Maternal Feeding Practices in Relation to Nutritional Status of the Mentally Challenged

                                 ...
Kristia Alcanicez

                                      Clarissa Blanza

                                   Shiela Mae De...
body size, growth rate and appetite. Foods contain similar nutrients are grouped into three

which are body building foods...
deficiency is considered to be a preventable cause of mental retardation. Vitamin A is a

vitamin which is needed by the r...
intellectually may become apparent early in a child's life. In the case of mild retardation,

these failures may not becom...
Model, since the health of the children means the straight of its social and economic

structure in the future according t...
The Paradigm shows that the Maternal Profile determines the feeding practices

towards Maternal feeding Practices Towards ...
B.2 Height

     B.3 Age

     B.4 Gender

2. What is the nutritional status of the mentally challenged children in relati...
To the student, this will help them to understand and meet their nutritional

needs. This will make them aware of what the...
The researchers did not cover about the awareness and knowledge of parents about

   proper nutrition and vaccination of c...
Mentally challenged- refers to an individual with disabilities and is currently under the

special school.



Nutritional ...
Health- is the general condition of a person in all aspects. It is also a level of functional

and/or metabolic efficiency...
catch up to other children (usually by the age of five) may be diagnosed as “mentally

retarded”. The term, “mental retard...
infections such as rubella, maternal phenylketonuria (even if the fetus doesn't have the

condition), use of drugs or alco...
Government nutrition programs are available to poor children in the first and most

critical years of life. These programs...
higher skill (e.g. in simple visuo-spatial tasks) against a background of severe mental

retardation. This presents proble...
According to Deborah Steward “Selection of growth Parameters to define failure

to thrive” state that failure to thrive in...
This topic of mental challenged children is rare privilege to some research to

conduct study since it imparts confidentia...
Hypothesis



        There is no significant relationship between milk feeding practice and nutritional

status of mental...
This chapter presents the methods and procedures used by the researchers. This

   includes the research design, subjects ...
-   describe the relation between the frequency of respondents to the total (n)

              no. of respondents

       ...
Instrument used



        A set of questionnaire was designed to determine the respondents feeding

practice in relation ...
QUESTIONAIRE



Please check the following statement application to the given question.



1 A. Age



( ) 25 below

( ) 2...
( ) 46 above



B.



( ) Civil status

( ) Single

( ) Married

( ) Widow



C. Education



( ) Elementary graduate

( )...
( ) 10,000 above



E. number of child



( )1

( ) 2-5

( ) 6-10

( ) 11 above




   3. Children profile




   Age     ...
___8      ____   ____




___9      ____   ____




___10     ____   ____




___11     ____   ____




___12     ____   _...
III. Please rate the question by checking the corresponding numbers that describe the

experience of the parents of the re...
Bibliography



Brown, Judith Nutrition Now 4th edition by Thomson Learning Asia Wadswort 2005



Potter, Patricia et al. ...
Read more: Mental Retardation - Causes of mental retardation, Preventive measures

http://psychology.jrank.org/pages/414/M...
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Maternal

