PHYSICALLY ,MENTALLY &SOCIALLY CHALLANGED CHILDREN

handicap develops as the consequence of the disability. It is defined as a disadvantage for a given individual resulting from impairment or a disability that limits and prevents the fulfillment of a role which is normal for that individual, depending on age, sex, social and cultural factors.

1. Presented by Mr. Mahaveer Swarnkar M.Sc. Child Health Nursing PHYSICALLY ,MENTALLY &SOCIALLY CHALLANGED CHILDREN

2. HANDICAPPED CHILDREN Handicapped child is one who deviates from normal health status either physically, mentally or socially and requires special care, treatment and education.

3. DEFINITION According to WHO, the sequence of events leading to disability and handicapped conditions are as follows

4. CLASSIFICATION OF HANDICAPPED CHILDREN

5. PHYSICALLY HANDICAPPED CHILDREN

6. PHYSICALLY HANDICAPPED CHILDREN

7. BLINDNESS According to WHO the inability to count fingers in day light from a distance of 3 meters is defined as blindness.

8. PROBLEM FACED BY BLIND CHILD Problem of attachment Unable to use hand as organ of perception Problem on locomotion Dependence on parents and caregiver Behavioral problems Less social interaction Less playing activity

9. Prevention Of Blindness Provide good antenatal care Immunization – meseals, rubella Genetic counseling and screening Prevent infection Prevent pre term birth and provide excellent neonatal care to pre term

10. Cont…. vitamin A supplement health education about eye safety, personal hygiene and nutrition for health promotion Treatment of causes of childhood blindness Retinopathy of prematurity (ROP) Cataract Glaucoma

11. Management Physiotherapy Orientation and mobility instructors Mobility aid and guides BRAIL technology

12. DEAFNESS A person who is not able to hear as well as someone with normal hearing . It can affect one ear or both ears, and leads to difficulty in hearing conversational speech or loud sounds

13. LEVELS OF HEARING IMPAIRMENT

14. IMPACT OF HEARING LOSS

15. MANAGEMENT Sign language Hearing devices - hearing aids, assistive listening devices and cochlear implants. lip-reading skills Speech therapy - use of written or printed text

16. SPEECH HANDICAPPED means an impairment of speech or sound production, fluency, voice or language which significantly affects a child’s educational performance or their social, emotional or vocational development.

17. TYPE OF SPEECH IMPAIRMENT

18. EMPACT OF SPEECH IMPAIRMENT Poor Communication skill Less social interactions Behavioral problem - children may feel shame, embarrassment, frustration, anger, and depression as a result of speech impairments. Poor academic performance

19. MANAGEMENT Early identification of speech impairment Elimination of hearing impairment Medical and surgical intervention for underlying causes Psychological counseling Avoid making fun of their voice or speech Voice or Speech therapy Physical therapy Cognitive rehabilitation

20. ORTHOPEDICALLY HANDICAPPED Orthopedic disability occur when movements in over body are affected due to disease, injury, any absence or deformities in the joints, bones, muscles or an injury in nervous system Loco motor disability means disability of the bones, joints or muscles leading to substantial restriction of the movement of the limbs

21. MANAGEMENT Correction Of Deformities Physical Therapy Occupational Therapy Massage Therapy Prosthetics devices for positioning and mobility

22. DEVICES FOR POSITIONING AND MOBILITY Canes Walkers Crutches Wheelchairs Specialized exercise equipment Specialized chairs, desks, and tables for proper posture development

23. MENTAL HANDICAPPED

24. MENTAL HANDICAPPED A mental handicap is an impairment in an individual's ability to function cognitively, emotionally or physically due to the presence of a psychiatric condition. This condition hinders someone's ability to perform a task or prevents that person from engaging in an activity without assistance.

25. Mentally handicap children include

26. MENTAL RETARDATION Mental retardation is defined as significantly sub average general intellectual functioning, resulting in associated with concurrent impairment in adaptive behavior, which manifests during the developmental period”. (American Association on Mental Deficiency)

27. MENTAL RETARDATION LEVEL

28. EFFECT ON CHILDREN Failure to achieve developmental milestones. Deficiencies in cognitive functioning such as inability to learn or to meet academic demands. Expressive or receptive language problems.

29. Cont… Psychomotor skill deficits. Difficulty performing self care activities. Neurologic impairments. Medical problems, such as seizures. Low self esteem depression and labile moods. Irritability when frustrated or upset. Lack of curiosity

30. TREATMENT MODALITIES Behavior management. Environment supervision Monitoring the child’s developmental needs and problems. Programs that maximum speech , language, cognitive, psychomotor, social , self care, and occupational skills. Family therapy Early intervention programs for children younger than age 3 with mental retardation. Provide day schools to train the child in basic skills, such as bathing and feeding. Vocational training

31. CEREBRAL PALSY It is a disability that affects ability to control muscles caused by damage to the brain while the brain is developing.

32. EFFECTS OF CEREBRAL PALSY Abnormal Muscle Tone Abnormal movements Skeletal deformities Seizures Speech problems Swallowing problems Hearing loss: Vision problems Dental problems Bowel and/or bladder control problems

33. SOCIALLY CHALLENGED CHILDREN€

34. SOCIALLY CHALLENGED CHILDREN A Socially handicapped children may be defined as a child whose opportunity for a healthy personality development and full unfolding of potentialities are hampered certain elements in his social environment such as parental inadequacy, environmental deprivation, (lack of learning opportunity) and emotional disturbance

35. CATEGORY OF SOCIALLY HANDICAPPED CHILDREN Orphan Neglected children Children of divorce or step parents Delinquent children

36. ORPHAN CHILDREN An orphan is a child permanently bereaved of or abandoned his or her parents. a child lost both parents is called orphan does not have any surviving parents to care for him or her

37. PROBLEM ASSOCIATED WITH ORPHANS Developmental retardation Conduct and sleep problem Personality problem Bed wetting Disturbance in eating Depression During adulthood Antisocial problem Drug addiction Alcoholism Marital problem

38. CHILD NEGLECT Child neglect is an ongoing failure to provide the right care and attention to a child's needs , including food and a safe environment , or to a child's emotional needs including warmth, security and love. A lack of these things are likely to result in serious damage to the child's health or development.

39. TYPES OF CHILD NEGLECT

40. CAUSE / FACTOR parental mental health problems such as depression Unstable and abusive relationships between parents parental history and learned parental behavior lack of knowledge of children's needs, an inability to plan, lack of confidence about the future,

41. Cont… being a teenage mother, Alcohol and drug abuse in care-givers unemployment poverty a large number of children, high levels of stress domestic violence

42. CONSEQUENCES OF NEGLECT Developmental delays- socialize delayed physical and mental growth, Neurological impairments. poor social skills, experience extended poverty or unemployment Face chronic illnesses or early death. cognitive deficits,

43. Cont… emotional development problems – Unusual fussiness, fear, or Lack of interest in activities. Being anxious or avoiding people Difficulty in making friends Being withdrawn. The effects on behavioral development Anti-social behavior Early sexual activity Being promiscuous or running away. Drug or alcohol misuse.

44. Cont… Poor mental health, such as exhibiting low self-esteem, anxiety, depression, or suicidal tendencies. Insecure-anxious attachment. Attachment difficulties and difficulty in formation of relationships in the future Affects intellectual ability and cognitive/ Sudden decline in academic performance. Anxiety or impulse-control disorders

45. Cont…. Failure to thrive” Obviously unhealthy Dirty or have poor personal hygiene or Inadequately clothed. The effects may last into adulthood and may cause a person to neglect their own children later in life.

46. Management For Parents Treatment for Substance abuse. Depression or other mental health problems. Low self-esteem Violent behavior realize responsibility regarding child educating and helping parents to correct their erroneous thinking and behavior or parenting skill

47. Cont…. For Child Child-centered interventions include pediatric care, mentoring Behavioral and mental health treatment. Provide stimulation programme to emotionally neglected child Develop timely and comprehensive assessments or placed in foster home

48. CHILDREN OF DIVORCED OR SEPRATED PARENTS A divorce always affects children, even adult children, and divorce is almost always stressful for children. And lead to lost contact with one parent, create economic hardships, and increase conflict between parents For all these reasons, most children have a hard time during the divorce transition.

49. EFFECTS OF DIVORCE OR SEPERATION ON CHILDREN Infants Loss of appetite. Upset stomach — may spit up more. More fretful or anxious. Toddlers More crying Sleeping Problem May feel anger May worry when parent is out of sight. May withdraw, bite or be irritable. Temper tantrums

50. Cont… Preschoolers Feels uncertain about the future. May feel responsible. May hold anger inside. May become aggressive and angry toward parent he/she lives with. May have more nightmares. Experiences feelings of grief because of sudden absence of parent.

51. Cont…. Early elementary Feels unfaithful and feels a sense of loss. Feels rejected by the parent who left. Ignores school and friendships. Worries about the future. Complains of headaches or stomachaches. Experiences loss of appetite, sleep problems, diarrhea, urinary frequency. Learning problem in school

52. Cont…. Preteens and adolescents Feels angry and disillusioned. Feels abandoned, that parent is leaving him/her not the other spouse. Shows extreme behavior (good and bad). Involved in high-risk behaviors (drugs, shoplifting, skipping school). Anti social behavior Drug or alcohol abuse Problem in maintaining relationship. Worries about financial matters.

53. MANAGEMENT Not expose child to conflict between parents Listen to child and provide emotional support Child should be reared to respect to both parents Child should taught that both parents are nice people but are separating because of they have different views about life

54. PREVENTION OF HANDICAPPED CONDITION IN CHILDREN

55. PRIMARY PREVENTION Genetic counseling Genetic screening Reduction of consanguineous marriage Pregnancy planning Rh incompablity Immunization of mother and baby Vitamin A prophylaxis Improve nutritional status of mother and child

56. Cont…. Prevention of iodine and folic acid deficiency Provide essential care in prenatal, Intranatal, postnatal period Prevent maternal and neonatal infection Prevent birth injury, asphyxia, hyperbilurubinemia Special care to high risk mother –abortion, premature birth Encourage to kick bad habits such as smoking or alcohol abuse. Reduce accident and provide better care when it happen

57. SECONDARY PREVENTION Careful history Regular medical supervision and developmental assessment Tereatment of particular handicap condition Correction of deformity Physiotherapy and exercise to improve physical condition Occupational therapy

58. Cont… Speech therapy to improve communication ability Prosthetics Special care for mentally handicapped children with warmth , love , tolerance, discipline, avoid criticism Counseling and guidance Referral for welfare services

59. REHABILITATION OF HANDICAP CHILDREN Medical rehabilitation Social rehabilitation Educational rehabilitation Psychological rehabilitation Vocational rehabilitation

60. WELFARE OF HANDICAPPED CHILDREN

61. WELFARE OF HANDICAPPED CHILDREN Persons with disabilities bill (equal opportunity, protection of right and full participation)-1995,introduced by ministry of welfare and Govt of India and it deal with preventive and promotional aspect of rehabilitation Children Act 1960- provide for the care protection, maintenance, welfare, education, and rehabilitation of socially handicapped children.

62. Schemes for handicapped children Deendhyal disabled rehabilitation scheme Assistance to disabled person to purchase or fitting of aids and appliance National handicapped finance and development cooperation Scheme for implementation of person with disabilities act 1995( sipda ) Scheme for incentive to employees in the private sector for providing employment to person with disabilities

63. National institute for handicapped National institute for orthopedically handicapped Calcutta National institute for mentally handicapped Hyderabad Ali yavar Jung National institute for hearing handicapped Mumbai National institute for rehabilitation, training, and research Calcutta National Institute for visually handicapped new Delhi and Dehradun

64. NURSING MANAGEMENT OF HANDICAPPED CHILDREN

65. NURSING MANAGEMENT OF HANDICAPPED CHILDREN Ineffective family coping and altered parenting related to handicapped condition Anxiety of parents and family members Altered nutrition less than body requirement Potential for infection Self care deficient Communication impaired Physical mobility impaired

66. Cont….. Altered elimination pattern Activity intolerance Altered sleep pattern Sensory alteration, visual/ auditory Altered growth and development Diversional activity deficit Knowledge deficit to continued care of handicapped children

67. Conclusion handicap develops as the consequence of the disability. It is defined as a disadvantage for a given individual resulting from impairment or a disability that limits and prevents the fulfillment of a role which is normal for that individual, depending on age, sex, social and cultural factors.

68. THANK YOU