Apraxia/Mute FACTS: Some children do not speak due to stress in their lives. Other children may have hearing loss or a tongue deformity.

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1 Apraxia/Mute Mutism is a lack of speech in children It can be due to hearing loss, mouth or tongue deformities, difficulty forming sounds or extreme stress as a result of trauma or anxiety. A child who does not speak or make sounds should have his or her hearing tested. The child should be checked to make sure he or she understands what is being said. Most children have normal intelligence and can learn; they just might not be able to speak. Children with normal intelligence may be unable to speak because of extreme stress or anxiety about their life situation. They may begin to speak after becoming comfortable and at ease in their surroundings. Some children do not speak due to stress in their lives. Other children may have hearing loss or a tongue deformity. 48

2 Apraxia/Mute TREATMENT: Have the child assessed by a doctor for problems with hearing or deformities of the mouth or tongue. Use pictures to help the child communicate. For example, make a picture board with drawings for every day needs, such as food, drink, bedtime, potty, etc. Encourage the child to watch as the caregiver forms the mouth, tongue and lips to make sounds. Check for tongue tie, which is when the stringy piece of tissue that connects the tongue to the bottom of the mouth is too tight to move the tongue to form words. Make sure the child can move his or her tongue from side to side and around the mouth. Can they lick their lips? Sweets may be used on the lips to test this. Teach the child to write. Use pictures to allow the child to express when they have to eat, go potty, etc. 49 Most of these children have normal intelligence.

3 Blindness Blindness may occur before birth as a result of the eye structures not developing properly in the womb, or immediately after birth as an result of infection, or later in life as a result of diseases such as glaucoma, cataracts, uncorrected crossed eyes or ptosis, eye injuries or infections. TREATMENT: Newborns may pick up an infection during birth and show signs of eye discharge. They should be seen by a doctor and treated with antibiotic ointment, which will prevent blindness. If a child has an eye discharge and possible infection, care must be taken not to spread the infection to the child s other eye or to other children. Use of one corner of a washcloth to bathe one eye and the other corner to wash the other eye may prevent spread of infection. Washcloths should not be shared with other children. Early treatment with antibiotics for eye infections will help prevent blindness from occurring. If an infant is unable to see due to drooping or crossed eyes, that child may lose the ability to see even though the eye structure is not damaged as a result of the brain not receiving information from the eye during the first years of life. Early diagnosis and treatment of glaucoma, crossed eyes, drooping eyelids and cataracts that obstruct sight will prevent blindness in these children. Many causes of blindness are preventable if early treatment occurs. 50

4 Blindness HELPFUL HINTS: Let a child smell and feel objects. The child is capable of learning about the world through their other senses. Talk to the child and let him or her know what you are doing. Describe the child s actions to them as they are doing them. Describe objects and what is happening around the child. Let the child explore. Different textures on clothing and blankets will provide the infant with stimulation as they use their sense of touch to explore. This is important for brain development. Playing with buttons and zippers on clothing teaches fine motor skills and independence. Music is important for brain development. Children with poor sight will greatly benefit from hearing music daily. A child may need time in a new environment just to sit and listen. Blind children learn by touch and hearing. Sit the infant upright in a chair and give objects to hold. This also stimulates brain development. Keep objects in the child s room in the same place. Place clothing, food and toys in the same place each day. Teach the child daily living skills. Try to give the child the least amount of assistance as possible so they may learn to do on their own. Most children like to be touched; it gives them reassurance. 51

5 Cataracts A cataract is a clouding area over the front part of the eye an area that is normally transparent. It can affect either one or both eyes. Some cataracts are small and do not cause any visual symptoms. Other times they can cause visual problems in children. Cataracts in children are uncommon. A child may be born with the disease or it may develop later in life. Cataracts may be caused by trauma, infection, diabetes, poisoning and from other eye diseases, such as glaucoma. Cataracts can affect one or both eyes. A cataract is a clouding of the front part of the eye. 52

6 Cataracts SYMPTOMS: The center of a child s eye might look cloudy or white, or like someone poured milk into the eye. The child might complain of feeling something scratchy in their eye. If an infant fails to show visual interest in the world around him, a cataract might be present. TREATMENT: Specific treatment for cataracts will be determined by a doctor. Eyeglasses can help vision loss. In some cases vision loss caused by a cataract may be aided by eyeglasses. Surgical removal of cataracts is often recommended in infants and children. This surgery must be done by a highly trained eye surgeon. 53

7 Cleft Lip/Palate Cleft lip or palate is not caused by something the mother or father did or did not do. In the normal course of development, structures simply do not close as is typical. Children with cleft lip/palate may have difficulty speaking clearly or may sound as if they are speaking through the nose. Children with cleft lip/palate may have difficulty eating. Food may come through the nose. Children with cleft lip/palate may have frequent middle ear infections and may tend to have dental cavities. TREATMENT: Cleft lip/palate may be surgically corrected. Middle ear infections should be treated by a physician. Speech therapy may help the child to speak more clearly. Good brushing of the teeth is very important. Cleft lip and palate can be surgically corrected. A child with a cleft lip and palate may develop ear infections. 54

