HANDICAP IN CHILDREN AND ADOLESCENTS

Definition Handicap = somatic, mental, sensory or social limitation resulting from defect of somatic development defect of psychomotor development acquired diseases with secondary irreversible abnormalities pathological social environment

Types of handicap in childhood Somatic and locomotor defects Congenital anomalies organs or systems (heart, lungs, kidney, brain…. ) locomotor system (dysplasia, hypoplasia, syndactyly..) Acquired defects posttraumatic consequence of surgical treatment Specific defects growth defect (overgrowth, growth retardation ) abnormal onset of puberty (precocious, delayed)

Types of handicap in childhood Sensory defects Congenital defects hearing, vision, speech, central nervous system Acquired defects consequence of trauma, inflammation, tumors of organs or CNS

Types of handicap in childhood Mental defects Congenital defects Down syndrom, hypothyroidism, phenylketonuria, defects of CNS development Pathological course of pregnancy and delivery congenital CNS infection (CMV, rubella…) prenatal, perinatal or early postnatal hypoxia of CNS hyperbilirubinemia in newborns (kern-icterus) prematurity

Types of handicap in childhood Mental defects Consequence of postnatal disease meningitis hyperpyrexia epilepsy degenerative CNS disease poisoning CNS tumors CNS trauma metabolic diseases

Types of handicap in childhood Mental defects Consequence of psychogenic deprivation psychosocial disturbances or emotional problems nutritional deficiency

Types of handicap in childhood Chronic diseases renal insufficiency cystic fibrosis diabetes mellitus allergy metabolic diseases ……….

Types of handicap in childhood Social defects family rejects the affected child familly is unable to care for the affected child (parents in poor health, lack of financial sources, inadequate living space, lack of education…)

Team care for handicapped child Family pediatrician physical specialist (consultant-neurologist……. teacher psychologist social worker societies or associations serving families or children with a specific handicap (diabetes, phenylketonuria, allergy, cystic fibrosis….)

Handicap from view of the child Limitation of sensory perception (blindness, deafness, deaf-mutism..) movement education and career limitation repeated hospitalizations diet unpleasant and /or painfull diagnostic and therapeutic procedures subjective difficulties and complaints long term medication

Diagnostic and screening approaches Prenatal : ultrasound methods prevention of blood antigens incompatibility genetic counselling amniocentesis Postnatal: screening of inborn metabolic errors dysplasia of bones and joints (hip) puls of aa. femorales (coarctation of the aortae)

Child´s handicap can modify the family clima Family relations : parents - handicapped child parents - healthy sibling(s) handicapped child - healthy sibling(s) father - mother parents - grandparents Father frequently leaves the family Danger of social isolation of handicapped child and his or her family

Educable children can be taught It is important to ensure an individual approach to the child´s access to education, depending on the type and severity of handicap. Educable children can be taught in special schools focusing on specific types of handicap, or be integrated in regular schools among healthy children.