Disabled Village Children A guide for community health workers, rehabilitation workers, and families

PART 1 WORKING WITH THE CHILD AND FAMILY: Information on different DisabilitiesB. Recognizing, Helping with, and Preventing Common Disabilities

051

CHAPTIER 6

Guide for Identifying Disabilities

This chapter has a chart, 7 pages long, to help you find out what disability a child possibly has, and where to look up that disability in this book.

In the first column of the chart, we list the more noticeable signs of different disabilities. Some of these signs are found in more than one disability. So in the second column we add other signs that can help you tell apart similar disabilities. The third column names the disability or disabilities that are most likely to have these signs. And the fourth column gives the page numbers where you should look in this book. (Where it says WTND and then a number, this refers to the page in Where There Is No Doctor.)

If you do not find the sign you are looking for in the first column, look for another sign. Or check the signs in the second column.

This chart will help you find out which disabilities a child might have. It is wise to look up each possibility. The first page of each chapter on a disability describes the signs in more detail.

IMPORTANT: Some disabilities can easily be confused. Others are not included in this book. When you are not sure, try to get help from someone with more experience. At times, special tests or X-rays may be needed to be sure what the problem is.

Fortunately,it is not always necessary to know exactly what disability a child has. For example, if a child has developed weakness in his legs and you are not sure of the cause, you can still do a lot to help him. Read the chapters on disabilities that cause similar weakness, and the chapters on other problems that the child may have. For this child, you might find useful information in the chapters on polio, contractures, exercises, braces, walking aids or wheelchairs, and many others.

Sometimes it is important to identify the specific disability. Some disabilities require specific medicines or foods-for example, night blindness, rickets, or cretinism. Others urgently need surgery - for example, spina bifida or cleft lip and palate. Others require special ways of doing therapy or exercises-for example, cerebral palsy. And others need specific precautions to avoid additional problems-for example, spinal cord injury and leprosy. For this reason, it helps to learn as much about the disability as you can. Whenever possible, seek information and advice from more experienced persons. (However, even experts are not always right. Do not follow anyone's advice without understanding the reasons for doing something, and considering if and why the advice applies to the individual child.)



In addition to this chart, 2 other guides for identifying disabilities are in this book :

GUIDE FOR IDENTIFYING CAUSES OF JOINT PAIN, Page 130. GUIDE FOR IDENTIFYING AND TREATING DIFFERENT FORMS OF FITS (EPILEPSY), Page 240.

052

GUIDE FOR IDENTIFYING DISABILITIES

SIGNS PRESENT AT OR SOON AFTER BIRTH

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
born weak or 'floppy' slow to begin to lift head or move arms.	often a difficult birth delayed breathing born blue and limp or born before 9 months and very small	cerebral palsy developmental delay	87 277
	round face slant eyes thick tongue	Down syndrome (mongolism) cretinism	279 282
	small head, or small top part of head	microcephalia (small brain) mental retardation	278
	none of above	developmental delay for other reasons	289
does not suck well or chokes on milk or food	pushes milk back out with tongue or will not suck	cerebral palsy	87
	cannot suck well chokes or milk comes out nose	check for cleft palate possibly severe retardation	120 277
one or both feet turned in or back.	no other signs	club foot	114
	hands weak, stiff or clubbed some joints stiff. in bent or straight positions	arthrogryposis	122
	dark lump on back	spina bifida	167
'bag' or dark lump on back	clubbed feet or feet bend up too far or feet lack movement and feeling	spina bifida (sometimes no 'bag' is seen, but foot signs may be present)	167
head too big; keeps growing.	may develop: eyes like 'setting sun' increasing mental and/or physical disability blindness	hydrocephalus (water on the brain)	169
		At birth, this is usually a sign of spina bifida.	167
		in an older child, possibly tapeworm in brain, or a brain tumor	WTND 143
upper lip and/or roof of mouth incomplete.	difficulty feeding later, speech difficulties	cleft lip (hare lip) and cleft palate	120
birth deformities, defects, or missing parts.	(may or may not be associated with other problems)	See birth defects amputations Down syndrome developmental delay	119 227 279 287
abnormal stiffness or position.	from birth some muscles weak some joints stiff head control and mind normal	arthrogryposis	122
	Muscles tighten more in certain positions. may grip thumb tightly	spastic cerebral palsy Note: muscle tightness(spasticity) usually does not appear until weeks or months after birth.	89