  1. 1. Maternal Feeding Practices in Relation to Nutritional Status of the Mentally Challenged Children in Selected Special School in Batangas City A Thesis Presented to the Faculty of College of Nursing Batangas City In Partial Fulfillment of the Requirements for the Degree Bachelor of Science in Nursing By:
  2. 2. Kristia Alcanicez Clarissa Blanza Shiela Mae De Chavez CHAPTER I THE PROBLEM AND ITS BACKGROUND Introduction Children constitute a big and relevant part of the nation. They are well loved and cared for by parents as they are the human symbols of their affection. Society on the hand also protects children, as they are future of society. Therefore efforts are taken to have the family, the school, and the community work together for them to be healthy. During the preschool years, children take on their own unique personality and strive for a greater independence. They are very active, playful and adventurous. Preschool children have a high energy requirement for their size because they are grieving and becoming more active. The amount of food they need depends on their age,
  3. 3. body size, growth rate and appetite. Foods contain similar nutrients are grouped into three which are body building foods, energy giving foods and regulating foods. This three food group serves as a guide for meal planning and good nutrition. The vision statement of the Department of health Nutrition emphasizes that proper nutrition is a basic human right of every Filipino and the basic nutrition values entail that it is a basic human right of child. Nutrition plays a vital role that will ensure a child’s proper growth, development and maintenance of life. As defined, nutrition is the science of food nutrient and other substances therein, action, interaction, and balance in relation to health and disease and the process by which the organism ingest, transport, utilizes and excretes food substances. Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Iron deficiency anemia is a decrease in the number of red cells in the blood caused by too little iron. Chronic iodine deficiency can lead to numerous health problems in children and adults, including thyroid gland dysfunction (including goiter) and various neurologic, gastrointestinal, and skin abnormalities. Iodine deficiency in pregnant or nursing mothers can lead to significant neurocognitive deficits in their infants. "Cretinism" or severe mental retardation is a rare outcome of severe iodine deficiency during early development. Growth stunting, apathy, impaired movement, or speech/hearing problems may occur. Many individuals living in developing countries may be at risk of iodine deficiency and its complications, and iodine
  4. 4. deficiency is considered to be a preventable cause of mental retardation. Vitamin A is a vitamin which is needed by the retina of the eye in the form of a specific metabolite, the light-absorbing molecule retinal. Since proper diet is crucial during pre-school stages it is that at this level the brain growth rapidly and nutrition is a critical factors. Failure to provide enough nutrients like deficiency in iron may cause Anemia. Lack of iodine may cause Goiter and may lead to mental retardation and vitamin A may cause blindness. Mental retardation affects about 1 - 3% of the population. There are many causes of mental retardation, but doctors find a specific reason in only 25% of cases. Mentally retarded people are more prone to both physical and mental disorders than the general population. Some of the conditions that cause mental retardation may also be characterized by seizures, hearing problems, congenital heart defects, and other symptoms. Mental disorders are much more common among the mentally retarded than among the general population: an estimated one million. Feeding is not only essential for growth, but is a primary context for interactions between infants and their mothers in early infancy. Early identification of dyads at risk for poor feeding offers an opportunity to intervene in the future health and wellbeing of the infant. A family may suspect mental retardation if the child's motor skills, language skills, and self-help skills do not seem to be developing, or are developing at a far slower rate than the child's peers. Failure to adapt (adjust to new situations) normally and grow
  5. 5. intellectually may become apparent early in a child's life. In the case of mild retardation, these failures may not become recognizable until school age or later. The degree of impairment from mental retardation varies widely, from profoundly impaired to mild or borderline retardation. Less emphasis is now placed on the degree of retardation and more on the amount of intervention and care needed for daily life. Based on this premises, this study aims to identify it the children with special needs were given priority and the mothers were able to come with their needs especially regarding their nutrition. Theoretical Framework “Neuman’s System Model” Her theory is based on scales developed to measure feeding teaching and environment with continuous research, she refined the theory and provided a close link to practice, she model the role of researcher in clinical practice as the advancement of nursing practice The above theories stated by the theorist and were simply collaborating to the different interpretation focus on our study like Kathlyn Bernard’s the “Parent-child Interaction Theory”, it emphasized that the parent has more responsible in dealing with their children from pregnancy up to the cycle of his/ her development as a human they have the responsibility to nourish and to nurture their child’s physical, emotional and psychological aspects of their growth development likewise when this growth develops into mature life cycle of individuals, adaptation and adjustment is particularly exist and disturb once stability if this process fails to stability, disharmony remain for too long is consequently unable to satisfy its needs and illness may develops to Neuman System
