Care of Handicapped Child

8/2/2019 Care of Handicapped Child

1/28

PRESENTED BYvirendra S Shekhawat

CKRD memorial nursing collagejhunjhunu

CARE OF THE HANDICAPPED

CHILD


2/28

INTRODUCTION

The term handicapped is onewho deviates from normal healthstatus either physically, mentally

or socially and requires specialcare, treatment and education.


3/28

CONCEPT OF DISABILITY

According to WHO, the sequence ofevents leading to disability andhandicapped conditions are asfollows:

Injury or disease ImpairmentDisability

Handicap


4/28

Cont..,Handicapping conditions in general, including

(1) chronic illness any illness with a protracted course

that can be progressive and fatal or one that is associatedwith a relatively normal life span despite impaired

physical or mental functioning

(2) permanent loss of a physical or sensory ability

(3) developmental disability any disability that is attributable tomental retardation, cerebral palsy, epilepsy, autism, dyslexia, orany other condition related to mental retardation; thatoriginates before age 18 years and has continued to be or can beexpected to continue indefinitely; and that constitutes asubstantial handicap to the ability to function normally in societyand

(4) multiple handicaps the presence of more than onehandicapping condition.


5/28

SCOPE OF PROBLEMIt is estimated that as many as 10% to 15% of all

children under 18 years of age have some type ofchronic illness, including sensory impairments.

Clearly nurses have a more crucial role than everbefore in early screening, case finding,

assessment, and diagnostic studies.Another major responsibility is preventing

further handicapping conditions by assuring immunization programs,

identifying infants and mothers who may be at riskprenatally or postnatally,

identifying the disability early, and

implementing innovative health education programs


6/28

AT RISK CONDITIONS FOR HANDICAPS IN INFANTS

Maternal factors Infant factors

History of infertility

History of abortions (3 times)

Previous delivery stillborn orsuffered neonatal death

Previous premature delivery

Previous delivery of infant withcongenital defects

Weight gain during pregnancy less

than 4.5 kg

Threatened abortion in first orsecond trimester

Premature labor

Fetal distress, meconium-stained ileus

Prematurity or postmaturity

Low gestational weight

Congenital defects

Apgar score of or below at 1 or 5 mins

Addiction withdrawal symptoms

Hypoglycemia requiring treatment

Seizures

Use of oxygen at greater than 40%concentration for more than 24 hrs

Recognized viral syndromes


7/28

Cont..,Maternal factors Infant factors

Prolonged rupture of membranes(more than 20 hours)

Cesarean section

Abruption placentae

Cord prolapse

Fetal distress (decreasing fetal hearttones)

Multiple birth

Breech birth

Preeclampsia-eclampsia

Recognized bacterial, protozoan, orfungal infections

Bilirubin level 15 mg/100 ml or abovein premature or low gestational weightinfants

Bilirubin level 20 mg/100 ml or abovein full term infants

Metabolic disease

Drug depression

Resuscitation needed for more than 2minutes

Chromosomal anomaly


8/28

CHANGING TRENDS IN CAREAmerican society has passed through three stages

in providing services to handicapped children.

The first stage of which is forget and hide.The parents and family were encouraged to place

the handicapped child in an institution or send himaway to relatives.

Persons were oriented to an out of sight-out ofmind philosophy in order to cope with differences.

Negative attitudes prevailed, and handicappedpersons were neglected.

Many constitutional rights were abused or violated.


9/28

Cont.., The second phase is described as screen and

segregate. During the years following world war II, special

classes for handicapped children were offered byspecially trained personnel.

Many believe that this was a subtle way ofsegregating handicapped children from regularteachers and classrooms.

The present stage is referred to as identify andhelpIt is characterized by finding children in need of

services at the earliest possible age and beginning

treatment.


10/28

FAMILIES OF HANDICAPPED CHILDRENIMPACT OF DIAGNOSIS:

Many of the reactions of parents to the birth of adefective child are observed when the diagnosis of ahandicapping condition is made later in life.

The parents have, in a sense, lost the perfect childthey had and now have to adjust to a child with adisability.