053

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
one arm weak or in strange position	does not move the arm much	Erb's palsy (weakness from damage to nerves in shoulder during birth)	127
	leg on same side often affected	hemiplegic (one-sided) cerebral palsy	90
dislocated hip at birth.	On opening legs like this, leg 'pops' into place or does not open as far.	dislocated hip from birth (often both hips) may be present with: spina bifida Down syndrome arthrogryposis Also see Page 156.	155 167 279 122
slow to respond to sound or to look at things	(may be due to one or a combination of problems)	Check for signs of: developmental delay cerebral palsy blindness deafness	290 87 243 257

SIGNS IN CHILDREN

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
slower than other children to do things (roll, sit, use hands, show interest, walk, talk)	slow in most or all areas:	Developmental delay, check for signs of:	287
	round face slant eyes single deep crease in hand	Down syndrome (mongolism)	279
	movements and response slow skin dry and cool hair often low on forehead puffy eyelids	cretinism	282
	has continuous strange movements positions, and/or stiffness	cerebral palsy also cheek for: blindness deafness malnutrition	87 243 257 320
does not respond to sounds, does not begin to speak by age 3	may respond to some sounds but not others Check for ear infection (pus).	Check for: deafness severe developmental delay (with or without deafness) severe cerebral palsy	257 283 87
does not turn head to look at things, or reach for things until they touch her	Eyes may or may not look normal.	blindness and/or severe mental retardation severe cerebral palsy	243 277 87
Eyelids or eyes make quick, jerky, or strange movements.	Check for one or a combination of these.	blindness fits too much medicine cerebral palsy other problems affecting or damaging the brain	243 233 15 87 14

054

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
All or part of body makes strange, uncontrolled movements.	begins suddenly, child may fall or lose consciousness child is normal (or more normal) between 'fits'	epileptic fits (Pattern varies a lot in different children-or even in the same child.)	233
	slow, sudden, or rhythmic movements; fairly continuous (except in sleep);no loss of consciousness	athetoid cerebral palsy (Note: Fits and cerebral palsy may occur in the same child.)	89
Body, or parts of it, stiffens when in certain positions: poor control of some or all movements.	different positions in different children Body may stiffen backward and legs cross.	spastic cerebral palsy	89

PARTS OF BODY WEAK OR PARALYZED

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
floppy or limp weakness in part or all of body no loss of feeling in affected parts no spasticity (muscles that tighten without control) normal at birth	usually began with a 'bad cold and fever before age 2 irregular pattern of parts weakened. Often one or both legs-sometimes arm, shoulder, hand, etc.	polio	59
	begins little by little and steadily gets worse about the same on both sides of body often others in the family also have it	muscular atrophy muscular atrophy	109 112
	Paralysis starts in legs and moves up; may affect whole body. or, pattern of paralysis variable	tick paralysis Guillain-Barre' paralysis (usually temporary) paralysis from pesticides, chemicals, foods (lathyrism)	not in book 62 15
	lump on back (See Page 57.)	tuberculosis of spine	165
floppy or limp weakness usually some loss of feeling	one or both hands or feet develops slowly in older child. Gets worse and worse.	leprosy	215
	born with bag on back (Look for scar.) feet weak, often without feeling	spina bifida	167
	usually from back or neck injury weakness, loss of feeling below level of injury may or may not have muscle spasms loss of bladder and bowel control	spinal cord injury	175
	injury to nerves going to one part of body	hand weakness sometimes caused by using crutches wrongly	393

