A growing body of evidence suggests that even healthy adolescents struggle with the transition from a pediatrician’s care to an adult primary care practitioner.

A 2020 study by the CDC found that only 15% of US adolescents received appropriate transition planning, including time alone with their clinician, coaching on managing their own health, and discussion of the shift to an adult provider. The study compared the experiences of adolescents with mental health issues and those without and found the rate was nearly identical between the two cohorts.

In other words, the vast majority of “average” teens receive little to no structured preparation before aging out of pediatric care.

“The division between distinct pediatric and adult care systems creates a chasm in care integration. This often results in a disorganized transfer process rather than an integrated transition,” said Vera Kohut, MD, medical director at Toronto-based Serefin Health, a care coordination company. “Also, adult practices may not have the same multidisciplinary team approach — for example, access to social work, occupational therapy, dietitians — found in the pediatric centers, so it’s also more difficult to reproduce the support systems.”

The consequences of a poorly managed handoff become even clearer — and more concerning — for adolescents with chronic conditions.

Research shows that among multiple disease cohorts, adolescents frequently fall out of care after leaving their pediatric team. An October 21, 2025, study published in Springer Nature Link showed that among young people with congenital heart disease, inadequate transition is associated with loss to follow-up rates in the range of 26%-32% or 20%-40% in adolescents with congenital heart disease or type 1 diabetes, respectively. It also states that gaps in healthcare transitions for adolescents and young adults with endocrine conditions generate loss to follow-up rates ranging from 22% to 37% when these individuals leave pediatric care.

At a time when youth mental health is an unparalleled concern, data show that the health system handoff creates a similar risk by leaving many young people without stable primary care at precisely the moment their needs are increasing.

A July 24, 2019, study in JAMA Network Open found that among adolescents with severe mental illness, 6.4% had no primary care during the transition years (ages 17-18 years), and 28.4% had discontinuous primary care — gaps associated with significantly higher rates of mental health-related hospitalization in young adulthood. Adolescents with no primary care had about a 30% increased adjusted relative risk for psychiatric hospitalization, while those with discontinuous care had roughly a 20% increased risk compared with peers who maintained continuous care.

At a time when youth mental health needs are rising sharply, the handoff from pediatric to adult services remains a critical point of vulnerability for this population.

Researchers suggest that if pediatric-to-adult transitions aren’t intentional, structured, and adolescent-centered, a substantial proportion of young people — healthy or not — may simply disappear from care.

Seeing the Whole Spectrum: A Family Medicine Perspective

Kate Eisenberg, MD, PhD, senior medical director of DynaMed AI at EBSCO Clinical Decisions, who also sees patients at her family medicine practice through the University of Rochester, Rochester, New York, said the transition looks different inside a clinic that cares for patients across the lifespan. Family medicine clinicians may follow children, adolescents, adults, and older adults in the same family for decades.

“I’ve always appreciated that element of family medicine,” she said. “It’s so based in those very longitudinal relationships, and it makes this particular transition smoother.”

She said that training pathways help define these differences.

“You get that training to take care of the patient along the whole spectrum,” Eisenberg said. “The key is knowing your limits — knowing when to bring in a specialist and when to lean on those long-term relationships.”

The continuity provided by the family medicine relationship becomes particularly valuable during the college years, when many adolescents are navigating moves, irregular schedules, and new stressors, Eisenberg said. Knowing a patient’s baseline — and often the family context — allows clinicians to recognize when something has shifted, whether physically, developmentally, or emotionally. Eisenberg said she sometimes treats the parents and the children, which enables her to assess the family dynamic as a whole.

Building Autonomy and Trust in the First Adult Visit

Eisenberg sees the first adult visit as pivotal for establishing independence and privacy. She routinely creates protected time alone with adolescents, even when parents are present, and when she has the opportunity, she said she starts to create that relationship early.

“The best practice in adolescent medicine is that as kids approach adolescence, you start having a period in visits where the parent steps out,” she said. “There may be nothing sensitive to discuss, but it sets the tone that the adolescent has an independent relationship with the clinician.”

She reminds adolescents explicitly that they must name their concerns.

“I tell them, ‘I don’t know your symptoms. I don’t know your concerns. I need you to say them out loud,’” she said.

Confidentiality is addressed early and clearly.

“You do set those bounds,” she said. “If we think there’s a danger to them, that would be cause for bringing the parent back in. But otherwise, this is their space.”

Eisenberg said this helps teens learn to advocate for themselves and helps clinicians distinguish typical first-visit nerves from more serious concerns.

“There’s an opportunity for partnership,” Eisenberg said. “Is this a new situation that’s uncomfortable? Or is there an underlying disorder that hasn’t been identified yet?”

Preparing Teens Early and Setting Expectations Clearly

Michael Glazier, MD, chief medical officer at Bluebird Kids Health, based in Boynton Beach, Florida, said that the depth of the familiarity in the pediatrician relationship can make the shift to adult medicine feel stark.

“Pediatricians are entrusted with the care of children from their very first days of life through young adulthood, first relying on adult family members for insight, and then eventually focusing on the child as the primary, and sometimes singular, source of information,” he said. “This contrasts with adult medicine, where for most patients the relationship with the primary care provider begins and often ends with the patient.”

Glazier said pediatricians should begin transition discussions around ages 12-14 years to foster independence. Adult primary care clinicians, in turn, have a responsibility to set expectations clearly during the first encounter.

“Older teenagers want to act and be treated as adults and often just need to understand the parameters,” he said.

He added that warm handoffs — even brief calls between pediatric and adult clinicians — remain an ideal, though underused, tool.

Creating a Smoother Handoff

Janet Lazieh, MD, pediatrician at Holy Name Medical Center in Teaneck, New Jersey, recommends acknowledging parents’ long-standing role and then transitioning to protected time with the adolescent.

“I tell them, ‘Everything we talk about here is private, unless I’m worried about your safety — like if you’re being hurt or thinking about hurting yourself,’” she said. “‘Otherwise, what we discuss stays between us.’”

Briefly bringing the parent back at the end helps align everyone on the care plan.

Transition readiness assessments, portable medical summaries endorsed by the American Academy of Pediatrics, electronic health record flags, and structured handoff templates can all improve continuity when an adolescent moves to an adult doctor — provided a family medicine doctor like Eisenberg does not see them. Once in the room, clear communication from the new doctor — beginning with acknowledging receipt of the adolescent’s previous records and outlining a plan to review them — can build trust.

“Often there is not enough time to digest all the records before the first visit,” Lazieh said. “But acknowledging receipt and a plan to review and transcribe them highlights the importance of ensuring continuity.”

With respect to practical tips for the all-important first visit, Eisenberg said that open, patient-centered dialogue — asking about school, work, hobbies, or social supports — helps adolescents feel respected. Additionally, Lazieh said that exploring past patterns of engagement, such as who handled scheduling or refills, can highlight where support is needed.