Challenged children are one who deviated from normal health status either physically, mentally or socially and requires special care, treatment and education. Definition Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” (McPherson,1998)

1. HANDICAPPED CHILDREN
By
Mr. Ravi Rai Dangi
Assistant Professor
MSc. Child Health Nursing

2. HANDICAPPED CHILDREN
Introduction
 Health is a state of complete physical, mental and
social wellbeing and not merely the absence of disease or
infirmity.

3.  Challenged children are one who deviated
from normal health status either physically,
mentally or socially and requires special care,
treatment and education.

4. Concept of Handicapped or
Challenged

5. According to WHO the sequence of events leading to
disability and handicapped OR challenged conditions are as
follows.

6. Definition
Children with special health care needs are those
who have or are at increased risk for a chronic physical,
developmental, behavioral, or emotional condition and
who also require health and related services of a type or
amount beyond that required by children generally.”
(McPherson,1998)

7. IMPAIRMENT
It is defining as any loss or abnormality of
psychological, physiological or anatomical
structure or function, e.g. Loss of vision, loss
of hearing, etc.
Primary impairment may lead to secondary
impairment e.g. Defective hearing results in
learning difficulties and poor school
performance.

8. DISABILITY
It develops as the consequence of impairment. E.g.
Loss of limbs results in inability to walk. Disability is the
inability to carry out certain activities which are
considered as normal for the age and sex.

9. HANDICAPED OR CHALLENGED
Handicap is defined as a disadvantage for a given
individual resulting from an impairment or a disability, that
limits and prevents the fulfillment of a role which is normal
for that individual, depending, on age, sex, social and
cultural factors.

10. Classification
 Physically challenged
Physically challenged children can be grouped
according to affected part of the body. These include
orthopedically handicapped, sensory handicapped,
neurologically handicapped and handicapped due to
systemic diseases.

11. Orthopedically handicapped
Children with congenital body defect, amputation
due to any accident, rickets , fracture or any bone
deformity.

12. Sensory handicapped
Visual problems – partial or complete blindness
Auditory problems- partial hearing loss, deaf and dumb
Speech problems- stammering, dysphonia.

13. Neurological handicapped
Children having mental retardation, conclusive disorder,
hydrocephalus, spina bifida , post meningitis or CNS
problems

14.  Handicapped due to chronic systemic disease
Heart disease, bronchial asthma, diabetes mellitus,
muscular dystrophy.
 Multiple physically handicapped children having
combination of orthopedically, sensory and neurological
handicapped

15. Socially challenged
Socially challenged children are having disturbed
opportunities for healthy personality development due to
social factors leading to non- achievement of full
potentialities.
Social disturbances are found in the form of broken
family, parental inadequacy, loss of parents, poverty, lack
of educational opportunities, environmental deprivation
and emotional disturbances as lack of tender loving care.

17. Mentally challenged
 The term “mentally handicap” is now used for the
conduction “mental retardation”.
 At least 2 to 3 % of Indian population are mentally
handicapped in any form.

18.  Mental handicapped is the significantly sub average
general intellectual functioning existing concurrently with
deficits in adaptive behavior manifested during the
developmental period.
 It includes the learning disability, poor maturation and
social mal adjustment in combination.

19. Cause/Etiology of Handicap
Perinatal factors
 Birth asphyxia
 Prolonged and difficult birth
 Pre maturity
 Kernicterus
 Instrumental delivery resulting in head injury

20. Genetic factors
 Genetic mutation
 Genetic incompatibilities between parents
 Chromosomal disorders

21. Placental dysfunction
 Toxemia of pregnancy
 Nutritional growth retardation
Placenta Previa Cord prolapse

22. Postnatal factors
 CNS Infections (encephalitis, meningitis, septicemia,
measles)
 Accidents
 Iodine deficiency
 Severe PEM
 Metabolic disorder

23. Environmental and social factors
 Poverty
 Broken family
 Faulty parenting
 Child abuse and neglecting
 Parental psychopathology
 Environmental deprivation

24. PREVENTION OF HANDICAPPED
CONDITION IN CHILDREN
Prevention at three levels
Primary Prevention –
Action taken prior to the onset of the
disease/disability, which will remove the possibility that a
disease/disability will occur.

