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- Laurie J. Glader, MD*
- Judith S. Palfrey, MD*
- *Children's Hospital, Harvard University, Boston, Mass
Objectives
After completing this article, readers should be able to:
Describe children who are dependent on technology.
List common indications for and complications of gastrostomy tubes.
Define invasive and noninvasive mechanical ventilation.
Recognize the psychosocial effects of having a child dependent on technology.
Introduction
Over the past 30 years, care for children who have life-threatening conditions has become more sophisticated. As a result, a new population of children who have special health-care needs has evolved: those assisted by medical technology. By definition, such children have a chronic condition that requires daily assistance by a medical device to replace or augment a bodily function to sustain life. (1) Such technologies allow children who previously would have required highly specialized care in a hospital to live at home. Understanding the scope of this population, general concepts, trends, and complications associated with some of the technologies themselves, along with the psychosocial aspects of caring for children assisted by technology at home, is critical for the pediatrician providing a medical home for this growing population of children.
Who Are Technology-dependent Children?
Results of a recent national survey indicate that nearly 13% of children in the United States have special health-care needs. (2) These are children who “have or are at risk for chronic physical, developmental, behavioral or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally.” (3) Approximately 50% of these children (6.5% of children nationally) have a disability that impairs their functional daily living. Detailed statistics relating to children dependent on technology are more challenging to obtain; estimates indicate that they comprise 0.16% of the population. (4)
The types of technologies on which children who have complex needs rely vary substantially. (5) Among the most common are forms of respiratory support, such as supplemental oxygen or …
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