Complex care is complicated!

has coordinated a terrifi c issue of Pediatric Annals, with a group of outstanding articles devoted to the child with complex medical needs. The fi rst four articles in the issue deal with the scien-tifi c and medical aspects of providing care to this patient population. Julie Hauer (see page 198) systematically clarifi es the mechanisms that cause pain in neurologi-cally impaired children, highlights the recognition of pain in non-verbal patients and provides specifi c actions that clinicians can take to relieve pain in these patients. I've never seen such a complete review of this interesting topic. Shubhra Mukherjee and colleagues (see page 206) review the various skin issues that can develop in these patients, including a wealth of information dealing with decubitus ulcers (pressure sores). Panitch and Healy (see page 216) very clearly review the pulmonary complications of pediatric neurological disease; in doing so, they really outline the pathophysi-ology of the parenchymal and ventilatory complications in an outstanding manner, with specifi c recommendations for evaluation and treatment. Similarly, Srivas-tava and colleagues (see page 225) review the issues of dysphagia and gastroesophageal refl ux disease in this population in a clear and practical manner. Mark Rosenberg writes about " Physician Payment in a Medical Home " (see page 235), an exceptionally important real-world issue. Mr. Rosenberg goes through billing strategies in great detail, with many tips regarding coding, which should benefi t most of you who read this journal. A somewhat complementary article is entitled " State and Federal Benefi ts for Children with Special Health Care Needs, " by Gold-stein, Altman, and Zimmerman (see page 240). They detail the various governmental programs, helping us