3-mx of Challenged Children

MANAGEMENT OF CHALLENGED CHILDREN
Introduction
A handicapped condition makes the normal functions of the individual very difficult & leads to
dependency. These conditions are increasing day by day due to changing life style &
complicated environment. It is a social problem.
Definition
Handicap is defined as disadvantage for a given individual resulting from impairment or a

disability that limits & prevents the fulfillment of a role which is normal for that individual,
depending on age, sex, social & cultural factor.
Concept of disability
According to WHO, the sequence of events leading to disability & handicapped conditions are-
Disease or injury Impairment disability handicapped.
Impairment-
 It is defined as any loss or abnormality of psychological, physiological or anatomical

structure or function. E.g. loss of vision, loss of hearing etc.
 Impairment can be temporary or permanent, progressive or regressive, visible or invisible
and extrinsic or intrinsic.
Disability-
 It is the inability to carry out certain activities which are considered as normal for the age
& sex.
 It is the restriction or lack of ability to perform an activity in the manner or within the
range considered as normal for the human being.
 It develops as the consequence of impairment. E.g. loss of limbs results in inability to
walk.
Handicapped-
 Handicapped children refer to those resulting from an impairment or a disability, that

limits and prevent the fulfillment of role which is normal for that individual, depending
on age, sex, social and cultural factors.
 Primary handicap condition leads to secondary handicap condition e.g. blindness leads to
economical handicapped situation i.e poverty.
CLASSIFICATION
1. Physically handicapped children
2. Mentally handicapped children
3. Socially handicapped children
PHYSICALLY HANDICAPPED
 This group includes the children with blindness, deaf & dumb, congenital malformations
like cleft lip, cleft palate, club foot, congenital heart disease, etc.
 The most important cause of physically handicaps is birth defects, malnutrition, infection
& accidents.
Physically handicapped children can be grouped according to affected part of body. These
include-
Orthopedically handicapped- children are having congenital bony defect, amputation, accidental
injury, fracture, rickets, leprosy etc.
Sensory handicapped- children present with blindness, hearing loss, stammering etc.
Neurologically handicapped- children include cerebral palsy, mental retardation, convulsion

disorders, hydrocephalus, spina bifida etc.
Handicapped condition due to chronic systemic disease, e.g. heart disease, bronchial asthma,
diabetes mellitus, muscular dystrophy, etc.
Multiple physically handicapped –children having combination of orthopedically, sensory and

neurological handicaps.
MENTALLY HANDICAPPED CHILDREN
 Mental retardation is the significantly sub average general intellectual functioning

