Author Amy Manion PhD, APRN, CPNP-PC
Co-Author Elizabeth Moran, MSN, RN, CPNP-PC
5 Tips for Pediatric Primary Care APPs: Helping Kids Grow Into Successful Adults
As any parent can attest to, children grow up fast. In the blink of an eye, the baby you just brought home from the hospital is now graduating from high school and leaving for college. Pediatric primary care providers have the honor and privilege of walking beside patients and families during the transitions of life from infancy to toddlerhood, school-aged years, adolescence, and into young adulthood. A large part of the role of pediatric providers during well-child checks is to support patients and families by knowing when and how to start them on the path to successful adulthood. Many are surprised to learn that laying the foundations for successful adulthood begins early in childhood. The following five tips can help serve as a guide to help Nurse Practitioner (NPs) and Physician Assistants (PAs), collectively referred to as Advanced Practice Providers (APPs), provide age-appropriate anticipatory guidance to help kids grow into successful adults.
Tip 1: Start Early
Many think of adulthood as the arbitrary age of 18, though the process of beginning transition to adulthood for pediatric patients does not have to wait until the teenage years. In fact, delaying until then can make it even harder since adolescence is already a difficult time of transition and growth, both mentally and physically. A step by step developmental approach at each annual visit is the best method to use when giving families anticipatory guidance on the path to adulthood. Explain to parents that even as early as two years of age, when a child typically begins to follow two-step commands, they are laying the groundwork for teaching him or her to listen to directions. For example, a young toddler can be taught how to help pick up their toys even at this very early stage. Having your child assist in this simple task is a crucial first step towards teaching children responsibility. In fact, APPs should teach parents that doing the very opposite—doing everything for their child—can be even more detrimental in the long run. It is never too early to start laying the groundwork of learning the skills that every individual needs to become a successful adult.
Tip 2: Start with Chores, Transition Responsibilities as Appropriate
At well visits, educate parents on ways to make chores fun for young children. For example, suggest turning on a special song to make picking up toys a game that the caregiver and child can do together. This builds rapport, demonstrates teamwork, and encourages responsibility in taking care of belongings. As a child grows and matures, new “chores” can be added. A preschool child can help cook a simple meal with a parent/guardian and measuring ingredients can be an opportunity to teach math skills. Stirring the cake batter or rolling cookie dough even promotes motor skills! Furthermore, the sense of accomplishment a child feels when they have helped create a meal for their family promotes self-esteem and self-confidence, which are the building blocks of good mental health (Bandura, 1997).
Yearly well-child checks are opportunities to check in with parents as to where a child is at with chores and work together to identify new, age-appropriate tasks. As children demonstrate that they can do simple chores successfully, more complex chores can be asked of them. School-aged children can take on more advanced responsibilities than toddlers, such as putting away their clean laundry, helping to unload the dishwasher, and/or setting the table. Teenagers can be given additional chores such as taking out the trash, feeding and walking the dog or doing their own laundry. Although many parents feel that the only “chore” a child should have is to get good grades, limiting them to only this benchmark sets them up for failure later in life when more demands are placed on them. As adults, they will be required to not only do a good job at their place of employment but also the drudgery work required to run a household. If children are not taught early on how to deal with minor responsibilities, their learning curve will be much steeper and more challenging later on in life when they are confronted with larger tasks as adults. For this reason, anticipatory guidance should be viewed as an essential part of a good exam.
Tip 3: Promote Executive Function Skills
Executive function is a set of cognitive skills, carried out by the frontal lobe of the brain, which helps with attention, organization, planning, and self-control— all of which are required to succeed in adulthood (Burns et al., 2017). Pediatric APPs can help guide parents on how to foster these skills in their children. At well visits, discuss with parents ways to promote executive function, such as talking to their children about the planning they do on a daily basis. For example, when preparing to go to the grocery store, have the child help make the list of items that are needed so they can begin to learn the whole process that goes into grocery shopping. Most children only see the food being brought into the house or experience the ride in the grocery cart—they don’t see the planning involved, which is the executive function part. The simple daily task of looking to see what food is needed, making a list of items, and then going to purchase those items may be lost on the child unless parents talk through the planning process out loud and have the child participate. Other examples of planning which help to promote executive function skills include: listening to the traffic report or checking a GPS app to plan drive time and route, coordinating school activities in order to schedule a dental visit, and pausing to think before answering a question. If these executive function skills are not learned, adults can have trouble with reasoning and cognitive flexibility, which can cause further issues with adapting to change and managing obstacles. As such, the primary care APP should help guide parents and patients on how to promote these skills in everyday activities.
