There has been an increase in the number of children with significant chronic illness requiring long-term care, as well as those with significant limitations of activities.1-4 This increase is, in large part, the result of improvements in medical care and technologic advances. Among the groups of children with chronic conditions requiring long-term care are children with developmental disabilities and major congenital defects; survivors of major trauma with residual severe neurologic, neuromuscular, or orthopedic abnormalities; and children with low incidence and extremely costly chronic disorders ranging from those who are dependent on ventilators or have renal failure to children who may be hospitalized less frequently, such as those with cystic fibrosis or hemophilia. These conditions tend to be costly not only in economic terms but also in psychologic respects.5-8
Many children with sever disabilities or long-term illness require special services to support home rather than institutional care. Transitional care may be defined as those services that support the move of the child from an institution to home and community. At times, special transitional care units provide such services, although, more typically, transitional care services refer to activities that directly strengthen the capacity of the family and community to care for the child at home. Transition to the community requires (1) careful planning and discharge efforts, (2) determination of special home equipment and service needs, (3) educational activities for family and community providers, and (4) development of an explicit plan to provide nursing care and other support services as needed.