivering comprehensive care to hospitalized teens.

“One of the things that I’ve noticed is that it’s very hard to take care of a teen when they’re in the hospital,” Breuner told MedPage Today. “We really like to have guardrails up and structure around that to make sure our kids get good care.”

“Coping with the stress and lack of independence, autonomy, and dignity during hospitalizations pose unique challenges to the healthcare team, family, peers, and adolescent patients because control and independence are integral to nearly all tasks of typical adolescence,” Breuner and colleagues wrote.

However, they added, by constructing and/or modifying existing facilities, services, and expectations, “hospital personnel can support ongoing adolescent development and encourage adolescents to advocate for themselves by taking appropriate control of their situation.”

Specific recommendations detailed in the policy statement include that hospital administrators and clinicians experienced in caring for adolescents — including pediatricians, nurse practitioners, physician assistants, and adolescent medicine specialists — should assist in the design of hospital settings and in the development and implementation of policies and guidelines for hospitalized teens.

Moreover, hospitalist training should include modules on adolescent health and wellness, and researchers should aggregate demographic data on trends in adolescent hospitalizations and identify areas of focus to improve patient care, as well as physician and staff training.

Breuner and colleagues also recommended that hospitals caring for adolescents should promote confidentiality, including knowledge of state confidentiality laws regarding adolescents, as well as privacy, dignity, and respect for hospitalized teens and their families.

In addition, when it comes to discharging adolescents, connecting teens to their primary care providers for follow-up and ongoing care is essential, they said.

Other recommendations detailed in the policy statement include the need for ongoing antiracist and anti-microaggression/implicit bias training for physicians and other caregivers, and the need for hospitalized teens to continue their typical activities, such as education, age-appropriate recreation, and visitation by family and friends, as much as possible.

“It’s really important that we’re diversifying our staff,” Breuner said. “There’s relentless work that we need to do [to make sure that] standard care is given to all.”

When it comes to putting together hospital teams to address the specific needs of adolescent patients, “I think that one of the things we’ve identified is that it’s challenging to do, but it isn’t impossible,” she added.

Breuner and team also noted that those caring for hospitalized adolescents — including teens in foster or kinship care — have a responsibility to understand the moral, ethical, legal, and developmental framework of patients’ medical decision making, consent, assent, and refusal of treatment.

Finally, the authors recommended that there should be transition, when appropriate, from pediatric- to adult-oriented providers and hospitals through a standardized process that includes a readiness checklist.

Breuner told MedPage Today that it can be especially difficult for teens who are very much trying to be an autonomous person to be in the hospital. Often, adolescents may be hospitalized alongside a much younger pediatric patient, or even an infant, and will also likely be in the company of their parent or guardian during much of their hospital stay.

Placing hospitalized teens in the same room as other patients in their age group can help, she said, as can supporting them in staying current with schoolwork and allowing them to stay connected with their friends.

In an accompanying clinical report, Breuner and colleagues provided further detail on hospital care for adolescents who may have learning, intellectual, or developmental disabilities, which emphasizes the evaluation of patients’ ability to participate in their own care.

The report also addresses the specific needs of LGBTQ+ hospitalized adolescents, noting that wishes around personal privacy and autonomy “become even more meaningful” for this population.

Furthermore, in light of the mental health crisis affecting adolescents across the U.S., mental health assessments are critical for hospitalized teens, Breuner said.

It’s already stressful to be in the hospital, she added, and that can be exacerbated for patients with mental health concerns.

In their statement, Breuner and colleagues highlighted the importance of issuing recommendations specific to hospitalized adolescents, noting that approximately 1.2 million — or 20% — of all pediatric hospital admissions in the U.S. are for patients ages 11 to 20, who require hospitalization for acute and chronic illnesses, including medical, surgical, gynecologic, mental health, and substance-use disorder diagnoses.