Health information resources

A non-progressive chronic neurologic disorder that interferes with the ability to control body and muscle movement. Cerebral palsy is caused by damage to specific areas of the brain that control muscle movement, coordination of body movement and posture. Depending upon the area of the brain that is damaged, speech, hearing, swallowing, breathing, and learning can also be affected. Cerebral Palsy cannot be cured. Maintaining mobility and independence are goals in care.

PHS homecare for CP patients
Pediatric Home Service therapists and clinicians provide scheduled routine in-home visits and 24/7 on-call assistance to families with our service. The respiratory therapists, infusion nurses, and dietitians at Pediatric Home Service assist children with a diagnosis of cerebral palsy by providing education, treatment, and clinical support to parents and in-home/community providers on prescribed respiratory treatments and individualized nutrition plans. Treatment modalities may include nebulization, oxygen therapy, CPAP, mechanical ventilation via tracheostomy, cough assist devices, bronchial drainage, enteral feeding, IV hydration, or suctioning. During weekly meetings with our medical director, therapists and clinicians give clinical updates and review the prescribed plan of care, if necessary, PHS makes recommendations to the child’s primary physician to update the plan of care per the child’s current status in the home. United Cerebral Palsy (UCP) provides timely information for parents and families of individuals with cerebral palsy. ;

Read about PHS patient Andy living with Cerebral Palsy.

There are many types of chromosomal abnormalities. Genes make up the chromosomes and the former give each individual his or her own unique characteristics. Chromosomes come in pairs. Each person usually has 46 chromosomes; 23 from the mother and 23 from the father. Sometimes, the chromosome pairs get mixed up and too many or too few chromosomes may end up together or in different sequences, resulting in a chromosomal abnormality. While parents often think they are responsible for the chromosomal abnormalities, this is usually not the case. Consultation by a geneticist is extremely helpful to review a new diagnosis and in finding avenues of support and follow-up. Chromosomal abnormalities have implications for future pregnancies.

PHS homecare for patients with chromosomal abnormalities
A multidisciplinary team of Pediatric Home Service infusion nurses, respiratory therapists, and dietitians support children with chromosomal abnormalities with the development of a plan of care that meets the individual needs of each child. PHS also offers medical social work follow-up. Our medical social worker assists families by providing support and community resources.

Chronic lung disease is a term used when an individual has long-term respiratory problems that last three months or longer. BPD is a chronic lung condition that affects premature infants. At birth, a premature infant’s lungs are immature, tiny and very fragile. Oxygen or mechanical ventilation is often necessary for the premature infant’s survival when he or she is born too early and not able to breathe on his or her own. When a ventilator is medically necessary, the ventilator pressures and oxygen used can cause lung damage and scarring of the tiny air sacs and tissue in the lungs; this damage is BPD.

Some symptoms of BPD are coughing, wheezing, and increased work in breathing. Premature infants with a diagnosis of chronic lung disease may need to be hospitalized months beyond their due date. Infants with BPD may need oxygen and home monitoring equipment when they are ready to be discharged to home. Other infants may have a tracheostomy and require ventilator support at home.

PHS homecare for patients with CLD/BPD
A PHS multidisciplinary team collaborates with area pulmonologists and specialty providers to achieve optimal outcomes and works closely with families to ensure a comprehensive and safe transition home for children with chronic respiratory disorders.

• PHS provides in-home medical equipment for children with CLD/BPD.
• PHS provides equipment and emergency response training for parents and caregivers
• PHS respiratory therapists, infusion and private duty nurses are trained in caring for children who have oxygen and ventilator needs at home
• PHS therapists conduct an initial home environmental assessment to determine if the child’s home is able to support the equipment needed. The company developed STAR kit, an educational, safety tool designed to ensure a safe plan of care at home

Premature infants can have trouble tolerating feedings orally, and will sometimes need tube feedings or IV nutrition. Growth, especially in length, is very important for children with BPD as lung development continues into the early years of childhood. Infants with chronic diseases may use more calories in breathing and maintaining their temperature than healthy infants. PHS employs registered dietitians who understand and adjust the caloric and dietary needs of this population.

Read about PHS patient Jackson living with Bronchopulmonary Dysplasia.

Congenital heart defects are problems with the heart’s structure that cause a change in the usual pattern of blood flow through the heart or heart vessels. There are many types of congenital heart defects. CHD is present at birth and may or may not be noticed at that time. In some cases, the exact cause of the defect is not known. Depending on the complexity of the defect, surgery may or may not be necessary. A pediatric cardiologist specializes in the care of children with heart conditions and should be consulted if a child is diagnosed with a congenital heart defect.

PHS homecare for patients with CHD
A PHS multidisciplinary team provides a variety of homecare services for children with CHD. Sometimes, an apnea monitor, oximeter, or oxygen is ordered for home. Depending upon insurance provisions, Pediatric Home Service may be able to provide this equipment. If equipment is ordered through our service by the primary physician, PHS therapists and clinicians train family caregivers on all home equipment and are available 24/7 to respond to any troubleshooting questions. Defects within the heart can also affect a child’s stamina or energy level and ability of a child to feed and gain weight. Cardiologists may want a child to be a little bigger before heart surgery is considered. At times, such children may be discharged from the hospital to home and later return for surgery once a specific weight is attained.

