Until the early 1900s, children who were ill were cared for at home and followed by physicians who made house calls. As technical care improved,sick children were admitted to hospitals. Then, in the mid-1970s, as the benefits of care at home were discerned and hospitals reached capacity,increasing numbers of children began to be cared for at home with high technology equipment. With the recent escalating pressure to reduce health-care costs, the growth of medical home care services has exploded.

Home care now includes a wide array of services: administration of intravenous medications; nutritional support, including enteral feedings and intravenous nutrition; monitoring for apnea and bradycardia; administration of supplemental oxygen; nebulization treatments; mechanical ventilation;phototherapy for hyperbilirubinemia; and rehabilitation/habilitation services. Although care at home can be cost-saving and provide a convenient,psychologically beneficial environment for the child, it also can increase the burden of care on the family (additional demands on time,responsibilities, and...

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