Medically fragile children with respiratory issues, spinal cord injuries, or cardiovascular anomalies are increasingly able to stay in the comfort and security of their own homes and receive medical care that in the past was reserved for the hospital setting. For many parents and families of medically fragile children, being able to enjoy the comforts of home is a luxury. In the past two decades, home healthcare has positively impacted families, children, and the way home care is perceived. For our medically fragile children, having the ability to stay at home and attend school surrounded by family and friends allows them to experience a childhood, and gives them a better quality of life and a sense of normalcy. For families, home healthcare provides the opportunity to hold jobs, and for some, even sleep.

Given that State Medicaid Programs remain the primary (or ultimate) payer for these services, it remains to be seen what impact budget pressures and healthcare reform will have in each state. Although there are still obstacles within the system, home healthcare continues to emerge as an alternative for children bound to the walls of a hospital or skilled nursing facility.

In this issue, Heather McKenzie, Senior Director of Educational Programs and Quality Initiatives at VNAA, discusses Children's Health Insurance Programs. In "Bringing Children Home: Bridging the Gap Between Inpatient Pediatric Care and Home Healthcare," Tina Smith stresses the importance of clinical competency and coordination of care as the child transitions from the hospital to the home care setting. James R. McWilliams provides an evidence-based pediatric fall risk assessment for home health practice, which has enabled nurses at Christiana Care VNA to reduce the risk of falls in their pediatric patient population.

To add to the ongoing national discussion about childhood obesity, Sandra E. McTernan and Helena Meiri from the Maternity, Newborn and Pediatric Program and the VNSNY provide a research brief on childhood obesity prevention and intervention. Holly Torbic provides a CE opportunity with "Children and Grief."

Also is this issue, we see:

* Safety in Practice: "From Hospital to Home Healthcare: The Need for Medication Reconciliation" by Kathryn Bruning and Florence Selder

* A commentary from Diana DeBartolomeo Mager on the "Unique Bonds That Form When Visiting Patients in Their Homes: One Nurse's Perspective"

Given the national discussion on healthcare reform and the concern regarding Medicare Home Health issues, we're proud that Home Healthcare Nurse has recognized the importance of Pediatric Home Care-giving a voice to the littlest patients-who also want to be at home...