Infections, which are often quite fulminant at the time of diagnosis, are frequent in the developmentally disabled population. Mentally retarded individuals frequently have oral-motor dyspraxias that result in frequent tracheal aspirations. Aspiration is also more common in individuals with esophageal reflux and with tube feedings. Urinary tract infections are common. An increased incidence of neurogenic bladder, limited mobility, and poor hygiene all contribute to this increase. Because individuals may initially not recognize or describe dysuria, they are at greater risk for pyelonephritis. With a history of repeated urinary tract infections, it is important to exclude congenital malformations of the urinary system. Skin infections are also frequent. In low functioning individuals, these most commonly occur over pressure points or in the skin folds of the genital and anal regions. Poor mobility and hygiene contribute significantly. In higher functioning individuals, skin infections may be a consequence of repeated biting or scratching or the insertion of foreign objects under the skin. Finally, 16 percent of mentally retarded individuals had severe periodontal disease as compared to 3 percent of controls.17 It is likely that both poor hygiene and anticonvulsant use contribute to this finding.
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