Home monitoring in infants and children with obstructive apnea.

It becomes apparent that the decision to prescribe home monitoring for the child who has, or is thought to be at risk for, obstructive apnea is not a straightforward one. There have been no studies documenting the effectiveness of home monitoring in this population. The risk of obstructive apnea in some children clearly supports the use of an obstructive apnea detection system. Unfortunately, the current home monitors are not designed to detect obstructive apnea. These monitors may alert parents to obstructive apnea by identifying the changes in heart rate that can accompany these episodes, but this warning may not be timely. There are a number of potential costs that may accrue to families who monitor their children. In some instances the "costs" of home monitoring may lead to failure of parents to comply with the treatment or to neglect of other aspects of their child's treatment regimen, thereby effectively increasing the child's risk of obstructive apnea. To achieve the maximum benefits of home monitoring requires high levels of commitment on the part of both the child's physician and his family. Parents need thorough preparation and continuous logistic and professional support if they are to carry out this monitoring. The physician should not need to provide all of this support, but he or she should expect to function in a co-ordinating capacity on behalf of the child and family.