This document provides information on physically, mentally, and socially challenged children. It begins with definitions of handicapped children and classifications including physical (blind, deaf, crippled), mental (mental retardation, cerebral palsy), and social (orphans, neglected children, children of divorce). It describes common problems faced and treatments for each group. The document aims to provide in-depth knowledge of challenges faced by these children and how to apply this in clinical settings.

1. PHYSICALLY,MENTALLY
&SOCIALLYCHALLANGED CHILDREN
Guided by;
Mrs grace mane hod
child health nursing
Ine Mumbai
PRESENTATION BY;
MS CHARUTA KUNJEER
FINAL YEAR MSC STUDENT
INE MUMBAI

2.  AIM:
At the end of the seminar the students will be able to gain
in-depth knowledge related to physically mentally
socially challenged children and will be able to apply in
various clinical settings.

3. Objectives:
The students will be able to:
 Define handicapped children.
 Know the classification of handicapped children.
 List the problems faced by handicapped children.
 Explain about the concept of physically handicapped children.
 Explain about the concept of mentally handicapped children.
 Explain about the concept of socially handicapped children.
 Describe the treatment modalities.
 Explain about the prevention of handicapped children.

4. HANDICAPPED CHILDREN
Handicapped child is one
who deviates from normal
health status either
physically, mentally or
socially and requires
special care, treatment and
education.

5. DEFINITION
According to WHO, the sequence of events leading to
disability and handicapped conditions are as follows
Injury or disease
Impairment,
Disability,
Handicap

6. CLASSIFICATION OF
HANDICAPPED CHILDREN
Physically handicapped
Mentally handicapped
Social handicapped

7. PHYSICALLY
HANDICAPPED
CHILDREN

8. BLIND
DEAF
DUMB
CRIPLLED
CHILD

9. BLINDNESS
According to WHO the inability to count fingers in
day light from a distance of 3 meters is defined as
blindness.

10. PROBLEM FACED BY BLIND
CHILD
⚫Problem of attachment
⚫Unable to use hand as organ of
perception
⚫Problem on locomotion
⚫Dependence on parents and caregiver
⚫Behavioral problems
⚫Less social interaction
⚫Less playing activity

11. Prevention Of
Blindness
⚫Provide good antenatal care
⚫Immunization – meseals,
rubella
⚫Genetic counseling and screening
⚫Prevent infection
⚫Prevent pre term birth and
⚫provide excellent neonatal
care to prevent blindness.

12. ⚫VitaminAsupplement
⚫Health education about eye safety,
personal hygiene and nutrition for
health promotion
⚫Treatment of causes of
childhood blindness
⚫Retinopathy of
prematurity (ROP)
⚫Cataract
⚫Glaucoma

13. Management
⚫Physiotherapy
⚫Orientation and mobility
instructors
⚫Mobility aid and guides
⚫BRAIL technology

14. DEAFNESS
A person who is not able
as well as
with normal
to hear
someone
hearing .
It can affect
one ear or both ears, and
leads to difficulty in
hearing conversational
speech or loud sounds

15. LEVELS OF HEARING
IMPAIRMENT
Mild deafness
25 to 39dB
Moderate deafness
40 to 69dB
Severe deafness - 70 to
89dB.
Profound deafness - 90dB <

16. IMPACT OF HEARING LOSS
Functional impact
Poor Academic Performance
Social and emotional impact
Economic impact

17. MANAGEMENT
⚫Sign language
⚫Hearing devices -
hearing aids, assistive
listening devices and
cochlear implants.
⚫lip-reading skills
⚫Speech therapy-
⚫use of written or
printed text

18. SPEECH HANDICAPPED
⚫Means an impairment of
Speech or
production,
sound
fluency,
voice or language which
affects a
educational
significantly
child’s
performance
social, emotional,
or their
vocational development.