  6. 6. Model, since the health of the children means the straight of its social and economic structure in the future according to “Deckham Child Health Care Theory,” parents despite limitations in their socioeconomic station in life must practice the health of the children. Conceptual Framework Mentally Challenged Children Maternal Profile Age Nutritional status of mentally Civil status challenged children Educational attainment Income/month Number o children Maternal feeding practices towards their mentally challenged children
  7. 7. The Paradigm shows that the Maternal Profile determines the feeding practices towards Maternal feeding Practices Towards their Mentally Challenged Children since Nutritional status of mentally challenged children is dependent on this practices on their mother, any failure with the age, civil status, educational attainment, as well as the M. income and number of children will result to poor feeding practices thereby sacrificing the good outcome of nutritional status of mentally challenged children. Statement of the Problem This study aims to find out the Maternal Feeding Practices in Relation to Nutritional Status of the Mentally Challenged Children in Selected Special School in Batangas City This study sought answer to the following problem: 1. What is the demographic profile of the mothers in terms of: A. a. Age b. Civil status c. Educational Attainment d. Occupation e. Income/ month f. Number of children B. School- age children profile as affiliated by the mothers B.1 Weight
  8. 8. B.2 Height B.3 Age B.4 Gender 2. What is the nutritional status of the mentally challenged children in relation to their age and gender? 3. What are the feeding practices of respondents applied to their mentally challenged children? 4. Is there significant relation between maternal feeding practices and nutritional status of mentally challenged children? 5. What is the implication of the result of the study to nursing education? Significance of the Study The result of the study is expected to be beneficial to the following sectors The finding of this study will ultimately benefit the parents because it will help them to understand the condition of their children The finding of the study will help the family. Define and understand the importance of nutrition. This will provide enough knowledge and information about the importance of proper and balanced diet. How it will be practice at home to prevent nutritional inadequacy in their children.
  9. 9. To the student, this will help them to understand and meet their nutritional needs. This will make them aware of what they have been taken for their meals and snacks and this will provide them advanced knowledge how to handle of a balance to the community, this will help them recognize and organize plans and project to avoid health deficiency such as plantation of vegetables, fruits and others which is appropriate for the high quality nutrition To the canteen owners, this will help them to encourage support for the implementation of the DOH Sangkap Pinoy Program and to establish food products with essential nutrients at level approved by the DOH to the nursing student they will help them to determine and understand the specific conditions of the affected mentally challenged children in relation to their behavior, growth and mental development hence this could serve as basis to explore certain strategies and organizations to implement programs to enhance and lessen nutritional deficiency among children as well as to lessen mentally challenged children in the community. Scope and Limitations of the study This study is mainly about the maternal feeding practices in relation to nutritional status of the mentally challenged children. Health practices of mother, their profile and possible factors that may affect the nutritional status of mentally challenged children when give focused.
  10. 10. The researchers did not cover about the awareness and knowledge of parents about proper nutrition and vaccination of children, which is also a part of a children’s profile, to know if the child is fully immunized or was not tackled here. School-aged children 6-12 and their characteristics had been emphasized to provide more understanding about their development for the researcher to provide more appropriate recommendation since the target group has known disabilities, the researcher decide to choose the mothers of mentally challenged children of some schools specifically the Batangas South, East, and Sampaga elementary school to retrieve more accurate into. Definition of terms: For better and clearer understanding of the following terms are defined according to how it was used in this study: Balanced diet- refers to the food eaten by the respondents. Feeding behavior- refer to how individual provide food. Malnutrition- refers to poor health status as a result of inadequate supply of nutrients needed by too much or too little intake of food by the body.
  11. 11. Mentally challenged- refers to an individual with disabilities and is currently under the special school. Nutritional status- refers to ones state of health which is determined by the age, height, weight and sex of children. Special school- refers to an institution that accommodates individuals with certain disability. Vitamin A deficiency- a condition characterized by depleted liver stress and low blood levels by vitamin A resulting from deficient dietary intake of vitamins A and secondarily from poor absorption that may lead to serious eyes lesions. Iron deficiency anemia- a condition in which the hemoglobin concentration of the blood is below accepted values. The more important causes of IDA are low dietary intake of iron, particularly from animal sources, poor absorption, chronic blood loss and increased demand. Weight- Height- is the measurement of vertical distance, but has two meanings in common use. It can either indicate how "tall" something is, or how "high up" it is. Nutrition- a process of absorbing nutrients from food and processing them in the body in order to keep healthy or to grow
