IMPACT OF COGNITIVE OR SENSORY IMPAIRMENT ON THE CHILD AND FAMILY

IMPACT OF COGNITIVE OR SENSORY IMPAIRMENT ON THE CHILD AND FAMILY

  • Angela M. Messick, DNP, MBA, RN

  • NURS 424

COGNITIVE IMPAIRMENT (CI)

  • Definition: Any type of intellectual disability.

  • Characteristics:

    • Umbrella term that encompasses various types of cognitive issues.

    • Affects approximately 1% of the population in the US.

    • Disability that originates during the developmental period prior to 22 years old.

    • Involves significant lag or delay in any of the child's physical, cognitive, behavioral, emotional, or social development compared to developmental norms.

    • Referrals should be made for counseling and diagnosis using standardized tests.

CAUSES OF COGNITIVE IMPAIRMENT (CI)

  • Various factors can lead to cognitive impairment, including:

    • Infections and intoxications: Can affect brain development.

    • Trauma: Physical injuries to the brain.

    • Metabolic or nutritional abnormalities: Can hinder brain function.

    • Gross postnatal brain diseases: Affect development after birth.

    • Unknown prenatal conditions: Environmental or genetic factors not identified.

    • Chromosomal abnormalities: Such as Down Syndrome.

    • Gestational disorders: Complications during pregnancy.

    • Psychiatric disorders with onset during the developmental period: Can impact cognitive function.

    • Environmental influences: Such as exposure to toxins.

EARLY SIGNS OF COGNITIVE IMPAIRMENT (CI)

  • Recognizable signs include:

    • Dysmorphic syndromes: Like Down Syndrome or Fragile X Syndrome.

    • Irritability or non-responsiveness: To environmental stimuli.

    • Major organ system dysfunction: Issues with feeding or breathing.

    • Gross motor delay: Delays in large muscle movements.

    • Language difficulties or delay: Trouble with speech development.

    • Behavior difficulties: Such as aggression or withdrawal.

    • Fine motor delay: Trouble with small muscle movements.

IDENTIFICATION AND EDUCATING CHILDREN WITH CI

  • Role of nurses:

    • Critical in identifying children with CI.

    • Few signs may be evident in newborns or early infancy (except conditions like Down syndrome).

    • Delayed developmental milestones: Primary indicator of cognitive impairment.

    • Early behavior patterns require a high index of suspicion for potential delays.

    • Parental concerns must be regarded seriously; families often notice signs first.

    • Regular developmental assessments: Conducted by nurses for monitoring.

    • Sensitivity and discretion are essential when discussing developmental delays with parents.

    • Teaching strategies should be tailored to the child's learning abilities and deficits.

DISABILITY LAWS & EDUCATIONAL SUPPORT PLANS

  • Americans with Disabilities Act (ADA):

    • Prohibits discrimination against individuals with disabilities.

  • Individuals with Disabilities Education Act (IDEA):

    • Provides educational rights and special education services.

    • Individualized Education Plan (IEP): Tailored education program for children with disabilities.

    • Individualized Family Service Plan (IFSP): Support plan focusing on family needs.

  • Education of the Handicapped Act Amendments:

    • Coordinates early intervention services for children with disabilities.

COMMUNITY RESOURCES AND SERVICES

  • Numerous organizations support children and families with cognitive and sensory impairment, including:

    • Children and Youth with Special Health Care Needs (CYSHCN)

    • Head Start

    • National Down Syndrome Society

    • Easter Seals

    • The Arc of the United States

PROMOTING OPTIMAL SELF-CARE AND DEVELOPMENT

  • Role of Nurses:

    • Support parents in teaching self-care skills such as eating, dressing, and grooming.

  • Family readiness is emphasized alongside the child's preparedness for self-care.

  • Assistive tools: Support independence and skill acquisition in daily activities.

  • Developmental timelines: Recognize that these vary widely among children.

  • Optimal development encompasses not only physical but also social and emotional health.

PROVIDING CARE FOR THE HOSPITALIZED CHILD WITH COGNITIVE IMPAIRMENT (CI)

  • Challenges: Nurses must recognize unique challenges and attitudes toward care.

  • Use a family-centered, mutual participation model in care approaches.

  • Obtain a detailed strengths-based history to understand the child better.

  • Assess the child’s functional level to tailor care appropriately.

  • Provide developmentally appropriate activities during hospitalization.

  • Explain procedures with suitable communication strategies.

  • Promote growth, independence, and ongoing family support throughout care.

