Not a Babysitter: The Clinical Reality of Pediatric Home Health Nursing

By Lauren Roschen, NP, Former Pediatric Home Health Nurse

Home care in pediatrics is far more complex than many people realize. During my time working in pediatric home health, I was often told that the role was essentially that of a “glorified babysitter.” It is anything but that. Pediatric home health nurses carry a significant level of responsibility, clinical judgment, and autonomy while caring for medically complex children in their own homes.

Unlike other home health settings where a nurse may briefly visit to set up medications or complete an assessment, pediatric home health nurses often provide continuous care for extended shifts-commonly 8 to 10 hours during the day or overnight. During this time, we are responsible for monitoring the patient’s medical status, administering medications, managing medical equipment, and supporting both the child and their family.

Many of the children cared for in this setting are medically fragile and have complex healthcare needs. A large percentage require advanced medical support such as tracheostomy care, gastrostomy or feeding tubes, and mechanical ventilation. In the home setting, the nurse is frequently the only medically trained professional present. If a patient begins to deteriorate or a medical emergency occurs, the nurse must quickly assess the situation and intervene using strong clinical judgment and critical thinking skills. Unlike a hospital environment where a full care team is immediately available, pediatric home health nurses must stabilize the patient independently while coordinating emergency support when necessary.

Pediatric patients can also present unique clinical challenges. When children begin to decline physiologically, their condition can deteriorate rapidly, and it may be more difficult to recover stability compared to adult patients. This reality requires constant vigilance, advanced assessment skills, and the ability to act decisively under pressure.

I am incredibly grateful that I had the opportunity to begin my nursing career in pediatric home health. The experience strengthened my clinical skills, deepened my critical thinking, and allowed me to build meaningful relationships with patients and their families. Pediatric home health nurses play an essential role in supporting medically complex children and enabling them to receive high-quality care in the comfort of their homes. Despite the demands of the role, these nurses often receive far less recognition than they deserve.

One of the patients I cared for frequently had Moebius syndrome, a rare congenital neurological condition. In Moebius syndrome, the sixth and seventh cranial nerves are underdeveloped, which results in facial paralysis and impaired lateral eye movement. These neurological differences can lead to significant challenges with feeding, speech, blinking, and facial expression.

Children with this condition often require extensive multidisciplinary support, including speech therapy, occupational therapy, physical therapy, and specialized feeding therapy. I had the opportunity to be involved in and observe many of these therapies firsthand while caring for this patient. Although Moebius syndrome is considered a non-progressive condition, that does not mean it is without challenges. Individuals living with this condition face many obstacles in daily life that most people take for granted.

In addition to the neurological features of the syndrome, this patient also experienced respiratory complications that required a tracheostomy tube and ventilator support. Managing these complex respiratory needs in the home environment requires careful monitoring, technical skills, and readiness to intervene if complications arise.

Working alongside this patient and their family was both rewarding and humbling. It provided a powerful reminder of the resilience of children with complex medical needs and reinforced the vital role pediatric home health nurses play in supporting their safety, development, and quality of life.

This experience ultimately solidified my passion for pediatric care and inspired me to pursue a career as a Pediatric Nurse Practitioner. I will always be grateful for the time I spent in pediatric home health, as it provided invaluable insight into the realities families face while caring for medically complex children in their homes. That perspective continues to shape how I approach patient care today. As a Pediatric Nurse Practitioner, I hope to play a larger role in supporting these patients and their families while bringing a deeper understanding of the challenges, resources, and daily care needs that exist beyond the clinical setting.