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Several factors influence the chronically ill child's susceptibility for skin breakdown. Nurses are an integral part of the care team that has the responsibility for identification of these factors, as well as pressure ulcer prevention and early intervention. An important aspect of this responsibility is identification of individuals at risk. This article provides a guide for assessment and early intervention for skin breakdown in chronically ill children. A care plan, and consultation recommendations are included.

Introduction: When clinic appointments are missed, families deprive their child of health care opportunities and contribute to rising health care costs. The purpose of this study was to determine families' perceptions of barriers to attending clinic appointments. Method: Two hundred participants with a history of missed appointments were randomly selected to participate in a telephone survey. Ninety-five of the families selected did not have telephones. Of the 105 families contacted by telephone, 101 consented to participate in a survey. For the group without phones (n = 95), demographic information was collected to use as comparison data with families that were reached. Patterns of missed appointments were also analyzed. Results: The majority of families were headed by young single mothers. The families identified transportation problems, wait times, and not knowing the reason for the appointment as barriers. Discussion: Clearly, many issues have an impact on decisions related to attending clinic appointments. In the interest of health, interventions to decrease barriers and increase attendance should be a priority for health care professionals. Further research of the effectiveness of these interventions will delineate the appropriate focus of health care professional's efforts.