Medically Fragile Children (Chapter 2)

Size: px

Start display at page:

Download "Medically Fragile Children (Chapter 2)"

Oscar Wesley Evans
6 years ago
Views:

1 Medically Fragile Children (Chapter 2) Birth to three programs classify children with delays as those who have either established risk or are at risk Established risk infants are those with Genetic disorders Neurological development disorders Metabolic disorders Sensory disorders Toxic exposure Chronic medical illness Infectious disease

2 Infants at risk are those exposed to both biological and environmental factors that pose a risk of delayed development if they do not receive intervention Some of these factors include: Teenage mothers Severe Prenatal/Perinatal complications Poverty Caregiver with drug/alcohol dependence, chronic illness, or mental retardation Infant Mortality Both established risk and at risk factors can cause prematurity and low birth weight, two risk factors highly correlated with infant mortality. Premature infant Low-birth weight Medical Complications Associated with these Infants 1. Respiratory Distress Syndrome (RDS) Pulmonary disorder characterized by deficiency in surfactant Surfactant is a fatty substance that lines the walls of the air sacs (alveoli) in the lungs Adequate surfactant by ~36 weeks

3 Signs/Symptoms: o Decreased respiratory efficiency o Poor suck, swallow, breath coordination Treatment Intubation (tube inserted into airway keeping lungs inflated with a ventilator) Continuous positive air pressure (CPAP) 2. Bronchopulmonary Dysplasia (BPD) Chronic lung disease caused by having premature lungs, and treatment involving being on a ventilator with high concentrations of O2 Signs/Symptoms: poor endurance, feeding problemsaspiration, stress cues (arching, hyperextension of extremities) 3. Necrotizing Entercolitis (NEC) GI disorder characterized by inflammation of the colon seen within 3-10 days of life Preemies have fragile bowels that are susceptible to infection Tx: Antibiotics, nasogastric tube placement, removal of the diseased portion of the colon

4 4. Intraventricular Hemorrhage Hemorrhagic lesions of cortex, cerebellum, brainstem caused by blood vessels breakage/or weakness as a result bleeding into the fluid-filled spaces of the brain Successful intervention is early detection via MRI Signs/Symptoms: Bradycardia (slowing of heart), Apnea (absence of breathing), lethargy, seizures ASSESSMENT Any activity that involves eliciting or observing samples of infant/toddler behaviors to make inferences about their developmental status Infant/Toddler Assessment Apgar Scoring System Criterion Color Blue-Pale Extremities Completely pink blue/rest of body pink Heart Rate Absent Below 100 Over 100 Respiratory Absent Weak/Irregular Good, Crying Effort Muscle Tone Limp Some flexion of extremities Active motion

5 Irritability (tested by catheter in nose) None Grimace Cough/Sneeze Direct Testing: Administering behavioral checklists or other standardized tests Observations: Usually conducted by an intervention team of specialists that may include: Social Worker, Pediatrician, OT, SLP, PT, Nurse, Early childhood specialist, etc. Play-based setting team approach focuses on: Examples of behaviors: Parental Report: Parents complete behavioral checklists appropriate for their child s chronological age (in months)

6 INTERVENTION Efficacy of an Early Intervention Program depends upon SLPs in the NICU (Neonatal Intensive Care Unit) Provide services to the 1. Child 2. Parents/caregivers 3. Other NICU staff members Make suggestions to modify the nursery environment to reduce environmental stressors

7 Encourage verbal and tactile stimulation from all caregivers including: Body stroking/massage Passive limb movements Oral motor stimulation Make recommendations for feeding: Soothing responses to infant s stress Developmental logs Parental Journals

8 Discharge Planning: SLPs in Home or Center-based Programs During the child s earliest stages of communication, intervention focuses on educating the parents about appropriate/beneficial ways to interact with their child: Slow rate of speech Shorter phrases be sure to include non-speech sounds BUT monitor your talking! Object-centered vocabulary Repeat adult/child utterances Use rituals or established routines to build child participation and responses Use facial expressions Use gestures with verbal input Turn-taking

9 Allow ample pause time for a response Goal of every activity is to elicit communication Keep an accurate tally of the number and variety of communicative attempts Incorporate the following activities into your therapy sessions Fine motor activities: Symbolic play: Pictures/Objects:

10 Books Songs Gross Motor: Temptations: Tactile/Visual Motor:

Guslihan Dasa Tjipta Division of Perinatology Department of Child Health Medical School University of Sumatera Utara

Guslihan Dasa Tjipta Division of Perinatology Department of Child Health Medical School University of Sumatera Utara 1 Definition Perinatal asphyxia is a fetus/newborn, due to: is an insult to the Lack