cushing syndrome

1. KADEN
A CHILD WITH CUSHING SYNDROME
By:
Sakthiya Raveenthiran

2. Intro About Kaden
 Kaden is six years old. She has diagnosed with Cushing Syndrome, which is rare.
 Favourite color: Blue and Green
 Favourite Food: McDonald’s, pizza & Candy.
 Favourite music: Pop music
 Favourite Activities : Pokémon, Water play and Blocks.
 Temperament : Slow to warm up
 Does not like: Sports, Onions and singing

3. CHILDS’ NEEDS
 Kaden Has been identified with Cushing syndrome.
 Kaden has rapid weight gain, excess sweating and appears depressed/ anxious
at times.
 Kaden temperament is to slow to warm up.

4. Families’ Needs
 Our child Kaden having some needs to cope with her activities.
We believe that this new center would help her in developing her
skills and create a pleasant learning experience.
 We would like to have a meeting with the RECE to learn more
about the programs.
 We are new to this area so we need help in finding some of the
local services that are available to help us to deal with our child
needs.

5. What is Cushing Syndrome?
 Cushing Syndrome, it is caused when the body produce excess of Hormone
called Cortisol by the adrenal glands for a long time.
 This is also being called as Hypercortisolism.
 This is a rare disease and it affects adults who are 20 – 50 years of age.
 Cushing syndrome creates a fatty hump on shoulders, faces and also creates pink
stretch marks on various parts of the body.

6. Common symptoms
 The rapid increase in body weight.
 Fatty muscles form between shoulders, around and on the face, and increase
of fatty tissues on the upper part of the body.
 Stretch marks appear on pink or purple color on the skin around the abdomen,
Brest, arms, and thighs.
 Takes time in the healing of any injuries, cuts or bites from injects.
 Acne
 Sleep disturbance
 Hypertension
 Muscles and bones weakness.
 Fatigue

7. Impacts On Developmental Domains
 Physical Development
Cushion Syndrome affect the growth for young children. This does not stop the growth in the young children it makes the growth in
slower space. Due to the fatty tissues build over the body it slows the movement and stops being active. This makes the child
difficult to engage in gross and fine motor activities and also to enhance the learning. Bones will become weak and have the higher
chance of breaking easily. It also increase the sense of thirst and urination. Children will also have excess sweating and appears to
be depress and anxious. This makes the child feel uncomfortable to participate in every day activities. Due to the disease it lower
the immune system and expose to frequent infections.

8. Impacts On Developmental Domains
 Physical Development Comparison with boys and girls

9. Impacts On Developmental Domains
 Cognitive Development
Due to the experiencing rapid headaches and fatigue it will be hard for the children to be active in participating in play or any
activities. Children have deficit in cognitive abilities and regulating emotions. It is also hard for the children to be focused and to
be concentrated for longer period of time. Having sleeping disorder will also get the child to be tired as soon as they engaged in
memory and attention tasks. Kaden Like to play with water and with blocks but still it is harder for her to engage in play for long
term.

10. Impacts On Developmental Domains
 Intellectual and social Development
Kaden has the temperament , slow to warm up so the child needs more time to engage in and finish play. When engaging in
small and large group activities Kaden need more sufficient time to get along with the other children and engage in
collaborative play. Due to the lower immunity it is not safe for them to play in outdoor environment and it limits the chance of
exploring as other typical children.

11. How it is Diagnosed?
 Dexamethasone Suppression test
 This testing is typically used to measure the function of the adrenal glands. It also used to
measure the level of cortisol.
 12 Hour urinary free cortisol level
 Patients’ urine is tested in various times on 24 hours and measure the amount of cortisol.
The measurement upper limits varies between laboratories, based on the lab equipment's.
 Saliva Test
 If a person has a Cushing syndrome the cortisol level will increase during the evening
time.
 Imaging Test
 Computerized scans helps to identify the abnormalities in pituitary glands and
adrenal glands.
 Petrosal Sinus Sampling

12. Treatment for Cushing syndrome
 Surgery
 Radiation Therapy
 Medications

13. Inclusive Environment
 It means creating or modifying the child care space that is accessible for all
children and families. When children in the center has different needs it is
the center and the RECE responsibility to create an inclusive environment
which help all children to engage in every day activities and play. It could be
designed by adding or removing any physical space that could help the
children and families to participate and also including supportive device and
creating a warm welcoming environment.

14.  Physical Adaptations
 Children with Cushing syndrome need more adaptation in providing the
physical space.
 Providing a quiet space for them to get some rest and spend time when
they feel overstimulated.
 Providing soft mats and cushions which is more comfortable to sit and
participate in activities.
 Child Kaden has a excess sweating so it is important to add various source
such as windows, where could get more fresh air and also by reducing the
temperature to keep the class cool.
Inclusive Environment

15. Inclusive Environment
 Physical Space/Removal of Barriers
 Children with Cushing syndrome have bones that could easily
brittle and has low immunity and it takes a long time to heal
bruises.
 It I important to maintain the Safe and healthy environment by
removing any hazards from the environment .
 Example: Having different textured carpets and anti slippery
floors.

16. Inclusive Environment
 Materials, toys and Equipment’s
 Children who has Cushing syndrome has fatty tissues build up
on their arms, face and in different parts of the body.
 Adding extensions to small objects to make it easy for the
child to hold.
 Example: Adding big handles to puzzles and toys which has
slippery texture.