19. TYPE OF SPEECH
IMPAIRMENT
Articulatio
n disorder
Fluency
disorder
stuttering
Voice
disorder
Aphonia
Langua
ge
disorder

20. IMPACT OF SPEECH IMPAIRMENT
⚫Poor Communication skill
⚫Less social interactions
⚫Behavioral problem - children
may feel shame,
embarrassment, frustration,
anger, and depression as a result
of speech impairments.
⚫Poor academic performance

21. MANAGEMENT
⚫Early identification of speech
impairment
⚫Elimination of hearing impairment
⚫Medical and surgical intervention for
underlying causes
⚫Psychological counseling
⚫Avoid making fun of their voice or
speech
⚫Voice or Speech therapy
⚫Physical therapy
⚫Cognitive rehabilitation

22. ORTHOPEDICALLY
HANDICAPPED
⚫Orthopedic disability occur when
movements in over body are affected
due to disease, injury, any absence
or deformities in the joints, bones,
muscles or an injury in nervous
system
⚫Loco motor disability means
disability of the bones, joints or
muscles leading to substantial
restriction of the movement of the
limbs

23. MANAGEMENT
⚫Correction Of
Deformities
⚫Physical Therapy
⚫Occupational Therapy
⚫Massage Therapy
⚫Prosthetics
⚫devices for positioning
and mobility

24. DEVICES FOR POSITIONING AND
MOBILITY
⚫Canes
⚫Walkers
⚫Crutches
⚫Wheelchairs
⚫Specialized exercise
equipment
⚫Specialized chairs, desks, and
tables for proper posture
development

26. MENTAL HANDICAPPED
⚫A mental handicap is an
in an
ability to
impairment
individual's
function cognitively,
emotionally or physically due
to the presence of a
psychiatric condition. This
hinders
condition
someone's
perform
ability to
a task or
prevents that person from
engaging in an activity
without assistance.

27. Mentally
handicap
children includ
MENTAL
RETARDATIO
N
CEREBRAL
PALSY

28. MENTAL RETARDATION
Mental retardation is defined as
significantly sub average
general intellectual functioning,
resulting in association with
concurrent impairment in
adaptive behaviour, which then
manifests during developmental
period.
(American association on
mental deficiency)

29. MENTALRETARDATION
LEVEL
Mild - 50-
70*
Moderate
- 35-50*
Severe -
20-35*
Profound
<20

30. EFFECT ON CHILDREN
⚫Failure to achieve developmental
milestones.
⚫Deficiencies in cognitive
functioning such as inability to
learn or to meet academic
demands.
⚫Expressive or receptive language
problems.

31. ⚫Psychomotor skill deficits.
⚫Difficulty performing self care
activities.
⚫Neurologic impairments.
⚫Medical problems, such as
seizures.
⚫Low self esteem depression
and labile moods.
⚫Irritability when frustrated or
upset.
⚫Lack of curiosity

32. TREATMENT MODALITIES
⚫Behavior management.
⚫Environment supervision
⚫Monitoring the child’s developmental needs and
problems.
⚫Programs that maximum speech , language,
cognitive, psychomotor, social , self care, and
occupational skills.
⚫Family therapy
⚫Early intervention programs for children younger
than age 3 with mental retardation.
⚫Provide day schools to train the child in basic skills,
such as bathing and feeding.

33. CEREBRAL PALSY
⚫It is a disability that
affects ability to control
muscles caused by
damage to the brain
brain is
while the
developing.

34. EFFECTS OF CEREBRAL PALSY
⚫Abnormal Muscle Tone
⚫Abnormal movements
⚫Skeletal deformities
⚫Seizures
⚫Speech problems
⚫Swallowing problems
⚫Hearing loss:
⚫Vision problems
⚫Dental problems
⚫Bowel and/or bladder control
problems

35. Possible signs in a child include:
• Delays in reaching development milestones – for
example, not sitting by 8 months or not walking by 18
months.
• Seeming too stiff or too floppy (hypotonia)
• Weak arms or legs.
• Fidgety, jerky or clumsy movements.
• Random, uncontrolled movements.
• Muscle spasms.
• Shaking hands (tremors)