• PHS dietitians provide in-home follow up with development of a feeding plan.
• PHS provides services to help if a child needs tube feeding supplements in addition to feedings taken orally or with a feeding pump,
• PHS infusion nurses and pharmacists currently care for children at home with CHD and have provided prescribed cardiac medications intravenously.

Muscular dystrophy is an inherited condition of progressive muscle weakness in both children and adults. There are many different types of muscular dystrophy. Depending upon the type, all muscles or specific groups of muscles can be involved. When heart and lung muscles are affected, irregular heart rhythms and difficulty breathing can result. Progressive muscle weakness affect the ability to swallow and nutritional needs can be compromised. There is no cure for muscular dystrophy.

PHS homecare for MD patients
Close follow up by specialty providers is recommended to manage the disease. By maintaining relationships with area hospitals and specialty providers, PHS stays current with new treatments, medications, and nutrition plans to best care for children at home. PHS provides 24/7 on-call assistance to families receiving our service. In addition to the therapy provided by community occupational and physical therapists, Pediatric Home Service’s respiratory therapists, nurse clinicians (infusion and/or private duty), dietitians, and pharmacists play an active role in supporting children with muscular dystrophy. Pediatric Home Service collaborates with hospitals and other in-home services to develop a comprehensive plan of care specific to the needs of each child.

Diseases of the skeletal muscles that are not caused by nerve disorders are myopathies. Skeletal or voluntary muscles become weak or shrunken. There are many different types of myopathies: genetic, inflammatory, endocrine, metabolic, and idiopathic (unknown cause). Although these myopathies vary greatly, they all have an effect on the skeletal muscles.

Genetic Myopathies
Genes in the body are responsible for many functions in the body, among them the oversight of protein production. Proteins are important in the maintenance of healthy cells in the body. The muscles cells produce thousands of proteins, and with genetic or inherited myopathies, there is a lack of, or defect in, one protein needed for normal muscle cell function.
Endocrine Related Myopathies
The body’s endocrine cells produce chemical messengers called hormones. These hormones have many important functions in regulation of the body. One of their many functions is to help with the regulation of the muscle cells. When these hormones are not regulating the muscle cells, muscle cell weakness may occur.
Inflammatory Myopathies
Inflammation is the body’s protective response to injured tissues. Normally, the response to the injury is redness, warmth, swelling, and pain. Inflammatory myopathies are caused by inflammation.
Muscular Dystrophies
Muscular dystrophies are a separate group of diseases, however, because they involve muscle wasting, they can be described as myopathies. Muscular dystrophy is a genetic disorder that results when there is a defect in the production of specific proteins.

PHS homecare for children with muscular myopathies
Children with muscular myopathies have varying degrees of muscle involvement. The necessary therapies are determined by a child’s physician, according to medical needs. Some children may not require any special equipment or interventions and some may require full respiratory support from a ventilator. Myopathies have the potential to make a significant impact on the general strength of a child’s body and the family may have frequent contact and interactions with medical professionals. If medical equipment is requested, PHS provides it, along with the necessary training and ongoing support.

• PHS pediatric respiratory therapists will provide education and ongoing support for respiratory equipment and issues.
• Should your child need laboratory values monitored at home or intravenous medications administered, PHS pediatric infusion therapy nurses are available to provide these services.
• PHS pediatric dietitians provide expert information that will help caregivers maximize the child’s nutritional status and growth potential.

Children with Pierre Robin Sequence have a small lower jaw (micrognathia) and a tongue that is displaced downward (glossoptosis). The hard and/or soft palates are sometimes affected as well (cleft palate). These children may have difficulty eating by mouth and sometimes, may even have difficulty breathing. Some of the children may require artificial airways, such as a tracheostomy tube. In some instances, a child may require additional respiratory support, possibly a ventilator.

PHS homecare for children with Pierre Robin syndrome
The PHS team provides support when medical complications associated with Pierre Robin arise. PHS pediatric respiratory therapists help families with children who require special respiratory equipment. Experienced in caring for many children with Pierre Robin, PHS respiratory therapists teach caregivers about the medical equipment providing support.

Children with Pierre Robin may have difficulty eating orally. PHS pediatric dietitians provide expert nutritional counseling/consultation and help caregivers monitor the child’s growth. They also communicate with the child’s physician to develop the best nutritional plan.

The brain and the spinal cord are the major parts of the central nervous system, sending messages throughout your body. Quadriplegia is the paralysis of both arms and legs and it occurs when the neck area of the spinal cord is injured. The location of the injury on the spinal cord and the severity of the injury will determine the amount of function a person will have when the spinal cord is injured. Sometimes, if an injury is high enough on the spinal cord and the injury severe, a person’s breathing may be impaired. A person who has a complete quadriplegia is unable to move any part of the body below the neck. Some of these people are also unable to move the neck.

A diagnosis of quadriplegia requires careful medical management of the potential common complications of quadriplegia.

