18-21 Years

We have arrived.

Adulthood, legally. Your child can vote, sign a contract, consent to their own medical care, and walk out the front door for good if they choose to. These are the last pediatric visits. In the eyes of the law they aren’t “your kid” anymore, even if they sleep down the hall, ride on your insurance, and ask you to explain a W-2 for years to come.

These four years hold three handoffs: high school to whatever’s next, your insurance to their own eventually (they can stay on yours until 26), and us to an adult provider by the end of it. We’ll plan that healthcare handoff together, do the clinical work, and have the real adult conversations you’ve been laying groundwork for since the newborn weight checks.

The transition.

From here down, this page talks to you, our patient.

Your parents are probably reading over your shoulder, and that’s a good thing. But you’re the patient now. You get the care, you make the calls, and nobody steps in between unless you ask them to.

Your visit at a glance

What we’ll do

This visit is mostly a conversation between us and you. A full well-check (weight, height, blood pressure, BMI), a physical exam, vision and hearing as needed, plus screening for mental health, substance use, and sexual health, a transition-planning talk, and a check-in on how you’re managing your own healthcare. Your parents can come in for part of it if you want them there. Your call.

Vaccines today

HPV completion through age 26 (if not yet done; approved and recommended through 26). Tdap booster every 10 years. Annual flu vaccine. COVID-19 boosters as recommended. MenACWY catch-up if not given at 16. MenB if shared decision-making favors it (especially for college-bound or higher-risk).

Bring with you

Your top questions about the adult transition, insurance, college, life. Your insurance card. The names of any specialists or other providers we should loop in for the handoff.

What’s happening with you right now

Physically, you’re grown. Adult development is complete, though sleep, eating, and exercise tend to swing hard when you move out or start college or work, and your body shifts right along with them.

Your brain is the part still under construction. It keeps wiring itself until around 25, and the last region to finish is the one that runs impulse control, planning, and judgment. That’s biology, not a flaw, and it’s worth knowing, because it’s part of why risk-taking tends to peak in this stretch.

Maturity doesn’t arrive on a schedule. Some 18-year-olds have it together, some 21-year-olds are still googling how to sort laundry, and both are normal. What’s new is real choices with real consequences, real legal standing, real freedom. And real mental health vulnerability, which doesn’t switch off just because you’re officially an adult.

🌿 Mind / Body / Spirit, for you (our patient)

🌟 Transition to adult healthcare: how we hand off well

This is your last pediatric visit window. After 21, you’ll see an adult provider for most or all of your care. Done right, it feels like a relay handoff, one runner passing the baton to the next. Done badly, young adults vanish from healthcare for years and resurface with problems that were small once.

Use Got Transition. It’s the national gold-standard resource for this exact handoff, free, with a readiness checklist and planning tools for both you and your family.

What changes at 18:

• You consent to all your own care.
• Your parents lose automatic access to your records, your appointments, and your decisions.
• You can choose your own provider, insurance permitting.
• You can sign a release to let your parents back in, if you want them involved. Without it, no one shares your details.

Finding an adult provider

We don’t list names here, because the list goes stale fast (providers retire, move, stop taking new patients, change insurance). What to ask instead:

• Family medicine or internal medicine? Family medicine treats all ages and often feels like a natural continuation of pediatrics. Internal medicine treats adults only. Both work.
• Do they take your insurance? Check your directory first.
• Affirming care? If you’re LGBTQ+, look for an affirming provider. Hawaiʻi’s list is growing and we can point you to someone.
• Mental health and chronic conditions. If you see a therapist or psychiatrist, or you manage asthma, ADHD, anxiety, anything ongoing, plan that handoff too. Ask how a new provider handles it.
• Where you’ll be. Mainland for college or staying on-island changes the plan. Campus health can bridge a gap but usually isn’t full primary care.

Ask us at your visit and we’ll help you find the right fit.

Timing. We care for you through your 21-year-old visit. Some patients move on right at 18, especially heading to college on the mainland, and we’ve got you either way. When you go, we send a “handshake” letter to your new provider summing up your history, so you don’t start over from scratch.

More from AAP on healthcare transitions.