TEST YOUR KNOWLEDGE

Question 1

  • Which disorder would be most likely to cause cognitive impairment in young children?

    • A. Hyperglycemia

    • B. Hyperthyroidism

    • C. Fetal Alcohol Syndrome

    • D. Microcephaly

Question 2

  • A deficit in which developmental milestone would be considered an early sign of cognitive impairment (CI) in a 9-month-old child?

    • A. Speaking

    • B. Walking

    • C. Throwing a Ball

    • D. Crawling

Question 3

  • Match the rationale for the nursing intervention when caring for a child with cognitive impairment (CI).

    • 1. Assessing functional level

    • 2. Obtaining a detailed history

    • 3. Providing toys and activities

    • 4. Explaining procedures

    • Rationales:

    • A. Communicating with the child at their cognitive level

    • B. Documenting the adaptive devices used

    • C. Observing the child during meals

    • D. Preventing loneliness and boredom

DOWN SYNDROME (DS)

  • Definition: Most prevalent chromosomal cause of cognitive impairment.

  • Cause: Results from an extra or abnormal chromosome 21.

  • Risk Factors: Increases with maternal age but can occur at any age.

  • Variations: Multiple genetic variations exist related to Down Syndrome.

  • Complications: Associated with a range of medical and physical complications, including:

    • Congenital heart defects

    • High incidence of frequent respiratory infections

    • Low muscle tone (hypotonia)

    • Problems with the immune system

    • Thyroid disorders

    • Increased risk of developing leukemia

DIAGNOSIS OF DOWN SYNDROME

  • Prenatal Testing Options:

    • Noninvasive prenatal testing (NIPT) for screening purposes.

    • Diagnostic testing necessary for confirmation of results.

    • Genetic Counseling: Offered to all women for informed decision-making.

CLINICAL MANIFESTATIONS OF DOWN SYNDROME

  • Physical features include:

    • Upward slant eyes

    • Protruding tongue

    • Transverse palmar creases

    • Overweight-small stature

    • Flat nasal bridge

    • Small ears and narrow canals

    • High-arched palate

    • Excess skin in neck area

    • Wide space between the big toe and 2nd toe

    • Hyperflexibility and Hypotonia present.

RECOMMENDED TESTING FOR CHILDREN WITH DOWN SYNDROME

  • Cardiac evaluation post-birth to detect congenital heart issues.

  • Vision and hearing screening to assess sensory capabilities.

  • Thyroid function testing for metabolic health.

  • Cervical spine screening for risk of atlantoaxial instability.

  • Ongoing health monitoring and follow-up for holistic healthcare.

NURSING SUPPORT AND CARE FOR FAMILIES

  • No comprehensive cure exists; care is primarily supportive.

  • Support parents during the diagnosis phase; emotional resources are critical.

  • Education about Down Syndrome should be provided in a respectful manner, considering family coping styles.

  • Promote long-term planning and adjustment for families dealing with this diagnosis.

NURSING SUPPORT FOR PHYSICAL CARE & DAILY MANAGEMENT

  • Focus on minimizing physical problems related to positioning and mobility.

  • Support respiratory health and prioritize prevention of infections.

  • Assist families in managing feeding and nutritional needs.

  • Promote overall health and skin care.

TEST YOUR KNOWLEDGE

Question 4

  • Which comorbidity is frequently found in children with Down syndrome?

    • A. Heart Defects

    • B. Hypersomnia

    • C. Malnutrition

    • D. Osteoporosis

Question 5

  • Which instruction would the nurse provide the parents of a child with Down syndrome to prevent respiratory infections?

    • A. Placing warm compresses on the nose

    • B. Use a bulb syringe to clear the nares

    • C. Rinse the oral cavity with water after feedings

    • D. Limit fluid intake

    • E. Place a cool-mist vaporizer in the room

FRAGILE X SYNDROME

  • Definition: Genetic condition most commonly causing cognitive impairment; inherited on the X chromosome.

  • Characteristics: Severe effects typically more noticeable in males; can be transmitted from parents to offspring.

CLINICAL MANIFESTATIONS OF FRAGILE X SYNDROME

  • Physical Features:

    • Large head size

    • Long face with protruding ears

    • Eye alignment problems (strabismus)

    • Low muscle tone (hypotonia)

    • Heart anomalies such as mitral valve prolapse

    • Enlarged testicles observed in post-pubertal males

  • Behavioral Features:

    • Cognitive impairment may range from mild to severe.