• The spinal nerves control the function of the bowel and bladder and people with quadriplegia have varying degrees of loss of control in this area. The most common complications are urinary tract infections and constipation. These are complications that can lead to serious medical situations if not caught and treated promptly.
• Pressure sores may result from being immobile for extended periods of time. The weight of the body being in one spot too long impairs circulation and is likely to cause sores. In addition to immobility, a quadriplegic is unable to shift his or her body weight from one spot to another to remove pressure. Pressure sores can become infected and cause serious illness.
• Blood clots may also form as a result of immobility. Circulation slows down in general with immobility.
• Because the signals from the nerves that go to your child’s chest and diaphragm may be impaired by quadriplegia, breathing may be difficult or impossible. In the instance of complete inability to breathe, your child will use a ventilator to breathe. The use of a ventilator puts a person at risk for respiratory infections.
• Spastic muscles may result from quadriplegia.
• Injuries may result from altered sensation. An example of this would be a burn happening due to inability to feel the heat and not responding to the painful stimuli.
• Pain may also occur. A child’s physician will assess and provide treatment for pain.

PHS homecare for children with quadriplegia
Quadriplegia is a complex condition and a child will need an extensive health care team to manage his or her needs and to assist the family in achieving a healthy home environment.

Pediatric Home Service provides all medical equipment that may be needed by a child with a diagnosis of quadriplegia. We are also available for initial consultation and ongoing follow-up throughout childhood and adolescence.

• PHS respiratory therapists provide necessary respiratory equipment and education and support related to a child’s respiratory health.
• PHS infusion nurses obtain laboratory specimens as needed in the home and also provide any intravenous medications ordered by the child’s physician.
• PHS pediatric dietitians provide information that maintains the highest level of nutritional health and minimizes complications of the condition.
• A PHS pediatric medical social worker is available to help children and their families cope with quadriplegia as a life-long condition and to ensure a child has been connected with appropriate resources.

Spina bifida is a condition in which the spinal column does not close all the way during prenatal development. There are four different types of spina bifida:

Occult spinal dysraphism (OSD)
This defect is suspected when a dimple, tufts of hair, red marks or small lumps are noted on the lower back. Not all babies with these physical characteristics have OSD and a physician will use special tools and tests to determine whether or not a child has OSD. The spinal cord may not grow the right way and may cause problems as the child grows.
Spina bifida occulta
This is “hidden spina bifida.” Healthy people may have it and not know it because it does not cause harm and has no symptoms. The spinal cord and nerves are fine. An x-ray of the back is usually how people discover they have spina bifida occulta.
Meningocele
A meningocele is a condition in which part of the spinal cord comes through the spine as a sac pushed outside of the skin. There is usually no nerve damage, as nerves and the spinal cord and fluid are enclosed in the sac. Some people with a meningocele may have minor disabilities.
Myelomeningocele
A myelomeningocele occurs when parts of the spinal cord and nerves come through an open part of the spine, causing nerve damage and other disabilities. Many of these children also have a condition called hydrocephalus, which is too much fluid on the brain. This results when fluid surrounds the brain and spinal cord and is unable to drain as it should. This fluid can build up and cause pressure and swelling.

PHS homecare for children with spina bifida
A physician will diagnose a child with spina bifida, develop an appropriate treatment plan, and make referrals to additional resources. Many of these children will have lifelong, extensive contact with the medical community. PHS is one of the resources available to assist children and families with a diagnosis of spina bifida. Frequent visits to the doctor’s office and hospital are often required. PHS is often able to help decrease these visits by providing many of the necessary therapies in the home.

PHS tailors its services to fit each child’s needs. PHS has all necessary medical equipment available and provides training on appropriate use.

• PHS respiratory therapists provide initial training and ongoing support for any necessary respiratory equipment and treatment a child may need. Our respiratory therapists provide ongoing support and follow-up for many pieces of respiratory equipment.
• PHS pediatric dietitians consult and provide recommendations to caregivers to ensure each child’s optimal nutrition, maximum growth and development, and overall health,
• PHS infusion therapy nurses and pharmacists provide necessary intravenous medication in the home and are also able to obtain specimens required for laboratory testing.
• A PHS medical social worker is available to help with many aspects of the family’s life, making certain your child and family is well connected with resources.

Read about PHS patient Tana living with Spina Bifida.

Spinal muscular atrophy is a genetic group of diseases that affect the motor neurons of the spinal cord and brain stem. These are the cells that supply electrical and chemical messages to the muscle cells, “telling” them what to do. Because these motor neuron cells do not work properly, the muscle cells fail to function and eventually die. Because the cells cannot function, the muscle cells become much smaller (atrophy) and become weak. The motor neuron cells are involved in the activities of swallowing, breathing, and movement of the limbs.

SMA is “autosomal recessive,” which means that the disease is inherited by receiving one SMA gene from each parent. The disease may be very severe or relatively benign. Muscle weakness is present in all cases. SMA does not affect intelligence.

