A
Adult body, adult dosesDose by weight and never exceed the adult maximum. There is no 50 kg switch and no pubertal switch — that is a myth. Heparins, insulin, vasoactives and relaxants never stop being size-dosed, and tidal volume comes from predicted body weight calculated from height, never from the scales. Front-of-neck access uses the adult scalpel technique rather than a needle, because the size of the membrane decides it and not the birthday — though the adult tube may still not fit a sixteen-year-old.
D
Deliberate, not delinquentInsulin omission, or an interrupted pump, lies behind most ketoacidosis in established diabetes, and graft loss peaks between seventeen and twenty-four. A seventeen-year-old who stops tacrolimus because taking it in front of friends means explaining the transplant has made an intelligible choice with a catastrophic price. Every part of that sentence points at something you could work on. “Non-compliant” points at nothing.
U
Unaccompanied, for part of every admissionSome part of every admission without the parent in the room — and say what confidentiality does and does not cover before they tell you anything. Be concrete about where the line falls: what they smoke at the weekend stays within the treating team, a disclosure that somebody is hurting them does not. Never offer a secrecy you will have to break. Their account of what happened is often not the parents' account.
L
Law is localMaturity decides capacity, not the birthday — the principle from the English Gillick case, which now runs through most of the common-law world. What differs, country by country and state by state, is the statute built around it. Consent and refusal are not mirror images either: a competent young person's consent generally stands, while a refusal of life-saving treatment can be overridden by a court. Look up your own jurisdiction rather than the number you were taught.
T
Transition is where they are lostThe handover from paediatric to adult services is the point at which a chronic disease most often comes off the rails, and it is the same years in which graft loss peaks. School, exams and sport are the outcomes that matter to them, and they are old enough to report their own — so they can hold their own follow-up, if anybody asks them to.
Choose one, then send. The button opens a reply straight to me with your choice already in it —
just add your reasoning.