36. Possible causes include:
• Head injuries as a result of a car accident, fall, or child
abuse
• Intracranial hemorrhage, or bleeding into the brain
• Brain infections, such as encephalitis and meningitis
• Infections acquired in the womb, such as german measles
(rubella) and herpes simplex
• Asphyxia neonatorum, or a lack of oxygen to the brain
during labor and delivery
• Gene mutations that result in atypical brain development
• Severe jaundice in the infant

37. Cerebral palsy risk factors
 Certain factors put babies at an increased risk for cerebral palsy.
These include:
• Premature birth
• Low birth weight
• A low apgar score, which is used to assess a baby’s physical health
at birth
• Breech birth, which occurs when a baby’s buttocks or feet come out
first
• Rh incompatibility, which occurs when the pregnant parent’s blood
rh type is incompatible with their baby’s blood rh type
• The pregnant parent’s exposure to toxic substances, such as illegal
drugs, or medications that damage the fetus
• Being a twin or triplet

38. DIAGNOSIS
• PHYSICAL EXAMINATION
• Electroencephalogram (EEG). An EEG is used to evaluate
electrical activity in the brain. A doctor may order it when
someone is showing signs of epilepsy, a primary cause of
seizures.
• MRI. An MRI uses powerful magnets and radio waves to
produce detailed images of the brain. A healthcare professional
may perform an MRI in order to identify brain irregularities or
injuries.

39. • CT scan. A CT scan creates clear, cross-sectional images
of the brain. It can also reveal brain damage.
• Ultrasound. A cranial ultrasound is a method of using
high-frequency sound waves to get basic images of a
young infant’s brain. It’s relatively quick and
inexpensive.
• Blood tests. A healthcare professional may take and test a
sample of blood in order to rule out other possible
conditions, such as bleeding disorders.

40. TREATMENT
 Treatment for cerebral palsy include:
• Speech therapy
• Occupational therapy
• Physical therapy
• Recreational therapy
• Counseling or psychotherapy
• Social services consultations

41. SOCIALLY
CHALLENGED
CHILDREN

42. SOCIALLY CHALLENGED CHILDREN
⚫A Socially handicapped children may be defined as a
child whose opportunity for a healthy personality
development and full unfolding of potentialities are
hampered certain elements in his social environment
such as parental inadequacy, environmental deprivation,
(lack of learningopportunity) and emotional disturbance

43. CATEGORY OF SOCIALLY
HANDICAPPED CHILDREN
⚫Orphan
⚫Neglected children
⚫Children of divorce or step parents
⚫Delinquent children

44. ORPHAN CHILDREN
An orphan is a child
permanently bereaved of or
abandoned his or her parents.
a child lost both parents is
called orphan does not have
any surviving parents to care
for him or her

45. PROBLEM ASSOCIATED WITH ORPHANS
⚫Developmental
retardation
⚫Conduct and sleep
problem
⚫Personality problem
⚫Bed wetting
⚫Disturbance in eating
⚫Depression
During adulthood
⚫Antisocial problem
⚫Drug addiction
⚫Alcoholism
⚫Marital problem

46. CHILD NEGLECT
and attention to a child's needs,
including food and a safe
environment, or to a child's
emotional needs including
warmth, security and love. A
lack of these things are likely
to result in serious damage to
children health.
ongoing
provide the
failure
right
⚫Child neglect is an
to
care

47. TYPES OF CHILD NEGLECT

48. ⚫Parental mental health problems such
as depression
⚫Unstable and abusive relationships between
parents
⚫Parental history and learned parental behavior
⚫Lack of knowledge of children's needs,
⚫ An inability to plan, lack of confidence about the
future,

49. ⚫Being a teenage
mother,
⚫Alcohol and drug
abuse in care-givers
⚫Unemployment
⚫Poverty
⚫A large number of
children,
⚫High levels of stress
⚫Domestic violence