25. Secondary Prevention –
Action, which halts the progress of the
disease/disability at its incipient stage and prevents
complications. The specific interventions are early
diagnosis and adequate treatment.

26. Tertiary Prevention
All measures available to reduce or limit
impairments and disabilities, and minimize suffering
caused by existing disability.
This phase is also called rehabilitation, which
includes physical, psychosocial and vocational
measures taken to restore the patient back to normal or
near normal condition

27. General Preventive Measures
 Marriage between very close blood relations like
uncle, niece, first cousin should be avoided for
prevention of hereditary disorders.
 Avoid pregnancies before the age of 18 years and after
the age of 35 years.
 Consult a doctor before planning the pregnancy.
 If there is incidence of birth defects in your family.

28.  If you have had difficulty in conceiving or have had a
series of miscarriages, still births, twins, delivery by
LSCS, obstructed labour/prolonged labour(more than
12 hours) and/or severe bleeding in previous
pregnancy .
 If you have RH - negative blood type.
 If you have diabetes.

29. Care During Pregnancy
 Avoid hard physical work such as carrying heavy loads,
especially in fields, and other accident - prone activities
such as walking on slippery ground or climbing stools
and chairs.
 Avoid unnecessary drugs and medications. Even the
normally considered safe drugs which are sold
commonly can potentially cause serious defects in an
unborn child.
 Avoid smoking, chewing tobacco, consuming alcohol
and narcotics.
 Avoid X - rays, and exposure to any kind of radiation.

30.  Avoid exposure to illnesses like measles, mumps etc,
especially during the first 3 months of pregnancy.
 Avoid sexual contact with a person having venereal
disease.
 Take precautions against lead poisoning.
 Avoid too much use of ‘Surma’ and ‘Kohl’.
 Eat a well-balanced and nourishing diet supplemented
with green leafy vegetables, proteins and vitamins.

31.  All women of the child bearing age need 0.4mg of folic
acid daily. It is also available in folic acid plus iron
tablets which should be taken for at least 3 months
during the third trimester when the risk of developing
iron deficiency anemia is greatest.
 Ensure weight gain of at last 10 kgs. Have regular
medical checkups.
 All pregnant women should be given tetanus injection.

32.  Woman at ‘high - risk’, whose weight is < 38 Kg, height is
less than 152 cm, weight gain during pregnancy <6 kg or
who is severly anaemia (Hb < 8mg), having frequent
pregnancies, having a history of miscarriage/
abortion/premature deliveries, must get expert prenatal
care so as to have a normal baby.
 Must consult a doctor, in case of edema (swelling) of feet,
persistent headache, fever, difficulty or pain in passing
urine, bleeding from the vagina, and yellowness of eyes
(jaundice)

33. Care at the time of birth
 Delivery must be conducted by trained personnel,
preferably in a hospital where all facilities are available.
 If a baby does not cry immediately after birth,
resuscitation measures should be undertaken at once.
 Babies born prematurely and with a low birth weight
(<2.5 Kg) may need Neonatal Intensive Care.

34.  If the baby’s head appears to be abnormally small or large
then a physician should be consulted, preferably a
pediatrician. The approximate head size for a male child at
birth is 35 cm and for female child is 34.5 cm.
 To protect a child from infections, breast - feeding must be
started immediately after birth. First milk (colostrum) must
be fed to the baby and should not be thrown away, as it has
antibodies which are protective.

35. Early Childhood Care
 Do not allow a child’s temperature to rise above 101-
degree F because of any reason. It can cause febrile
seizures
 If a child gets fits take him to doctor immediately.
 Every child should be immunized against infectious
diseases as per the recommended schedule of
immunization.
 Do not allow a child to have too much contact with paint,
newsprint ink, lead etc. as they are toxic.

36.  Take precautions against head injury, and other accidents.
 Ensure that the child gets a well-balanced diet and clean
drinking water.
 Introduce additional foods of good quality and in sufficient
quantity when the child is 4 -6 months old.

37.  Protect a child from Meningitis and Encephalitis by
providing a hygienic environment which is free of
overcrowding.
 Common salt must be iodized as a precaution against
goiter and cretinism.
 Vitamin A deficiency and its consequences including
night blindness can be easily prevented through the use of
Vitamin A supplementation.

38.  Use ear protectors to reduce the exposure to high levels
of noise, if children are living or working in a noisy
environment.