Running your own healthcare

At 18, your healthcare becomes yours. Skills worth practicing this year:

• Know your medical history: major illnesses, surgeries, allergies, family history, vaccinations.
• Know your medications: names, doses, why you take them, how to refill them yourself.
• Make your own appointments and get there on time.
• Talk to providers in your own voice: describe symptoms, ask questions, push back if you need to.
• Understand your insurance: what’s covered, in-network vs out-of-network, copays and deductibles.
• Handle the pharmacy: where to fill, when to refill, how prior authorizations work.
• Know when to call us vs urgent care vs the ED.

None of this is intuitive, and all of it can be learned. We can help you practice now.

Mental wellness in adulthood

Somewhere in here, your mental health quietly became your job. Nobody hands you a manual for the day it stops being your parents’ thing to track and starts being yours. That shift is a lot, and feeling unsteady in it doesn’t mean you’re doing it wrong.

This is also a real high-risk window. The early adult years are a peak time for the first onset of serious mental illness (major depression, severe anxiety, bipolar disorder, schizophrenia), and the college transition stacks on stressors: leaving home, lost sleep, academic pressure, new social worlds, substances, identity questions.

Worth paying attention to:

• a low mood that won’t lift
• panic out of nowhere
• pulling away from people
• sleeping too much or too little
• falling behind at school or work
• drinking or using that’s started running the show
• a tense relationship with food
• a loss you’re still carrying
• any thought that life isn’t worth living

None of it is too small to bring up, and you don’t have to sort out whether it “counts” first. Talking to someone isn’t the emergency option. It’s the smart one.

If you’ve had support that helps, don’t let it lapse by accident. Heading to college changes how you get care: the therapist from high school may not be an option, and you’re suddenly looking at campus health, a new adult provider, and what your insurance covers. Make a plan to keep your care going before you leave, so it follows you instead of stopping at the door. Coverage improved under the Mental Health Parity Act, so check your plan before you assume help is out of reach.

And if you want a familiar place to start, we’re still your team. No question is silly, even now that you’re the one asking it.

Other Resources: 988 (call or text), Hawaiʻi CARES (1-808-832-3100), Crisis Text Line (text ALOHA to 741741),Child Mind Institute, The Trevor Project, the JED Foundation for college students, and your campus counseling center.

Sexual health, contraception, and STI screening

Most young adults are sexually active by 21.

A few reminders:

• Pap smears start at 21 for patients with a cervix.
• Annual STI (sexually transmitted infection) screening for sexually active young adults, especially with new or multiple partners.
• HPV vaccine can be completed through age 26 if the series isn’t done.
• Contraception options widen as an adult (long-acting methods like IUDs and the Nexplanon implant become more accessible).
• PrEP for HIV prevention fits some young adults at higher risk.
• Emergency contraception is available over the counter.
• For LGBTQ+ patients: gender-affirming care, screening tailored to your own anatomy and your own life, and STI screening that doesn’t presume anything about your body or your partners. We talk all of it through privately, on your terms.
• Confidentiality: even on a parent’s insurance until 26, you can ask that explanations of benefits for confidential services come only to you. We can help arrange that.
• More from Planned Parenthood and Bedsider.

Substance use peaks between 18 and 21

For a lot of people this stretch is the highest: the most binge drinking, marijuana use, and exposure to other substances. Knowing the pattern helps you watch your own.

• On your radar: alcohol that tips into dependence, cannabis that becomes hard to stop, leaning on stimulants like Adderall to study, sexual risks and driving under the influence, and the way all of it tangles with your mental health. The biggest one: any pill that didn’t come from a pharmacy can be contaminated with fentanyl, and it only takes once.
• If you’re wondering about your own use, talk to us. No judgment, nothing leaves the room. Treatment for adults works and it’s everywhere. On-island: Hina Mauka, Bridge House, ARC Pacific, and outpatient providers we can point you to.
• Everyone should know this: Narcan (naloxone) is available without a prescription at Hawaiʻi pharmacies, and it reverses an opioid overdose. If you or anyone you know uses opioids or counterfeit pills, keep it within reach. Carry it. Tell your friends where it is.
• More help: SAMHSA’s national helpline, 1-800-662-4357, available 24/7, free, and confidential.

Sleep, nutrition, exercise

When you move out, these become your own to maintain.

