Cognitive Sensory Dysfunction in Children Fall 2024 STUDENT

Cognitive Impairment

  • Definition: Cognitive impairment (CI) is a general term that encompasses any type of mental difficulty or deficiency. It is often used synonymously with "intellectual disability".
  • Diagnosis of Cognitive Impairment:
    • Made following a period of suspicion by family or health professionals.
    • In some instances, diagnosis is made at birth.

Common Causes of Intellectual Disability

  • Chromosomal Abnormalities:
    • Down syndrome
    • Fragile X syndrome
  • Infection in Utero:
    • Examples: Rubella, Cytomegalic inclusion disease.
  • Anoxia at Birth:
    • Caused by umbilical cord compression.
  • Fetal Alcohol Spectrum Disorder
  • Inherited Metabolic Disorders:
    • Examples: Phenylketonuria, Tay-Sachs disease.
  • Acquired Factors:
    • Head trauma, lead poisoning, hypothyroidism.
  • Brain Malformations:
    • Such as anencephaly.
  • Low Birth Weight
  • Infections:
    • Example: Measles encephalitis.
  • Autism Spectrum Disorder (ASD).

Nursing Care of the Child with Impaired Cognitive Function

  • Educational Support:
    • Educate the child and family about cognitive impairment.
    • Provide early intervention strategies.
    • Teach child self-care skills and promote optimal development.
    • Encourage play and exercise.
  • Communication Aids:
    • Use talking picture boards, sign language, or symbols (e.g., help my sister, clean up).
  • Discipline:
    • Begin early with behavior modification and setting clear limits.
  • Normalization:
    • Foster socialization, play, acceptable behaviors, and peer experiences.
  • Sexuality Education:
    • Provide sex education and address concerns related to vulnerability and menstruation.
  • Future Care Considerations:
    • Helping families manage attitudes and activities related to care and support the child’s parents and caretakers.

Caring for the Hospitalized Child with Cognitive Impairment

  • Avoid Isolation: Do not ignore or isolate the child to mitigate feelings of insecurity.
  • Assessment:
    • Obtain a detailed history of the child’s abilities.
    • Assess developmental age and explain procedures at the child’s developmental level; demonstrations are preferred.
    • Select roommates based on the child’s developmental level.
  • Promoting Optimum Development:
    • Establish acceptable social behavior, promote self-esteem, and ensure physical health through play and exercise.

Autism Spectrum Disorders (ASD)

  • Definition: A complex neurodevelopmental disorder characterized by intellectual and social alterations, verbal effects, and repetitive and restrictive behavior patterns.
  • Epidemiology:
    • Occurs in 1 in every 100-150 children.
    • Four times more common in boys than in girls.

Red Flags of Autism Spectrum Disorder

  • Impairment in Social Interaction:
    • Lack of appropriate eye gaze, joyful expressions, and sharing interests or enjoyment.
    • Lack of response to name.
  • Impairment in Communication:
    • Lack of showing gestures and coordination of nonverbal communication; unusual prosody.
  • Repetitive Behaviors and Restricted Interests:
    • Includes repetitive movements with objects and posturing of the body, arms, hands, or fingers.

Common Symptoms of ASD

  • Failure to develop social relations.
  • Stereotyped behaviors such as hand gestures.
  • Extreme resistance to changes in routine.
  • Abnormal responses to sensory stimuli, including decreased sensitivity to pain.
  • Impaired ability to initiate or sustain conversations.

Clinical Manifestations of ASD

  • Complex developmental disability impacting normal brain development in areas like social interaction and communication skills along with leisure/play activities.
  • Characteristics include becoming withdrawn or indifferent to social overtures after an engaging early development phase.
  • Symptoms vary, with each individual displaying unique traits and reactions.

