Children with chronic respiratory insufficiency who require assisted ventilation are a very complex and vulnerable cohort within the growing spectrum of children with physical and developmental disabilities. Beginning in the late 1970s, technological innovation and a growing appreciation of the broader social contributions of children and adults with disabilities, facilitated the transition of these patients from hospital-based or long-term care to the home setting.1 Integrated with their families and communities, these children have not only survived but also experienced better developmental outcomes.

McDougall and colleagues2 describe the expansion of a single institution programme providing long-term mechanical ventilation for children throughout the Canadian province of British Columbia. Over a 15-year period, they documented a 10-fold increase in enrolment. I applaud the authors and their staff who worked with these children and their families. The upward trend in mechanical support is indicated by the several …