50. CONSEQUENCES OF NEGLECT
⚫Developmental delays-
socialize
⚫Delayed physical and
mental growth,
⚫Neurological impairments.
⚫Poor social skills,
⚫Experience extended
poverty or unemployment
⚫Face chronic illnesses or
early death.
⚫Cognitive deficits,

51. ⚫Emotional development
problems
⚫Unusual fussiness, fear, or
⚫Lack of interest in activities.
⚫Being anxious or avoiding
people
⚫Difficulty in making friends
⚫Being withdrawn.
⚫The effects on behavioral
development
⚫Anti-social behavior
⚫Early sexual activity

52. ⚫Poor mental health, such as exhibiting low self-
esteem, anxiety, depression, or suicidal tendencies.
⚫Insecure-anxious attachment.
⚫Attachment difficulties and difficulty in
formation of relationships in the future
⚫Affects intellectual ability and cognitive/ Sudden
decline in academic performance.
⚫Anxiety or impulse-control

53. ⚫Failure to thrive”
⚫Obviously unhealthy
⚫Dirty or have poor personal hygiene or
Inadequately clothed.
⚫The effects may last into adulthood and may cause a
person to neglect their own children later in life.

54. Management
For parents
⚫Treatment for
⚫Substance abuse.
⚫Depression or other mental health problems.
⚫Low self-esteem
⚫Violent behavior
⚫Realize responsibility regarding child
⚫Educating and helping parents to correct their erroneous
thinking and behavior or parenting skill

55. Cont….
For child
⚫Child-centered interventions include
⚫Pediatric care, mentoring
⚫Behavioral and mental health treatment.
⚫Provide stimulation programme to emotionally
neglected child
⚫Develop timely and comprehensive assessments or
placed in foster home

56. CHILDREN OF DIVORCED OR SEPRATED
PARENTS
always
even
affects
adult
⚫A divorce
children,
children, and divorce is
almost always stressful for
children. And
contact with
lead to lost
one parent,
create economic hardships,
and increase conflict
between
these
parents For all
reasons, most
children have a hard time
during the divorce transition.

57. EFFECTS OF DIVORCE OR
SEPERATION ON CHILDREN
Infants
⚫Loss of appetite.
⚫Upset stomach — may spit up more. More fretful
or anxious.
Toddlers
⚫More crying
⚫Sleeping Problem
⚫May feel anger
⚫May worry when parent is out of sight.
⚫May withdraw, bite or be irritable.
⚫Temper tantrums

58. Preschoolers
⚫Feels uncertain about the future.
⚫May feel responsible.
⚫May hold anger inside.
⚫May become aggressive and angry toward parent he/she
lives with.
⚫May have more nightmares.
⚫Experiences feelings of grief because of sudden absence of
parent.

59. Cont….
Early elementary
⚫Feels unfaithful and feels a sense of loss.
⚫Feels rejected by the parent who left.
⚫Ignores school and friendships.
⚫Worries about the future.
⚫Complains of headaches or stomachaches.
⚫Experiences loss of appetite, sleep problems, diarrhea,
urinary frequency.
⚫Learning problem in school

60. Cont….
teenagers and adolescents
⚫Feels angry and disillusioned.
⚫Feels abandoned, that parent is leaving him/her not the
other spouse.
⚫Shows extreme behavior (good and bad).
⚫Involved in high-risk behaviors (drugs, shoplifting,
skipping school).
⚫Anti social behavior
⚫Drug or alcohol abuse
⚫Problem in maintaining relationship.
⚫Worries about financial matters.

61. MANAGEMENT
⚫Not expose child to conflict between parents
⚫Listen to child and provide emotional support
⚫Child should be reared to respect to both
parents
⚫Child should taught that both parents are nice
people but are separating because of they have
different views about life

62. PREVENTION
OFHANDICAPPED
CONDITION IN
CHILDREN

63. PRIMARY PREVENTION
⚫Genetic counseling
⚫Genetic screening
⚫Reduction of consanguineous
marriage
⚫Pregnancy planning
⚫Rh incompablity
⚫Immunization of mother and baby
⚫VitaminAprophylaxis
⚫Improve nutritional status of mother
and child

64. Cont….
⚫Prevention of iodine and folic acid
deficiency
⚫Provide essential care in prenatal,
Intranatal, postnatal period
⚫Prevent maternal and neonatal
infection
⚫Prevent birth injury, asphyxia,
hyperbilurubinemia
⚫Special care to high risk mother
–abortion, premature birth
⚫Encourage to kick bad habits such
as smoking or alcohol abuse.

