HANDICAPPED CHILDREN

Challenged children are one who deviated from normal health status either physically, mentally or socially and requires special care, treatment and education.
Definition
Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” (McPherson,1998)

1. HANDICAPPED CHILDREN
By
Mr. Ravi Rai Dangi
Assistant Professor
MSc. Child Health Nursing

2. HANDICAPPED CHILDREN
Introduction
Healthisastateofcompletephysical,mentaland
socialwellbeingandnotmerelytheabsenceofdiseaseor
infirmity.

3. Challengedchildrenareonewhodeviated
fromnormalhealthstatuseitherphysically,
mentallyorsociallyandrequiresspecialcare,
treatmentandeducation.

4. Concept of Handicapped or
Challenged

5. AccordingtoWHOthesequenceofeventsleadingto
disabilityandhandicappedORchallengedconditionsareas
follows.

6. Definition
Childrenwithspecialhealthcareneedsarethose
whohaveorareatincreasedriskforachronicphysical,
developmental,behavioral,oremotionalconditionand
whoalsorequirehealthandrelatedservicesofatypeor
amountbeyondthatrequiredbychildrengenerally.”
(McPherson,1998)

7. IMPAIRMENT
Itisdefiningasanylossorabnormalityof
psychological,physiologicaloranatomical
structureorfunction,e.g.Lossofvision,loss
ofhearing,etc.
Primaryimpairmentmayleadtosecondary
impairmente.g.Defectivehearingresultsin
learningdifficultiesandpoorschool
performance.

8. DISABILITY
Itdevelopsastheconsequenceofimpairment.E.g.
Lossoflimbsresultsininabilitytowalk.Disabilityisthe
inabilitytocarryoutcertainactivitieswhichare
consideredasnormalfortheageandsex.

9. HANDICAPED ORCHALLENGED
Handicapisdefinedasadisadvantageforagiven
individualresultingfromanimpairmentoradisability,that
limitsandpreventsthefulfillmentofarolewhichisnormal
forthatindividual,depending,onage,sex,socialand
culturalfactors.

10. Classification
Physicallychallenged
Physicallychallengedchildrencanbegrouped
accordingtoaffectedpartofthebody.Theseinclude
orthopedicallyhandicapped,sensoryhandicapped,
neurologicallyhandicappedandhandicappeddueto
systemicdiseases.

11. Orthopedicallyhandicapped
Childrenwithcongenitalbodydefect,amputation
duetoanyaccident,rickets,fractureoranybone
deformity.

12. Sensory handicapped
Visualproblems–partialorcompleteblindness
Auditoryproblems-partialhearingloss,deafanddumb
Speechproblems-stammering,dysphonia.

13. Neurologicalhandicapped
Childrenhavingmentalretardation,conclusivedisorder,
hydrocephalus,spinabifida,postmeningitisorCNS
problems

14. Handicappedduetochronicsystemicdisease
Heartdisease,bronchialasthma,diabetesmellitus,
musculardystrophy.
Multiplephysicallyhandicappedchildrenhaving
combinationoforthopedically,sensoryandneurological
handicapped

15. Socially challenged
Sociallychallengedchildrenarehavingdisturbed
opportunitiesforhealthypersonalitydevelopmentdueto
socialfactorsleadingtonon-achievementoffull
potentialities.
Socialdisturbancesarefoundintheformofbroken
family,parentalinadequacy,lossofparents,poverty,lack
ofeducationalopportunities,environmentaldeprivation
andemotionaldisturbancesaslackoftenderlovingcare.

17. Mentally challenged
Theterm“mentallyhandicap”isnowusedforthe
conduction“mentalretardation”.
Atleast2to3%ofIndianpopulationarementally
handicappedinanyform.

18. Mentalhandicappedisthesignificantlysubaverage
generalintellectualfunctioningexistingconcurrentlywith
deficitsinadaptivebehaviormanifestedduringthe
developmentalperiod.
Itincludesthelearningdisability,poormaturationand
socialmaladjustmentincombination.

19. Cause/Etiology of Handicap
Perinatalfactors
Birthasphyxia
Prolongedanddifficultbirth
Prematurity
Kernicterus
Instrumentaldeliveryresultinginheadinjury

20. Geneticfactors
Geneticmutation
Geneticincompatibilitiesbetweenparents
Chromosomaldisorders

21. Placentaldysfunction
Toxemiaofpregnancy
Nutritionalgrowthretardation
Placenta Previa Cord prolapse

22. Postnatalfactors
CNSInfections(encephalitis,meningitis,septicemia,
measles)
Accidents
Iodinedeficiency
SeverePEM
Metabolicdisorder

23. Environmental and social factors
Poverty
Brokenfamily
Faultyparenting
Childabuseandneglecting
Parentalpsychopathology
Environmentaldeprivation

24. PREVENTION OF HANDICAPPED
CONDITION IN CHILDREN
Preventionatthreelevels
PrimaryPrevention–
Actiontakenpriortotheonsetofthe
disease/disability,whichwillremovethepossibilitythata
disease/disabilitywilloccur.

25. SecondaryPrevention–
Action,whichhaltstheprogressofthe
disease/disabilityatitsincipientstageandprevents
complications.Thespecificinterventionsareearly
diagnosisandadequatetreatment.

