1. WHO has officially defined a Child as one who is below the age of 18 years. This definition has been applied globally to all their programmes.

2. In most countries in the world, the paediatric age limit has been set at 18 years. This is not only true in western countries in Europe, North America and Australia but also in Asia, eg. Japan, Hong Kong, Korea, Taiwan and Singapore. Unless we want to isolate ourselves from the rest of the world, it is only a matter of time before Malaysia follows suit. Why not NOW?

3. Adolescents in Malaysia need interested specialists who will dedicate their time and energy to address important issues relating to their health and to advance their interests through continuing clinical care, research and international collaboration. Paediatricians in Malaysia are sensitive to the needs of adolescents and are interested to specialise in adolescent medicine, now a recognised subspeciality under Paediatrics in all western countries (also in Hong Kong and Singapore). As far as we know, adolescent medicine is not a sub-specialty in internal medicine. Any further delay in designating paediatricians to care for adolescents would be against the best long-term interests of this group of patients.

4. We are already continuing to look after many adolescents, following them up from their childhood illnesses, many beyond the Malaysia 'cut-off point of 12 years, eg. thalassaemia, cerebral palsy, congenital and rheumatic heart diseases, epilepsy. Following them up only to the 'legal' age in Malaysia of 12 years is often insufficient and many parents have requested that paediatricians continue to look after their children well beyond the age of 12 years. But trying to get some of them admitted for hospitalisation has often put paediatricians in trouble with the Administration.

5. The problems of adolescents are more allied to those of paediatrics and therefore paediatricians are in a better position to look after them compared to adult physicians. Many of these are of a psycho-social nature, eg, juvenile delinquency, drug abuse, smoking, family, school and other social issues. For example, adult physicians at present are generally very uncomfortable with and are reluctant to look after cases of 'Child and Sexual Abuse' that are presented to them after the age to 12 years. Most have referred them to paediatricians who are more familiar with the care of such cases. This surely is tacit acknowledgement that paediatricians are better trained to manage adolescents.

Gathering of paediatric health statistics; the whole world collects health statistics for children by 5year a~e groups up to at least 15 years. Malaysian paediatric statistics would not be comparable with those of the rest of the world if our paediatric age limit is set at only 12 years. Right now there is no designated group collecting such statistics on adolescent health in Malaysia, mainly because this group ofpatients belongs to nobody. Adolescents have special requirements in the design and construction of physical facilities in clinics and wards relating to their unique needs. Paediatricians, being sensitive to their needs, are in the best position to attend to these.

Berita MPA Jan 2000

Footnote: This issue has been brought up by Prof Lin Hai Peng with the then DG of Health, Tan Sri Abu Bakar and the College of Physicians. A dialogue is awaited.