65. SECONDARY PREVENTION
⚫Careful history
⚫Regular medical supervision and
developmental assessment
⚫Tereatment of particular
handicap condition
⚫Correction of deformity
⚫Physiotherapy and exercise to
improve physical condition
⚫Occupational therapy

66. Cont…
⚫Speech therapy to improve
communication ability
⚫Prosthetics
⚫Special care for mentally
handicapped children with
warmth , love , tolerance,
discipline, avoid criticism
⚫Counseling and guidance
⚫Referral for welfare
services

67. REHABILITATION OF HANDICAP
CHILDREN
⚫Medical rehabilitation
⚫Social rehabilitation
⚫Educational rehabilitation
⚫Psychological rehabilitation
⚫Vocational rehabilitation

68. WELFARE OF
HANDICAPPED
CHILDREN

69. WELFARE OF HANDICAPPED
CHILDREN
⚫Persons with disabilities bill (equal opportunity,
protection of right and full participation)-
1995,introduced by ministry of welfare and Govt of
India and it deal with preventive and promotional aspect
of rehabilitation
⚫Children Act 1960- provide for the care protection,
maintenance, welfare, education, and rehabilitation of
socially handicapped children.

70. Schemes for handicapped children
⚫Deendhyal disabled rehabilitation scheme
⚫Assistance to disabled person to purchase or
fitting of aids and appliance
⚫National handicapped finance and development
cooperation
⚫Scheme for implementation of person with
disabilities act 1995(sipda)
⚫Scheme for incentive to employees in the private
sector for providing employment to person with
disabilities

71. National institute for handicapped
⚫National institute for orthopedically handicapped
Calcutta
⚫National institute for mentally handicapped
Hyderabad
⚫Ali yavar Jung National institute for hearing
handicapped Mumbai
⚫National institute for rehabilitation, training, and
research Calcutta
⚫National Institute for visually handicapped new
Delhi and Dehradun

73. NURSING MANAGEMENT OF
HANDICAPPED CHILDREN
⚫Ineffective family coping and altered parenting
related to handicapped condition
⚫Anxiety of parents and family members
⚫Altered nutrition less than body requirement
⚫Potential for infection
⚫Self care deficient
⚫Communication impaired
⚫Physical mobility impaired

74. Cont…..
⚫Altered elimination pattern
⚫Activity intolerance
⚫Altered sleep pattern
⚫Sensory alteration, visual/ auditory
⚫Altered growth and development
⚫Diversional activity deficit
⚫Knowledge deficit to continued care of
handicapped children

75. Conclusion
⚫Handicap develops as the consequence of the
disability. It is defined as a disadvantage for a given
individual resulting from impairment or a disability
that limits and prevents the fulfillment of a role
which is normal for that individual, depending on
age, sex, social and cultural factors.

76. BIBLIOGRAPHY
 Paraul Datta, Pediatric Nursing, Second Edition, Jaypee
Publication, Page No.177-184
 R Sreevani , A Guide to Mental
Health and Psychiatric Nursing ; Edition, 4, Publisher, Jaypee
Brothers Medical
 Dorothy Marlow, Textbook Of Pediatric Nursing, South
Asian Edition ,Page No.
 Rimple Sharma’s, Essentials Of Pediatric Nursing, Second,
Page No.629-644
 Ghai Essentials Pediatrics, Ninth Edition, Cbs Publishers
And Distributors, Page No.
 Wongs, Essentials Of Pediatric Nursing, Eight
Edition,elsevier, Page No.554-559