Managing the Medically Complex, Neurologically Impaired Child in the Inpatient Setting

Abstract

Provide an approach to the management of problems that children with medical complexity experience in the hospital, with particular attention to children with severe neurologic impairment. Children with medical complexity account for an increasing number of bed days and admissions in children’s hospitals and utilize resources far out of proportion to their numbers. They are often neurologically impaired and may be technology dependent. This group of children, however, are often excluded from studies, leaving the clinician with a limited evidence base to make treatment decisions. Although the causes of severe neurologic impairment are varied, the clinical problems these children encounter are similar and include respiratory infections, problems with secretions, dysphagia, feeding intolerance, constipation, gastroesophageal reflux, scoliosis, hip dysplasia, irritability, seizures, osteopenia, and bladder dysfunction, among others. Children with medical complexity due to severe neurological impairment are high utilizers of inpatient resources. Familiarity with the common and predictable problems they experience can assist the clinician in providing care for this population.