Children permanent disabilities

The physical disability, such as amputations, deformities and skin lesions extended also ruin the image of self and child development. While each disability is rare, affecting all together about 10% of children and may constitute an important part of children.

Effects of permanent disability on the child despite many differences, children with permanent disabilities have joint pain, discomfort, limited growth and development, frequent hospitalization, outpatient visits, treatment of pain and discomfort, the inability to participate in peer a significant burden of daily care and an unpredictable course.

The low number of disabled adults who can be role models (eg., TV personalities) makes it difficult for children to determine their identity. The physical differences can lead to social rejection by peers and a weakening of motivation. The disability may also interfere with the child’s ability to achieve objectives (eg., Independence of the child who can not physically get away from his parents) and can change the temperament of the child, leading to a mismatch (eg., distracted the child of nature who is also suffering from deafness).

Effects of permanent disability on the family regarding the family, permanent disability leading to loss of hope of having a “perfect child”, to neglect the brothers, increased costs and time commitment to treatment methods confused, loss opportunities (eg. the mother who can not return to work) and social isolation. This stress can cause family breakdown, especially when there are other marital and family problems.

Conditions that damage the appearance of a child, eg., Cleft lip and / or palate or hydrocephalus, may affect the attachment between the child and family who look after it. Once the diagnosis of abnormality, the parents may grieve for the loss of the “ideal child” showing signs of shock, denial, anger, sadness or depression, guilt and anxiety. This can happen at any moment in the development of the child and each parent can be in a different stage of acceptance of the abnormal, such as to hinder communication between them. They may express their anger at health professionals can take them or their refusal to seek multiple opinions about the condition of their child.

Needs to be borne by the family and compassion for the child, may make it impossible to discipline and may lead to behavioral difficulties. One parent (usually the mother) can get involved in an excessive way from the problems of the child, thus ignoring the normal family responsibilities. The other parent may become isolated hours of surgery doctors can prevent many parents to be present together with medical, leaving one parent is not informed.

Effects of permanent disabilities in the community: a problem in the community is the lack of understanding by many people, whose only contact with the chronic childhood disability occurs during the telethon designed to raise sympathy and money. Further aggravating the problem and investment policies are inconsistent, inadequate access to facilities (including physical barriers to access) and poor communication and coordination between the health, education and community support.

Coordination of medical care without co-ordination of services, medical care will be in deficit, some interventions will be doubled, while others are neglected. Coordination therapy requires knowledge of the conditions of the child, family and community in which it operates.

All professionals who provide care for a chronically ill child must ensure that someone coordinate assistance. In ideal conditions, the coordinators should be the parents. However, systems that must be dealt with are often so complex that even the most capable parents need help. Other possible coordinators are general practitioners, specialists in program management teams, nurse, and representatives of insurance and the state. Regardless of who work in the coordination of services, family and the child must be actively involved.

• Balancing thoraco-abdominal inspiration: mobilization of the thorax and abdomen.
• Indrawing depression abnormal chest wall, visible up to the intercostal spaces (circulation under sternum) during heavy breaths.
• This draw may also be visible above the sternum (sternal random addition). This phenomenon occurs when the entry of air into the lungs is obstructed by a mechanical obstacle.
• Funnel xiphoid.
• Flapping wings of the nose.
• Grunting.

These parameters are scored from 0 (normal) to 2 (worst condition), with Note 1 for intermediate gravity. The total score ranges from 0 (no respiratory distress) to 10 (maximum distress).
This score is a useful benchmark for assessing the lung function of newborn and its evolution, it depends on the weight and force of the child. There is no specific respiratory distress.

If the score is below 6 or 7 he indicates respiratory distress may require respiratory assistance determined by the pediatrician.

Note the notion of repeated infections caused by a deficiency of immunoglobulins (IgA, IgG). Other factors may encourage respiratory infections: passive smoking, pollution, community development, psychological factors (overprotection of the mother anguish …), gastro-esophageal reflux. The hereditary factor is not negligible: the existence of an allergic component with an atopic family plot (often in association with skin reactions).