26. TertiaryPrevention
Allmeasuresavailabletoreduceorlimit
impairmentsanddisabilities,andminimizesuffering
causedbyexistingdisability.
Thisphaseisalsocalledrehabilitation,which
includesphysical,psychosocialandvocational
measurestakentorestorethepatientbacktonormalor
nearnormalcondition

27. General Preventive Measures
Marriagebetweenveryclosebloodrelationslike
uncle,niece,firstcousinshouldbeavoidedfor
preventionofhereditarydisorders.
Avoidpregnanciesbeforetheageof18yearsandafter
theageof35years.
Consultadoctorbeforeplanningthepregnancy.
Ifthereisincidenceofbirthdefectsinyourfamily.

28. Ifyouhavehaddifficultyinconceivingorhavehada
seriesofmiscarriages,stillbirths,twins,deliveryby
LSCS,obstructedlabour/prolongedlabour(morethan
12hours)and/orseverebleedinginprevious
pregnancy.
IfyouhaveRH-negativebloodtype.
Ifyouhavediabetes.

29. Care During Pregnancy
Avoidhardphysicalworksuchascarryingheavyloads,
especiallyinfields,andotheraccident-proneactivities
suchaswalkingonslipperygroundorclimbingstools
andchairs.
Avoidunnecessarydrugsandmedications.Eventhe
normallyconsideredsafedrugswhicharesold
commonlycanpotentiallycauseseriousdefectsinan
unbornchild.
Avoidsmoking,chewingtobacco,consumingalcohol
andnarcotics.
AvoidX-rays,andexposuretoanykindofradiation.

30. Avoidexposuretoillnesseslikemeasles,mumpsetc,
especiallyduringthefirst3monthsofpregnancy.
Avoidsexualcontactwithapersonhavingvenereal
disease.
Takeprecautionsagainstleadpoisoning.
Avoidtoomuchuseof‘Surma’and‘Kohl’.
Eatawell-balancedandnourishingdietsupplemented
withgreenleafyvegetables,proteinsandvitamins.

31. Allwomenofthechildbearingageneed0.4mgoffolic
aciddaily.Itisalsoavailableinfolicacidplusiron
tabletswhichshouldbetakenforatleast3months
duringthethirdtrimesterwhentheriskofdeveloping
irondeficiencyanemiaisgreatest.
Ensureweightgainofatlast10kgs.Haveregular
medicalcheckups.
Allpregnantwomenshouldbegiventetanusinjection.

32. Womanat‘high-risk’,whoseweightis<38Kg,heightis
lessthan152cm,weightgainduringpregnancy<6kgor
whoisseverlyanaemia(Hb<8mg),havingfrequent
pregnancies,havingahistoryofmiscarriage/
abortion/prematuredeliveries,mustgetexpertprenatal
caresoastohaveanormalbaby.
Mustconsultadoctor,incaseofedema(swelling)offeet,
persistentheadache,fever,difficultyorpaininpassing
urine,bleedingfromthevagina,andyellownessofeyes
(jaundice)

33. Care at the time of birth
Deliverymustbeconductedbytrainedpersonnel,
preferablyinahospitalwhereallfacilitiesareavailable.
Ifababydoesnotcryimmediatelyafterbirth,
resuscitationmeasuresshouldbeundertakenatonce.
Babiesbornprematurelyandwithalowbirthweight
(<2.5Kg)mayneedNeonatalIntensiveCare.

34. Ifthebaby’sheadappearstobeabnormallysmallorlarge
thenaphysicianshouldbeconsulted,preferablya
pediatrician.Theapproximateheadsizeforamalechildat
birthis35cmandforfemalechildis34.5cm.
Toprotectachildfrominfections,breast-feedingmustbe
startedimmediatelyafterbirth.Firstmilk(colostrum)must
befedtothebabyandshouldnotbethrownaway,asithas
antibodieswhichareprotective.

35. Early Childhood Care
Donotallowachild’stemperaturetoriseabove101-
degreeFbecauseofanyreason.Itcancausefebrile
seizures
Ifachildgetsfitstakehimtodoctorimmediately.
Everychildshouldbeimmunizedagainstinfectious
diseasesaspertherecommendedscheduleof
immunization.
Donotallowachildtohavetoomuchcontactwithpaint,
newsprintink,leadetc.astheyaretoxic.

36. Takeprecautionsagainstheadinjury,andotheraccidents.
Ensurethatthechildgetsawell-balanceddietandclean
drinkingwater.
Introduceadditionalfoodsofgoodqualityandinsufficient
quantitywhenthechildis4-6monthsold.

37. ProtectachildfromMeningitisandEncephalitisby
providingahygienicenvironmentwhichisfreeof
overcrowding.
Commonsaltmustbeiodizedasaprecautionagainst
goiterandcretinism.
VitaminAdeficiencyanditsconsequencesincluding
nightblindnesscanbeeasilypreventedthroughtheuseof
VitaminAsupplementation.

38. Useearprotectorstoreducetheexposuretohighlevels
ofnoise,ifchildrenarelivingorworkinginanoisy
environment.