existing concurrently with deficits in adaptive behavior manifested during the
developmental period.
 It includes low learning abilities, poor malnutrition & social mal adjustment in
combination.
 The cognitive and functional ability are affected with limitation in adaptive and
communication. Self-care, home living, social interaction skills, community relationship,
self-direction, health behavior, safety measures, academic achievement, leisure time
utilization and working capacity are altered in mentally handicapped children.
 Mental handicaps are caused by multiple factors like genetic, social & physiological. The
causative factors can be genetic, social and physiological
SOCIALLY HANDICAPPED CHILDREN
These children are having disturbed opportunities for healthy personality development due to
social factors leading to non- achievement of full potentialities.
These children include orphan child, child labor, maternal deprivation, emotional deprivation,
neglected or destitute child, exploited or victimized and delinquent child.
Causes
 Congenital anomalies
 Genetic disorder
 Poliomyelitis
 Other communicable disease
 Perinatal condition
 Malnutrition
 Accidental injury
 Socio- cultural factors.
Prevention
The Primary Prevention can be achieved by the following measures-
 Improvement of maternal health & adequate care during peri-conceptional, prenatal &
intra natal period.
 Genetic counseling- optimal maternal age for producing normal babies is between 20-30
years, this information should be explained.
 Genetic screening of ‘at risk’ people to prevent inherited diseases like chromosomal or
sex linked congenital anomalies.
 Reduction of consanguineous marriages by creating health awareness.
 Universal immunization coverage especially for poliomyelitis and MMR (mumps,
measles and rubella)
 Improvement of nutritional status of mother & children especially for girl child ,future
mother.
 Prevention of iodine deficiency & folic acid deficiency condition in peri-conceptional
period.
 Essential care in antenatal, intra-natal & neonatal periods.
 Avoidance of teratogenic agents in antenatal periods & special care in high- risk mothers.
 Medical termination of pregnancy of malformed fetus.
 Improvement of health awareness about preventive measures of handicapped conditions
in children by elimination of causes like malnutrition, accidental, injures etc.
 Special care to high risk mother –abortion, premature birth Encourage to kick bad habits
such as smoking or alcohol abuse
Management
Early diagnosis & treatment of particular cause of handicapping condition along with disability
limitation and rehabilitation should be promoted. The aim of management is to safeguard against
or halt the progression of disease process from impairment to disability.
The approaches of management should include the following aspects.
 Careful history, thorough physical examination and necessary investigations for early
detection of handicapped conditions are important
 Regular medical supervision & developmental assessment help to identify the abnormal
condition in initial stage.
 Treatment of particular handicapped conditions by medical & surgical management.
 Correction of deformities e.g visual or hearing problems by spectacles or hearing aids.
 Physiotherapy & exercise to improve physical conditions.
 Occupational therapy according to the child’s ability & that should be provided with
music, painting, weaving etc.
 Speech therapy to improve communication ability.
 Use of prosthetics, e.g provision of artificial limb in the child with amputed leg.
 Special care for mentally handicapped children with love, warmth, patience, tolerance.
 Counseling and guidance to the parents and family members for continuation of care of
the children with emotional, educational and social support
 Referral for welfare services (GOVT,NGO) for assistance of aids and appliances and
support services like pension, scholarship, special allowances etc.
REHABILITATION
 Rehabilitation should be approached by combined and co-ordinated use of medical ,

social, educational, psychological and vocational measures for training and retraining the
children to the highest possible level of functional ability.
 The goal is to reduce the fallout of disability and handicapped conditions.
 Strengthening the individual actively participate in welfare of community, and improve
the social integration in population.
It should involve the following aspects-
 Medical rehabilitation includes restoration of functions by prosthesis, artificial limbs etc.

 Social rehabilitation includes restoration of family & social relationship by replacement
in the family.
 Educational rehabilitation includes specialized training & educational facilities.
 Psychological rehabilitation includes restoration of personal dignity & confidence
during period of growth & development.
 Vocational rehabilitation includes restoration of the capacity to earn a
livelihood.
The children act, 1960, provides care and welfare services in various aspects of the handicapped.
Welfare institutes for handicapped at national level-
 National institute for orthopedically handicapped, Kolkata.

 National institute for mentally handicapped, Hyderabad.
 National institute for visually handicapped, New Delhi.
 National institute for rehabilitation, training and research, Cuttack.
 National institute for physically handicapped, New Delhi.
CONCLUSION
A handicapped is a major problem in pediatric health today. Disability occurs as a part of the
continuum of health and illness which can influence quality of pediatric life today. Disability
occur as a result of the disease, congenital or genetic condition or some type of impairment of
health or physical function of children.

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MANAGEMENT OF CHALLENGED CHILDREN

Handicap is defined as disadvantage for a given individual resulting from impairment or a

Disease or injury Impairment disability handicapped.

 It is defined as any loss or abnormality of psychological, physiological or anatomical

 Handicapped children refer to those resulting from an impairment or a disability, that

1. Physically handicapped children

2. Mentally handicapped children

3. Socially handicapped children

Neurologically handicapped- children include cerebral palsy, mental retardation, convulsion

Multiple physically handicapped –children having combination of orthopedically, sensory and

MENTALLY HANDICAPPED CHILDREN

 Mental retardation is the significantly sub average general intellectual functioning

SOCIALLY HANDICAPPED CHILDREN

The Primary Prevention can be achieved by the following measures-

The approaches of management should include the following aspects.

 Rehabilitation should be approached by combined and co-ordinated use of medical ,

 Medical rehabilitation includes restoration of functions by prosthesis, artificial limbs etc.

Welfare institutes for handicapped at national level-

 National institute for orthopedically handicapped, Kolkata.

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