There are three types of SMA:

Type 1 (also known as Werdnig-Hoffman disease)
Most mothers talk about abnormal inactivity of the fetus in the latter stages of pregnancy. Babies with SMA type I are inactive and have floppy muscle tone. There is little movement of the extremities; the fingers and toes usually move due to the sparing of the distal musculature. The SMA type I patient is unable to roll over or sit, and will experience progressive deterioration. By age two, death usually occurs from complications of the disease and ultimate respiratory failure.
Type II
These patients generally have normal development for the first 4 to 6 months of life. Sitting is a milestone that may be reached; however, these patients are never able to walk. The life span of people with type II SMA is longer than for patients with type I.
Type III
These patients often have nearly normal life spans. The usual complaint is climbing or getting up from the floor. Most experience limited endurance and approximately 30 percent require a wheelchair as an adult.

PHS homecare for children with spinal muscle atrophy
A child’s physician provides a diagnosis of SMA. PHS is able to support family caregivers in the comprehensive care and treatment at home for children with spinal muscle atrophy. SMA is a lifelong illness and affects the entire family in many ways.

• PHS provides the medical equipment needed by a child with SMA.
• PHS pediatric respiratory therapists are available for the initial set up and ongoing support for respiratory equipment and necessary respiratory therapies.
• If a child requires assessment of nutritional needs, PHS pediatric dietitians are available for consultation and ongoing involvement to help the child maintain the best possible health. The dietitians assist caregivers in helping a child reach his or her maximum growth potential.
• PHS pharmacists are familiar with medications used for all children and for children with SMA.
• PHS infusion therapy nurses are available for any medications that need to be given intravenously and to obtain laboratory specimens ordered by a child’s physician.

A PHS medical social worker is available to help the family deal with the many issues and concerns that may arise with an SMA diagnosis.

Read about PHS patient Mary Kate living with SMA.

The body has its own defense system (immune system) built in order to protect it against infection and disease. The body’s immune system makes special proteins (antibodies or immunoglobulins) that protect and defend the body against antigens. Antigens can include harmful bacteria, viruses, toxins, or cancer cells. When an antigen enters the body, antibodies are made to destroy the antigen and to protect the body against injury or disease. In autoimmune disorders, the body thinks some of its own cells are harmful and attempts to destroy them.

There are many types of autoimmune disorders, but the most common group of autoimmune disorders is collagen-vascular diseases (CVDs). A person might have more than one autoimmune disorder at the same time. Treatment is aimed at balancing the body’s immune response and its ability to fight disease. Immunosuppressive medications, hormone replacements, vitamin supplements, or blood transfusions may be included in the treatment and control of autoimmune disorders.

PHS homecare for patients with autoimmune disorder
PHS takes a team approach in providing homecare for children with autoimmune disorders. PHS pharmacists, infusion and private duty nurses, dietitians, medical social worker, and respiratory therapists work together to assure quality care at home. The PHS team attends weekly team rounds to develop a plan of care that addresses the concerns and needs of each child per the primary physicians orders.

• Intravenous gammaglobin, glucocorticoids and other IV medications can be prepared by our pharmacists and administered in home by our skilled infusion nurses.
• Registered dietitians collaborate with a child’s medical provider to develop an individual nutrition plan to optimize the child’s growth and development.
• A medical social worker is available to help families identify community resources and support groups associated with specific diagnosis.

Congenital abnormalities are conditions that are present at birth and may include any of the body’s systems. There are many types and variations of congenital abnormalities. Some congenital abnormalities, such as having extra toes or fingers, can be diagnosed more easily than others. Conditions that affect the heart, brain, or internal organs may require special diagnostic testing and evaluation in determining a diagnosis. Some conditions can be corrected with surgery. Others may be life-long and may require ongoing support and therapy. The cause of a congenital abnormality is often unknown. A genetic consult can be helpful in gaining understanding into a new diagnosis.

PHS homecare for patients with congenital abnormalities
PHS cares for many children with congenital abnormalities. The respiratory therapists, infusion and private duty nurses, dietitians, pharmacists, and medical social worker at PHS provide a team approach to care.

• The PHS medical director attends team care rounds and presents medical updates and new treatment modalities in caring for children with congenital abnormalities.
• PHS collaborates with hospital, provider and community services that are in place in the home to provide a safe plan of care.
• If respiratory support is needed, PHS therapists educate and support children, families, and caregivers on home monitoring equipment, oxygen therapy, and ventilator therapy.
• If intravenous hydration, nutrition or medication is ordered for home, PHS pharmacists, infusion nurses, and dietitians support the child’s needs.
• A medical social worker provides support in locating additional information, programs and services specific to your child’s diagnosis.

Osteomyelitis is an infection within the bone or skeletal system, usually caused by bacteria that enter the bone through the blood, a wound or injury or with surgery. Treatment with intravenous antibiotics is common.

PHS homecare for patients with osteomyelitis
Because this treatment takes time — with the medication being given over several weeks — some providers order antibiotics to be administered at home.