  12. 12. Health- is the general condition of a person in all aspects. It is also a level of functional and/or metabolic efficiency of an organism, often implicitly human. CHAPTER II REVIEW OF RELATED LITERATURE The chapter presents the research literatures reviewed by the researchers that as guide in conducting the study. Conceptual Literature The cycle of infants’ nutrition contributing to their success as future mothers and of mothers’ nutrition determining that of infants is fundamentally important to the long−term solution to malnutrition. For example, it is now better understood that the period of growth up to around two to three years of age provides a window of opportunity for ensuring adequate future growth, development, and nutritional status. Before that, the relation between low birth weight, survival and child growth is also well established. And, going further back, growth in utero even from the time of conception is now known to be crucially affected by nutrition, and to have effects throughout the individual’s life. As children mature they pass through stages of growth and development. It is very important that they must receive proper nutrition. Parents are the first people concerned towards developmental process and health maintenance. Approximately 2.5 to 3% of the total populations are mentally retarded. In most cases, it is a lifelong condition. There is no connection between mental retardation and gender or race. The children who cannot
  13. 13. catch up to other children (usually by the age of five) may be diagnosed as “mentally retarded”. The term, “mental retardation,” means that a person has certain limitations in their ability to thinkand learn. These limitations will cause this person to be less able to communicate with others, to take care of him or herself, and to develop social skills. Children with mental retardation may take longer to learn to speak, walk, and take care of their personal needs such as dressing or eating. They are likely to have trouble learning in school and there may be some things that they are unable to learn. Unlike developmental delays where a child might catch up to other children, mental retardation is a permanent condition. People with mental retardation can be helped to learn and to care for themselves through special education and training, but their mental retardation cannot be cured. Mental illnesses (such as depression) and specific learning disabilities (such as dyslexia) are not the same thing as mental retardation. The term mental retardation is commonly used to refer to people with an intelligence quotient (IQ) below70. An IQ of 80-130 is considered the normal range, and 100 is considered average. According to the definition in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV), a mentally retarded person is significantly limited in at least two of the following areas: self-care, communication, home living, social/interpersonal skills, self-direction, use of community resources, functional academic skills, work, leisure, health, and safety. Mental retardation affects roughly 1% of the American population. According to the U.S. Department of Education, about 11% of school-aged children were enrolled in special education programs for students with mental retardation. Mental retardation may be caused by problems that occur during pregnancy and birth, including maternal nutritional deficiencies, toxemia,
  14. 14. infections such as rubella, maternal phenylketonuria (even if the fetus doesn't have the condition), use of drugs or alcohol, maternal injury during pregnancy, extreme prematurity, low birth weight, perinatal injury, or lack of oxygen at birth. Retardation can also be the result of medical conditions and injuries that occur after birth, including metabolic disorders, severe childhood malnutrition, prolonged high fever, near drowning, lead poisoning, severe mental disorders such as autism, and infections such as meningitis that affect the brain. Environmental factors influencing mental retardation include deprivation of physical or emotional nurturance and stimulation. Altogether, there are hundreds of possible causes of, or factors contributing to, mental retardation. Mental retardation is a condition diagnosed before age 18 that includes below- average general intellectual function, and a lack of the skills necessary for daily living. The primary goal of treatment is to develop the person's potential to the fullest. Special education and training may begin as early as infancy. This includes social skills to help the person function as normally as possible. It is important for a specialist to evaluate the person for other affective disorders and treat those disorders. Behavioral approaches are important for people with mental retardation. Prenatal screening for genetic defects and genetic counseling for families at risk for known inherited disorders can decrease the risk of inherited mental retardation.
