Pediatricians have always been concerned about the loss of systematic medical attention to young patients as they enter adolescence and increasingly take it upon themselves to avoid the routine follow-up care they had received as children. For patients with congenital heart disease concern is greatly heightened for fear of the occurrence of preventable complications. Some adolescents are eager to prove their physical capabilities and engage in activities that were previously disallowed. Others discontinue the care of dental hygiene and may become at risk of bacterial endocarditis following dental procedures by new practitioners unaware of their medical history.

A major concern is depression and emotional problems that affect growing children with chronic diseases in the absence of intensive social support. Clinical experience has shown that adolescents rarely confide in their parents regarding their feelings of inferiority in their school and recreational settings. There are few systematic studies of the indicators of emotional problems and very little guidance on their management. Pediatric cardiologists tend to be very encouraging to their patients, but it has long been said that the patients soon find out that “doing well” is “not good enough.”

A recent survey by the Cochrane Review (Lip, 2003) was unable to identify any systematic research in this important field in spite of the various forms of pharmacologic and counseling therapies that are available.

The outreach of the new clinics for adults and adolescents with heart disease must therefore have a strong emphasis on preventive guidance of the patients and their families.

Selected References