Debate to weigh latest considerations for timing pediatric to adult health care transitions

Timing the transition from pediatric to adult health care is a perennial challenge in pulmonary medicine, but there is renewed urgency behind the conversation given advancements in therapeutic treatments, increased life expectancy for some conditions, and changing guidelines for optimal patient care.

“This question of when a patient should transition from pediatric to adult care teams is becoming increasingly relevant as more young adults with chronic pulmonary disease make their way into adulthood and face new challenges,” said Sarah Cohen, MD. “To some degree, these will always be individualized conversations, but what should be the major driving points of these decisions? What does the evidence tell us? How can we engage colleagues and care teams in this conversation?”

At CHEST 2026, Dr. Cohen will chair the pro-con debate session Timing of Transition From Pediatric to Adult Health Care at 3:15 pm MST on Monday, October 19, in the Phoenix Convention Center, North Building, Room 129B.

During the session, presenters will advocate for a different criterion as the key factor in guiding the transition from pediatric to adult care. Akshay Vijayaraman, MD, specialist at Critical Care and Pulmonary Consultants PC, will argue that age should be a consideration in considering a transition from pediatric to adult health care teams. Mena Botros, MD, Assistant Professor at Weill Cornell Medicine and Houston Methodist Academic Institute, will contend that primary consideration should be given to the disease processes in evaluating transition timing. Dr. Cohen, Pediatric and Adult Pulmonologist at Nationwide Children’s, will present research and clinical studies on how cognitive and developmental abilities should lead the transition discussions.

Age has been the traditional criterion for initiating transitions from pediatric to adult health care, Dr. Cohen said, guided by the premise that patients with adult bodies will have adult health problems and should consult clinical teams who are experts in adult health issues. Using age as the primary transition criterion is also increasingly appropriate in the treatment of some diseases, such as cystic fibrosis, where tremendous life expectancy gains have been made, reshaping a patient’s lifespan expectations and needs.

“Now we have more adults than children with cystic fibrosis,” Dr. Cohen said, “and more people are recognizing that these patients should be transitioned and cared for as adults, as their average life expectancy extends well into middle age and beyond.”

But, she noted, there might be less of a compelling reason for an age-based transition in treating diseases such as Duchenne muscular dystrophy, where the life expectancy is in the 20s and early 30s. And in some patient populations, such as those with developmental disabilities, a particular patient might receive the best care by continuing with a pediatric care team in close consultation with adult care specialists for specific concerns.

Dr. Cohen said her goal in the session is for attendees to think about how considerations of age, disease process, and developmental levels should affect personalized decisions to begin transitioning patients from pediatric to adult care. However, she stressed that these are also themes that clinicians should initiate and consider at a wider level.

“We need to make these choices at a system level,” Dr. Cohen said. “Because if we don’t, then we will run into equity gaps. We will run into issues such as: ‘This is the patient everyone on our team likes, so I’ll keep them,’ versus ‘This is my difficult patient, so I am going to send them on for transition.’ And that’s certainly not the way we want to make decisions.

“Policies might be different at different facilities based on capacity, but, overall, when we transition patients to adult care should be clinician-led decisions based on individual care for each patient while understanding how we can, as a group, provide the best care for all our patients.”