1. Meeting the Needs of
Children and FamiliesBY: JING YAO
STUDENT ID: 300723432
COURSE: ECEP233-062 INCLUSION OF CHILDREN WITH SPECIAL NEEDS
PROFESSOR：LISA MCCAIE-WATTERS
DUE DATE：MARCH, 30,2015
2. Outline
Introduction to the Needs of Child and Family
Introduction of Cushing’s Syndrome
Meeting the Needs of Child
Meeting the Needs of Parent/Family
Meeting the Needs in Child Care Center
Teaching Strategies
Agencies
References
3. Introduction to the child and family
Scenario
Duncan, a child who has rapid
weight gain , excess sweating and
appears depressed and anxious. His
parent was informed that Duncan
has Cushing’s Syndrome.
4. Needs of the Child
Duncan will experience weight gain, growth failure and
change in facial appearance
He will look different than other children in the facility
He will feel tired easily which limits the activities he can
possibly anticipate
He might be isolated by his friends because they cannot play
together
Emotional lability and concentration problems
He could be out of control of his moods and relatively slow in
learning.
Lethargy/Depression
Low self-esteem and quiet. Sometimes unresponsive to
questions.
5. Needs of the Parents
Knowing minimal about Cushing’s Syndrome
Confused, looking for help understanding the disease
Financially Stressed
Extra expenses due to medical care, additional
equipment, new diets, etc.
Emotionally Unstable
Worrying about the child, still in shock, tired from seeking
help
6. Introduction of Cushing’s Syndrome
Cushing’s syndrome (CS) resulted from prolonged exposure to supraphysiological levels of
circulating glucocorticoids
Extremely rare in childhood
Difficult to be diagnosed and treated
Two major groups
Adrenocorticotrophic hormone (ACTH) dependent
ACTH-independent
Causes
Exogenous
Iatrogenic (Most Common)
Endogenous
Tumor
8. Changes in Cushing’s Syndrome
https://youtu.be/DCXp4oUeYGU
A poor girl’s story about her Cushing’s syndrome and
recovery (2013)
9. Pediatric Cushing’s Syndrome
Caused by prolonged exposure to excessive glucocorticoids (i.e. Cortisol) which can be
secreted endogenously or administered exogenously.
Sometimes symptoms will be resolved by simply remove or reduce glucocorticoids therapy.
Cushing’s Disease (CD)
To describe the Cushing’s syndrome that is caused by an ACTH-secreting pituitary tumor (corticotroph
adenoma)
Most common cause of CS after the age of 5 (pre-school)
The peak incidence occurs during adolescence
CS in infancy is usually associated with McCune-Albright Syndrome
Excessive hormone causing early puberty and increased rate of growth
Deformed extremities and skulls
Patches of pigmentation on the skin
Adrenocortical tumors are responsible for CS under four years of age.
11. Signs and Symptoms (cont.)
Bruising 27
Mental Changes 18
“Delayed” bone age 14
Hyperpigmentation 13
Muscle weakness 13
Acanthosis nigricans 10
“Accelerated” bone age 10
Sleep disturbances 7
Pubertal Delay 7
Hypercalcemia 6
Alkalosis 6
Hypokalemia 2
Slipped femoral capital epephysis 2
Presenting Symptoms & Signs of Cushing’s Syndrome
Symptom Frequency %
12. Classification of Pediatric CS
Some distinct features to differentiate pediatric from adult CS:
1. The presentation of McCune Albright Syndrome with CS in infancy
2. The predominance of mixed androgen and cortisol secreting adrenocortical tumors in early
childhood
3. The increased frequency of prepubertal Cushing’s Disease in males compared to females
ACTH-dependent
Cushing’s Disease
ACTH-independent
Adrenal gland tumors
Iatrogenic glucocorticoid administration
Treatment of eczema and asthma
In forms of topical, inhaled or oral corticosteroids
13. Diagnosis of Pediatric CS
Review of past photographs/History
Confirm physical changes to the child
Medication records for drug related cause
Auxological assessment
Physical growth including weight, height, bone age, etc.
Blood Tests
Various serum hormone levels
Basal plasma ACTH level
Urine Test
Urinary Free Cortisol Test
Radiological Imaging
Pituitary MRI
Adrenal MRI/CT
Chest CT
14. Treatment of Pediatric CS
Removing or reducing glucocorticoid therapy
Medical therapies such as Metyrapone and Ketoconazole to lower serum
cortisol levels
Surgery
Bilateral adrenelectomy
Side effect such as Nelson’s Syndrome
Long-term glucocorticoid replacement
Microadenomectomy
Preserve normal functions of pituitary tissue
Radiotherapy
15. Meeting the Needs of Child
Try to fit the child into orders so that the child is not being discriminated or isolated
Introduce more group activities to the class
Plan the activity wisely so that the child will have additional chance of taking rest
Decrease physical requirement of the activities
Communicate more with the child and pay attention to the child’s emotion
Extra effort in teaching the child about essential skills and keeping the child happy
Encourage the child
Tell the child that it’s not his fault to have this disease
Work out problems together with the child
16. Meeting the needs of Parent/Family
As an ECE, I would make an extra effort to connect him with agencies that support children
with Cushing’s Syndrome and his family. I will :
Communicate and report him regularly about Duncan’s progress
Provide lists of Cushing’s Syndrome services agencies
Brochures or pamphlets that provide information about Cushing’s Syndrome
Provide support system that maintains open communication with the child’s family
18. Adaptation to the Physical Environment
Physical Space
Have a “rest area” or a “safe spot”
available for when the child feels
tired or they want to lie down.