    • Commonly observed speech delays or atypical patterns.

    • Present with short attention spans and hyperactivity.

    • Sensitivity to various stimuli (e.g., sound, touch, taste).

    • Often struggle with changes in routine, leading to social anxiety and behaviors resembling autism.

TREATMENT OPTIONS FOR FRAGILE X SYNDROME

  • Treatment does not cure but can manage symptoms effectively.

  • Early intervention is crucial for improved outcomes.

  • Medications can assist with behavioral and attention-related symptoms.

  • Ongoing therapeutic strategies to support development are recommended.

  • Emphasis on nursing care that involves family education and support.

  • National Fragile X Foundation as a resource for families.

TEST YOUR KNOWLEDGE

Question 6

  • Which condition would warrant the use of clonidine in a child with fragile X syndrome (FXS)?

    • A. Violent Temper Outbursts

    • B. Hyperactivity

    • C. Acute Mania

    • D. Seizures

Question 7

  • After genetic counseling, which statement made by the parents indicates understanding of fragile X syndrome (FXS)?

    • A. “All females who carry the disorder will develop the disease.”

    • B. “Males carry the disease and can pass it on to their daughters.”

    • C. “All affected males will display symptoms of the disorder.”

    • D. “Females are more affected by this disease than males.”

AUTISM SPECTRUM DISORDERS (ASD)

  • Definition: A common childhood neurodevelopmental disorder characterized by two primary behavior domains:

    • Social communication and interaction deficits.

    • Restricted or repetitive patterns of behavior and interests.

  • The DSM-5 categorizes several related conditions under ASD.

  • Diagnosis typically occurs during the toddler years.

ASD ETIOLOGIES

  • The precise cause of ASD remains undetermined:

    • Not influenced by socioeconomic status, race, or parenting methods.

    • Strong evidence points toward a genetic component.

    • Distinctive brain and neurological differences are often noted.

    • Certain medical and prenatal factors can elevate risk levels.

    • Associated with various other health conditions; vaccines do not contribute to ASD development.

ASD CLINICAL MANIFESTATIONS

  • Core indicators include:

    • Deficits in social interaction and communication, e.g.,

    • Lack of response to social cues (not smiling or engaging with others).

    • Failure to orient to one's name or engage in interactive play.

    • Impairments in gestures and non-verbal communication.

    • Focus on repetitive behaviors and restricted interests (e.g., hand-flapping, spinning).

    • Severe variation in behavior and ability severity; some may exhibit self-injurious behavior.

    • Often linked with gastrointestinal issues such as constipation.

ASD DIAGNOSIS

  • Developmental delays: Early warning signs prompting evaluation.

  • Loss of previously acquired skills: A significant red flag.

  • Routine screening is recommended for early identification.

  • Tools such as the Modified CHAT for children 16 to 30 months old and the Pervasive Development Disorders Screening Tool are utilized.

  • Early referrals improve health outcomes; assessing by specialists such as pediatricians, neurologists, psychiatrists, and psychologists can help confirm diagnosis.

  • Diagnosis may face delays while ruling out alternate conditions.

THERAPEUTIC INTERVENTIONS FOR ASD

  • While a cure is not available, early intervention can drastically alter the trajectory.

  • Structured behavioral modification programs are effective:

    • Featuring positive reinforcement techniques.

    • Enhancing social awareness and offering coping skill development.

    • Focusing on improving verbal communication abilities.

    • Strategies to minimize unacceptable behaviors.

    • Other therapies such as equine therapy, dietary interventions, and family support services from organizations like Autism Society and Autism Speaks may provide help.

CARE OF THE HOSPITALIZED CHILD WITH ASD

  • Strategies to alleviate stress during hospitalization include:

    • Maintaining routines as much as possible.

    • Reducing sensory stimulation; employing private rooms and minimizing noise and bright lights.

    • Using familiar items and routines, such as favorite toys or blankets.

    • Communicate according to the child's developmental level.

    • Supporting feeding and medication adherence, understanding that dietary habits may vary significantly from child to child.

TEST YOUR KNOWLEDGE

Question 8

  • Which behavior displayed by a 2.5-year-old child would indicate ASD?

    • A. Displaying new onset regression in verbal development

    • B. Speaking in 2 to 3 word sentences

    • C. Playing without interacting with other children

    • D. Demonstrating shyness around new people

Question 9

  • Which factor has been linked to the development of ASD?