Nursing Care Management for ASD

  • Environmental Consistency: Maintain a consistent environment to promote comfort and stability.
  • Family Involvement: Encourage family presence and decrease environmental stimulation.
  • Communication Strategies: Use effective communication methods tailored to the child's needs.
  • No Cure: Acknowledge that while there is no cure for autism, therapies may improve language skills, and behavior modification attempts can be beneficial.

Family Support in ASD

  • Autism is often described as a family disease due to the emotional and logistical challenges it presents.
  • Regularly address parents' feelings of guilt and shame through counseling and support resources.
  • Reference Autism Society of America for information and management techniques for at-home care or during long-term facility placements.

Common Chromosomal Disorders

  • Examples:
    • Fragile X Syndrome
    • Trisomy 13 Syndrome (Patau Syndrome)
    • Trisomy 18 Syndrome (Edward’s Syndrome)
    • Turner Syndrome
    • Down Syndrome (Trisomy 21)

Genetic Disorder Screening and Diagnostic Tests

  • Preimplantation Diagnosis: To be conducted during in vitro fertilization (IVF).
  • Various tests with specific timings such as:
    • Nuchal translucency screening at 11-14 weeks.
    • Maternal quadruple marker screen between 15-20 weeks.
  • Invasive Tests: Such as amniocentesis and chorionic villi sampling with associated risks (e.g., miscarriage).

Fragile X Syndrome

  • The most common cause of cognitive impairment in males: occurs in approximately 1 in 3600 boys and 1 in 4000-6000 girls.
  • Causes: Abnormal gene on the lower end of the long arm of the X chromosome, characterized by a trinucleotide repeat in the FMR-1 gene.

Clinical Manifestations of Fragile X Syndrome

  • Physical Features: Large head circumference, long face, prominent jaw, large ears, scoliosis, pliable joints, cardiac disorders.
  • Behavioral Features: Range from mild to severe cognitive impairment, delayed speech, hyperactivity, hypersensitivity, autistic-like behaviors, and aggressiveness.

Other Chromosomal Disorders

  • Trisomy 13 (Patau Syndrome): Extra chromosome 13; incidence is low (1.68 per 10,000 live births). Most children do not survive beyond early childhood.
  • Trisomy 18 (Edward’s Syndrome): Three copies of chromosome 18; incidence is approximately 2.63 per 10,000 live births.
  • Turner Syndrome: Characterized by one functional X chromosome, incidence is approximately 1 per 10,000 live births. Manifestations include short stature and streak ovaries.
  • Down Syndrome (Trisomy 21): The most common chromosomal abnormality occurring at a rate of 1 in 800 live births. Associated with a variety of clinical manifestations including characteristic facial features and cognitive disability.

Therapeutic Management for Down Syndrome

  • Available therapies, surgeries to correct congenital anomalies, evaluation of hearing and sight, periodic testing of thyroid function, and providing support to families.

Vision and Hearing Disorders in Children

Assessment Parameters for Vision and Hearing Screening

  • Age-specific Parameters:
    • Infants: Ability to follow objects and reaction to light stimuli.
    • School-age: Use of Snellen E chart for visual acuity testing.
    • Adolescents: Pure tone audiometry starting at age 14 years.

Hearing Disorders Risk Factors

  • Common causes include ear infections, congenital infections (e.g., rubella), and exposure to noise or trauma.

Hearing Impairment Pathology

  • Types: Conductive, sensorineural, and mixed conductive-sensorineural hearing loss.
  • Severity measured in decibels (db) at varying frequencies.

Nursing Care Management for Hearing Impairment

  • Address children’s self-help skills and family communication methods. Ensure the functionality of hearing aids if used.
  • Provide appropriate communication devices and utilize picture boards in hospital settings.

Types of Vision Impairment

  • Includes myopia, hyperopia, astigmatism, strabismus, and amblyopia (lazy eye). Amblyopia is treated with corrective methods such as patching and corrective lenses.

Conjunctivitis Infection

  • Definition: Inflammation of the conjunctiva caused by various agents (viruses, bacteria, allergens).
  • Symptoms and Treatment: Symptoms include itching