Before a medically complex, fully dependent child turns 18 years old, parents need to make a mental shift to address the needs of the child as an adult. To continue making medical decisions for a fully dependent adult child, legal guardianship will need to be addressed. Also, the child's medical care will likely need to be transitioned to adult providers. These processes can be daunting and overwhelming and parents look to providers for support. Pediatric providers need to understand the logistical and the emotional challenges faced by families. This will allow for improved outcomes and for the patient, family and provider.