“Demetrius is here today because he’s got leg swelling?” ask Dr. Goo, “Yes,” says 5-year-old Demetrius’ Mother, Shantricia Anderson.

Not only that, “And he’s also had a fever today, right?” ask Dr. Goo, “Yes,” replies Mrs. Anderson.

To make matters worse, Demetrius is having trouble breathing.

Doctors are worried it’s a replay of what happened two months ago…

“This is the same leg that he had a history of a blood clot previously on,” says Dr. Goo, “And my concern immediately again was that he had another clot in his leg, and maybe the blood clot had traveled from his leg into his lungs.”

Demetrius has a condition called brittle bone disease… so another possibility is that his leg is fractured.

“When you have brittle bones, you can have a broken bone or fracture from very minor trauma,” says Dr. Goo.

And, to add to the mystery, his breathing problem could be his asthma….

“So he was very interesting in that he is a medically fragile child and he has many possibilities for him to have a swollen leg and difficulty breathing,” says Dr. Goo.

But… after an x-ray… a sonogram, and a c-t scan… doctors find no evidence of a broken bone, or a blood clot.

“But they did see some areas that were consistent with infection of the lung,” says Dr. Goo.

It turns out… Demetrius has pneumonia.

The leg swelling is a harmless side effect of his previous blood clot.

So it turns out… all Demetrius needs is an antibiotic, and doctors will send him home.

“I think Demetrius is going to do very well in this particular illness,” says Dr. Goo, “I think he’s going to resolve his pneumonia. He’s going to get treatments for his asthma and feel better and probably resolve this 100-percent.”

The number of medically fragile children is growing, and proper assessment and treatment is becoming more necessary. According to a study preformed by North Carolina Public Health, the top 10 procedures used to identify medically fragile children in North Carolina recently included:

• Continuous mechanical ventilation for 96 consecutive hours or more
• Enteral infusion of concentrated nutritional substances
• Replacement of ventricular shunt
• Other procedures for esophagogastric sphincteric competence
• Parenteral infusion of concentrated nutritional substances
• Ventricular shunt to abdominal cavity and organs
• Ureteroneocystostomy
• Temporary tracheostomy
• Closed [endoscopic] biopsy of bronchus
• Other partial resection of small intestine

Because of the recent rise in the number of medically fragile children, there has been a growing need in recent years for crisis nurseries geared toward providing medically supervised care for medically fragile children. According to experts at the ARCH National Resource Center for Respite and Crisis Care Services, children who meet the criteria identifying medically fragile children include :

• Infants on an apnea monitor
• Infants born prenatally exposed to alcohol or drugs (e.g., infants with Fetal Alcohol Syndrome or Crack/Cocaine exposure)
• Children who are admitted directly from a hospital where they have received care for a significant injury or illness
• Children with special breathing problems requiring significant care or ongoing alteration in the daily routine due to the medical condition
• Children in Spica Casts (body casts from waist to feet)
• Children with specialized feeding problems (e.g., feeding tubes, cleft lip and palate)
• Children with infectious or contagious diseases (e.g., hepatitis, sexually transmitted diseases, HIV–related conditions)
• Children with chronic health problems such as diabetes, asthma or seizure disorders

In order for a child to receive crisis nursery care, a medical program which includes the following elements must be developed by medical professionals:

• Initial medical exam and assessment
• Medical history and prescribed treatment from referring entity (infants referred from hospitals are more likely to have this information available)
• A weekly clinic where children who are medically fragile may be examined by a physician, treatment can be revised, and any staff concerns addressed
• The availability of emergency consultation with a physician during evening and weekend hours
• Separate medical exam room where children may be seen by the nurse or physician, sick children may be monitored, medications stored in locked cabinets or a locked refrigerator, and medical supplies and equipment stored (this room may also store special foods or formulas required by children)
• Procedures for when, how and where to refer children requiring urgent medical treatment
• Medical staff capability to teach older children aged six to eleven how to care for their own medical conditions