055

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
weakness usually with stiffness or spasticity of muscles no loss of feeling	usually affects body in one of these patterns Muscles tighten and resist movement because of joint pain.	1: cerebral palsy (or stroke, usually older persons) 2 and 3: cerebral palsy occasional other causes JOINT PAIN (many causes-see below)	87 130

JOINT PAIN

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
one or more painful joints	begins with or without fever gradually gets worse, but there are better and worse periods	juvenile arthritis	135
		other causes of joint pain See chart on joint pain.	130

WALKS WITH DIFFICULTY OR LIMPS

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
dips to one side with each step	one leg often weaker and shorter	Check for: polio cerebral palsy dislocated hip	59 87 155
	usually begins age 4 to 8 may complain of knee pain	damaged hip joint	157
walks with knees pressed together	muscle spasm and tightness upper body little affected	spastic diplegic or paraplegic cerebral palsy	87
stands and walks with knees together and feet apart no other problems	feet less than 3" apart at age 3	normal from ages 2 to 12	113
	feet more than 3" apart at age 3	knock-kneed	114
walks awkwardly with one foot tiptoe	muscle spasms and poor control on that side. Hand on that side often affected.	hemiplegic cerebral palsy	90
		(stroke in older persons)	not in book
walks awkwardly with knees bent and legs usually separated	jerky steps, poor balance sudden, uncontrolled movements that may cause failing	athetoid cerebral palsy	89
	slow 'drunken' way of walking learns to walk late and falls often	poor balance (ataxia)-often with cerebral palsy Down syndrome (mongolism) cretinism	90 279 282
walks with both feet tiptoe	weakness, especially in legs and feet gradually gets worse and worse	muscular dystrophy	109
	legs and feet stiffen (spasticity of muscle)	spastic cerebral palsy	89
	no other problems	normal? (some normal children at first walk on tiptoes)	292

056

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
walks with hand(s) pushing thigh(s) or with knee(s) bent back		polio muscular dystrophy arthritis (joint pain) other causes of muscle weakness	59 109 135 112
Foot hangs down weakly (foot drop).	Child lifts foot high with each step so that it will not drag.	polio spina bifida muscular dystrophy muscular atrophy nerve or muscle injury other cause of weakness	59 167 109 112 35 139
dips from side to side with each step	due to muscle weakness at side of hips, or double dislocated hips, or both	polio cerebral palsy spina bifida Down syndrome muscular dystrophy child who stays small arthrogryposis dislocated hips (may occur with any of the above)	59 87 167 279 109 126 122 155
walks with one (or both) hip, knee, or ankle that stays bent	joints cannot be slowly straightened when child relaxes (see page 79).	contractures (shortened muscles) joined or fused joints may be secondary to: polio joint infection other causes	77 80 59 131 231
	Joints can gradually be straightened when child relaxes.	spasticity, often cerebral palsy	89
Knees wide apart when feet together (bow legs). Waddles or dips from side to side (if he walks).	under 18 months old	often normal	113
	Any combination of these: Joints look big or thick. Child is short for age. Bones weak, bent, or break easily. Arms and legs may seem too short for body, or 'out of proportion'. Belly and butt stick out a lot.	Consider: rickets (lack of vitamin D and sunlight) brittle bone disease children who stay very short (dwarfism) cretinism Down syndrome dislocated hips	125 125 126 282 279 155
flat feet	no pain or other problems	normal in many children	113
	Pain may occur in arch of foot. Deformity may get worse.	may be problems in: cerebral palsy polio spina bifida Down syndrome	87 59 167 279

BACK CURVES AND DEFORMITIES

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
sideways curve of backbone	When child bends over, look for a lump on one side.	'scoliosis' - may occur alone or as complication of: polio cerebral palsy muscular dystrophy spina bifida other physical disability	59 87 109 167 162