• PHS infusion nurses and pharmacists provide in-home antibiotic therapy for children with osteomyelitis.
• PHS infusion nurses provide intravenous medication administration, laboratory blood draws and line maintenance for children with peripheral lines, port-a-catheters, and peripherally inserted central catheter lines.
• PHS pharmacists understand the special medication needs of children. Being sick or in pain, missing school and friends, or being poked for intravenous medication administration and laboratory draws is no fun and can be scary for children. They ensure that families and caregivers understand each ordered procedure or therapy before it is carried out.

By having blood values drawn at home, children who are immunosuppressed, home bound, or susceptible to illness are able to avoid clinic visits where there is a potential risk of exposure to others who are ill.

PHS homecare in providing laboratory blood draws
PHS skilled infusion nurses provide laboratory blood draws for children with many conditions at home. PHS infusion nurses may receive orders from providers to obtain scheduled laboratory specimens to evaluate blood, respiratory, electrolyte, or the nutritional status of children who have undergone organ transplants, are on total parenteral nutrition (TPN), or for those requiring special therapies. Infusion nurses also provide laboratory draws for children who require less frequent blood draws, such as bilirubin levels.

Laboratory specimens obtained in the home are hand-delivered to area hospitals and clinics by our infusion nurses where blood work analysis is completed. Resulting blood values are communicated to ordering providers and PHS infusion nurses. After evaluating laboratory values, ordering providers update your child’s nutrition, ventilator, or medication administration plan. Providers collaborate with our nursing, dietitian, respiratory, and pharmacy staff, discussing any changes in the plan of care based upon laboratory results.

The body has its own defense system (immune system) built in to protect it against infection and disease. The body’s immune system makes special proteins (antibodies or immunoglobulins) that protect and defend the body against antigens. Antigens can include harmful bacteria, viruses, toxins, or cancer cells. When antigen enters the body, antibodies are made to destroy the antigen and to protect the body against injury or disease. Immunodeficiency is a condition that occurs when part of the immune system is not working the way it should or when part of the system does not exist.

Immunodeficiency disorders can be present at birth. Other times immunodeficiency conditions can be acquired as a result of illness, disease, cancer, malnutrition, or medications. Without an intact immune system, the body’s ability to fight disease and infection is threatened. Treatment might include scheduled immunoglobulin replacement therapy.

PHS homecare for patients with immunodeficiency
Avoiding readmission to the hospital and the potential risks of illness to children with immunodeficiency associated with clinic visits is important to you and to the staff at PHS.
A PHS team of pharmacists, infusion and/or private duty nurses, respiratory therapists, dietitians, and social workers collaborate to help keep a child safely at home. The PHS pharmacy can dispense ordered immunoglobulin therapy for children at home. PHS infusion nurses give ordered intravenous medications, including immunoglobulin therapy in home. Children who have undergone organ transplant surgeries take prescribed medications to suppress their body’s immune systems reaction to new organs and tissues. In this case, immunosuppression medication is taken to avoid rejection of the donor tissue after organ transplant.

• PHS and a child’s provider to work together to develop a plan of care that supports the child’s health care needs at home.
• The PHS on-site medical director is involved in weekly care rounds and updates staff on current treatment modalities.
• PHS infusion nurses, respiratory therapists, dietitians and social workers make scheduled home visits to administered ordered therapies, and provide family support, education and resources specific to for child’s diagnosis.

Read about PHS patients Kevin, Ashlyn, and Josie living with Immunodeficiency.

Short bowel syndrome is a condition that results from loss of a significant portion of a child’s bowel. This causes an alteration of intestinal digestion and absorption of nutrients and vitamins, which affects a child’s growth. To grow and develop, these children require extra attention given to their nutritional status. Many require nutrition that is given intravenously (total parenteral nutrition known as TPN) and they may also require extra care for adjustments associated with oral or tube feedings.

PHS homecare for children with short bowel syndrome
A multidisciplinary team, including infusion nurses, dietitians, and pharmacists, collaborate with one another and with a child’s health care team to provide ongoing support for home based therapy for pediatric patients with short bowel syndrome.

A diagnosis requiring frequent interaction with the medical community is stressful for all members of a child’s family; we have a medical social worker available to help your family and to provide play therapy for your child.

• PHS dietitians monitor ongoing laboratory values and the child’s growth.
• PHS pharmacists provide intravenous nutrition for children with SBS.
• Pediatric infusion nurses obtain laboratory specimens in the home and assist in educating home caregivers on how to provide the child’s TPN.

Read about PHS patients Emily R, Lucas, and Tyler living with SBS.

Cystic fibrosis is a genetic disease that causes mucus in the body to become thick and sticky. This mucus builds up and often causes problems in organs of the body. The lungs are affected, often leading to significant breathing problems. The pancreas and liver are also frequently affected, and it is often necessary to monitor with laboratory studies. Children with cystic fibrosis have a difficult time gaining weight and growing and developing optimally without medical intervention.

PHS homecare for children with cystic fibrosis
The primary treatment for cystic fibrosis is a respiratory treatment. PHS respiratory therapists teach children and their families about the treatment and the disease. PHS infusion nurses complete laboratory tests and administer intravenous medications in the home.

Nutritional status has been shown to be directly linked to lung function in individuals with cystic fibrosis; the better the nutritional status, the better the lung capacity will be. Because nutrition is so important for CF patients, PHS dietitians help maximize each child’s nutritional status.

