Referral profile of a child development clinic in northern India

Effectiveness of training on primary care nurses' knowledge and screening practice in identification of children at risk for developmental delay: An Indian perspective

Background

In India, overall, 1.5-19.8% of the children were found to be developmentally delayed. The evaluation of development in young children and health professionals' early referrals for diagnostic assessment will accelerate appropriate early intervention as early as possible. Nurses can screen the children and help the parents by providing the necessary information and support.

Aim

To train the primary care nurses on developmental screening and early identification of developmental delay (DD) in children and find the effectiveness of the same.

Objectives of the study

To evaluate the effectiveness of the training program on the knowledge and screening practice of the nurses towards the identification of children at risk for DD and to find out the relationship between nurses' knowledge and screening practice.

Methods and Materials

A quasi-experimental, one-group pretest, post-test design was adopted among 69 nurses, who were providing child care services and working in the selected government hospitals in Bengaluru, South India. Nurses' knowledge and screening practice in identifying children at risk for DD were assessed before and after the training. SPSS package 21.00 version was used to analyse the descriptive and inferential statistics.

Results

The training program was effective in the enhancement of primary care nurses' knowledge and screening practice in the identification of DDs in under-five children.

Conclusion

The findings of this study concluded that developmental screening can be performed by nurses with suitable training programs. The training program played a significant role in the enhancement of nurses' knowledge and screening practice in the identification of DDs in under-five children.

Profile of children assisted in a teaching outpatient clinic of developmental disabilities in São Paulo, Brazil

OBJECTIVE

To analyze the epidemiological and clinical profile of patients with developmental disabilities followed in a university clinic in Brazil.

METHODS

Descriptive, retrospective study, based on medical records. Children aged zero to 18 years with developmental problems, firstly evaluated between 2009 and 2018, were included. Patients with missing data or out of the age and time period established were excluded. There were nine losses and 374 patients constituted the final sample. Linear regression models were performed.

RESULTS

The mean age at the first assessment was 52.2±39.7 months and the age when the parents perceived the symptoms was 20.9±23.8 months. The most common impairment was motor associated with language delay (28.3%). The interval between the parents' perception and the first consultation was associated with the mothers' education and number of pregnancies. The age at first assessment was associated with the disability type. The number of pregnancies was associated with the child's age when the parents noticed the symptoms and at the first consultation.

CONCLUSIONS

Parents' recognition of the symptoms occurred early, however, there was a delay until the arrival at the clinic. Higher maternal education was associated with a shorter gap between perception of the developmental disability and consultation. A greater number of pregnancies was associated with a later perception of the developmental delay by the parents as well as a delay in the assessment and a wider interval between them. Motor problems were the most common in younger children, and language complaints in older ones.

Effect of multilevel lower-limb botulinum injections & intensive physical therapy on children with cerebral palsy

Background & objectives

Botulinum toxin is considered as an effective treatment for spasticity in children with cerebral palsy (CP). However, there are only a few long-term studies, and the effects on motor function have been inconclusive. Moreover, due to its high cost and need for intensive post-injection therapy, utility in context of developing nations has not been established. This retrospective study was undertaken to assess the long term effects of botulinum toxin-A with physical therapy in children with CP.

Methods

This retrospective study was conducted at a tertiary care centre in India, where a limited supply of botulinum toxin was introduced in the year 2009. It was used in a selective group of patients with CP along with intensive physical therapies. All children who received lower-limb botulinum injections over a 42-month period were analyzed. For evaluation of treatment effect, the measurement at 1^st pre-injection assessment and the last measurements, i.e. 12 wk after last injection received by that child were compared.

Results

Twenty nine patients (20 males, median age 51 months) received 69 sessions of botulinum toxin injections in the lower limbs over a 42-month period. Thirteen patients were diplegic, 10 were quadriplegic, five were triplegic and one was hemiplegic. There was a significant improvement in pre- and post-injection scores on Observational Gait Scale (right side 7.1±3.6 to 10.7±3.7, left side 6.7±3.5 to 9.9±3.4), Gross Motor Function Measure Scale (47.9±17.7 to 67.6±17.2), Modified Ashworth Scale, passive range of motion and Gross Motor Function Classification System. Most of the patients showed gain in motor milestones as well.

Interpretation & conclusions

Our results showed that judicious use of botulinum injections along with intensive physio/occupational therapies could yield good results in children with CP.

Study of Parental Perceptions on Health & Social Needs of Children with Neuro-Developmental Disability and It's Impact on the Family

INTRODUCTION

The term Neuro Developmental Disorder (NDD) is used for conditions caused by a dysfunction in any part of the brain or nervous system, resulting in physical and/or psychological symptoms as a child develops. Family of children with NDD face many problems. It is very important to find them and create awareness so that gaps in essential services and supports can be decreased.

AIM

To explore parental perceptions on health & social needs of children with NDD, to understand the impact of disability on the families having children with disability, and to find out the parental perceptions on availability of services for children with NDD and its utilization by families.

MATERIALS AND METHODS

The parents of 30 children with NDD were interviewed using a questionnaire and data elicited in these interviews were analysed. The questionnaire had preliminary information about parents and child with NDDs, socio-demographic profile of the family and the parental perceptions on health and social needs of their child having NDDs.

RESULTS

There were total 30 patients 17 were males and 13 were females. Most of the patients suffered from Cerebral Palsy (13 cases) and were diagnosed by General Practitioner (22 cases) while Developmental Neurologist/paediatrician had diagnosed remaining cases of NDD (8 cases). Most common disability for which parents were worried was inability to walk (17 cases). Common difficulties countered in daily care by parents were feeding and bathing (10 cases). Only 2 children were given assistance with tuition & psychologist (cases of ADHD). Most of the parents knew about special schools but didn't know which place such facilities were available and none of the children were attending special schools. Twenty two parents said they have no plans for the future studies but wish that at least child learns to read & write. With help of spiritual power (doing prayers and pooja) 25 parents got courage to face the difficulties and discrimination. Two parents required antidepressants. Six Mothers had to quit their jobs so as to concentrate and give more time to their children. Experience with services provided was satisfactory in 17 cases, while 13 parents reported problem of arranging money, adjusting time for long travelling and regular follow-up.

CONCLUSION

The findings can be utilized in developing supportive activities for families with disabled children. It addresses the need for new prospective of stigma reduction in our society. The study has found that the care givers of child with NDDs suffer from significant physical and mental stress, and their health should be taken into consideration. The study has found need of "care givers' support group". The professionals can help parents in establishing positive thinking towards care giving. There is need of provision of comprehensive and latest rehabilitation/ support resources & information.