• Sleep: still 7 to 9 hours. College students average 6 to 7. Less sleep tracks with worse mental health, academic, and life outcomes.
• Nutrition: dining halls and cheap food don’t have to mean bad food. Protein at every meal, vegetables daily, water, limit ultra-processed foods, don’t skip breakfast on a big day.
• Exercise: 150 minutes a week of moderate activity (walking, biking, stairs all count). Find what you enjoy.

The three work together. Build the habits until they run on autopilot, and everything else gets easier.

💗 Family / Community, for you and your ʻohana

🌟 Financial literacy and adulting practical skills.

Khan Academy’s free personal finance course is one of the most useful things a young adult can spend a few hours on. It covers budgeting, saving, credit, debt, investing, taxes, insurance, and major purchases. Take it. It’s free.

Beyond Khan Academy, here’s the short list of what actually moves the needle. You don’t need all of it today. Know these exist, and come back to each as it gets real:

Money fundamentals

• Track what comes in and goes out, with an app (YNAB, Monarch Money) or a spreadsheet. Tracking alone tends to improve behavior.
• Emergency fund first (3 to 6 months of expenses), then the rest. High-yield savings accounts are worth using.
• If you started a Roth IRA earlier, keep going. If not and you earn income, you can start one. Index funds beat actively managed funds over time, and boring investing wins.
• You need it for adult life (renting, buying, some jobs). Get a low-limit credit card, pay it off every month, never carry a balance.
• Understand what carrying debt actually costs over time, and pay aggressively on high-interest debt.
• Learn to file your own once it’s simple enough. Free options exist (FreeTaxUSA, IRS Free File, Cash App Taxes).
• Know what your health plan covers, know auto basics, and get renters insurance (cheap and worth it).

Other adulting topics

• Even 3 to 5 meals you can make from scratch.
• Laundry, including reading clothing labels.
• Cars, apartments, basic tools. YouTube is your friend.
• Healthcare navigation. Covered in the Mind / Body / Spirit section above.
• Hard conversations. Saying no, asking for what you need, setting boundaries, apologizing well, ending things well.
• Asking for help. Knowing what you can’t do alone and being willing to ask.

Relationships

Adult relationships look different from teen ones, even with the same people.

• Healthy patterns: communication, conflict resolution, shared values, independent identities. Unhealthy ones: control, isolation, financial abuse, manipulation, jealousy that cuts you off from other people.
• Consent as an adult still means capacity (not impaired by substances), communication, and comfort.
• Dating apps are common now. Real risks: misrepresentation, coercion, the toll of ghosting, and meeting safety. Tell someone where you’re going and meet in public the first few times.

Many people clarify or shift their understanding of their own identity in this window. Affirming care is available in Hawaiʻi.

The evolving parent-adult-child relationship. The relationship between you and your parents is becoming something new.

• For you: you’re learning to relate to your parents as another adult. Boundaries get more real, you may see them clearly for the first time, and family-of-origin stuff often surfaces.
• For parents: your child isn’t your child in the same way. Letting go is hard and important. Advising without being asked tends to backfire, and showing up when invited beats constant input.
• For both: therapy helps when family-of-origin issues come up. So does reading (Lindsay Gibson’s Adult Children of Emotionally Immature Parents, Lisa Damour on emerging adulthood, Brené Brown on hard conversations).

For your ʻohana

You’re the patient now, but the people who raised you may still be reading this alongside you. The slot below is for them.

Parent wellbeing at 18-21: becoming the parent of an adult. This is the strangest transition of your parenting life. Your child is legally an adult now. They make their own decisions, consent to their own care, and may or may not call or come home for the holidays. The daily proximity that defined two decades is ending or already over. Some parents feel this as freedom, some as real grief, most as some of both in the same day. Your wellbeing in this transition matters as much as theirs.

Signs worth attention: trouble letting go of authority you no longer have, anxiety about decisions made without you, grief that surprises you with its intensity, the empty nest hitting harder than expected, hurt when they don’t call or come home, marital strain in the new configuration, or feeling like you’re failing the transition.

What helps: therapy if it’s harder than expected. Real conversations with your partner about your post-launch life. Re-engaging with your own interests, career, and the projects that have been waiting. Friendships at the same stage. Reading on this phase (Lisa Damour and Lindsay Gibson on the adult-child transition). Permission to grieve and to thrive in the same season. Being available without being intrusive. Building the new relationship rather than mourning the old one.The long view: parents who navigate this well usually end up closest to their adult children.