Tip 4: Support Children to Choose Their Own Path
Guiding parents to allow their child to choose their own path can be one of the more difficult concepts to convey to parents, yet it is an important conversation for all pediatric APPs to have with parents. Parents have expectations for their children’s future and though this often comes from good intentions, such expectations are not always shared by the child. A parent may want their child to grow up to be a pharmacist, but the child dislikes science and is instead inspired by fashion and design. If a parent forces a child to choose a career path that the child does not feel passionately about, there is an increased risk of relationship discord, inner self-conflict, and even estrangement, all of which can negatively impact mental health.
Helping parents to acknowledge that their goals for success can differ from their child’s is not an easy task. Talk with parents about instead fostering a child’s strengths in order to build self-esteem. Providers can promote a positive relationship between children and their parents, and help children to express their interests by asking questions such as: “What subject do you like best at school?”, “What books do you like to read?”, and/or “What do you post or read on social media?”(Lythcott-Haims, 2015). Providers can also help parents identify their child’s strengths by pointing out different types of strengths, such as those pertaining to character (honesty and kindness) and social strengths (listening and sense of humor) (Morin, 2014). Providers can also encourage parents not to do too much for their children which can impede the child’s ability to develop and identify their own strengths. For example, parents sometimes feel pressure to compete with other parents, which can lead to adults over helping when it comes to child responsibilities like homework and projects. Children cannot learn the skills they need to be successful adults if the success they experience growing up is given to them by overachieving adults.
Tip 5: Provide a Variety of Learning Opportunities and Hobbies
The last tip APPs should reiterate to all pediatric patients and their parent(s)/guardian(s) is to provide a variety of opportunities for their children to develop and discover their strengths. If a child enjoys reading, advocate that they write a letter to their favorite author. Older children can volunteer at a food pantry or an animal humane society to learn about helping their community and to provide a sense of purpose. Even sports enthusiasts should be encouraged to try a variety of sports, not just hone in on one game so young. In addition, encourage parents to share with their children what opportunities lead them to find their purpose or help them choose their career path.
One of the final key elements of the healthcare provider’s responsibility to help kids grow into successful adults is the ultimate transition out of the pediatric setting into adult medicine. The age at which pediatric practices will see young adults to is variable—some practices will see up to 18 years old, whereas others will see through 21 or even 25. Moreover, when young adults present with more adult-like chronic illnesses, such as diabetes or hypertension, many pediatric providers will attempt to transition them even earlier. Whatever the norm at your clinic or organization, it is best practice to begin to introduce the concept of transition beginning as far as 3 to 5 years before it must be made. This gives adolescents time to warm-up to the idea of moving their care and time to think about where, and with whom, they’d prefer to be followed by in the future. If you work at a clinic or hospital with multiple departments, consider working closely with family or internal medicine providers to develop a seamless transition of care. If possible, and especially in complex cases, warm hand-offs where the patient is introduced within the comfort of the pediatric setting to the adult care provider are beneficial.
Furthermore, children with chronic illness are the most vulnerable when it comes to transitioning to adulthood. Often these medically fragile patients are delayed in finding adult care services and their health suffers as a result (Little, Odiaga, & Minutti, 2017). Providers should give children with special care needs the highest priority to assure that their transition to adulthood is successful, without any gaps in care.
Overall, the path to adulthood can be fraught with challenges, but children who are supported and given opportunities to grow are most likely to become successful adult individuals they desire to be. Healthcare providers can help them achieve that goal by offering anticipatory guidance to children and their parents/guardians with these five tips in mind: start early, encourage chores, promote executive function skills, allow children to choose their own path, and provide opportunities to develop strengths.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: W.H. Freeman.
Burns, C.E., Dunn, A.M., Grady, M.A., Starr, N.B., Blosser, C.G., & Garzon, D.L. (2017). Pediatric primary care (6th ed.) St. Louis, MO: Saunders.
Little, J. M., Odiaga, J. A. & Minnutti, C. Z. (2017). Implementation of a diabetes transition of care program. Journal of Pediatric Health Care, 215-221. http://dx.doi.org/10.1016/j.pedhc.2016.08.009.
Lynthoctt, Haims, J. (2015). How to raise an adult: break free of the overparenting trap and prepare your kid for success. New York, NY: Henry Holt.
Morin, A. (2014). Types of strengths in kids. Retrieved from https://www.understood.org/en/friends-feelings/empowering-your-child/building-on- strengths/types-of-strengths-in-kids