Recommendations for Pneumonia in Hospitalized Children With Neurologic Impairment

On behalf of the authorship team, I sincerely thank Dr He and colleagues for their thoughtful engagement with our article, Recommendations for pneumonia in hospitalized children with neurologic impairment.1 We deeply appreciate their efforts to extend the conversation on children with neurological impairment—a population that is indeed underrepresented in both research and clinical protocols.We fully agree with the importance of early functional stratification and its potential to refine antimicrobial decision-making. Their proposed bedside assessment of “swallowing-cough-airway protection” capabilities offers a practical and nuanced approach to identifying aspiration risk for patients who do not have such a risk yet established. This suggestion aligns with our core principle of minimizing broad-spectrum antibiotic use. This kind of targeted assessment could be a valuable addition to clinical pathways.The recommendation to individualize airway clearance techniques, though, is particularly compelling and, again, aligns with our overall approach of individualizing care for this heterogenous group of patients while also collaborating with expert respiratory therapists. We appreciate the emphasis on dynamic adjustment and interdisciplinary collaboration with respiratory therapists. The closed-loop model described by Dr Hechen et al not only enhances therapeutic precision but also supports continuity of care as patients transition from hospital to home environment, a critical factor in long-term outcomes for children with neurologic impairment.Finally, we appreciate the emphasis on caregiver training and discharge planning. Moving these efforts earlier in the hospitalization process and providing structured deescalation plans are practical strategies that can empower families and reduce readmission risk. Their framing of a “low-burden, sustainable” rehabilitation model is both timely and actionable, particularly in contexts where systemic challenges exist.We view these contributions as a meaningful extension of our framework and a valuable step toward more inclusive and adaptive care models. We hope future research and clinical collaborations will continue to explore and validate these approaches, ultimately improving outcomes for all children with neurological impairment.