Understanding Special Health Care Needs for Children: Guidelines and Strategies

1. Chapter 16 Children with Special Health Care Needs

2. Defining Special Health Care Needs • IDEA 2004 • Other health impairment means having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that-- • Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention-deficit/ hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and • Adversely affects a child's educational performance.

3. Prevalence of Special Health Care Needs • Children served under the IDEA • 1976-1977 3.8% of school population • 2003-2004 7% of school population • Estimates of children with special health care needs • 12.8%

4. Causes of Special Health Care Needs • Varied causes • Congenital • Prenatal influences • Genetic factors • Acquired • Infections • Environmental influences • Accidents • Illnesses • Unknown causes

5. Rolland’s Typology • Onset • Acute • Gradual • Course • Progressive • Constant • Relapsing or episodic • Outcome • Fatal or shortened life span • Normal life span • Incapacitation • Mild • Moderate • Severe

6. Rolland’s Typology • Phases of illness • Crisis • Chronic • Terminal

7. Early Identification of Special Health Care Needs • Based on particular illness • Based on the course of the illness • Based on the phase of the illness when identified

8. Universal Precautions and Protective Barriers • Precautions: Designed to prevent transmission of HIV, HBV, and other blood borne pathogens when providing first aid • Wear disposable gloves • Put a layer between you and a sick child • Wash all toys with disinfectant • Cover open wounds until scab forms • Use single disposable tissues for runny noses • Wash hands frequently

9. Special Health Care Needs • Allergies • Asthma • Bleeding and clotting disorders • Cancer • Childhood arthritis • Congenital heart defects • Cystic fibrosis

10. Special Health Care Needs • Diabetes Mellitus: Types 1 and 2 • Epilepsy and other seizure disorders • Hepatitis • HIV • Obesity and Overweight • Sickle-cell disease • Tourette syndrome

11. Guidelines • Use activities that allow children to be in control • Allow children to do as much as possible for themselves • Schedule the class so vigorous activities are followed quiet ones • Schedule the day flexibly • Plan open-ended activities • Be a good observer • Find out about the illnesses a children has and how it affects him • Find out what a child has been told about her illness and its implications

12. Guidelines • Help children learn about the implications of their special health care needs • Provide an atmosphere where children can discuss fears and problems • Provide accommodations • Play cooperative games • Learn to recognize warning signs of emergencies

13. Adapting Curriculum • Social awareness • Help children become aware of and express their feelings • Emphasize ways of approaching others • Help children about the roles of health care providers

14. Adapting Curriculum • Language and literacy • Use field trips to expand children's knowledge • Exchange cards that include digital photographs • Use fingerplays to increase body awareness • Play Simon Says with medical requests • Read stories about illnesses and children in hospitals • Help children sequence events • Encourage children to write about their experiences

15. Adapting Curriculum • Discovery • Make math relevant • Make patterns of, sort, and classify medical equipment • Help children make predictions • Talk about different seasons and their implications • Use technology, particularly computers • Wellness • Discuss food groups relative to nutrition and allergies • Discuss healthy life styles • Keep activities noncompetitive and pressure-free • Choose toys that are washable and can be disinfected • Incorporate yoga into your daily schedule

16. Adapting Curriculum • Creative arts • Concentrate on the process • Incorporate music and language experiences • Introduce concepts of pitch, loudness, and duration • Sing songs that call children by name • Do movement exploration activities, especially relaxation • Set up a doctor’s office, or emergency room and role play

17. Adapting Curriculum • Routines and transitions • Have a predictable arrival schedule • Make each day end on a positive note • Dismiss children early from group if needed • Use transitions to take needed medication • Emphasize all children’s similarities and differences

18. Reflections • There are many different special health care needs. Learning about them can be intimidating. How do you plan to do this? • What parts of Rolland’s model is useful for your thinking about special health care needs and their implications for children and families?