8 Cleft Lip/Palate SPEECH: Reward a child for trying to speak. Look directly at the child when you speak so he may see how your lips and tongue move to produce sounds. Make sounds clear and precise. Practice simple words together. Play copycat games. For example, have the child imitate or copy what you say. Blow bubbles, whistles or horns. Hold a tissue and try to make it move by blowing. FEEDING/SWALLOWING: The child should be in an upright position. If food comes out of the nose, child should be seated upright, chin tucked toward chest, shoulders pulled forward The child should be fed thick foods (such as thicker congee) that is chilled or room temperature. A child should use a cup with a side cut out. The head should not tilt back to take sips. A specially designed bottle may be needed. If a special bottle is not available, use a squeezable bottle with an orthodontic nipple and cut a larger X hole. Help with speech may be needed. Babies should be burped frequently. Babies will take a longer period of time to feed. Twenty to thirty minutes to take a two to three ounce bottle is normal. A baby should be held upright when eating. 55 Babies may need to eat smaller amounts but feed more often such as early morning, mid-morning, lunch, mid-afternoon, early evening and later evening.

9 Deafness/Hearing Loss Hearing loss is often genetic. It may also be caused by the mother having an infection during pregnancy or the child having an illness with a very high fever. Frequent ear infections can also result in hearing loss. There is a range of hearing loss from mild hearing loss to total deafness. Most children with hearing loss have normal intelligence and can learn many things. Their learning of language will be delayed because they can t hear people talking. Children with hearing loss live normal, healthy lives. Deaf adults do many different jobs. I use my other senses to explore my world! Children with hearing loss are intelligent kids and can learn many things. 56

10 Deafness/Hearing Loss TREATMENT: Most hearing loss cannot be improved or cured directly. Children with hearing loss can sometimes benefit from hearing aids or a surgical treatment called cochlear implants. Children who are deaf may communicate using sign language. Children with hearing loss learn using their other senses, especially their vision. Use pictures and gestures to help the child understand and communicate. Show them what you want them to do and allow them to watch other children. Get the child s attention before speaking to him or her. Speak slowly and clearly. There is no need to shout. Children who are deaf can communicate with sign language. Deaf children benefit from early adoption. 57

11 Glaucoma Glaucoma is the build-up of pressure in the eye. Glaucoma may affect one or both eyes. Glaucoma seems to run in some families. Babies and children with glaucoma dislike bright lights and sunlight. The child may complain of headaches, strange lights or tunnels in his or her vision. Babies and children may have big eyes or one eye that is larger than the other. In some cases the clear front part of the eye may be cloudy. Babies and children will have excessive tearing. If any of these symptoms are present, see a doctor for an eye examination. Glaucoma is a condition where there is increased pressure in one or both eyes. 58

12 Glaucoma TREATMENT: The primary treatment for glaucoma is surgery. Surgical treatment has a high success rate. Drug therapy may also be used for treatment. Treatment can be most successful when done as early as possible. Early treatment will prevent blindness. Children with glaucoma need to have surgery as early as possible. 59

13 Hemifacial Microsomia Children with this condition usually have one side of the face smaller than the other; it can rarely occur on both sides of the face. The eye, jaw and ear on the smaller side can be affected. Children with hemifacial microsomia may have trouble hearing on the affected side. Sometimes children have weakness in the movement of the face on the affected side. There can be mild to severe cases. This is not a genetic or inherited disease but is usually caused by a problem during pregnancy with blood flow to the baby. Microsomia does not affect the intelligence of the child. Children with microsomia usually have one side of the face that is smaller than the other. Microsomia does not affect a child s intellience. 60

14 Hemifacial Microsomia TREATMENT: Sometimes hearing can be improved with surgery or with hearing aids. The appearance of the ear and jaw can be helped with surgery when the child is older. HELPFUL HINTS: A child may have trouble hearing when it is crowded or noisy. It may help to speak towards the good ear. If a child has difficulty hearing, try speaking toward his or her good ear. I am so beautiful! 61

15 Microtia and Atresia Microtia is when the outside part of the ear is not properly formed. Atresia is a condition when the opening to the ear is closed. The ear does not form properly when the baby is growing in the womb; it happens by chance. The child can have microtia, atresia or both. One or both ears may be affected. If the ear canal is closed, the hearing will be somewhat limited in that ear; but the child can still hear. Sometimes the child also has a cleft lip/ palate or other facial conditions. These children have normal intelligence and are healthy. Microtia and atresia are very manageable needs with no health or developmental problems. The ear canal is closed and the outer ear is small, folded or misshapen. 62

16 Microtia and Atresia TREATMENT: If the hearing is affected, surgery can open the ear canals. Cosmetic surgery can be performed to create a normal looking ear. Children with hearing loss can sometimes benefit from hearing aids or surgical treatment. Children with hearing loss learn using their other senses, especially vision. Use pictures and gestures to help the child understand and communicate. Show them what you want them to do and allow them to watch other children. Get the child s attention before speaking to him or her. Speak slowly and clearly but don t shout. This little girl has microtia, atresia and a cleft lip and palate. She is a real joy to her family! 63 Children with microtia and atresia have normal intelligence.

