physically ans mentally challenged children has diffirent and special needs that to be addressed definitely in health care which usually doesnt happens
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Caring for Children with Special Health Needs
1. The child with Special Health
care Needs
Dr.Soma Sekhara Reddy.k
Emergency medicine
2. Who…
• Increased risk for chronic
Physical
Developmental
Behavioral and
Emotional conditions
• Require extra care in health and related
services beyond that required in general.
3. Why… special..
COZ OF DIFFENRENT IN -
• Development
• Vital signs
• Weight
• Cant use standard reference charts
• Reduced compensatory mechanisms
• Allergies
• Medications
4. Ex amples…………………………
• Chromosomal disorders
- Down syn.
- Turners syn.
- Noonans syn.
- Fragile x syn.
- Trisomy 18 syn.
- cri – du - chat syn.
5. In fact all disorders…
• Disorders with facial defects
• Disorders with limb defects
• Inherited metabolic disorders
• Connective tissue disorders
• Vascular disorders – hamartoses
• Toxins – Fetal hydantoin syndrome
• Trauma - TBI , CP
7. One special case in detail – cerebral palsy
• Collection of non progressive disorders of
movement and posture originating from injury
sustained by the developing brain within the
first 3 to 5 years of life
• Many causes and in 25% no cause.
• Many types with wide spectrum of disease
8. Complications
1. Seizures :
• 2/3 rds of CP
• Manage ABC
• Initiate RX – BDZ
* Special considerations
- Ample history important
- Drug interactions – multiple drugs
- Early expert involvement
- Avoid dextrose in refractory seizures on
ketogenic diet
9. 2. Respiratory complications:
• Common – restrictive lung disease, pneumonia
congestion , recurrent aspiration
• Coz of:
Oral motor dysfunction
GER
Neuromuscular compromise
Scoliosis
* Low respiratory reserve volume
• Early initiation of Rx,Ix and low threshold for
admission
10. 3. GI complications:
• Dehydration – poor intake , increased losses
• Infections
• Constipation and overflow diarrhea
*Retarded growth with marginal reserves
*Feeding tube complications
• Early fluid replacement
• Avoid multiple enemas , mineral oils
• Early gastro consultation
11. 4.Musculoskeletol complications:
• Secondary to disuse and nutritionally induced
osteopenia
• Frequent falls
• Keep low threshold for #s in trivial injuries
especially in non verbal , irritable and retarded
child
• Check for cutaneous complications coz of
orthopaedic braces
• Early pain Mx, splinting ,expert consultation.
12. So as in other disorders too..
• Meningo myelocele
• Neural tube defects
• TBI and spinal cord injury
• Autism
• Mental retardation
• Downs babies
13. TECHNO KIDS
• Technology dependent children:
Needs extra support / medical devices to
compensate lost vital functions of the body along
with the nursing care
1.Ventilation
2.Tracheostomy
3.Feeding tube and gastrostomy tubes
4.CSF shunts
5.Urinary shunts and tubes
14. Give a plan..
EMERGENCY CARE PLAN and GO-BAG
• Written document/plan contains
- Child’s disease , condition and status
- Special equipments and needs
- Medications
- Information about parents , caretakers,
primary physicians etc..
• Access to all care givers and with patient
15. Autonomic dysreflexia
• Serious ,life threatening condition
• Associated with cord injuries proximal to mid
thoracic levels
• Hyperactivity of Sympathetic and
Parasympathetic systems
• Initiated by stimuli below the level of the lesion
like bladder over distension , fecal impaction,
fractures..
16. C/F:
• Sweating, flushing, piloerection, pounding head
ache
• Hypertension, bradycardia
Rx:
• Treat the primary cause
• Relieve the pain
• Treat as hypertensive emergency if not
responding
17. Take home
• Recognise the child with special health care needs
• Anticipate life threatening issues
• Early intervention
• Keep low threshold for investigations and admission
• Always take expert advise for this special children
18. • Check the tubes and positions and associated
complications and other supportive equipment
• Fully involve family and caregivers and take
complete information about medications ,
allergies and equipment sizes and their
conditions
• Double check dosages and weight of child
• Always examine p/o , p/r and p/v