    • A. MMR Vaccine

    • B. Teenage Pregnancy

    • C. Seizure Disorder

    • D. Genetic History

Question 10

  • Which action would the nurse take to reduce anxiety in a child hospitalized with ASD?

    • A. Maintaining constant eye contact

    • B. Assigning a semi-private room

    • C. Having the parent bring in favorite toys and belongings

    • D. Instructing the parents to leave at night

SENSORY IMPAIRMENT

HEARING IMPAIRMENT

  • Recognized as one of the most prevalent childhood disabilities, it impacts all age groups from infants to adolescents.

  • Statistics: About 1 million children aged from birth to 21 years experience hearing impairment.

  • Severity of hearing loss can range from slight to profound.

  • Details about Severity:

    • Slight to moderate hearing loss typically allows for language processing through the auditory channel using hearing aids.

    • Severe to profound hearing loss obstructs the ability to process language through hearing, even with assistance from hearing aids.

    • Approximately 1/3 of children with hearing impairment exhibit additional disabilities, such as cognitive impairment or visual issues.

    • Hearing impairment can be classified to assist in guiding treatment and care.

HEARING IMPAIRMENT ETIOLOGY

  • Various causes include:

    • Genetic factors

    • Low birth weight: Associated with higher risk of hearing issues.

    • Kernicterus: A type of brain damage that can occur in newborns.

    • Cerebral palsy: May include associated hearing difficulties.

    • Down syndrome: Related to various physical anomalies, including auditory processing issues.

    • Malformations of the head or neck areas.

    • Issues arising from perinatal asphyxia or infections during the prenatal period.

    • Prenatal substance abuse: Connections to developmental problems including hearing loss.

    • Chronic ear infections: An ongoing problem leading to further degrading of hearing capabilities.

    • Administration of ototoxic drugs: Which can cause hearing impairment.

PREVENTING HEARING IMPAIRMENT

  • Prevention Strategies:

    • Proactively treat and prevent ear infections.

    • Encourage prenatal care to avoid complications.

    • Promote routine hearing screenings for early detection.

    • Take measures to prevent noise-related damage to hearing.

    • Provide education for families around hearing protection techniques.

HEARING IMPAIRMENT CLINICAL MANIFESTATIONS IN INFANTS

  • Indicators include:

    • Absence of startle or blink reflex in reaction to loud sounds.

    • Failure to awaken in response to loud noises from the environment.

    • Inability to localize sound sources by 6 months of age.

    • Absence of babbling or voice modulation by 7 months.

    • General indifference to sounds in the environment.

    • Lack of response to spoken words, or failing to follow verbal cues.

    • Response primarily to loud noises rather than voice.

    • Absence of well-formed syllables should result in immediate referral by 11 months of age.

HEARING IMPAIRMENT CLINICAL MANIFESTATIONS IN CHILDREN

  • Observable features may include:

    • Reliance on gestures versus verbalized communication after 15 months.

    • Lack of intelligible speech development by 24 months.

    • Speech may appear monotone or unintelligible; decreased laughter noted.

    • Some children may exhibit vocal play, such as head banging or foot stamping for vibrational input.

    • Frequent requests to repeat statements or miscommunication can occur.

    • Great reliance on facial expressions and gestures instead of verbal cues.

    • Often display avoidance of social interactions, preferring isolation during play.

    • Suspicious alertness can alternate with cooperation, fluctuating in social contexts.

    • Increased stubbornness may arise due to misunderstanding difficulties.

    • Many may show irritability due to communication frustrations.

    • Shyness and withdrawal are common behavioral traits.

    • Frequent perception of being in a "world of their own" or display marked inattention.

COMMUNICATING WITH THE CHILD WITH HEARING IMPAIRMENT

  • Engaging communication strategies include:

    • Utilizing lipreading and visual cues to enhance understanding.

    • Incorporating cued speech for clearer communication.

    • Teaching and using sign language for expression.

    • Implementing speech-language therapy to support verbal capabilities.

    • Use of hearing aids where appropriate to facilitate hearing.

    • TDD/TTY systems can help in direct communication.

    • Employ closed captioning for media purposes.

    • Foster socialization opportunities for children.

    • Family involvement is crucial in supporting a child’s communication development.

TEST YOUR KNOWLEDGE

Question 11

  • For effective communication with a child with hearing impairment, which action is recommended for staff? (Select all that apply)

    • A. Standing to the left side of the child

    • B. Positioning oneself at the child’s eye level when speaking

    • C. Tapping the child’s shoulder to gain their attention

    • D. Using long sentences when talking to the child

    • E. Refraining from chewing gum during communication

Question 12

  • What assessment finding noted by the nurse warrants further follow-up for potential hearing loss?

