physically ans mentally challenged children has diffirent and special needs that to be addressed definitely in health care which usually doesnt happens

1. The child with Special Health
care Needs
Dr.Soma Sekhara Reddy.k
Emergency medicine

2. Who…
• Increased risk for chronic
Physical
Developmental
Behavioral and
Emotional conditions
• Require extra care in health and related
services beyond that required in general.

3. Why… special..
COZ OF DIFFENRENT IN -
• Development
• Vital signs
• Weight
• Cant use standard reference charts
• Reduced compensatory mechanisms
• Allergies
• Medications

4. Ex amples…………………………
• Chromosomal disorders
- Down syn.
- Turners syn.
- Noonans syn.
- Fragile x syn.
- Trisomy 18 syn.
- cri – du - chat syn.

5. In fact all disorders…
• Disorders with facial defects
• Disorders with limb defects
• Inherited metabolic disorders
• Connective tissue disorders
• Vascular disorders – hamartoses
• Toxins – Fetal hydantoin syndrome
• Trauma - TBI , CP

6. Our job..
• Recognition
• Consideration
• Anticipation
• Initiation
• Stabilisation
• Disposition

7. One special case in detail – cerebral palsy
• Collection of non progressive disorders of
movement and posture originating from injury
sustained by the developing brain within the
first 3 to 5 years of life
• Many causes and in 25% no cause.
• Many types with wide spectrum of disease

8. Complications
1. Seizures :
• 2/3 rds of CP
• Manage ABC
• Initiate RX – BDZ
* Special considerations
- Ample history important
- Drug interactions – multiple drugs
- Early expert involvement
- Avoid dextrose in refractory seizures on
ketogenic diet

9. 2. Respiratory complications:
• Common – restrictive lung disease, pneumonia
congestion , recurrent aspiration
• Coz of:
Oral motor dysfunction
GER
Neuromuscular compromise
Scoliosis
* Low respiratory reserve volume
• Early initiation of Rx,Ix and low threshold for
admission

10. 3. GI complications:
• Dehydration – poor intake , increased losses
• Infections
• Constipation and overflow diarrhea
*Retarded growth with marginal reserves
*Feeding tube complications
• Early fluid replacement
• Avoid multiple enemas , mineral oils
• Early gastro consultation

11. 4.Musculoskeletol complications:
• Secondary to disuse and nutritionally induced
osteopenia
• Frequent falls
• Keep low threshold for #s in trivial injuries
especially in non verbal , irritable and retarded
child
• Check for cutaneous complications coz of
orthopaedic braces
• Early pain Mx, splinting ,expert consultation.

12. So as in other disorders too..
• Meningo myelocele
• Neural tube defects
• TBI and spinal cord injury
• Autism
• Mental retardation
• Downs babies

13. TECHNO KIDS
• Technology dependent children:
Needs extra support / medical devices to
compensate lost vital functions of the body along
with the nursing care
1.Ventilation
2.Tracheostomy
3.Feeding tube and gastrostomy tubes
4.CSF shunts
5.Urinary shunts and tubes

14. Give a plan..
EMERGENCY CARE PLAN and GO-BAG
• Written document/plan contains
- Child’s disease , condition and status
- Special equipments and needs
- Medications
- Information about parents , caretakers,
primary physicians etc..
• Access to all care givers and with patient

15. Autonomic dysreflexia
• Serious ,life threatening condition
• Associated with cord injuries proximal to mid
thoracic levels
• Hyperactivity of Sympathetic and
Parasympathetic systems
• Initiated by stimuli below the level of the lesion
like bladder over distension , fecal impaction,
fractures..

16. C/F:
• Sweating, flushing, piloerection, pounding head
ache
• Hypertension, bradycardia
Rx:
• Treat the primary cause
• Relieve the pain
• Treat as hypertensive emergency if not
responding

17. Take home
• Recognise the child with special health care needs
• Anticipate life threatening issues
• Early intervention
• Keep low threshold for investigations and admission
• Always take expert advise for this special children

18. • Check the tubes and positions and associated
complications and other supportive equipment
• Fully involve family and caregivers and take
complete information about medications ,
allergies and equipment sizes and their
conditions
• Double check dosages and weight of child
• Always examine p/o , p/r and p/v

19. Please mind
• This special debilitated child might be precious
child…

20. THANK YOU