17.  Flexibility
 Kaden has temperament of slow to warm up, since need more time
for transitions and to participate in daily programmes
 Giving reminders and notifying about the next transitions earlier to
the transitions help the child to get ready by mentally and physically.
 Example: Having visual schedules in child's eye level for the child to
be prepared for the routines.
 Giving adequate times to get ready for the transitions.
Inclusive Environment

18. Inclusive Environment
 Stimulation & Novelty
 Creating and environment witch has
affordable lighting and Air to keep
the room cool.
 Based on the parent information it
says that Kaden has excess sweating.
 Adding a small fan to keep the room
more cool down and comfortable or
opening the windows so that the
natural aid could rotate.

19. Inclusive Environment
 Involvement of Typical Children
 Engaging in conversation about special needs with children
during small and large group gatherings.
 Teaching about Cushing syndrome for the other typical children.
 Encouraging other children to play and help the child who has
Cushing Syndrome.
 Explaining what are some needs and difficulties that the child
with Cushing syndrome faces.

20. Inclusive Environment
 Collaborative Planning
 To provide support for Kaden it is important to work collaboratively as a team with the RECE, center staff, Parents ,with
other typical children and other families and parents.
 Sharing the information with the other staff in the center will help them be aware of the child need and they would be
mindful when communicating with Kaden.
 Documenting the observations and measuring the development using observational tools, example checklist.
CHECKLIST

21. Inclusive Environment
 Staff Support & Training
 Staff should be knowledgeable and resourceful in order to supporting
the child with Cushing Syndrome.
 Staff can attend for workshop and trainings regarding the Cushing
Syndrome.
 Modifying the environment to support the child learning.
 Communicating with the other staff about the child needs.
 Understanding the child temperaments, interest, and also the
difficulties child faces during the transitions and supporting the child to
feel the sense of belonging.

22. Parents of children with special needs.
 Parents of children with special needs.
 Having discussion between the child parents and the RECE to
exchange the observations they had in home and in the center.
 Communicating with parents using respectful language.
 Supporting parents by providing information about the
resource that is accessible for them.

23. Teaching Strategies
 Expectations and Follow through
 Talking with Kaden about the transitions and what are the activities we are doing now and after.
Could use visuals to remind Kaden.
 Consistency
 Setting up the environment and the routines consistent for Kaden to support with the
temperament and to prevent her from being anxiousness.
 Waiting
 Kaden has physical challenges and also has temperament to slow to warm up. It is important to
give adequate time to follow up with the routines and transitions.

24. Teaching Strategies
 Choices
 Providing of possible choices and breaking down each steps in smaller parts to
Support Kaden to think about what she is going to do and it help her to understand the
activity and it helps to increase the self-esteem.
 Praise & Encouragement
 Kaden appears depressed and anxious at times. Giving praise and
encouragement help to keep her motivated and engage in the activities.
This build self confidence and encourage child to actively participate in learning.

25. Teaching Strategies
 Reinforcement
 Kaden has difficulties in motor skills as she has Cushing syndrome which has signs of building fatty tissues around the
body.
 Reinforcement encourage participation and involvement in activities.
 This also help to repeat the actions and activities.

26. Teaching Strategies
 Encouraging other children
 Talking with other children about the special needs.
 Encouraging typical children to play with Kaden.
 Make simple stories for typical children to understand about the values of
Kaden and how to respect as a child similar to them.
 Giving other children chances to help and support Kaden in daily activities
and transitions.

27. Supporting Agency – Child
 Kaden has been going through the Cushing syndrome and it is the RECE responsibility to support the child needs.
 Using simple and short sentence when talking with Kaden so that it will be easy to understand.
 Explaining her about what is going to happen next based on the schedule. It will help her to ease the transition
from one activity to another.
 Providing Kaden an inclusive environment by modifying seating so Kaden could engage in activities for a long
period of time and including different floor textures which is anti slippery to help Kaden with physical activities.

28. Supporting Agency – Families
 Letting Kaden parents know how Kaden did in the center and what activities that she
engaged in.
 Talking with Kaden parents about the changes or developmental activities that could
be able to notice through out the day.
 Providing information about agencies and resources that support to cope with or
treat Cushing syndrome.

29. Supportive Agencies
 Cushing’s Support and Research Foundation – CSFR
 National Organization for Rare Disorders – NORD
 National institute of Neurological Disorders and stroke – NIH
 Kinder Care Pediatrics
 City of Toronto
 Ministry of Children and youth services

30. Cushing’s Support and Research Foundation – CSFR
 CSFR is an agency which is founded in 1995.
 This provides information about Cushing syndrome to the patients and to their families.
 It also engage in creating awareness about Cushing syndrome among public.
 It is being as resource to educate other professionals about Cushing Syndrome.

31. National institute of Neurological Disorders and stroke – NIH
 NORD operates under the National institute of health.
 Its mission is to research about the fundamentals of brain and to find solutions to neurological diseases.

32. National Organization for Rare Disorders – NORD
 NORD help patients and their families to support with the rare disease.
 The organization provide services and support to find professionals, medical institutions, advocacy, research for
diagnose and treatments for rare disease.

33. A success story – Cushing Syndrome

34. Bibliography
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35. Bibliography
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36. Bibliography
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37. Bibliography
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