The parents need the opportunity to mourn the loss

of the perfect child before they can adjust to and fullyaccept a child who is handicapped.

This period varies with each parent but usuallyproceeds through the following stages.


11/28

REACTIONS TO DIAGNOSIS

DISINTEGRATIONDENIAL

ACCEPTANCE

DENIAL

REJECTION

OVERPROTECTION


12/28

I. Shock

It is a period of intense emotion.

It may be accompanied bydenial, especially if thehandicap is not obvious, such as in chronic

illness.

If the defect is highly obvious and overwhelming,

such as the loss of eyesight or a limb, this periodmay be characterized bydisintegration, becausethe emotional development for dealing with thediagnosis leave no reserve for dealing with

realistic problems.


13/28

II. AdjustmentAdjustments soon follows shock and is usually

characterized by an open admission that the handicap

exists. This stage is one ofchronic sorrow and onlypartial acceptance.

This period is manifest by several responses, probablythe most universal of which are guilt and self-

accusation.Other common reactions arebitterness or anger

because the child is an obstacle interfering withparental goals and envytoward those who are notburdened with a handicapped child.

Because the real reason for such feelings is usuallyunacceptable to parents, the emotions may beredirected toward others, such as health professionals,for not curing their child.


14/28

TYPICAL PARENTAL REACTIONS

in which parents anticipate social rejection,pity, or ridicule and related loss of social prestigeand may experience social withdrawal

in which parents perceive a defect in theirchild as a defect in themselves;

their life goals may be abruptly anddramatically altered, andthey lose the fantasy of immortality throughtheir child

in which the simultaneous experience of loveand hatred normally experienced by parentstoward their children

1.Loss of self esteem

2.Shame

3.Ambivalence


15/28

TYPICAL PARENTAL REACTIONS

in which parents adopt a martyr attitude andfocus their total interest on the child with mentalretardation, often to the detriment of otherfamily members

in which parents experience chronic feelings ofsorrow as a nonneurotic reaction to having a

retarded child;to some parents MR symbolizes the childsdeath and therefore precipitates a grief reaction

in which parents become acutely sensitive toimplied criticism of their retarded child and

may react with resentment and belligerence, or they may deny the existence of MR and seekprofessional opinions to substantiate their own

belief that there is really nothing wrong with

him.

4.Depression

5.Self-sacrifice

6.Defensiveness


16/28

The period of readjustment

in which the parents detach themselvesemotionally from the child but usually provideadequate physical care or constantly nag and

scold the child

in which the parents fear letting the child achieveany new skill, avoid all discipline, and cater to

every desire to prevent frustration

in which parents act as if the handicap does notexist or attempt to have the child overcompensate

for it

1.Overprotection orthe benevolentoverreaction

2.Rejection

3.Denial

in which parents place necessary and realisticrestrictions on the child, encourage self-careactivities, and promote reasonable physical and

social abilities.

4.Gradual acceptance


17/28

III. Reintegration and acceptance

The last stage is characterized by realisticexpectations for the child and reintegration offamily life with the handicap in properperspective.

Since a large portion of the adjustment phase isone of grief for a loss, total resolution is notpossible until the child dies.

Therefore, one can regard adjustment to chronicsorrow as increased comfortableness witheveryday living.


18/28

It is also one of social reintegration in which thefamily broadens its activities to includerelationships outside of the home with thehandicapped child as an acceptable and

participating member of the group.

This last criterion often differentiates thereaction of gradual acceptance during theadjustment period from total acceptance.


19/28

IV. Freezing-out phase

Not all families reach the stage of acceptance andreintegration.

However, if strategies of coping cannot beemployed to minimize the stress and

disorganization of maintaining the child withinthe home to tolerable levels, the handicappedchild may be permanently eliminated by placinghim outside the home in some type of residential

setting, usually institutionalization.


20/28

EFFECTS ON FAMILY MEMBERS

Each family who has a child with a handicapcomprises a handicapped family.

No one member remains uninvolved or

unaffected by the experience.

The childs and siblings reactions are usually

direct consequences of the parents responses.


