Even though the current cut-off age for admission to Sri Lankan paediatric wards is 14 years of age, in order to be in compliance with international standards, there are discussions underway at present to increase the cut-off age to 16 years.

This observation was made in an editorial on "‘Child’, ‘adolescent’ and ‘youth’: Definitions" which was authored by the Joint Editor of the Sri Lanka Journal of Child Health and Specialist Consultant Paediatrician, Dr. G.N. Lucas and published in the said Journal's 52nd Volume's Second Issue in June, 2023. 

The United Nations (UN) Convention on the Rights of the Child defines a ‘child’ as any person under the age of 18 years. The National Society for the Prevention of Cruelty to Children's "Children and the law: Definitions of a child" points out that in England, a ‘child’ is defined as anyone who has not yet reached their 18th birthday while similarly, in Scotland, Wales and Northern Ireland, a ‘child’ is defined as a person under the age of 18 years. 

Adolescence is the phase of life stretching between childhood and adulthood. The World Health Organisation (WHO) and the UN define an ‘adolescent’ as any person between the ages of 10 and 19 years, where early adolescence occurs from the ages of 10-14 years while late adolescence encompasses the latter part of the teenage years between the ages of 15-19 years. It is important to realise that all ‘adolescents’ are not children. Teenagers who are 18 and 19 years of age belong to the category of ‘youth’ although they may be grouped under ‘adolescents’. ‘Adolescent children’ fall into the age range of 10-17 years.

According to the UN, youth is best understood as a period of transition from the dependence of childhood to adulthood’s independence. As a category, youth is more fluid than other fixed age groups. The UN defines ‘youth’ as those persons between the ages of 15 and 24 years.

These definitions are of interest when decisions have to be made regarding the provision of healthcare for these groups of patients. For obvious reasons, some of them, like adolescents and youth, would need special infrastructure facilities in purpose built adolescent wards, while such units would need specially trained staff as well. There is a need for clear guidelines on the stage or age at which some children who need long term care will need to be handed over through transition care to physicians who manage adults. There are also certain policy decisions that need to be made regarding the cut-off ages for admission to paediatric wards. It must be remembered that several studies show that adolescents and youth are quite unhappy in paediatric wards as well as in adult wards.

There are many sides to this story and a reasonable compromise that would benefit both the patients and the care providers should be arrived at, Lucas observed.