Pediatric Update

Many remember childhood and adolescence as both pleasant and unpleasant experiences. Those that made it easier for us tend to stick out in our thoughts as we reflect on difficult experiences. No where is this more true than in the home medical equipment (HME) market for pediatric products.

One issue that surrounds the design and recommendation for a pediatric product is there are often a lot of decision makers involved in selecting the product such as parents, discharge planners, clinicians HME providers, and the child.

"It is a much more focused market because it requires a real expertise and knowledge of equipment and special disabilities," said Jim Papac, general manager, Levo USA Inc., Peachtree City, Ga.

Alison Cherney, consultant, Cherney & Associates also says a strong education base is needed especially for really young children.

"It is important to be aware of the conditions that surround taking care of the child," she said.

Another thing that defines the pediatric market is that it goes from birth to 18 or 21 years of age


"Pediatric patients are a different size than adults and less trained. They have very special needs . . . you can't just shrink down the adults size of a product for a pediatric patient," said Cherney.

depending on the state. It is important to look at who is being targeted whether it is a baby, a small child or a teenager.

"I think sometimes we think of pediatrics as really small kids but it is not . . . it is a broad range of ages and they have different requirements for products so I think you have to be pretty good at targeting those groups," Cherney said.

Children are often afflicted by the same conditions as adults; however, many of us often feel helpless when dealing with children and pediatric products. There is often a stigma associated with conditions such as asthma, cerebral palsy or other chronic illnesses of which children and parents are aware.

Various conditions each have specific criteria due to the different aspects of the illness. A patient with asthma is going to have different needs than a patient with cardio-respiratory problems. Children with cerebral palsy may deteriorate or stay the same as they age, and it is important for providers and manufacturers to be aware of the everchanging needs of a child.

Manufacturers and HME providers are becoming more sensitive to these needs and are trying to make the lives of pediatric patients and their parents easier by creating products with growth potential, ease of use and a fun appearance.

"Pediatric patients are a different size than adults and less trained. They have very special needs . . . you can't just shrink down the adults size of a product for a pediatric patient," said Cherney.

Adaptability and Adjustment

Levo USA Inc. designs pediatric standers for children and emphasizes the products' ability to accommodate seating and positing devices because there are so many disabilities and specific needs of children so the product must be versatile.

"I think there is a real emphasis on standing because when a child is disabled and confined to a chair there are all kinds of medical problems that develop," said Jim Papac, general manager, Levo USA Inc.


Growth potential has the largest impact on pediatric products.

During the early years of growth if the bones do not bear weight they will not grow properly and that can lead to contractures,which are relief surgeries for ankles, hips and knees. When a child sits in a chair for a long time the ligaments are not stretched so they ultimately become shorter which can also limit the range of motion.

"The ligaments can become so tight they have to cut them to fix them. This can be avoided with a standing regiment," Papac said.

Growth potential has the largest impact on pediatric products. HME can be very cumbersome financially, and parents and caregivers want products that are going to last for more than just a couple of years.

"With pediatric patients you have to incorporate growth into the evaluation process because they are constantly growing and changing," said Dalina Ganakes, director of national sales, Convaid Inc., Torrance, Calif.

"These products have to offer much more flexibility in terms of growth than in adult products," said Beth Walsh, education specialist, Sunrise Medical Inc., Longmont, Colo.

Many companies are implementing built-in growth features such as adjustable height and seat width.

"It is important to keep the standard frame but have interchangeable components that allow for growth," said Pearl Goldstein, vice president, Wenzelite Re/hab, Brooklyn, N.Y.

The adaptability to the child as the child ages is very important, according to Cherney.

Sunrise Medical's KidKart Xpress can be used as a mobility base, but it can also be used in a multifunctional aspect for a floor chair, high chair or desk chair.

This type of multifunctional design enables the product to serve a child's needs for a much longer period of time.

Independence as the child grows older is beginning to play a role in the design of products. Tools such as full center of gravity, different size wheels, seat-to-floor adjustment and self-transfer can make a product more adaptable, Walsh said.

Parents Needs

Parents' needs have a huge influence on the design of pediatric products.

"We're always trying to keep the weight down because parents are having to disassemble it and load it into their car," Walsh said.

