This issue of Pediatric Annals is devoted to Children With Special Healthcare Needs. This term, which is commonly used by many professionals who work with children, including physicians, teachers, social workers, and psychologists, describes a unique group of children who require ongoing medical input to maintain their health status because they have chronic health conditions, are technologically dependent, and experience functional limitations in their age- appropria te normal daily lifestyle. The spectrum of diseases meeting the criteria is broad. Children with cystic fibrosis, those with chronic renal failure undergoing dialysis and transplantation, and those with meningomye locele or cerebral palsy qualify as "children with special healthcare needs." Between 3% and 25% of children experience disabling conditions and meet criteria for this designation. Their care utilizes a large fraction of the professional time of pediatrie specialists and of healthcare dollars spent on caring for children.
The commitment to children with chronic disease by physicians, nurses, social workers, dieticians, institutions, community, and government has been remarkable. Organizational structures and programs for children with special healthcare needs have been developed during the 20th century in a manner that is unparalleled in history. Some of these activities have resulted in new therapies and cures; others have resulted in reductions in morbidity and enhanced quality of life for affected children and their families. The development and continued existence of children's hospitals, university-based pediatrie departments, and community- based pediatrie facilities exist in part because of the development and provision of these programs. Furthermore, these activities demonstrate the responsibility assumed by these professionals and institutions to assist and help children with special healthcare needs.
The changing structure of healthcare services threatens access to the best care for these children by altering referral patterns and eliminating components of team care that have been shown to be effective. As systems change, it is increasingly necessary that we who care for children advocate for the continuation of programs that can provide the required quality and breadth of care these children need. Outcomes for children can be best achieved by pediatrie generalises and pediatrie subspecialists working together.
Individual articles in this issue of Pediatrie Annals address the role of the pediatrie generalist, the organization and care of their children, the types and availability of community services, the organization of care in small and large states, and, finally, financial issues involved in providing care. I trust you will find them instructive and helpful.