  15. 15. Government nutrition programs are available to poor children in the first and most critical years of life. These programs can reduce retardation associated with malnutrition. Early intervention in situations involving abuse and poverty will also help. Environmental programs to reduce exposure to lead, mercury, and other toxins will reduce toxin-associated retardation. However, the benefits may take years to become apparent. Increased public awareness of the risks of alcohol and drugs during pregnancy can help reduce the incidence of retardation. Mental retardation is a condition of arrested or incomplete development of the mind, which is especially characterized by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence, i.e. cognitive, language, motor, and social abilities. Retardation can occur with or without any other mental or physical disorder. However, mentally retarded individuals can experience the full range of mental disorders, and the prevalence of other mental disorders is at least three to four times greater in this population than in the general population. In addition, mentally retarded individuals are at greater risk of exploitation and physical/sexual abuse. Adaptive behavior is always impaired, but in protected social environments where support is available this impairment may not be at all obvious in subjects with mild mental retardation. Intelligence is not a unitary characteristic but is assessed on the basis of a large number of different, more or less specific skills. Although the general tendency is for all these skills to develop to a similar level in each individual, there can be large discrepancies, especially in persons who are mentally retarded. Such people may show severe impairment in on particular area (e.g. language), or may have a particular area of
  16. 16. higher skill (e.g. in simple visuo-spatial tasks) against a background of severe mental retardation. This presents problems when determining the diagnostic category in which a retarded person should be classified. The assessment of intellectual level should be based on whatever information is available, including clinical findings, adaptive behavior (judged in relation to the individual's cultural background), and psychometric test performance. Foreign literature According to Johnson SL, in his study “influence of parents eating behavior and child feeding practices on children’s weight status” Based on his findings it seems evident that the way parents eat affects the environment in which they feed their children and this may be gender biased. Louela Villalis Cordova indicators of nutritional status of school aged child Implication for school nursing service. At ages 3-5 years old the behavior might only be evident in a controlled setting and may not be reflected in their weight status due to limited autonomy over eating this young age at older when children have greater independence in food selections and intake these earlier learned behaviors may begin to be expressed and subsequently affect the child’s weight status or the nutritional status. It is similar to the present study because it shows that parents eating and feeding practices affect the children’s weight status. It also status that parents eating and feeding practices is with determinant of what will be the eating a nd feeding practices of their children
  17. 17. According to Deborah Steward “Selection of growth Parameters to define failure to thrive” state that failure to thrive in infants occurs when infants might gain deviates from an established pattern of growth and is directly attributed to under nutrition. In addition to this, Belton (2002) study entitled “Childhood Nutritional Deficiency”, stated that one deficiency occurs; it is probably too late to achieve optimal development. Ideally, iron and other deficiency lately in the diet will compensate for any lack in early childhood. Iron deficiency may be serious public health problem that can lead to irreversible development delay, impaired behavior, lower attention span and growth retardation. It is significant to the present study because it cited different factors where under nutrition may occur though it is different because it is more applicable to infants which is their target group. According to some researcher male children suffer from disabilities more frequently than female children. Among all disabled children under age 15, 38% were girls and 62% were boys. Children age 6 were twice as likely to have a developed mental disability, as they were to have a difficulty with improvement. Among children aged 6-14, 4 million or 11% had some type of disability in 2001 while 13% of boys had some type of disability 18% of girls did. Significance of the related literature
  18. 18. This topic of mental challenged children is rare privilege to some research to conduct study since it imparts confidentially and differenced as an opportunities the quest to make a constructive contribution in the art of giving and providing health education are greatest achievement to conduct this study. It aimed to look into a deeper possible aspect that the practices between eating and feeding behavior of parents and adults may significantly influence the children’s nutritional status. Of all the studies read and summary, this it does not focused on the nutritional status of children with normal capabilities. In general, we conducted this research not only the nutritional status nut of eating and feeding practice of children with mentally challenged children specifically to those children with mental and physical disabilities. Synthesis of the related literature The research cited in support of this study proves that there has been a range of explanations offered to understand why children eat what they eat. Lack of knowledge had been implicated as causing poor diets, but is not explained enough as health education campaign have had limited success is hanging eating habits Based on the various researches we may conclude that nutrition influence mental ability scores, physical development, social development and even the child’s participation in school activities and has attention span. Parents must be educated on the importance of nutritional for the total development of their children.
  19. 19. Hypothesis There is no significant relationship between milk feeding practice and nutritional status of mentally challenged children. Assumption 1. Feeding practices of mother greatly influenced the nutritional outcome of mentally challenged children. 2. the nutritional status of schooled age is combined effect of the situation at home and school 3. T.V. commercial and adults have predominant influence over the eating behaviors of children’s food choices. CHAPTER III RESEARCH METHOD AND PROCEDURES
