Pediatric Services for Infants and Children With Special Health Care Needs

Abstract

The discipline of infant and child development has expanded greatly during the last 3 decades.1 Much of this growth is due to new knowledge regarding special services that can improve early development of children with, or at risk for, disabilities.2 Passage of Public Law 101-476, the Individuals With Disabilities Education Act (IDEA) revising Public Law 99-457,3 particularly Part H, coupled with existing federal child care mandates and increasing public expression of concern regarding all forms of child care, shows a significant national commitment to the concept that early services are critical if children with disabilities are to reach their full potential.4 While there may be debate over the relative importance of environmental vs hereditary factors in a child's developmental outcome, any approach used to promote child development must consider how these factors interact. A child's intelligence, temperament, and motor skills combine in a complex fashion with family and peers, to influence his or her development. There is much to learn about how to positively influence child/caregiver/societal interactions. As work in the area of early intervention* grows, attempts to prove that such efforts can help a child with disabilities overcome innate cognitive and motor skill limitations have met with inconsistent and often controversial results.5 Improved outcomes are most likely to occur when services are based on the premise that parents or primary caregivers are the most important factors influencing a child's development. All services, even those as clear-cut as a specific health intervention, must follow this premise.6-8 Future studies documenting successful outcomes of programs influencing child development—namely measures of effects on cognitive and motor development—need to be expanded to include at least the following variables: