Slide 1

Presented byMr. Mahaveer SwarnkarM.Sc. Child Health NursingPHYSICALLY ,MENTALLY &SOCIALLY CHALLANGED CHILDREN

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

DEFINITIONAccording to WHO, the sequence of events leading to disability and handicapped conditions are as follows

CLASSIFICATION OF HANDICAPPED CHILDREN

PHYSICALLY HANDICAPPED CHILDREN

PHYSICALLY HANDICAPPED CHILDREN

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

PROBLEM FACED BY BLIND CHILDProblem of attachmentUnable to use hand as organ of perceptionProblem on locomotionDependence on parents and caregiverBehavioral problemsLess social interactionLess playing activity

Prevention Of BlindnessProvide good antenatal careImmunization meseals, rubellaGenetic counseling and screeningPrevent infectionPrevent pre term birth and provide excellent neonatal care to pre term

Cont.vitamin A supplementhealth education about eye safety, personal hygiene and nutrition for health promotionTreatment of causes of childhood blindnessRetinopathy of prematurity (ROP) Cataract Glaucoma

ManagementPhysiotherapyOrientation and mobility instructors Mobility aid and guidesBRAIL technology

DEAFNESSA 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

LEVELS OF HEARING IMPAIRMENT

IMPACT OF HEARING LOSS

MANAGEMENTSign languageHearing devices - hearing aids, assistive listening devices and cochlear implants. lip-reading skillsSpeech therapy-use of written or printed text

SPEECH HANDICAPPEDmeans an impairment of speech or sound production, fluency, voice or language which significantly affects a childs educational performance or their social, emotional or vocational development.

TYPE OF SPEECH IMPAIRMENT

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

MANAGEMENTEarly identification of speech impairmentElimination of hearing impairmentMedical and surgical intervention for underlying causesPsychological counselingAvoid making fun of their voice or speechVoice or Speech therapyPhysical therapyCognitive rehabilitation

ORTHOPEDICALLY HANDICAPPEDOrthopedic 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

MANAGEMENTCorrection Of DeformitiesPhysical TherapyOccupational Therapy Massage TherapyProstheticsdevices for positioning and mobility

DEVICES FOR POSITIONING AND MOBILITYCanesWalkersCrutchesWheelchairsSpecialized exercise equipmentSpecialized chairs, desks, and tables for proper posture development

MENTAL HANDICAPPED

MENTAL HANDICAPPEDA 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.

Mentally handicap children include

MENTAL RETARDATIONMental 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)

MENTAL RETARDATION LEVEL

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

ContPsychomotor 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

TREATMENT MODALITIESBehavior management.Environment supervision Monitoring the childs developmental needs and problems.Programs that maximum speech , language, cognitive, psychomotor, social , self care, and occupational skills.Family therapyEarly 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

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

EFFECTS OF CEREBRAL PALSY Abnormal Muscle ToneAbnormal movementsSkeletal deformitiesSeizuresSpeech problemsSwallowing problemsHearing loss:Vision problemsDental problemsBowel and/or bladder control problems

SOCIALLY CHALLENGED CHILDREN

SOCIALLY CHALLENGED CHILDRENA 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

CATEGORY OF SOCIALLY HANDICAPPED CHILDRENOrphanNeglected childrenChildren of divorce or step parentsDelinquent children

ORPHAN CHILDRENAn 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

PROBLEM ASSOCIATED WITH ORPHANSDevelopmental retardationConduct and sleep problemPersonality problemBed wettingDisturbance in eatingDepressionDuring adulthoodAntisocial problemDrug addictionAlcoholismMarital problem

CHILD NEGLECTChild 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.

TYPES OF CHILD NEGLECT

CAUSE / FACTOR parental mental health problems such as depressionUnstable and abusive relationships between parentsparental history and learned parental behaviorlack of knowledge of children's needs, an inability to plan, lack of confidence about the future,

Contbeing a teenage mother, Alcohol and drug abuse in care-givers unemploymentpovertya large number of children, high levels of stressdomestic violence

CONSEQUENCES OF NEGLECTDevelopmental delays- socializedelayed physical and mental growth,Neurological impairments. poor social skills, experience extended poverty or unemploymentFace chronic illnesses or early death.cognitive deficits,

Contemotional development problems Unusual fussiness, fear, or Lack of interest in activities. Being anxious or avoiding peopleDifficulty in making friendsBeing withdrawn.The effects on behavioral developmentAnti-social behaviorEarly sexual activityBeing promiscuous or running away.Drug or alcohol misuse.

ContPoor 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

Cont.Failure to thriveObviously unhealthyDirty 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.

ManagementFor ParentsTreatment for Substance abuse.Depression or other mental health problems.Low self-esteemViolent behavior realize responsibility regarding childeducating and helping parents to correct their erroneous thinking and behavior or parenting skill

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

CHILDREN OF DIVORCED OR SEPRATED PARENTSA 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.

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 angerMay worry when parent is out of sight. May withdraw, bite or be irritable. Temper tantrums

ContPreschoolers 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.

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

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 behaviorDrug or alcohol abuseProblem in maintaining relationship. Worries about financial matters.

MANAGEMENTNot expose child to conflict between parentsListen to child and provide emotional supportChild should be reared to respect to both parentsChild should taught that both parents are nice people but are separating because of they have different views about life

PREVENTION OF HANDICAPPED CONDITION IN CHILDREN

PRIMARY PREVENTIONGenetic counselingGenetic screeningReduction of consanguineous marriagePregnancy planningRh incompablityImmunization of mother and babyVitamin A prophylaxisImprove nutritional status of mother and child

Cont.Prevention of iodine and folic acid deficiencyProvide essential care in prenatal, Intranatal, postnatal periodPrevent maternal and neonatal infectionPrevent birth injury, asphyxia, hyperbilurubinemiaSpecial care to high risk mother abortion, premature birthEncourage to kick bad habits such as smoking or alcohol abuse.Reduce accident and provide better care when it happen

SECONDARY PREVENTION Careful history Regular medical supervision and developmental assessmentTereatment of particular handicap conditionCorrection of deformityPhysiotherapy and exercise to improve physical conditionOccupational therapy

ContSpeech therapy to improve communication abilityProsthetics Special care for mentally handicapped children with warmth , love , tolerance, discipline, avoid criticismCounseling and guidanceReferral for welfare services

REHABILITATION OF HANDICAP CHILDRENMedical rehabilitationSocial rehabilitationEducational rehabilitationPsychological rehabilitationVocational rehabilitation

WELFARE OF HANDICAPPED CHILDREN

WELFARE OF HANDICAPPED CHILDRENPersons 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 rehabilitationChildren Act 1960- provide for the care protection, maintenance, welfare, education, and rehabilitation of socially handicapped children.

Schemes for handicapped children Deendhyal disabled rehabilitation schemeAssistance to disabled person to purchase or fitting of aids and applianceNational handicapped finance and development cooperationScheme 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

National institute for handicappedNational institute for orthopedically handicapped CalcuttaNational institute for mentally handicapped HyderabadAli yavar Jung National institute for hearing handicapped MumbaiNational institute for rehabilitation, training, and research CalcuttaNational Institute for visually handicapped new Delhi and Dehradun

NURSING MANAGEMENT OF HANDICAPPED CHILDREN

NURSING MANAGEMENT OF HANDICAPPED CHILDRENIneffective family coping and altered parenting related to handicapped conditionAnxiety of parents and family membersAltered nutrition less than body requirementPotential for infectionSelf care deficientCommunication impairedPhysical mobility impaired

Cont..Altered elimination patternActivity intoleranceAltered sleep patternSensory alteration, visual/ auditoryAltered growth and developmentDiversional activity deficitKnowledge deficit to continued care of handicapped children

Conclusionhandicap 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.

THANK YOU