The continuing care for a child survivor of a near-drowning accident presents a variety of challenges for the tertiary-care setting, community-based health care providers, and especially the family. The trauma the child receives from this type of neurologic insult coupled with the emotional issue of an accident such as a near drowning result in a long-term, usually lifetime situation of great stress and responsibilities for the family. Although long-term hospitalization is usually required for medical stabilization of the child, survivors of this type of injury will require some kind of continuing care outside of the hospital setting. In most instances, pediatric home care offers a reasonable alternative for the family. In the provision of skilled nursing support in the child's home environment, their medical needs can be met effectively. Additionally, home care offers a strong support to the families and can assist in fostering the long-term care environment parents must face if they are to successfully provide for their child at home. Planning for the child's discharge to home involves a comprehensive and coordinated approach to providing a community-based support network of care for the child and family. Additionally, parents must learn complicated, technical skills to meet the physical needs of their child. This process requires careful planning and implementation. During this time the hospital will assist the family in procuring the community-based services they will need. Once the child is discharged, the family focus is directed toward establishing positive work partnerships with the other service providers necessary to assist them in the care of their child. This process takes considerable planning and effort for all involved but, when successful, facilitates a positive, nurturing home care environment. The family remains the guiding force in this situation and ultimately determines if their child's care at home will be successful. In this context, success is not measured by recovery or cure but, instead, by the degree of enhancement the family receives in providing home-based care. The role of the home care nurse is an important one and is comprehensive in scope and responsibilities. The nurse not only delivers skilled care and treatment to the child but also offers support and assistance to the family. These home care nurses must be highly skilled and trained in the delivery of complex medical care and effectively provide the emotional and psychological support families of these children demand. An equally important function of the home care nurse is that of family advocate.(ABSTRACT TRUNCATED AT 400 WORDS)