Coordinating care among multidisciplinary teams—with input from patients and their families—is essential for successful nutrition transitions, speakers said during the ASPEN 2025 Nutrition Science & Practice Conference.
For example, transferring adolescents from pediatric to adult services is a crucial time in the health of young people, because they could fall into a care gap, said Beth Deen, PharmD, a nutrition support clinical pharmacy specialist at Cook Children’s Medical Center, in Fort Worth, Texas. Patient and family wishes should be incorporated into these moves, she said.
Partnering with adolescents can be a challenge, Dr. Deen said, because these patients may have behavioral health risks, and/or be susceptible to emerging or worsening health conditions, yet use very little healthcare resources. “Adolescents can regard healthcare as a low priority compared to other aspects of their adult transition such as education, employment, housing or relationships,” she said. “However, there are a growing number of adolescents with chronic illnesses, so we need to raise awareness that maintaining health and continuity of care is central to the attainment of these adult goals.”
The American Academy of Pediatrics has provided guidance including defining six core elements to help pediatric and adult providers ensure a successful transition beginning when the patient is 12 to 14 years of age (Box) (Pediatrics 2018;142[5]:e20182587).
Common barriers reported by adolescents and parents to a smooth transition of care include apprehension to leave the pediatric providers, parental anxiety of relinquishing control and negative perceptions of adult care. Others include system difficulties such as a lack of coordination or transfer of records, limited availability of adult providers, and loss of insurance, Dr. Deen said (Pediatrics 2018;142[5]:e20182587).
On the flip side, she said, clinicians are likely to report their own transition barriers, including communication gaps with families, training limitations, gaps in care coordination, and a lack of patient knowledge and engagement. The Pediatrics guidance helps provide a framework for transitioning youth successfully, she said.
Finally, Dr. Deen said, as patients are transitioning to adult care, certain parenteral nutrition (PN) changes are necessary. Ensure patients are taking adult vitamins (starting at 11 years of age), that they are taking an adult preparation of trace element products and amino acid solutions, and that the PN formulation is switched from a 2:1, with lipids running separately, to a 3:1 including lipids—the standard in adults.
The National Alliance to Advance Adolescent Health maintains the Got Transition website (gottransition.org), which has additional resources on transitioning youth to adult care, she said.
Moving infants with complex medical/surgical conditions from the neonatal ICU to the pediatric ward or discharging to home also can pose transition challenges, including a heightened risk for medication errors, noted Senthil Sankararaman, MD, the co-director of the pediatric nutrition support and intestinal rehabilitation program at Cleveland Clinic Children’s Hospital, in Ohio.
Transfers from the neonatal ICU often are done by clinicians without much input from caregivers, which can result in parents or caregivers not feeling prepared to receive babies who were premature or have feeding issues, Dr. Sankararaman said. If you add in a patient on enteral or parenteral support for a condition such as intestinal failure or short bowel syndrome (SBS), or a patient with an ostomy bag, it magnifies the complexity, he said.
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In the hospital, providers have a team of clinical expert colleagues coupled with readings from sophisticated instruments, he said, but “we just expect mom, most of the time, to manage the kids when they go home. Are we checking that the parents are ready for that? Oftentimes, the answer is no.”
A multidisciplinary team approach is essential to a successful transition, Dr. Sankararaman said. There should be open, two-way communication between parents and members of the infant’s care team, he said, and emotional and educational support should be offered to families. Establish an individualized, flexible but realistic post-discharge plan that spells out goals. Involve any other caregivers such as a grandparent or nanny in education about what to expect when they go home and how to handle minor concerns or setbacks.
Conduct a family and home needs assessment to ensure there is electricity to run PN equipment, and inquire whether the family has any food, water or transportation needs, he advised. It also is important to account for any other barriers such as language or religious barriers or cultural perceptions in discussions about care.
—Karen Blum
Dr. Deen reported no relevant financial disclosures. Dr. Sankararaman is a consultant to NestlÉ.
This article is from the July 2025 print issue.