Caring for the Special Needs Child

Chapter 12: Peds Test 2

Failure to Thrive

Inadequate growth in infants/children; poor weight gain over time.

Risk Factors for Failure to Thrive

Developmental delays

Inability to suck and/or swallow correctly

Malabsorption

Inadequate preparation of food

Diarrhea

Vomiting

Alterations in metabolism or caloric/nutrient needs associated with chronic illness

Disrupted relationship with maternal figure

Treatment for Failure ot Thrive

Based on cause, if cause is found, they may need special high-calorie formula or fortifiers, change from breast to bottle, strict I/Os, tube feeding, foster care, etc.

Observe parent-child interactions, establish an appropriate feeding schedule, and provide feeding as prescribed (correct strength/calories), using proper feeding technique and volumes. Weigh the child daily/strict Is and Os.

Vulnerable Child Syndrome

Parents’ reactions (a pattern of excessive parental concern and overprotection) to a serious illness or event in the child’s past continue to have long-term psychologically harmful side effects on the child and parents for many years.

Vulnerable Child Syndrome Risk Factors

Preterm birth

Congenital anomaly

Newborn jaundice

Handicapping condition

An accident or illness that the child was not expected to recover from

Crying or feeding problems in the first five years of life

Impact of a special needs child on the family: They may experience

May experience

A multitude of emotions and life changes 

Overwhelm

Burdened with care

Fear, anger, sadness, guilt, frustration, or resentment

Financial burdens

Altered family activities

Siblings may feel cheated of parental time and affection

The nurse is caring for a school-age child with cerebral palsy.  What developmental task, appropriate for this age, may be delayed, and why?

The school-age child is tasked with achieving industry.

CP child can be in the hospital a lot, and that can affect development.

Transition Time in Care of Special Needs Children

Increased symptoms

When the child moves to a new setting (hospital, school)

During a parent’s absence

During periods of developmental change

Arrival of new family members

Nursing Management of Children with Special Needs

Case management and advocacy

Screening and ongoing assessment of the child

Provision of appropriate home care

Care of the technology-dependent child

Education and support of the child and family

Referral for resources

Complementary Therapies Used by Families With Special Needs Children

Homeopathic and herbal medicine

Pet therapy

Hippotherapy

Music

Massage 

Culture-specific therapies 

The Individuals with Disabilities Education Act (IDEA)

It is a law that makes available a free, appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those children.

Educational opportunities mandated by law

Early intervention from birth to age 2 and preschool for 3‐ to 5‐year‐olds

IDEA (2004) 

Local school system

Palliative Care

Focuses on maintaining the highest quality of life while managing treatment and other needs.

A child with a life-threatening or progressive incurable condition.

Home, hospital, or hospice setting.

The goal is to provide the best quality of life possible at the end of life while alleviating physical, psychological, emotional, and spiritual suffering.

Hospice

Focuses on the period closest to death but focuses on the needs of the patient and their quality of life.  

Focuses of Palliative Care

Managing pain and discomfort

Providing nutrition

Providing emotional support to the dying child and family

Assisting the family through the grief process

Orders related to End of Life Care

Limitations of Care: Parents and patients (when able) may specify their wishes for care at the end of life

Do Not Resuscitate (DNR)

• –Withhold cardiopulmonary resuscitation if child’s heart stops beating

• –May have special limitations as part of order (oxygen and comfort care but no compressions)

Allow Natural Death (AND): In some institutions DNR is being replaced by AND

True or False: The nurse initiates transition planning for adulthood when the patient reaches 21?

False