Local Oʻahu resources 🌺

🌺 Finding an adult provider on Oʻahu

The big systems: Hawaii Pacific Health (Straub, Kapiʻolani, Pali Momi), Queen’s Health System, and Adventist Health Castle on the windward side, plus many independent family and internal medicine practices.

Plan ahead: new-patient waits can run weeks to months.

For specific needs: ask us for LGBTQ+ affirming recommendations. For Native Hawaiian-focused care, Papa Ola Lokahi and Waianae Coast Comprehensive Health Center. For sliding-scale or uninsured care, Hawaiʻi’s Federally Qualified Health Centers (Waianae Coast, Kalihi-Palama, Kokua Kalihi Valley, and others).

We’ll help you sort through options at your transition visit.

🌺 Hawaiʻi adult mental health resources

• Therapy: Talkspace for telehealth, plus local providers. For in-person care on Oʻahu, the Hawaii Psychological Association directory, Psychology Today, or your insurance directory.
• Specialty care: substance use (Hina Mauka, Bridge House, ARC Pacific), eating disorders, LGBTQ+-affirming and trauma-informed therapy.
• Campus counseling: free or low-cost at UH and other Hawaiʻi schools through student health. Use it.
• Continuity: if a therapist or psychiatrist saw you as a teen, ask whether they keep seeing young adults. Many do.

True at every age

Some things never stop mattering, no matter the age on this page:

• Dental care: keep up cleanings every 6 months.
• Water safety. In Hawaiʻi it’s a year-round priority at every age.
• Sun protection, every day, even when it’s overcast.

🚨 When to call us

For a young adult 18-21 years old who is still in our care, call us right away (or go to the ED) for any of these:

• Any active suicidal thoughts, self-harm, plans, or statements about not wanting to be here. Go to the ED or call 988.
• Any mental health crisis, including severe anxiety, panic, dissociation, or psychotic symptoms.
• Substance use crisis (overdose, dangerous level of use, dependency concerns).
• Sexual exposure concerns, possible pregnancy, STI exposure, or sexual assault.
• A motor vehicle crash, even minor.
• Possible concussion after head impact.
• Significant injury (possible fracture, deep cut, burn).
• Eating behaviors that have escalated.
• Significant academic failure or college crisis.
• A relationship that’s becoming unsafe.
• Anything regarding the transition process you need help with.
• Your gut says something is wrong. Call.

📞 Call us when you need us: 808-600-2180

During office hours, you’ll reach our team. After hours, call the same number and select option 1 for our after-hours line (Hello Pediatrics), who follow our medical protocols.

For anything life-threatening, call 911.

Once you’ve transitioned to adult care, your new provider becomes your call. For the in-between period, we’re still here.

What’s ahead: beyond the pediatric portal

This is the last well-check portal in our pediatric practice.

A few things that don’t stop at 21:

Keep up annual well-checks with your new provider. The habit of preventive care matters more in adulthood than most young adults expect.

Vaccines continue: Tdap every 10 years, annual flu, COVID-19 boosters as recommended, and new ones as you age (shingles at 50, pneumonia later).

Mental health, sexual health, and substance-use risk all stay live well into your mid-20s. Keep STI screening up if you’re sexually active, keep Pap smears every 3 years starting at 21 (for those with a cervix), and don’t let mental health care lapse in this transition.

The financial habits you build now compound over decades, boring consistency wins, and most people are still figuring out who they are at 25. That’s normal. Stay open.

A note as this chapter closes

This is the last entry in your Keānuenue Pediatrics portal. From your first weight check through the vaccines, the milestones, the school years, the late-night calls, and the college conversations, you’ve been ours to care for.

Soon you’ll be someone else’s patient, and that’s how it should be. But we’ll still miss you.

We’ll write to your new provider and send your records during the transition, and we’ll be here for questions the whole way through. The relationship doesn’t end. It just changes shape.

Take care of yourself. Eat. Sleep. Move. Call your parents. Call us if you need us. We’re so proud of who you’ve become, and so honored we got to walk with you this far. 🥹