PHCNEWS

42A Volume 16 Number 4 JOURNAL OF PEDIATRIC HEALTH CARE

Age Parameters for PediatricNurse Practitioner PracticeThe National Association of PediatricNurse Practitioners (NAPNAP) advo-cates for children (infants throughyoung adults) and provides leadershipfor pediatric nurse practitioners (PNPs)who deliver primary health care in a va-riety of settings. NAPNAP broadly de-fines the patient population seen byPNPs as children, which supports PNPs’scope of practice to incorporate all chil-dren from birth through 21 years of age,and in specific situations to personsolder than 21 years.

NAPNAP concurs with the parame-ter of pediatrics as described by theAmerican Academy of Pediatrics (AAP)in the 1998 position statement entitledAge Limits of Pediatrics. However, NAP-NAP believes that where the definitionstates “pediatrician,” the term “pedi-atric primary health care provider”should be substituted. The AAP state-ment is: “The purview of pediatrics in-cludes the physical and psychosocialgrowth, development, and health of the in-dividual. This commitment begins prior tobirth when conception is apparent and con-tinues throughout infancy, childhood, ado-lescence, and early adulthood, when thegrowth and developmental processes aregenerally completed. The responsibility ofpediatrics may therefore begin with the fetusand continue through 21 years of age. Thereare special circumstances (e.g., a chronic ill-ness and/or disability) in which, if mutuallyagreeable to the pediatrician, the patient,and when appropriate the patient’s family,the services of the pediatrician may con-tinue to be the optimal source of health carepast the age of 21 years” (AAP, 1998).

NAPNAP works with the Associa-tion of Faculties of Pediatric Nurse Prac-titioners (AFPNP) and the NationalCertification Board of Pediatric NursePractitioners and Nurses (NCBPNP/N)with the common goals of ensuring thatchildren and families receive qualityhealth care and ensuring that PNPs areeducated and prepared to provide thatcare. The organizations collaborativelyuse an evidence-based approach to en-sure congruency among PNP educa-tional programs, national certificationstandards, and PNP practice. This rela-

tionship provides the essential founda-tion to ensure the highest standards ofpractice, education, and regulation forPNPs. The AFPNP (1996) has estab-lished core competencies for graduatesof PNP programs. These competenciesinclude providing health care to chil-dren from birth through adolescence.Nursing and medical textbooks used inPNP educational programs focus on thecare of children through young adult-hood. The NCBPNP/N (2001) examina-tion for PNPs includes items related tothe PNP’s role in caring for age cate-gories of neonatal (0-30 days) to youngadulthood (20-21 years). These core ele-ments and existing congruencies inpractice, education, and regulation en-sure that the PNP has the expertise andqualifications to care for children of allages through young adulthood.

Recent studies (Brady & Neal, 2000,and Jackson et al., 2001) have validatedthe diverse and expanding role of thePNP in providing health care to chil-dren of all ages. Many PNPs work inthe school health setting. Often highschool children are 18, 19, or even up to21 years of age. The pediatric healthcare provider is well prepared to dealwith the physical health and psychoso-cial needs of high school students of allages. Additionally, the PNP is educatedto perform pre-participation athletic ex-aminations for adolescents and youngadults. Many PNPs also have the edu-cation to facilitate the transition toadulthood by performing precollegeexaminations (Muscari & Berkstresser,2001) and providing health care toyoung adult college students.

There are special situations in whichit is appropriate for the PNP or otherpediatric health care provider to carefor an individual older than age 21years until appropriate transition toadult health care is successful. There isa growing population of adolescentsand young adults with special health

care needs, chronic conditions, and dis-abilities who need transition care frompediatric to adult health care settings.These adolescents and young adultsface unique challenges in accessingadult health care providers who canprovide adequate primary and special-ized health care services (Betz, 1998a,1998b). Pediatric health care providershave an extensive knowledge base re-garding developmental issues and aunique awareness of the concerns per-taining to adolescent and young adulthealth care provider transitions and arequalified to assist these patients duringthe transition phase (Lindeke, Krajicek,& Patterson, 2001). Establishing exclu-sive upper age limits to PNPs’ practicemay create a significant barrier forPNPs and may limit access to healthcare for this population.

In summary, the PNP is highly quali-fied to provide care to individuals frombirth to age 21 years and in special circumstances beyond age 21 years.NAPNAP firmly supports the scope ofpractice for PNPs to be inclusive ofnewborns, infants, children, adoles-cents, and young adults. NAPNAP ad-ditionally supports the PNP’s role as aprovider of health care for individualsolder than 21 years with unique needsand for young adults during the transi-tion to adult health care.

REFERENCESAmerican Academy of Pediatrics. (1998). Age limits

of pediatrics. Retrieved January 8, 2002, fromhttp://www.aap.org/policy/02031.html

Association of Faculties of Pediatric Nurse Practi-tioners. (1996). Philosophy, conceptual model,terminal competencies for the education of pe-diatric nurse practitioners. In The National Cer-tification Board of Pediatric Nurse Practitionersand Nurses PNP program review manual.Gaithersburg, MD: Author.

Betz, C. (1998a). Adolescent transitions: a nursingconcern. Pediatric Nursing, 24, 23-30.

Betz, C. (1998b). Facilitating the transition of ado-lescents with chronic conditions from pedi-atric to adult health care and community set-

Position Statement

Reprint requests: NAPNAP National Office, 20 Brace Rd, Suite 200, Cherry Hill, NJ 08034-2633.

J Pediatr Health Care. (2002). 16, 42A-43A.

Copyright © 2002 by the National Association of Pediatric Nurse Practitioners.

0891-5245/2002/$35.00 + 0 25/8/126521

doi:10.1067/mph.2002.126521

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July/August 2002 43AJOURNAL OF PEDIATRIC HEALTH CARE

tings. Issues in Comprehensive Pediatric Nursing,21, 97-115.

Brady, M., & Neal, A. (2000). Role delineationstudy of pediatric nurse practitioners: A na-tional study of practice responsibilities andtrends in role functions. Journal of PediatricHealth Care, 14, 149-159.

Jackson, P. L., Kennedy, C., Sadler, L. S., Kenney, K.M., Lindeke, L. L., Sperhac, A. M., et al. (2001).Professional practice of pediatric nurse practi-tioners: Implications for education and train-ing of PNPs. Journal of Pediatric Health Care, 15,291-298.

Lindeke, L. L., Krajicek, M., & Patterson, D. L.

(2001). PNP roles and interventions with chil-dren with special needs and their families.Journal of Pediatric Health Care, 15, 138-143.

Muscari, M. E., & Berkstresser, M. (2001). The pre-college examination: Fostering a healthy tran-sition. Journal of Pediatric Health Care, 15, 63-70.

National Certification Board of Pediatric NursePractitioners and Nurses. (2001). PNP test blueprint for 2000-2002. Gaithersburg, MD: Author.

Approved by the NAPNAP ExecutiveBoard: April 9, 2002

Designation: Regular

Supporting Organizations• Association of Faculties of Pediatric

Nurse Practitioners (AFPNP)• National Certification Board of Pedi-

atric Nurse Practitioners and Nurses(NCBPNP/N)

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