Easier access of toys and books for
the child with special needs
19. Adaptation to the Physical Environment
Safety & Safe Risk taking
Baby Proof the corners of shelves and tables with cushioning
material to reduce injury if he were to pass out.
Provide more calcium and vitamin D food for the child. It
would be more effective to prevent osteoporosis.
20. Adaptation to the Physical Environment
Involvement of Typical Children
Encourage typical children to play with the child
Teach children about the child’s special needs
Introduce signs/ symptoms of Cushing’s Syndrome.
Gain an understanding and acceptance from other
children.
21. Adaptation to the Physical Environment
Collaborative Planning
All the staff should be aware of the child’s special
needs
Share ideas in meeting
Working together to discuss a working plan
Help the child to promote an inclusive environment.
22. Adaptation to the Physical Environment
Staff support & Training
Learn about Cushing's Syndrome
Be aware of signs of Cushing's Syndrome
Understand actions to handle the disease
Communicate to each other to work together as a
team
Develop new systems and plans to work with the
child with special needs
23. Adaptation to the Physical Environment
Parents of Children with Special Needs
Communicate more frequently with the child’s
parent
Provide them with verbal support
Find more information about Cushing’s Syndrome for
the parents
Learn about the services and agencies that can
support them.
24. Inclusion of the child
Modifications to the physical environment can be made
to support Duncan’s development, encourage
participation and independence
Duncan will be treated with respect , fairness justice and
equity from the staff and other children in child care
setting
Duncan will be gain some opportunity to learn, enjoy and
participate as other children.
Teaching the other children about Duncan’s special
need and to gain an understanding and acceptance
25. Inclusion of the Family
One thing I could do is advise Duncan’s parent to
sign a form 14 to get access to services that are
available to help her and give relief to the family
with support.
Make a written document (log) from observations I
made of Duncan throughout the day to share with
his parent.
Have open communication with his parent about
Duncan’s progress and be available to talk with
them when needed in person or by phone.
26. Teaching Strategies
More time/ waiting
Be more patient when handling the child.
Educate other children to be patient as well
Accept the fact that the child takes longer time than others to complete a task. DO NOT MAKE THIS A
NEGATIVE THING.
Praise & Encouragement
When this child did something correctly, make sure he gets a compliment to encourage him to do it again
Praise the child to his friends so others know that the child is useful even he has a condition
Document all the progress of the child and set up goals for the child to accomplish
Active Listening
Always listen for cues from the child
Indication of his current status (emotional changes)
Obtain feedbacks from the child
Teamwork
Collaborate with other staff to work as a team
Communicate with parents as well to make them part of the team
Talk to other children to understand the child’s situation in the children’s aspect
27. Agencies
*Due to the rareness of the disease, only limited resources were found locally.
Kindercare Pediatrics
Toronto government
Cushing’s Syndrome Research Foundation (US)
28. Agencies
Kindercare Pediatrics
Provides a number of services of Parent and their children
of all ages. Such as “ Primary Care; Breastfeeding &
Lactation; Neurology; Asthma & Allergy; Respirology;
Dermatology; Rheumatology; Adolescent Medicine;
Nutrition & Lifestyle; Developmental Pediatrics;
Child/Family Psychology; Occupational Therapy; Dietitian
Services; Speech & Language Therapy.” ( Kindercare
Pediatrics Website)
491 Eglinton Avenue West
Suite 301
Toronto, ON M5N 1A8
P 416.848.7665
F 416.848.7664
E admin@kindercarepediatrics.ca
29. Agencies
Toronto government
Planning for Toronto’s Children
Toronto's Vision for Children: 'Regardless of the socio-economic status of his/her family and community,
every child has the right to childhood experiences which promote the chances of developing into a
healthy, well-adjusted and productive adult. 'The City's children's agenda is guided by Toronto's Vision
for Children: 'Regardless of the socio-economic status of his/her family and community, every child has
the right to childhood experiences which promote the chances of developing into a healthy, well-
adjusted and productive adult.' - adopted by Toronto City Council, 1999. ( Toronto Government
Website)
Provides Children’s Strategy, Children’s Charter, Child and Family Network, Toronto Report Card on
Children,
30. Agencies
Cushing’s Syndrome Research Foundation (US)
“To provide information and support for Cushing’s Disease
and Cushing’s Syndrome patients and their families;
To increase awareness in the medical community and the
general public about Cushing’s Disease and Cushing’s
Syndrome;
To be a resource for information and support to health care
professionals;”
(CSRF Website)
CSRF
60 Robbins Rd, #12
Plymouth, MA 02360
31.
