Pediatric Multimorbidity and Medical Complexity: Diagnostic and Therapeutic Perspectives from Internal Medicine

Pediatric multimorbidity has emerged as a significant clinical challenge that extends beyond the traditional single-disease model of pediatric care. The coexistence of multiple chronic conditions in children and adolescents generates complex diagnostic and therapeutic scenarios that demand advanced clinical reasoning, coordinated care, and long-term management strategies. This review synthesizes current international evidence on pediatric multimorbidity, with a specific focus on its implications for diagnostic complexity, therapeutic burden, polypharmacy, and healthcare utilization, framed within an internal medicine perspective. The findings highlight that pediatric multimorbidity follows identifiable patterns of disease clustering, frequently involving neurodevelopmental, mental health, respiratory, metabolic, and neurologic conditions. These patterns are associated with increased diagnostic uncertainty due to overlapping symptoms, atypical presentations, care fragmentation, and medication-related confounding. Therapeutic management is similarly complex, with polypharmacy and cumulative treatment burden representing central risks for patient safety and quality of life. Care coordination and family-centered approaches emerge as critical mechanisms for mitigating complexity, while gaps in transition planning to adult care remain a persistent challenge. From an educational standpoint, pediatric multimorbidity offers a valuable framework for teaching core internal medicine competencies, including diagnostic reasoning under uncertainty, systems-based practice, and patient-centered care. This review underscores the need to integrate multimorbidity-focused approaches into medical training and clinical practice, particularly within healthcare systems in Mexico, Colombia, and Ecuador.