Evaluating The Handicapped Or Disabled Child

Cheryl H. Hack CerebraLPalsy

Seizures

PulmonaryProblems Drooling GrowthFailure Dehydration

Constipation

Enuresis

Sensory Problems

Spasticlty^Management, and .Contractures Fractures

Scpliosis

Meni.ngomyelocele,,i(.Myel.omeningocele) Hydrocephalus

Urinary „Tract,, Problems

Ch.iari,, IInMalformation Spinal, nCprdn,TethleriMng Skin,,Problems Bowel, „Problems Sexual, Abuse

LatexAllergy

Fractures

RespiratoryTraM Problems Spinal ..Cord,.Iniu.!!Y

Pain

HeterotopicBone ..Formation

Respiratory Dysfunction

Psychiatric, and.Psyc.hplogical Problems

Developmental Disability, (Mental Retardation) Pulmonary,, Problems

Gastrolespphagea|.l „Reflux

Seizures

Psychiatric, and „BeMvipral.Eroblems Down„Syndrome

F.r3.g.lle..lX..S.y.n.d,.rp.m,e prader-W||l|ninSyndlrome

Williams ..Syndrome

RettSyndrome Chapter, References

There are about 7 million children in the United States who have conditions that impair their ability to function physically or mentally. Some disabilities and handicaps may be medically distinct and self-limited, such as limb deformities, hearing impairments, or spastic diplegia. Others are multidimensional, consisting of multiple medical problems such as meningomyelocele or severe mental impairment with associated severe cerebral palsy. Impaired neurologic functioning, orthopedic deformity, and chronic illness with multiple system involvement result in complex medical problems and greater likelihood that an individual will encounter difficulties and require emergency evaluation and treatment. Caring for handicapped or disabled children in the emergency department (ED) can be a difficult task due to complex ongoing medical problems, limited historical information, altered baseline functioning, and/or the need for the emergency physician to consider the impact of interventions on the course of the underlying disability or impairment.

Evaluating the child with handicapping or disabling conditions in the ED requires more time. Patience in obtaining a good history will assist the physician in decision making. Knowledge of specific medical problems associated with various handicapping or disabling conditions will help to focus the history and examination. Identification of management issues will allow the physician to design interventions that benefit the child and the family in both the long and short term.

Obtaining a medical history in the ED can be difficult, even with a normally healthy child. Obtaining a medical history in a disabled or handicapped child provides even more challenges. A medical condition of importance may not be reported because it is under treatment and is not currently creating any difficulty for the individual (e.g., neurogenic bowel or bladder). Information regarding the use of assistive devices such as braces, hearing aids, glasses, or prosthetics may not be offered because the family does not realize that this may give the physician information needed for making treatment decisions. Directed questioning may be necessary to avoid difficulties.

While obtaining the medical history, attempt to identify all existing medical conditions. Medications currently being used can be helpful in this task. A list of medications commonly used in cerebral palsy is given in Table 134-1. Information regarding the use of assistive devices may be important in management issues. Ask specifically about bracing, hearing aids, glasses, and use of suppositories and enemas. Hearing aids in a child with external otitis media or perforated tympanic membrane must be a consideration. Braces or night splints must be considered when lacerations or skin lesions are present. Children with complex medical problems may receive a variety of medical procedures in the home setting, including suctioning, nebulizer treatments, chest percussion and drainage, clean intermittent catheterization, and fecal disimpactions. Knowledge of these home-based procedures will help in making decisions regarding hospitalization and/or further home treatment. Associated medical conditions may have an impact on development of a differential diagnosis. By using information from the medical conditions associated with individual disorders described below, the physician can better guide questioning regarding associated medical problems.

TABLE 134-1 Medications Commonly Used for Spasticity

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