AAP hospital recommendations I/DD

The American Academy of Pediatrics has published a new “statement” on “The Hospitalized Adolescent” that describes how teens may be uniquely impacted by hospitalization for acute and chronic illnesses. The hope is that pediatricians will have a broader understanding of the requirements that will ensure “compassionate management.”

Importantly, an additional clinical report provides more detail on hospital care for adolescents who may have learning, intellectual, or developmental disabilities, with an emphasis on the evaluation of their ability to participate in their care and assent to decisions.

Adolescents and young adults (AYAs) with developmental disabilities, it notes, “have varying degrees of cognitive abilities; therefore, there are important considerations for these patients in the hospital setting. Although no studies exist on minor patients, a study of adults older than 18 years with intellectual disabilities demonstrated that, for the same admitting diagnoses, patients with intellectual disabilities had statistically significant longer lengths of stay, longer ICU stays, and higher rates of surgical complications. Patients with developmental disabilities, in addition to a chronic health condition such as autism spectrum disorder, aggressive behavior, spastic quadriplegia, or respiratory illnesses, and patients admitted through the emergency department were 4 times as likely to have complications.”

Some of the recommendations include:

  • Involving people with disabilities in their own care “to the best extent possible to ensure that providers do not minimize patients’ autonomy because of the presence of a disability and tailor participation to their ability.”
  • Being thoughtful and deliberate toward adolescents with IDDs who may have experienced medical trauma.
  • Evaluating this population for their ability to participate in their care and assent to decisions.
  • Partnering with caregivers, including education and training to care for the patient’s needs.
  • Obtaining the most current medical record and the timing of medications, and speaking to a medical provider at the transferring facility when the patient is admitted from an outside facility and not from home.

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