Clinic:

• Type asthmatic dyspnea with rapid onset, especially at night.
• Distended thorax
• Expiatory wheezing
• Getting inspiring game accessories
• Acceleration of respiratory rate (> 60 cycles / min)
• Dry Cough
• Eating for disturbance, vomiting
• fever (unsystematic)
• fatigability

With treatment, favorable changes in the 5 to 6 days.

Treatment:

• bronchodilators (salbutamol)
• corticosteroids orally or by aerosol
• antibiotic therapy in cases of super infection
• Oxygen reserved for severe attacks

Physiotherapy:
It should not be too early: wait secreting phase of the disease (24 to 48h). During the dry phase, help the infant to exhale through gentle exercises to relax the chest. Then intervene bronchial drainage sessions themselves:

• release of the upper airway, disinfection nasopharyngeal
• trimming or naso-pharyngeal suction.
• increase in expiratory flow for mobilizing secretions distal.
• trigger cough reflex tracheal secretions to drain.

Precautions:

• Splitting meals
• Humidification Room
• Elevate head of bed
• Learning I’utilisation baby-haul
• Donate to drink regularly
• Trimming

Outlawing tobacco smoke. Wash hands before any contact with the infant.
Detection and evaluation of respiratory distress:

• Excitement of NFE
• Cyanosis lip or in the nails (blue color)
• Position of NFE sitting knees bent in dorsal kyphosis “rabbit”
• Shallow breathing
• High respiratory rate (> 60 cycles / min)
• Use of accessory inspiratory muscles (indrawing, mobilization scm)
• Balancing thoraco-abdominal
• Flapping wings of the nose
• Elevated heart rate (> 140 beats / min)

Aetiology:
Found primarily in the socio economic disadvantage (underprivileged, single women, standing work and painful, …)
Then find uteroplacental abnormalities, morphological type (bifid uterus, hypoplastic), cervical incompetence, smoking or maternal pathology.
Finally, there may be a factor directly fetus, including twins and other multiple births.
In 40% of cases the origin is unknown.

Risks associated with prematurity:

• The risk of hypothermia is the most important: the premature lacks capacity to regulate body temperature, and therefore he should receive from birth care on hot table and then be placed in an incubator, resulting in hypothermia apnea, acidosis and hypoglycemia responsible for significant sequelae.
• The hyaline membrane disease: it is secondary to a lack of surfactant production by the alveoli, the latter then collapses at the end and carrying an array of respiratory distress. The administration’s mother steroids can stimulate the production of surfactant, and advances in respiratory strongly improved the prognosis in recent years. In case of oxygen, it must be carefully controlled to avoid hyperoxia.
• The apnea is common in premature and should not worry if they do not exceed 7 seconds. Beyond that, it becomes dangerous and pathological, and may indicate a meningeal infection, hypocalcemia, hypoglycemia, hypoxia or cerebral hemorrhage.




• Risk of brain damage, digestive disorders exposing false roads
• Risk of ulcerative enterocolitis requiring cessation of any food, antibiotics and sometimes surgery.
• Metabolic risk of type hypocalcemia, hypoglycemia and hyperbilirubinemia, frequent.
• Risk hematologic with anemia may require frequent transfusions
• Infectious risks related to the immunological immaturity, to impose rules of strict asepsis which must obey parents
• Risks associated with the use of oxygen: The hyperoxic retinopathy and bronchopulmonary displasie

Today, the legacy can relate almost exclusively in premature infants under 32 weeks of pregnancy.

• Average weight: 3300g
• Average size: 50cm
• Head circumference: 35 cm
• Members flexed, hands closed
• Skin covered with a variable amount of vernix caseosa (sebaceous white fatty substance)
• cyanosis of the extremities often
• Fine hairs on the forehead, cheeks, shoulders and back, called lanugo
• jaundice frequently to 2-3 days, physiological
• perception of fontanelles
• Respiratory rate 20 to 60/min
• Short neck, large tongue, glottis and anterior very high (risk of difficulty in intubation)
• Heart rate of 120 to 160/min
• Systolic blood pressure NNE at approximately 70mmHg (PAM = Term)
• APGAR test near or equal to 10 (see table), assessed at 1 minute and 5 minutes.