Age limits of pediatrics, American Academy of Pediatrics, Council on Child Health, Pediatrics, 1972;49:463.

The purview of pediatrics includes the growth, development , and health of the child and therefore begins in the period before birth when conception is apparent. It continues through childhood and adolescence when the growth and developmental processes are generally completed. The responsibility of pediatrics therefore may begin during pregnancy and usually terminates by 21 years of age. 1 COMMENTARY S hort and concise, yet this Statement developed by the Council on Child Health of the American Academy of Pediatrics (AAP) and published in 1972 had a monumental impact on the health of teenagers, as well as on the practice of pediatrics. An earlier position of the AAP (1938) had defined the upper limits of pediatric practice to extend " well into adolescence. " 2 Although some pediatricians at the time were seeing early adolescents, many chose to discontinue care for patients who were approximately 12 years of age. The age cutoff for admission to hospital pediatric services was 14 years. It is noteworthy that in 1969, the Council on Child Health had been charged with updating this position. What transpired in the 3 years that intervened reflects perceptions about the respective practice domains of the other specialties, as well as changing views about the health of adolescents. According to those close to the debates that took place, the Statement went forth only after reassurance from the leaders of those other fields that such an extension of the age limits of pediatrics would not be opposed. That views about adolescent health changed over a 30-year period reflects the results of research, as well as the realization that the developmental perspective of the pediatrician would best serve teenagers. In relationship to this critical Statement, let us consider the five stages of evolution of the field of adolescent medicine over its 40-year history (dating from the time of the establishment of the first training program at the Children's Hospital in Boston, MA, by Dr J. Roswell Gallagher): 1. recognition of the biologic uniqueness of adolescents ; 2. recognition of systematic differences among groups of adolescents (based on pubertal stage and timing, gender, ethnicity, chronic illness, etc); 3. recognition of the interaction of psychosocial and biologic factors in determining health of teenagers ; 4. recognition that physicians require special skills and orientation to best care for adolescents; and 5. advocacy for special health care needs of adolescents. Research by pediatricians, as well as …