Major advances in medical technology, such as chemotherapy, bone marrow transplantation, and immunotherapy, have increased survival rates and changed the lives of ill children and their families. One consequence of these advances in medical care has been that many children have experienced multiple, intensive, long-term hospitalizations. Despite pressures from insurers to shorten lengths of stay, children with serious chronic conditions can spend much of their childhood in a hospital. In 2000, approximately 2 million children and adolescents were hospitalized for pediatric illness.2 It also has been estimated that “childhood disability” accounts for 5 million hospital days each year.3 These illnesses can range from relatively common pediatric diagnoses such as sickle cell disease, severe asthma, and cystic fibrosis, to rare conditions such as immunodeficiencies, cancer, and unusual genetic syndromes. Prolonged hospitalizations, though necessary for adequate medical care, change the physical and emotional environment, disciplinary context, schooling, family life, and neurobiology of the chronically ill child.4 Thoughtful and integrated multidisciplinary care is more important today than ever before.
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