Read about PHS patient Emily R living with CF.

The body’s basic unit of life is the cell. Normally, cells grow in an orderly manner to keep the body healthy. Sometimes this process goes wrong; disruptions in the cells affect normal cell growth and division. In this situation, the life span of the cells is not what it should be. Some cells do not die when they should, and even though the body may not need them, new cells form. These cells may form a mass of tissue called a tumor. Some tumors are benign (not cancerous) and other tumors are malignant (cancerous).

Malignant tumors can spread to other tissue and even spread throughout the body. This spread of the tumor throughout the body is called metastasis. Not all cancers form tumors — leukemia, for example — which is a cancer of the bone marrow and blood.

Cancer cells grow and require more of the body’s nutrition to thrive, causing poor nutritional status, decreased strength, destruction of organs and bones. The body’s ability to fight other infections and diseases may be weakened.

PHS homecare for patients with childhood cancer
Because there are many types of cancer and the treatment and care is individualized, a child’s physician works with family caregivers to explain the options and appropriate treatment plans. Often, treatment for cancer is continued after discharge from the hospital on a homecare basis. A multidisciplinary PHS team — experienced in working with infants, children and young adults with cancer — works together with a child’s physician, health care team and entire family to provide family-centered care along with needed services. Some medications for cancer require frequent monitoring of laboratory values.

• PHS pediatric infusion therapy nurses are available to obtain these in the child’s own home.
• PHS infusion and private duty nurses and pharmacists provide medications and, as necessary, IV hydration ordered by the child’s physician.
• Pediatric dietitians provide individualized nutritional counseling for children needing extra help with nutrition.

Read about PHS patient Lexi, who survived a kidney transplant with the help of PHS.

The mastoid bone is located behind the outside part of the ear. Mastoiditis is an infection of the mastoid bone and is usually caused by a middle ear infection spreading to the mastoid bone. When the infection spreads, the mastoid bone becomes filled with mucopurulent fluid, which increases the pressure of the fragile cells of the mastoid bone and begins to damage the cell walls. When this situation occurs, abcess formation is more likely as is the chance of the infection spreading to surrounding areas of the head and neck.

PHS homecare for children with mastoiditis
Mastoiditis is often treated with long-term intravenous antibiotic therapy. Many times this therapy can be completed at home. PHS pediatric infusion therapy nurses provide this service, and PHS pharmacists are experienced in providing the medication ordered by a child’s physician. The same team is familiar with medications that require monitoring of laboratory values and works with a child’s physician to make necessary adjustments to dosing of the medication.

Tracheobronchitis is an inflammation affecting the lower respiratory tract: the trachea or windpipe and the bronchi. Tracheobronchitis is usually a viral or bacterial infection, although sometimes chemical, physical or allergic antigens can be responsible for the inflammation. Tracheobronchitis usually starts with a dry, non-productive cough, but may lead to coughing up phlegm. The inflammation also may develop into a significant bacterial infectious bronchitis, and in these cases, the phlegm will be purulent and may be tinged with blood. A fever may or may not be present, and shortness of breath may or may be present.

PHS homecare for children with tracheobronchitis
A physician may determine that a child needs additional respiratory treatments or antibiotic treatment given in a manner that requires intravenous access. PHS respiratory therapists provide education and ongoing support about breathing related issues and special respiratory equipment that a child may need to heal at home. Should intravenous medications be required, PHS infusion therapy nurses also provide education about the medication and administer the medication. PHS infusion and private duty nurses also provide assessment of the child’s status and communicate with the child’s physician.

Sometimes the body’s immune system overreacts to a substance (allergen) that is harmless to most people. In this situation, the body thinks the substance (allergen) is an invader to the body and overreacts. The resulting symptoms can range from a simple annoyance to a life threatening response. The body’s antibodies react to the substance, causing the body cells to release chemicals, which cause the reaction. As a person’s body attempts to rid itself of the invading substance, the release of these chemicals causes the reaction — many different reactions of the eyes, throat, skin, lungs, gastrointestinal tract. Every time a person is exposed to the substance (allergen) he/she will have an allergic reaction. Many people experience increasingly more severe reactions with each exposure to the allergen.

Pediatric homecare for children with allergies
In instances of severe or many allergies, a physician will diagnose the allergies and decide what treatment is needed to minimize exposure to the allergen and to also minimize the severity of any allergic reactions that may occur.

• If a child requires a dietary evaluation for allergies, PHS pediatric dietitians will provide professional recommendations on how to best accommodate the child’s allergies while maximizing his/her growth and development.
• PHS pediatric respiratory therapists provide education and professional guidance on any respiratory equipment a child may need. They are also available to help with initial and ongoing respiratory treatments.
• PHSO infusion therapy nurses are available if in home lab draws or intravenous medications are needed.

Eczema is a condition of inflamed and irritated skin. Atopic eczema is the most common type of eczema and is common in infants and young children. Many people with atopic eczema have other conditions: allergies, asthma, and hay fever. Atopic eczema is common in infants and young children. Many infants with atopic dermatitis will outgrow the condition, although there are some people who will experience symptoms intermittently throughout life. The disease can usually be controlled with proper treatment.

