Some children are born disabled although this may not be apparent for some time, as in many cases of cerebral palsy. The damage may have a genetic cause; the baby may have been damaged in the uterus, for example by the mother’s suffering from an infection such as rubella, which can cause deafness; or there may have been a problem during the birth such as a birth injury, a lack of oxygenatedreaching the baby from the placenta during pregnancy, or a haemorrhage into the brain, causing cerebral palsy. Some children have become visually disabled by the condition retrolental fibroplasia, caused by being given too high a concentration of oxygen during resuscitation after birth.
A child can develop a physical handicap later as a result of meningitis or encephalitis, although poliomyelitis has now been virtually eradicated. Accidents, often on the road, are an increasing cause of handicap among children.
A common cause of physical handicap is cerebral palsy, caused by damage to part of the brain before, during or after birth; the type and degree of the disability depends on the part of the brain affected and the extent of the damage. Children only mildly affected can live nearly normal lives; those severely affected have to spend most of their lives in a wheelchair. Cerebral palsy may cause stiffness of movement, paralysis, involuntary movements, incoordination and impaired balance, but stiffness (or spasticity) is the most usual manifestation. The child’s arms and legs are stiff even when he is asleep. One side of the body may be affected, or just the legs, or all four limbs.
Athetosis is another expression of cerebral palsy in which there are uncontrollable writhing movements of the limbs. This can follow very severe untreatedafterbirth.
Spina bifida is a usually serious condition affecting the spinal cord. It occurs during the development of the spine, when the groove down the back of the vertebrae does not close properly over the spinal cord which protrudes, often not even covered with skin. This occurs once in a thousand births. The most severely affected children suffer from paralysis of the legs and incontinence of urine and bowel movements.
Nine out often children with severe spina bifida have hydrocephalus and about half are mentally retarded to some degree. The cause is not yet fully understood but a combination of genetic and environmental factors is thought to be responsible.
Advances have been made in the prevention of physical handicap. The avoidance or early treatment of infection (unless known to be harmless) during pregnancy is important, as is good obstetric care. During labour, babies may receive a better oxygen supply, and may be delivered more quickly if their mothers keep an upright position (kneeling, squatting or crouching) rather than lying on their backs in the more usual delivery position.
Spina bifida can be diagnosed during pregnancy from an examination of the amniotic fluid, but there is little point in undergoing amniocentesis unless the woman agrees to an abortion if the baby is found to be affected.
Training children in road safety is also a straightforward preventive measure.
Treatment and care
Treatment varies from one child to another depending on the child’s age and the type and degree of disability. There may be associated problems such as a visual or hearing deficiency. Each child must be fully assessed, preferably by a specialist team, and an individual programme of treatment and care suggested. Assessment should be repeated regularly.
Visual problems include total blindness (extremely rare), partial blindness, long sight, short sight, squint (strabismus) and astigmatism. Hearing problems can also be diagnosed early by regular testing. Caring for a physically disabled child is an arduous task for parents or care-takers. When the child is young, he (or she) is light and easy to move around. But as he grows, practical modifications in the home can help. Facilities in the community include day nurseries for physically disabled children and special schools equipped to cater for the child in a wheelchair and able to provide necessary treatments. In general physically disabled children have normal intellectual capacities. Most of the time this is also the case when the cause of the handicap has been brain damage. Intellectual development can therefore progress in the usual way.
It can be difficult for parents to bring up a physically disabled child. Apart from the hard work and frequent visits to hospitals, there is the worry of knowing the child may not be able to care for himself in the future. Two policies are particularly important: first, encourage the child to be as capable and independent as possible; second, help him come to terms with his disability, not feel bitter about it, and to make the most of his life. This may be easier for a child who grows up never having known what it is like to be able-bodied. A child who is disabled after a normal start may find his disability harder to accept.