Children with chronic conditions: the importance of growth assessment.

Growth assessment is crucial in the evaluation of all children. The growth of children with chronic conditions is often inadequately assessed by subspecialty services because of the following beliefs: (1) short stature is secondary to the disorder and therefore the cause is known, (2) poor growth is caused by a syndrome and is untreatable, and (3) growth is assessed adequately by the children's primary care providers. In reality, growth failure in children with chronic conditions may be caused by other factors and may be treatable. In addition, growth is often inadequately assessed by primary health care providers. Growth abnormalities should never be ignored or minimized in populations of children having other significant health care problems.

Discontinuing treatment in children with chronic, critical illnesses.

Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.