No matter where it appears on the body, eczema is almost always itchy and is often associated with a rash. The affected areas are usually very dry, thickened, or scaly.

Although the exact cause of eczema is unknown, a strong theory is that it is associated with an overactive response by the body’s immune system to unknown triggers. Eczema may also occur in families with a history of allergies and asthma. “Flare ups” of the rash and itching may happen in response to certain substances or condition. The substance or condition that causes the “flare up” is different for everyone. There is some belief that stress may cause the condition to worsen.

The best way to effectively manage the condition is to avoid known irritants and to seek medical treatment after diagnosis. The goal of treatment for eczema is to relieve and prevent itching as itching can lead to infection. Because eczema causes dry and itchy skin, the use of lotion and creams are helpful in keeping the skin moist. The best time to apply these is when the skin is damp. It is important to speak with a child’s physician for recommendations on an appropriate cream or lotion to use, and it is best to avoid perfumed or scented lotions.

PHS homecare for children with eczema
PHS has professionals available to help children with allergies or respiratory issues, such as asthma, associated with eczema.

• PHS pediatric dietitians are available for consultation regarding food allergies.
• PHS respiratory therapists provide education and ongoing support for any necessary respiratory treatments ordered by a child’s physician.
• PHS pediatric infusion therapy nurses are also available to provide infusion therapy in the home or child’s school for intravenous medications, laboratory draws and skilled nursing visits.
• A PHS pediatric medical social worker is available to help children who need help coping with eczema and associated symptoms.

Gastroesophageal reflux disease is a condition in which the stomach contents back up into the esophagus, causing heartburn and associated symptoms. GERD can occur in all ages, however, symptoms vary according to age. Infants may have regurgitation, choking, gagging, irritability, arched posturing, and excessive hiccups. Young children may experience abdominal pain, vomiting, excessive belching, and painful or difficult swallowing. Symptoms that may be noticed prior to a GERD diagnosis include poor weight gain, excessive crying, disturbed sleep, and feeding or respiratory problems. Therapy early in life to reduce the risk of long-term complications is very important, and a physician will work with families to develop the best treatment plan for their children. The physician will ask about the child’s history and will also examine the child. Sometimes special diagnostic tests are ordered to establish a diagnosis.

PHS homecare for children with gastroesophageal reflux disease
PHS has the medical equipment that may be requested by a child’s physician to help alleviate or lessen the symptoms of GERD. If GERD has caused respiratory symptoms for a child, PHS pediatric respiratory therapists are available to provide initial and ongoing training and consultation for needed respiratory equipment and associated respiratory symptoms. The respiratory therapy staff is also available to provide some of the diagnostic testing in the family’s home or the hospital. PHS is also available for ongoing support and education.

If a child’s physician recommends consultation with a dietitian, PHS pediatric dietitians are available to provide expert information and recommendations regarding maximizing your child’s growth and development. It is also important to assure that your child is comfortable. Medication will help with this, however, sometimes in addition to medication, other therapies are helpful in keeping your child comfortable.

Asthma is the tightening of airways and production of extra mucus. Symptoms of asthma may include coughing, wheezing, or feeling out of breath. Symptoms of exercise induced asthma occur with physical exertion. Sometimes the symptoms start within the first few minutes of exercise, and sometimes they may happen several minutes after exercising. In addition to physical exertion, pollen, pet dander, and other airborne allergens or food may trigger exercise induced asthma. Other conditions make a child’s exercise-induced asthma worse, including cold air, dry air, air pollution, high pollen counts, having a cold, being out of shape, and exposure to chemicals such as chlorine, paint, fertilizers, or herbicides.

PHS homecare for children with exercise induced asthma
A child’s physician will determine situations in addition to exercise that seem to trigger or make the child’s exercise induced asthma worse.

The PHS pediatric respiratory therapy staff is able to provide an initial education session and ongoing support for any special equipment a child may require to control symptoms of exercise induced asthma. According to the information provided by the child’s physician, the respiratory therapy staff will speak with family caregivers about how to best manage and prevent exposure to asthma triggers. They can also help you learn to assess or know what to look for in your child’s asthma attacks.

• If food or common ingredients of food have been determined to play a role in triggering a child’s asthma, PHS pediatric dietitians are available to design a custom food plan for your child.
• If your child’s physician requests that intravenous medications or laboratory tests be done at home, PHS pediatric infusion therapy nurses will make the visit to your home.

According to The Center for Disease Control and Prevention (CDC), each year, seasonal flu places a large burden on the health and well being of children and families. Children younger than 5 years of age are at especially high risk of developing complications of the flu. Many children younger than 5 years of age and children with chronic health problems, such as asthma and diabetes, will require medical care because of influenza. These same children are at high risk for developing serious complications from the influenza.

The best way to protect against seasonal influenza and its potential severe complications in children is to get a seasonal vaccine each year. Current recommendations from the CDC state that everyone 6 months and older get a seasonal flu vaccine. This is especially important for those children with a long-term health condition.

