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, in Columbus, Ohio.
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 poorly managed care gap, said Beth Deen, PharmD, BCNSP, BCPPS, 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 sometimes 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 defined six core elements to help pediatric and adult providers ensure a successful transition (box), beginning when the patient is 12 to 14 years of age (Pediatrics 2018;142[5]:e20182587).
Anxiety, Inadequate Planning
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 or 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 guide 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.
Advice for Transitioning Infants
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, PNS, D-ABOM, the co-director of the pediatric nutrition support and intestinal rehabilitation program at Cleveland Clinic Children’s Hospital. Although there is a paucity of studies, “we are becoming more and more proactive in systematically approaching this problem,” he said in a companion presentation at ASPEN.
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. In the case of SBS, it also magnifies the cost: In one recent study of 2,200 pediatric patients with neonatal SBS, the median hospital stay exceeded 5 months and the median cost was $528,628, Dr. Sankararaman noted, citing data from Raghu et al (JAMA Netw Open 2025;8[2]:e2459548).
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 focused on the family 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 offered to families. Establish an individualized, flexible but realistic post-discharge plan that spells out goals. Involve any other caregivers like 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. Also account for any other barriers such as language or religious barriers, or cultural perceptions, in discussions about care.
Dr. Deen reported no relevant financial disclosures. Dr. Sankararaman is a consultant to NestlÉ.
This article is from the June 2025 print issue.