21/28

PARENTS

Parenting handicapped children may be a series of

unrewarding experiences, which continually support theparents feelings of inadequacy and failure.

Parents mayhave excessive demands placed on their time,energy, and financial resources.

Each partner may displace feelings ofresentment, anger, andbitterness on the other for having their life-style disrupted bythe childs handicap, unaware of the true reason for suchfeelings. For example, a mother who is forced to terminate acareer in order to assume full-time child care may express

her feelings of resentment and bitterness as anger toward herhusband for not sharing more in the house-hold chores.

Reports indicate that divorce and suicide rates are higher infamilies with a handicapped child than in the generalpopulation.


22/28

SIBLINGS

Siblings are deeply affectedby the handicapped childsmembership in the family.

Frequently the developmentally disabled child causes arevision of age and sex roleswithin the family.

For example, if the retarded child is firstborn, hebecomes the youngestby virtue of his developmental

age. Conversely the second-born becomes the oldest,often shouldering adult-like responsibilities andachieving parental expectations that would have been

reserved for the eldest.


23/28

Reactions of siblings to a mentally retarded childdiffer.

In one study about half the siblings reported that theybenefited from the experience, about half believed thatthey were harmed, and a minorityfelt unaffected.

In the investigators opinions those siblingswho hadbenefited had a greater understanding of people,

showed more compassion,

were more sensitive about prejudice and its consequences,and

had more appreciation of their peers who had not had theexperience of growing up with a mentally retarded sibling.


24/28

In contrast the siblings,who were judged to be harmedexhibited shame about their handicapped sibling and guilt about

their feelings,

conveyed a sense of guilt about their own good health,

felt neglected by their parents, and believed that the handicapped child had negatively affected

the rest of the family.

HANDICAPPED CHILD


25/28

HANDICAPPED CHILDThe childs reaction to his handicap depends to a great

extent

on the reactions of significant others to him and to hisdisability,

the childs developmental and his available copyingmechanisms, and,

to a lesser extent, the handicap itself.

The well-adapted child slowly learns to accept hisphysical limitations but finds achievement in a varietyof compensatory motor and intellectual pursuits. He

functions well at home, at school, and with peers.

He has an understanding of his disorder that allowshim to accept his limitations, assume responsibility for

care, and assist in treatment and rehabilitation


26/28

The well-adjusted handicapped person displays pride andself-confidence in his ability to master a productive,successful life despite the disability.

When a child experiences a serious disability, he proceedsthrough three predictable stages.

The first is immediate withdrawal in which the child becomesdepressed and nonresponsive.

The second is preoccupation with self, in which the child focuseson his disability and loss of previous abilities.

The third is a gradual return to reality, which is closely linked tothe parents ability to adjust to the handicap. Response to loss ofa body function and/or part is manifest in grief responses, no,

not me (denial), why me?(anger), and yes me (depression).

CHILD WITH CHRONIC ILLNESS


27/28

CHILD WITH CHRONIC ILLNESSChildren with serious respiratory disorders commonly harbor

fears of suffocation, drowning, or dying while asleep.

Children with convulsive disorders frequentlyfear loss ofconsciousness or uncontrollable strange behavior. They may resistobtaining a drivers license for fear of a seizure, which prolongstheir dependency on their parents.

Children withbleeding disorders mayfear hemorrhaging to deathand may resist medical procedures, such as injections, for fear ofinitiating such an episode.

Children with chronic renal disease often have frighteningfantasies about hemodialysis, such as fears of bleeding to death orof the machine assuming control of them. After kidney transplantparents may overprotect them and use possible graft rejection as ameans of controlling their activity. If an actual rejection occurs, the

child may respond with depression, withdrawal, and self-blame forhaving destroyed the kidney.


28/28

EXTENDED MEMBERSExtended members include two groups of people who

experience the effects of a handicapped child:

(1) the significance nonnuclear family members or friends, and

(2) society as a whole.

Although extended family relationships are oftenhelpful to parents in rearing a handicapped child, theymay also be sources of stress.

Documents

Care of Handicapped Child