17 Missing Eye Children may be born with one underdeveloped eye or absent eye. In rare cases a baby may be born missing both eyes. It is important to have the child s vision assessed early (and every year) to ensure they have good vision in the one remaining eye. This condition occurs when the eye tissue does not form correctly, or the eye tissue is damaged during early pregnancy. It may occur as a single birth defect or with other birth defects. The child is permanently blind in one or both eyes. Children with vision in just one eye can lead active and normal lives. These children usually have normal intelligence. Children with missing eyes can lead normal lives and have a normal appearance with prosthetic eyes. 64

18 Missing Eye TREATMENT: The child may be fitted with an artificial eye, called a prosthetic, to allow a normal appearance and growth of the face. This typically does not require any surgery. It is important to have the child s vision in their normal eye checked and corrected with glasses if needed. The child should wear glasses (for eye protection) at all times to protect the one eye with vision to protect the remaining eye s vision. Glasses can help protect a child s good eye. HELPFUL HINTS: The child should be approached from the sighted eye side. Provide colorful and textured toys and blankets to stimulate brain development. It is important for children with poor vision to be able to touch objects and to also be touched frequently by the people and children around them. The child should be encouraged to use stairs, climb and be active to help develop good depth perception. 65

19 Nystagmus Nystagmus is any form of involuntary, rhythmic eye movement. It may occur in horizontal, vertical or semicircular paths. This occurs when a child s brain believes the body is rotating for some reason, causing the eyes to move to compensate for the body s movement. It is a fairly common condition. Nystagmus may be inherited. It usually is not present in newborns but develops in the first few months of life. In older children and adults, it is usually a temporary, non-progressive condition that stops spontaneously. Some side effects of this condition are involuntary head twitching, vision loss, some difficulty with coordination and/or inability to recognize a person that is not totally familiar. Nystagmus is a common condition affecting the eyes. Children with albinism often have nystagmus. 66

20 Nystagmus TREATMENT: There is no cure for nystagmus. If it does not stop on its own, it can be a lifelong condition. Nystagmus may be untreatable, but it does not have to stop a child from having a happy life. Eyewear can be used for less than perfect vision. Many times children with nystagmus learn to work around involuntary movements. Nystagmus can sometimes look scary to people, but understanding the condition helps care-givers interact as normally as possible with the children who have it. Most children with nystagmus can function and see well enough to read and to live an independent, normal life. Eyeglasses can help a child function more easily. I love my sister! 67 Occasionally nystagmus can be associated with more serious illnesses. A child with this disorder should see an eye doctor if possible. Encourage the child to use his eyes. Provide good lighting, large print books and big, bright, noisy, colored toys. Sometimes eyesight is improved in these children by using a different angle of vision.

21 Ptosis Ptosis is a condition in which one or both of a child s upper eyelids droop. It is caused by a poorly developed levator muscle (the muscle that lifts the eyelid upward). The eyelid may droop slightly or it may cover the pupil and impair sight. If children cannot easily see beyond their eyelids, they will often tilt the head backward in order to be able to better see. Sometimes they will wrinkle the forehead to lift the eyebrows upward to allow better vision. If the condition is severe, the child s sight may not develop properly and the child can develop lazy eye a condition where the brain only uses the images from the good eye. Most children with this condition have normal intelligence and functioning. If the condition interferes with sight, surgery is needed and can correct eyesight. Ptosis is a condition where a child s eyelid droops. Simple ptosis does not affect a child s intelligence. 68

22 Strabismus This condition can affect one or both eyes. Crossed eyes can be constant when the eye turns in, out, up or down all of the time or intermittent turning some of the time, such as under stressful conditions or when ill. It is important to have the child seen by an eye doctor. Children do not outgrow this condition. If not treated the brain will eventually disregard the input from the eye, leaving that eye functionally blind even if the eye is structurally fine. The brain can't reverse this, and sight in that eye can't be regained. Children with strabismus have normal intelligence. Children with strabismus should be seen by an eye doctor as soon as possible. Some people call strabismus crossed eyes. 70

23 Strabismus TREATMENT: All children should have an eye exam done by age three to check for vision problems. In some cases eyeglasses may be able to straighten the eyes. If the strabismus is present along with amblyopia (inability to see clearly with one eye), patching of the stronger eye is often helpful. If the eye doesn't respond to vision therapy, surgery may be needed. In some cases this restores normal vision; in other cases it just improves the physical appearance by realigning the eye. With early diagnosis the defect can usually be treated. With delayed treatment vision loss in one eye may become permanent. Eyeglasses can often help straighten the eyes. Parents love their children with strabismus. 71