PHS homecare for children with influenza
PHS can help provide care for children who have developed complications of the flu and are able to be treated at home. PHS provides intravenous therapy and medications in the home, if needed, and PHS pediatric respiratory therapists provide initial set-up and ongoing education of respiratory equipment and treatments. If a child needs special medical equipment or supplies, PHS will provide that as well.

Pediatric asthma is a potentially life-threatening childhood disease that needs to be taken seriously. Asthma begins with the body’s reaction to a trigger. Triggers are specific for each child and may include one or more of the following: smoke, exercise, foods, dust, mold, emotions, changes in weather, or animals (dander or hair). The body’s response to a trigger can result in swelling, mucous production, and narrowing of the breathing tubes. Narrowed airways filled with mucous increase airway resistance, making each breath difficult.

PHS homecare for children with tracheobronchitis
The PHS Asthma Management Program provides comprehensive asthma education and services that support children with asthma and their families in the home. Knowledge of the signs and symptoms of asthma, the ability to identify individual triggers, an understanding of proper medication administration, and the development of an asthma action plan all aid in reducing emergency department visits and hospital admissions. The PHS In-Home Asthma Management Program empowers children and their families to manage asthma at home.

• PHS dietitians develop individualized nutrition plans for children who have specific food-triggered asthma.
• Depending upon insurance provisions, PHS may be able to provide home oxygen or nebulizer supplies that are ordered by a child’s provider.
• If oxygen or additional follow-up are needed, PHS respiratory therapists and home infusion nurses may be involved in your child’s care at home.

Reactive Airway Disease (RAD) is a term used to categorize symptoms similar to those caused by asthma that present in younger infants and children. These symptoms often abate as the child grows. RAD is irritation of the breathing tubes that causes increased mucous production and swelling of the airways, making breathing very difficult. Coughing, wheezing, chest tightness, increased work in breathing, and a worried look associated with the inability to breathe are signs of reactive airway disease. A health care provider should be consulted when a child has difficulty breathing. Reactive airway disease — like asthma — is triggered by many things. Knowing a child’s triggers is especially important in managing and treating RAD.

PHS homecare for RAD patients
PHS respiratory therapists and a PHS asthma management team care for many children diagnosed with reactive airway disease. They provide support and education to promote self-management skills to identify triggers, properly use medication, troubleshoot ordered respiratory equipment, and decrease hospital admissions.

RSV affects people of all ages, but it causes the most trouble for children under the age of two — especially if the child is premature or immunosuppressed. Premature infants and children under age two have smaller airways and the mucous that fills the tiny breathing tubes with this virus makes breathing very difficult. RSV can be life threatening. Coughing, wheezing, fever, increased work in breathing, congestion, runny nose, and a change in a child’s normal behavior are all symptoms of this virus. A child who has difficulty breathing should be seen by a medical provider.

RSV is generally seen during the winter and spring months when people tend to be cooped up together. A nasal secretion test is used to identify the presence of RSV in pediatric patients. Because this is a virus, treatment is aimed at providing comfort, adequate fluids and nutrition, and easing the work of breathing.

PHS homecare for patients with RSV
Some children need to be hospitalized for RSV. Others may be treated at home with oxygen, nebulizer treatments, and close medical follow-up. PHS respiratory therapists, asthma management team, infusion and private duty nurses care for children with RSV. Respiratory therapists, infusion nurses, the asthma management team and pharmacists at PHS coordinate care under the direction of medical providers for children at home. Because there is no active vaccination to prevent this virus, knowledge of RSV prevention is very important. Palivizumab (Synagis®), which is passive immunization, may be available for high risk patients. Pediatric Home Service is involved RSV prevention and has developed educational materials on this very contagious condition. RSV prevention aids include: proper hand washing, avoiding exposure to cigarette smoke, avoiding others with cold symptoms, avoiding crowded places during the RSV season, and discussing with a physician whether or not a child should have the medication palivizumab (Synagis®).

Rhinitis is a stuffy nose or nasal congestion. Allergies, bacteria, or viruses can cause irritation and swelling of the membranes within the nose. There are many causes. Rhinitis may be triggered by pollen, mold, dust mites, foods, animal dander, pollution, smoke, temperature, or perfumes. Each person responds differently to triggers, but reactions include runny nose, sneezing, sore throat, watery eyes, or coughing. Medications to control symptoms might be ordered by your child’s health care provider.

PHS homecare
The PHS In-Home Asthma Management Team helps children and families identify and manage triggers and symptoms of rhinitis at home.

Sinusitis is a swelling of the spaces around the bones in the forehead, cheeks, eyes, and nose. Sinusitis can be caused by allergies, a cold, or infection. Sinusitis can be bacterial, viral or fungal. Symptoms can include a runny nose, cough, a feeling of stuffiness, congestion, headache, or pain around the nose, eyes or mouth. Sinusitis can make asthma symptoms worse.

PHS homecare
The Pediatric Home Service In-Home Asthma Management team provides environmental home assessment and education on in-home symptom management and treatment of sinusitis.

Read about PHS patient Josie living with Chronic Sinusitis.