Zusammenfassung
Der Übergang von der fürsorglichen, kind- und familienzentrierten pädiatrischen Betreuung in die durch Autonomie und Eigenverantwortung geprägte Erwachsenenmedizin ist nicht nur für die jugendlichen Patienten sondern auch für ihre zukünftigen Ärzte eine Herausforderung. Im Umgang mit Adoleszenten fühlen sich „Erwachsenenmediziner“ in der Regel nur unzureichend geschult. Sie sind verunsichert, wenn sich ihre jungen Patienten mit häufig verzögerter somatischer und/oder psychosozialer Entwicklung nicht nur gegen die elterliche sondern auch gegen die ärztliche Autorität auflehnen, sich schwer führen lassen und ihre Therapieprotokolle nur ungenügend einhalten. Durch die Fortschritte in der Medizin erreichen immer mehr Kinder mit schweren chronischen Erkrankungen das Erwachsenenalter. Fundiertes Wissen über die bislang fast ausschließlich „pädiatrischen“ Krankheitsbilder sowie Kenntnisse der normalen körperlichen, kognitiven und psychischen Entwicklungsstufen eines Jugendlichen gehören noch immer nicht zur Weiterbildung eines Internisten. In dieser Darstellung soll es um Erfahrungen des Kinder- und Jugendarztes gehen, die dem Internisten bei der Weiterbetreuung dieser speziellen Patienten helfen können.
Abstract
Transition from the protective, child and family centered pediatric care to the adult health care system with the expectation of patient self care and self management, is challenging the adolescent as well as his adult specialist. The young patients often show a delayed somatic and psychosocial development and oppose not only against their parents but also against their medical team. Adult specialists feel not well trained and experienced in dealing with adolescents. They are worried about the difficulties in the guidance of the patients and the non adherence to therapeutic recommendations. Due to medical progress, many children with severe or/and fatal chronic disorders are now surviving into adulthood. Profound knowledge of diseases that were known until now almost exclusively in the pediatric population as well as an awareness of normal physical, mental and psychosocial development of childhood and adolescence is not training content of German internists. The intention of this article is to discuss some of the experiences of pediatricians that might be helpful to internists to take better care for these special young patients.
Literatur
Auvin S, Molinie F, Gower-Rousseau C et al. (2005) Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in northern France (1988–1999). J Pediatr Gastroenterol Nutr 41: 49–55
Bryon M, Madge S (2001) Transition from paediatric to adult care: psychological principles. J R Soc Med 94 (Suppl 40): 5–7
DeMeo DL, Silverman EK (2004) Alpha1-antitrypsin deficiency. 2: Genetic aspects of alpha(1)-antitrypsin deficiency: phenotypes and genetic modifiers of emphysema risk. Thorax 59: 259–264
Dodge JA, Lewis PA, Stanton M et al. (2007) Cystic fibrosis mortality and survival in the UK: 1947–2003. Eur Respir J 29: 522–526
Glickman JN, Bousvaros A, Farraye FA et al. (2004) Pediatric patients with untreated ulcerative colitis may present initially with unusual morphologic findings. Am J Surg Pathol 28: 190–197
Hait EJ, Barendse RM, Arnold JH et al. (2009) Transition of adolescents with inflammatory bowel disease from pediatric to adult care: a survey of adult gastroenterologists. J Pediatr Gastroenterol Nutr 48: 61–65
Heyman MB, Kirschner BS, Gold BD et al. (2005) Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr 146: 35–40
Hildebrand H, Finkel Y, Grahnquist L et al. (2003) Changing pattern of paediatric inflammatory bowel disease in northern Stockholm 1990–2001. Gut 52: 1432–1434
Hyams J, Markowitz J, Lerer T et al. (2006) The natural history of corticosteroid therapy for ulcerative colitis in children. Clin Gastroenterol Hepatol 4: 1118–1123
Keljo DJ, Markowitz J, Langton C et al. (2009) Course and treatment of perianal disease in children newly diagnosed with Crohn’s disease. Inflamm Bowel Dis 15: 383–387
Kromeyer-Hauschild K, Wabitsch M, Kunze D et al. (2001) Perzentilen für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 149: 807–818
Kugathasan S, Judd RH, Hoffmann RG et al. (2003) Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study. J Pediatr 143: 525–531
Levine A (2009) Pediatric inflammatory bowel disease: is it different? Dig Dis 27: 212–214
Levine A, Kugathasan S, Annese V et al. (2007) Pediatric onset Crohn’s colitis is characterized by genotype-dependent age-related susceptibility. Inflamm Bowel Dis 13: 1509–1515
Lomas DA, Mahadeva R (2002) Alpha1-antitrypsin polymerization and the serpinopathies: pathobiology and prospects for therapy. J Clin Invest 110: 1585–1590
Markowitz J, Hyams J, Mack D et al. (2006) Corticosteroid therapy in the age of infliximab: acute and 1-year outcomes in newly diagnosed children with Crohn’s disease. Clin Gastroenterol Hepatol 4: 1124–1129
Mensink G, Burger M, Beitz R et al. (Hrsg) (2002)Was essen wir heute? – Ernährungsverhalten in Deutschland. Robert Koch-Institut, Berlin, S 125–130
Peter NG, Forke CM, Ginsburg KR et al. (2009) Transition from pediatric to adult care: internists‘ perspectives. Pediatrics 123: 417–423
Scherr R, Essers J, Hakonarson H et al. (2009) Genetic determinants of pediatric inflammatory bowel disease: is age of onset genetically determined? Dig Dis 27: 236–239
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Gelbmann, C., Melter, M. Chronisch kranke Kinder werden erwachsen. Internist 51, 482–488 (2010). https://doi.org/10.1007/s00108-009-2455-2
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DOI: https://doi.org/10.1007/s00108-009-2455-2