32. Reference
Chan, Li F., Helen L. Storr, Ashley B. Grossman, and Martin O. Savage. "Pediatric Cushing's
Syndrome: Clinical Features, Diagnosis, and Treatment." Arquivos Brasileiros De Endocrinologia &
Metabologia: 1261-271. Print.
Savage, Martin, and Helen Storr. "Pediatric Cusing's Disease: Management Issues." Indian Journal
of Endocrinology and Metabolism 16 (2012). Print.
Kindercare Pediatrics. Retrieved from http://kindercarepediatrics.ca/
Toronto government. Retrieved from
http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=103e8ed34ce9e310VgnVCM1000007
1d60f89RCRD
Cushing’s Syndrome Research Foundation (US). Retrieved from http://csrf.net/
Inclusion of Children with Special Needs. Class note. Week 1 to Week7.
33. Image References
Image of child anxiety. (Slide 3). Retrieved from http://www.autism-community.com/wp-content/uploads/2010/09/childhood-
anxiety.jpg
Boy with Cushing’s. (Slide 4). Retrieved from http://pixshark.com/cushing-disease-in-children.htm
Cushing’s Symptoms Diagrams 1 & 2. (Slide 10 & 11). Retrieved from http://pixshark.com/cushing-disease-in-children.htm
Child on Cushion. (Slide). Retrieved from
http://www.lfccatalogue.co.uk/media/catalog/product/cache/6/image/9df78eab33525d08d6e5fb8d27136e95/L/2/L217032_301-
2753_1.jpg
Playing Together. (Slide). Retrieved from http://www.flickr.com/photos/cityofop/3342390370/
Thank you. (Slide). Retrieved from http://www.businessnewsdaily.com/images/i/000/004/904/iFF/thank-you.jpg?1386281303
Cushing’s Family. (Slide 5). Retrieved from http://www.cushings-help.com/media.htm
Normal vs Cushing’s. (Slide 7). Retrieved from http://csrf.net/wp-content/uploads/2013/06/boy-normal-and-with-cushings.jpg
Child on cushion.(Slide 15). Retrieved from
http://www.lfccatalogue.co.uk/media/catalog/product/cache/6/image/9df78eab33525d08d6e5fb8d27136e95/L/2/L217032_301-
2753_1.jpg
Child watching book.( Slide 15). Retrieved from http://c.o0bg.com/rf/image_960w/Boston/2011-
2020/2014/05/02/BostonGlobe.com/Business/Images/snoozer.jpg
34. Image References (Con’t)
Baby proofing.(Slide 16). Retrieved from http://successfulmommyadvice.com/wp-content/uploads/2013/10/dd.jpg
Canada’s food guide.(Slide 16). Retrieved from http://thetyee.cachefly.net/News/2014/10/19/CanadaFoodGuide_300px.jpg
Play together.(Slide 17). Retrieved from http://courthousechristian.com/wp-content/uploads/2011/07/Preschool1.jpg
Staff meeting.(Slide 18). Retrieved from http://www.schooljotter.com/imagefolders/crossley/Website_clipart/Meeting.jpg
Staff training.(Slide 19). Retrieved from http://blog.onclickltd.com/wp-content/uploads/2014/05/Training.jpg
Family.(Slide 20). Retrieved from http://cf.ltkcdn.net/autism/images/std/138917-425x282-parentsautimsupport.jpg
Learning, grow together.(Slide 21).Retrieved from https://makingeducationfun.files.wordpress.com/2012/02/clip_art_for_website3.jpg
Communication with parent.(Slide 22). Retrieved from
http://www.metrokids.com/images/cache/cache_d/cache_c/cache_8/Educationcopy-dc78e8cd.jpeg?ver=1415292464&aspectratio=1.508
Teaching in class.(Slide 23). Retrieved from http://community.prometheanplanet.com/cfs-filesystemfile.ashx/__key/CommunityServer-
Components-ImageFileViewer/CommunityServer-Blogs-Components-WeblogFiles-00-00-00-01-
22/1373.ClassroomDiscussions_5F00_Image.jpg_2D00_550x0.jpg
Blood Test. (Slide 13). Retrieved from http://www.warringtonandhaltonhospitals.nhs.uk/uploads/images/blood-test.jpg
MRI. (Slide 13). Retrieved from http://bic.beckman.illinois.edu/images/BICISL3twbInstalled.jpg
General Surgery. (Slide 14). Retrieved from http://www.northokaloosaphysiciangroup.com/wp-content/uploads/2013/10/general-surgery.jpg
Surgery Joke. (Slide 14). Retrieved from http://bic.beckman.illinois.edu/images/BICISL3twbInstalled.jpg
35. Video References
My Cushing's Syndrome & Tumor PICTURE PART 1. (Slide 8). Retrieved from
https://youtu.be/DCXp4oUeYGU