  20. 20. This chapter presents the methods and procedures used by the researchers. This includes the research design, subjects of the study setting of the study, data- gathering instrument, data gathering procedures and statistical treatment of data. Research Method Design To obtain necessary information that will seek answer to the problems the researcher used to observe, describe and document aspects of a situation as it naturally occur. This type of research answer question and satisfies curiosity about a certain phenomenon. It also describes and elaborates the nature and causes of an existing condition its meaning and significantly and then making adequate and accurate interpretations of the data with or without the aid of statistics. Using descriptive method the study wanted to know the nutritional status feeding and eating practices of mentally challenged children. Statistical Treatment of Data The data from the questionnaire and interview will be studied and interpreted using statistical method. In order to complete the requirement of this particularly study, the researcher will use %, height, and weight tools for children ranking method and weighted mean. 1. Distribution
  21. 21. - describe the relation between the frequency of respondents to the total (n) no. of respondents Formula: P= percentage (%) F= frequency N= total no. of respondents 2. The respondent and sampling design The respondent of this study are the mothers of mentally challenged children with the age of 6-12 special schools of batangas city. The researcher’s respondents are composed of 100 individuals who had the chance of participating in the study provided by the researchers. The researchers are also used the homogenous kind of sampling this kind of sampling permits a more focused inquiry in order to understand a particular group of people. 3. Setting of the study The setting of the study is located in batangas city, a commercialized city where many schools and buildings were establish and is also known for its high standard of education. There are also schools attended by special children and these schools where the researchers aim to seek answer about nutritional status feeding and eating practiced of mentally challenged children.
  22. 22. Instrument used A set of questionnaire was designed to determine the respondents feeding practice in relation to be nutritional status of their mentally challenged children. Questions were instructed close-ended, which made used of a checklist to determine the maternal feeding practices in relation to nutritional status of mentally challenged children. The questionnaire for the respondents is consist of P1, which is about the demographic profile of parents, P2 is about the nutritional status of mentally challenged children based on their age, weight, height and sex; P3 about feeding practices of mothers applied to their children. Interview is also conducted for further expansion of knowledge of this study. Distribution and retrieval of questionnaire Since the respondents of the study were the mothers of the mentally challenged children and were not readily accessible personally the researcher asked permission of the head of the different special schools in the distribution of the questionnaires. The researcher explained to the principals and teacher of selected schools the purpose of the study and its benefits for them to cooperate and will be the one to encourage the mother of mentally challenged children to answer question honestly and correctly. The retrieval of questionnaires was done after a week.
  23. 23. QUESTIONAIRE Please check the following statement application to the given question. 1 A. Age ( ) 25 below ( ) 26-30 ( ) 31-35 ( ) 36-40 ( ) 41-45
  24. 24. ( ) 46 above B. ( ) Civil status ( ) Single ( ) Married ( ) Widow C. Education ( ) Elementary graduate ( ) Elementary undergraduate ( ) High school graduate ( ) High school undergraduate ( ) College graduate ( ) College undergraduate ( ) Vocational D. occupation/ month ( ) Less than 5,000 ( ) 6,000-10,000
  25. 25. ( ) 10,000 above E. number of child ( )1 ( ) 2-5 ( ) 6-10 ( ) 11 above 3. Children profile Age weight height ___6 ____ ____ ___7 ____ ____
  26. 26. ___8 ____ ____ ___9 ____ ____ ___10 ____ ____ ___11 ____ ____ ___12 ____ ____ Gender: F ( ) M( )
  27. 27. III. Please rate the question by checking the corresponding numbers that describe the experience of the parents of the respondents when: 1-never 2-seldom 3- sometime 4- often 5- always QUESTIONS: 1 2 3 4 5 I do not allow my child to eat street foods My child eats the food I personally prepared I let my child eat on hi/her own My child is taking vitamins I provide fresh fruits and juices for my child I feed my child on time 3x a say I advised my child to wash hands after and before eating. I encourage my child to drink milk regularly I do not let my Childs eat junk foods My child eats vegetables regaularly.
  28. 28. Bibliography Brown, Judith Nutrition Now 4th edition by Thomson Learning Asia Wadswort 2005 Potter, Patricia et al. fundamentals of nursing 6th edition Singapore Mosby Inc. 2005 Lucas, Betty. Food, Nutrition and Diet therapy. Published in the Philippines by Elsevier Science Inc. Singapore 2004 Hockenberry, Marilyn et. Al Wong’s essentials of pediatric nursery 7th edition reprinted edition, Elsevier Inc. Singapore 2005 www.nlm.nih.gov/medlineplus/drugs/info/natural/patient/-iodine.html www.nlm.nih.gov/medlineplus/drugs/info/ency/article/001523.htm Read more: Mental Retardation - Causes of mental retardation, Preventive measures http://psychology.jrank.org/pages/414/Mental- Retardation.html#ixzz0eoRdqXbT
  29. 29. Read more: Mental Retardation - Causes of mental retardation, Preventive measures http://psychology.jrank.org/pages/414/Mental-Retardation.html#ixzz0eoRLRf2w

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