    • A. Using gestures instead of speech in a 9-month-old

    • B. Absence of babbling by 3 months

    • C. Lack of a startle reflex in a 1-month-old infant

    • D. Failure to localize sound by 3 months

VISUAL IMPAIRMENT

  • A common condition affecting children's learning and development.

  • Serious visual impairments affect 30–64 per 100,000 children in the U.S.

  • About 5–10% of preschool-aged children experience vision problems.

TYPES OF VISUAL IMPAIRMENT

  • Partial sight: Visual acuity between 20/70 to 20/200.

  • Legal blindness: Defined as visual acuity ≤20/200 or a visual field ≤20° in the better eye; important for services.

VISUAL IMPAIRMENT ETIOLOGIES

  • Multiple causes include:

    • Perinatal infections: e.g., herpes, chlamydial infection, gonorrhea, rubella, syphilis, or toxoplasmosis.

    • Retinopathy of prematurity: Eye disorder in premature infants.

    • Postnatal infections: Such as meningitis that can affect vision.

    • Sickle cell disease: Increased risk of vision disorders.

    • Juvenile rheumatoid arthritis: Connection to ocular health.

    • Genetic disorders: Such as Tay-Sachs disease, albinism, and retinoblastoma.

    • Trauma: Physical injuries can lead to visual impairments.

PREVENTING VISUAL IMPAIRMENT

  • Preventative measures include:

    • Ensuring adequate prenatal and perinatal care.

    • Consistent periodic screenings for early identification.

    • MMR immunization can aid in preventing certain infections.

    • Providing safety counseling to prevent ocular trauma.

    • Utilize special protective guards to prevent accidents.

TYPES OF VISUAL IMPAIRMENT

  • Types include:

    • Myopia: Nearsightedness.

    • Hyperopia: Farsightedness.

    • Amblyopia: Lazy eye condition.

    • Strabismus: Misalignment of the eyes including

    • Esotropia: Inward eye deviation.

    • Exotropia: Outward eye deviation.

    • Cataracts: Opacities develop in the lens.

    • Glaucoma: Characterized by increased intraocular pressure.

    • Retinoblastoma: Identified by the absence of the red eye reflex in photographs.

VISUAL IMPAIRMENT CLINICAL MANIFESTATIONS

  • Signs indicating visual impairment include:

    • Excessive eye rubbing.

    • Difficulty with reading, or holding books too close to the eyes.

    • Clumsiness: Frequent collisions with objects while walking.

    • Increased blinking rates.

    • Poor performance in academic settings.

    • Physical symptoms like dizziness or nausea may be reported.

    • Malalignment of the eyes can be observed.

    • Inability to see objects clearly; misjudgement in distances.

ASSESSMENT FOR VISUAL IMPAIRMENT

  • Importance of early identification:

    • Key nursing strategies for assessment include:

    • Screening for high-risk populations.

    • Evaluating in infancy using visual stimuli and responses.

    • Maintenance of binocular vision by two to four months.

    • Family support and appropriate referrals are critical.

CARE OF THE CHILD WITH VISUAL IMPAIRMENT

  • Strategies to support children include:

    • Reassurance and orientation of the child and family to care processes.

    • Introduce oneself to foster trust and understanding.

    • Explain procedures and utilize familiar objects to support comfort.

    • Promote safety through consistency and avoidance of clutter in environments.

    • Encourage independence and self-care strategies.

    • Activities should be suitable and inclusive; e.g., audiobooks, textured toys, and braille applications.

    • Use contact lenses when the child demonstrates readiness for them.

    • Glasses for refractive errors should be recommended.

    • Occlusion Patching to correct lazy eye; surgery may be necessary if other interventions are ineffective.

TEST YOUR KNOWLEDGE

Question 13

  • Which treatment would the nurse prescribe for a 6-year-old child with strabismus?

    • A. Contact Lenses

    • B. Occlusion Patching

    • C. Pressure-Reducing Eye Drops

    • D. Ocular Lens Replacement

Question 14

  • Which finding from a home visit of a 7-year-old child with severe visual impairment reflects self-stimulating behaviors?

    • A. Playing alone

    • B. Listening to the TV

    • C. Touching objects as they walk

    • D. Body Rocking

QUESTIONS?

  • Open floor for inquiries and discussions regarding cognitive or sensory impairments and their implications on children and families.