Children with Special Healthcare Needs

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Children with Special Healthcare Needs
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Children with Special Health Care Needs

• Children with disabilities including
• Physical limitations
• Mental limitations
• Chronic illness

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Children with Special Health Care Needs

• Technology-assisted Children Those
  with special health care needs who depend on
  medical devices to support vital bodily functions.

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Children with Special Health Care Needs

• Assessment
• Critical to ask parent or home care attendant
  about patients
• baseline
• present problem (why did they call?)
• past history
• past treatment for similar problem
• hospital where the patient is normally seen

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Children with Special Health Care Needs

• Tracheostomy
• bypass upper airway obstruction caused by birth
  defect, surgery, trauma
• allow long-term mechanical ventilatory support as
  result of chronic disease
• temporary following severe illness, trauma
• mucus obstruction is common problem
• instill sterile saline, then suction while
  withdrawing catheter

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Children with Special Health Care Needs
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Children with Special Health Care Needs
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Children with Special Health Care Needs

• Constant Positive Airway Pressure
• Recurring partial airway obstruction
• Weak inspiratory effort
• Some only wear device at night
• May be disconnected but child may tire easily

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Children with Special Health Care Needs

• Central Venous Catheters
• May be used to deliver
• nutrition
• special medications
• Usually on chest but may be at neck, groin or arm

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Children with Special Health Care Needs

• CSF shunt
• Used to drain fluid from cranial cavity into
  abdomen
• Obstruction may result in ? ICP or seizures

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Children with Special Health Care Needs

• Feeding Catheters
• Deliver nutrition or medication
• NG/OG tube used for brief periods or surgically
  implanted for longer periods
• gastrostomy tube (GT) passes through abdomen into
  stomach
• jejunostomy tube (JT) passes through abdomen into
  small intestine
• percutaneous endoscopic gastrostomy (PEG)
  (button) similar to GT but is equipped with a
  cap and valve

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Children with Special Health Care Needs
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Children with Special Health Care Needs

• Pacemaker
• Demand, constant, or antiarrhythmic
• Generator can usually be felt under skin
• Leads may fracture causing failure
• Ask about type of pacemaker and its function

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Children with Special Health Care Needs

• Congenital Heart Disease
• Usually manifested in first few days of life
• Often detected prenatally
• Examples
• Patent ductus arteriosus
• Atrial septal defect
• Ventricular septal defect
• Tetralogy of Fallot
• Transposition of great vessels
• Aortic coarctation

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Children with Special Health Care Needs

• Congenital malformation
• Trisomy 21 (Downs syndrome)
• 1 in 800 births
• more common in older mothers
• smaller stature developmental delays small
  midface with upturned nose flat occiput, short
  broad hands and feet short ears exaggerated
  space between first and second toes

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Children with Special Health Care Needs

• Congenital Malformation
• Trisomy 18
• 1 in 8,000 births
• higher risk of spontaneous death in utero
• small, premature appearance narrow nose
  prominent occiput cleft lip or palate
  congenital heart disease overlapping of finders
  (index over 3rd, 5th over 4th) developmental
  delays underdeveloped nails
• most die in infancy few survive 1 year

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Children with Special Health Care Needs

• Congenital Malformation
• Trisomy 13
• 1 in 10,000 births
• higher risk of spontaneous death in utero
• scalp defects cleft lip or palate microcephaly
  sloping forehead congenital heart disease
  overlapping of fingers and toes underdeveloped
  nails developmental delays
• most die in infancy few survive 1 year