Many of us wonder about when does the childhood end? Researchers are now answering this question by charting age cut-offs for paediatric services around the world.
Adolescent health professor at the Murdoch Children's Research Institute and the University of Melbourne Susan Sawyer said that previous research has found that global health systems do not meet adolescents' needs.
"Yet paediatricians are well placed to provide age-appropriate care to adolescents, especially if they are trained in adolescent medicine," she said.
"The World Health Organisation defines adolescents as aged being 10 to 19 years. However, there's been little research into the age of patients that paediatricians actually treat and how this varies across the world," she added.
The researchers developed an online survey to explore these questions and obtained responses from 1,372 paediatricians in 115 countries.
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They reported the results in a policy paper -- The Age of Paediatrics -- published in The Lancet Child and Adolescent Health.
"There was a striking difference in the upper age by country and disappointingly only a handful of countries had a mean upper age of 19 years," said Prof Sawyer.
"South Africa had the lowest upper age at 11.5 years, it seems paediatrics is yet to embrace adolescence. The US had the highest upper age, with 19.5 years," added Prof Sawyer.
Despite similar health care systems, Australia's mean upper age of paediatric care was 17.8 years while New Zealand's was 15.6 years.
"The world means is 17.4 years," said Prof Sawyer. "This average has increased over the past 20 years, rapidly in some countries."
The discipline of paediatrics has historically focused on very young children, largely neglecting adolescents, but the pattern of disease across childhood and adolescence is changing. Public health interventions and medical advances have seen the mortality rate of young children fall dramatically.
"This is not mirrored in adolescents, whose more complex disease burden remains relatively unchanged. The World Health Organisation estimates that more than one million adolescents die every year," said Prof Sawyer.
"Young people face a childhood and adult health burdens, including chronic physical conditions like diabetes and asthma, mental health disorders, anaemia, rising levels of obesity, interpersonal violence, diarrheal and bronchial illnesses, drug and alcohol abuse, sexually transmitted disease and road trauma."
Co-author Professor Jonathan Klein from the University of Illinois and Coordinator of the International Paediatric Association Executive Committee said few nations paid sufficient attention to including adolescent heath within paediatric training.
To meet the health needs of young people, a diverse workforce is required including paediatricians, family physicians, nurses, and community and school health workers, all schooled in adolescent health.
"The evidence is clear. Our health care systems need to be more attuned to the needs of adolescents and young adults," Professor Jonathan Klein said.
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