Caring for the Hospitalized Adolescent: New AAP Guidance

Cora Collette Breuner, MD, MPH, FAAP
Professor Department of Pediatrics, Adolescent Medicine Division
Adjunct Professor Orthopedics and Sports Medicine
Seattle Children’s Hospital, University of Washington
Member, Executive Committee Section on Integrative Medicine
American Academy of Pediatrics
Trustee, Washington Chapter of the American Academy of Pediatrics

You are on call and covering one of the inpatient hospital teams over the weekend.  A 16-year-old patient was admitted at 2:00 AM with acute abdominal pain for observation.  What do you do? How do you care for them? How do you protect confidentiality and prevent microaggression while at the same time ensuring excellent and evidence-based standard of care? The AAP has now provided timely guidance for the pediatric healthcare provider caring for the hospitalized adolescent.

This policy statement and clinical report are the first published material on the care and management of the hospitalized adolescent 13-18 years of age in the United States with objectives to provide clinicians with evidence-based information on the unique aspects required for their care. Included in this policy statement and accompanying clinical report are detailed descriptions of adolescent hospital admission demographics, personnel recommendations, and hospital design advice, as well as sections on educational services, legal and ethical matters, and transitions to adult facilities.  An explanation of the possible effects hospitalization may have on the developmental and emotional progress of adolescence, the role of the hospital setting, the importance of confidentiality, and issues related to legal/ethical matters and bias and institutional and systemic racism that may occur during hospitalization are also included. The policy statement and clinical report also reference several policies related to adolescent care covering adolescent behavioral and mental health, LGBTQ+ equity, intellectual and developmental disabilities, integrative medicine, reproductive health and substance use confidentiality and transition to adult facilities.

The documents, from the AAP Committee on Adolescence, are available at American Academy of Pediatrics Issues New Recommendations on Hospitalized Adolescents ( and were published in the January 2023 issue of Pediatrics.

To properly care for hospitalized adolescents, an awareness of adolescent growth and development as well as legal, ethical, ableism, and racism issues is essential.  While we understand that not all topics described in the clinical report can be fully evaluated or treated during a hospitalization, screening for these conditions and definitive reporting of concerns to the medical home, outpatient primary care provider, or specialist is crucial for comprehensive care. Many hospital staff will not be familiar or even comfortable with the adolescent and care, so consultation with a pediatrician, adolescent medicine subspecialist, or provider with comfort and experience in caring for adolescents (e.g., family medicine physician, physician assistant, nurse practitioner, social worker) can be vital for a successful hospitalization. Other ancillary staff such as child life specialists can be consulted. They are experts in child and adolescent development and can guide and promote therapeutic relationships among patients, families, and health care team members. Also covered in this report is how to smoothly transition an adolescent as they age into adult status from a children’s hospital to an adult facility. There may be a reluctance to transition yet there are resources available.

The policy statement and clinical report address key issues including:

  • Hospital administrations, along with clinicians experienced in caring for adolescents including pediatricians, advanced practice practitioners (i.e., nurse practitioners and physician assistants), and adolescent medicine specialists, should assist in the design of hospital settings and in the development and implementation of policies and guidelines for inpatient adolescents.
  •  Hospitalist training should include modules on adolescent health and wellness.
  •  Researchers should aggregate demographic data to describe new and ongoing trends in adolescent hospitalizations and to identify specific areas of focus to improve patient care and physician/staff training.
  • Care of adolescents in the hospital setting should be centered around confidentiality, including knowledge of state confidentiality laws regarding adolescents, privacy, dignity, and respect for adolescent patients and their families. For those with intellectual or developmental disabilities, care should be centered around their ability to participate in their care and assent to decisions.
  • Connecting adolescents to their primary care medical homes for follow-up and ongoing care are an essential part of hospital discharge.
  • Ongoing anti-racist, anti-microaggression/implicit bias training of physicians and other adolescent hospital caregivers are imperative.
  • Typical adolescent activities, including attending to their educational needs, recreational needs (such as making available age-appropriate reading materials, games, music, arts, and electronics), and visitation needs by family and friends during hospitalization, should continue as much as possible.
  • Personnel caring for adolescents, including adolescents in foster or kinship care, have a responsibility to understand the moral, ethical, legal, and developmental framework of adolescent patients’ medical decision-making, consent, assent, and refusal of treatment.

Download a list of helpful adolescent health resources here.