Products that can break down into small parts are appeasing to parents and caregivers because it makes their job easier. These parts may include removable feet and back or chairs and walkers that can be folded for easy transport.

"It is important to clearly mark how the parts come on and off so they can be placed back in the right spot," Walsh said.

Pittsburgh-based Respironics manufactures monitors for pediatric patients who suffer from cardio- respiratory problems. Not only do weight and disassembly appeal to parents and caregivers but also when dealing with respiratory issues -alarm systems can be a parent's best friend.

"The alarm gives (parents) peace of mind. If the child stops breathing, an audible alarm will notify them . . . sometimes the parents become almost dependent on that alarm," said Chas Kaufman, infant specialist, Respironics.


Parents' needs have a huge influence on the design of pediatric products.

Asthma is another chronic condition that children often suffer from.

"Its a very frightening disease for both children and parents . . . if you've ever seen your child stop breathing, it can be a very scary experience," said Hugh McGill, manager of business development, Medlink America, an asthma disease management company based in Covington, La.

McGill said they try to give the parents and children help by educating them about what can trigger an attack such as a family pet or other items in the home.

"We give the children and parents regular follow-up calls so we can help them be compliant," McGill said.

Aesthetics

Parents and children are also concerned with the appearance of the various products. Many parents and children are afraid of the stigmatization association with a particular condition and the attention the child may attract.

"Parents sometimes find it hard to come to terms with the fact that their child will need equipment for a special condition," Goldstein said.

Manufacturers are placing a huge emphasis on aesthetics and are moving toward a more appealing appearance in an attempt to make the products look less clinical.

"If you manage to combine the two aspects of need and appearance then parents might feel better about purchasing that equipment," Goldstein said.

Many companies, such as Convaid, are moving away from chrome and using a black powder-coated finish.

"It makes the product look more appealing," Ganakes said.

Other companies use bright colors and fun fabrics to brighten up the appearance of the product.

"A lot of parents don't want to go out and have people stare at their child. They want something that looks typical . . . more like a stroller even though it is technically a wheelchair," Walsh said.


Manufacturers are placing a huge emphasis on aesthetics and are moving toward a more appealing appearance in an attempt to make the products look less clinical.

Cherney said, "I think children especially are looking for something that doesn't look medical at all so the more you can jazz it up and the more simple you can make it is great."

Papac said standers have a great socialization impact. They enable children to see eye to eye with other children as well as allow them to "stand up" to do chores such as washing dishes or doing laundry. This can have a huge impact on a child's self esteem and comfort level with their disability.

Medlink America uses a nebulizer mask in the shape of a dragon to help increase the comfort zone of the pediatric patient.

"Sometimes the children are real self-conscious about carrying a nebulizer so we give them stickers so they can customize it and make it their own," McGill said.

Education

Medlink also provides literature for older children who are more capable of understanding their condition. The materials are in the form of games, which are fun for the children but give them information about their disease.

"One game might be a word find with words relative to their particular situation," McGill said.

There are also several Web sites designed for pediatric patients. PedsLink at www.pedslink.com offers home videos that offer step-by-step demonstrations of providing home care for infants and children with various diagnoses. Current titles include Infant Home Apnea Monitoring and Home Phototherapy for Infants.

PedsLink will soon be introducing new videos titled Managing Medically Complex Children in the Home Care Setting and Equipment Commonly Used for Technology Assisted Children.

Reimbursement

Funding and reimbursement also have strong influences in the pediatric market. According to Ganakes, the funding for pediatric patients seems to be a little easier to work with.

"I think we kind of have a sensitivity to children," she said.

However, the funding is different for each state. Some plans cover the patient until the age of 18 while other states include pediatric patients up to age 21.

"Providers and dealers need to consider the payment and reimbursement process so they know how much growth potential to put into the product to make sure it will be covered," Goldstein said.

While the pediatric market is one that unfortunately will not go away, it is beginning to answer the needs of children, parents and caregivers. The three A's-adaptability, adjustment and aesthetics-seem to be the latest trends in the market.

Manufacturers and providers can continue to successfully serve the pediatric market by maintaining an awareness of not only the physical needs of the actual condition but of the social and psychological needs of their patients as well.



Whitfield is assistant editor for Home Health Products

This article originally appeared in the June 2000 issue of HME Business.

The Key to Patient Engagement