057

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
swayback	belly often sticks out may be due to contractures here, or weak stomach muscles	'lordosis' - may occur in: polio spina bifida cerebral palsy muscular dystrophy Down syndrome cretinism child who stays small many other disabilities	59 167 87 109 279 282 126 161
rounded back		'kyphosis' - often occurs with: arthritis spinal cord injury severe polio brittle bone disease	136 175 59 125
hard, sharp bend of or bump in backbone	starts slowly and without pain often family history of tuberculosis may lead to paralysis of lower body	tuberculosis of the spine	165
dark soft lump over backbone	present at birth sometimes only a soft or slightly swollen area over spine weakness and loss of feeling in feet or lower body	spina bifida ('sack on the back')	167

OTHER DEFORMITIES

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
missing body parts	born that way	born with missing or incomplete parts	121
	accidental or surgical loss of limbs (amputation)	amputations	227
	gradual loss of fingers, toes, hands, or feet, often in persons who lack feeling	osteomyelitis (bone infections) sometimes seen with leprosy (hands or feet) spina bifida (feet only)	159 215 167
hand problems (For hand problems from birth, see Page 305)	floppy paralysis (no spasticity) without care may lead to contractures so that fingers cannot be opened	may occur with: polio muscular dystrophy muscular atrophy spinal cord injury (at neck level) leprosy damage to nerves or cords of arms All may lead to contractures.	59 109 112 175 215 127
	uncontrolled muscle tightness (spasticity) strange movements or hand in tight fist *	spastic cerebral palsy may lead to contractures	89
	burn scars and deformities	burns	231
clubbing or bending of feet (For club feet from birth, see Page 114.)	may begin as floppy weakness and become stiff from contractures, if not prevented	may occur with many physical disabilities, including: polio cerebral palsy spina bifida muscular dystrophy arthritis spinal cord injury	59 87 167 109 139 175

058

DISABILITIES THAT OFTEN OCCUR WITH OR ARE SECONDARY TO OTHER DISABILITIES

IF THE CHILD HAS THIS	AND ALSO THIS	HE MAY HAVE	SEE PAGE
Developmental delay: child slow to learn to use her body or develop basic skills	caused by slow or incomplete brain function or by severe physical disability, or both	often seen in: mental retardation cerebral palsy severely or multiply disabled children	277 87 283
	caused by overprotection: treating children like babies when they could do more for themselves	some delay can occur with almost any disability	287
Contractures joints that no longer straighten because muscles have shortened	usually due to muscle weakness or spasticity Often, muscles that pull a joint one way are much weaker than those that pull it the other way (muscle imbalance).	often secondary to: polio cerebral palsy spina bifida arthritis muscular dystrophy Erb's palsy amputations leprosy	59 87 167 135 109 127 227 215
	sometimes due to scarring from burns or injuries	burns	231
Behavior problems	may come from: brain damage difficulty understanding things overprotection difficult home situation (Some children with epilepsy from brain damage may pull out hair, bite themselves, etc.)	behavior problems common with: mental retardation fits (epilepsy) cerebral palsy and for emotional reasons, with: spinal cord injury muscular dystrophy deafness learning disability	277 233 87 175 109 257 365
Slow to learn certain things only; otherwise intelligent.	often over-active or nervous sometimes behavior problems	learning disability	365
Speech and communication problems	often, but not always, due to deafness or retardation (or both) Some children can hear well and are but still cannot speak.	may occur with: deafness developmental delay cerebral palsy Down syndrome cretinism children who stay small brittle bone disease cleft lip and palate (Deafness may occur together with these and other disabilities.)	257 287 87 279 282 126 125 120
other problems that sometimes occur secondary to other disabilities (Some of these we have already included in this chart.)	Main disability cerebral palsy	Common secondary disabilities blindness deafness fits	243 257 233
	many disabilities with paralysis	spinal curve	161
	persons who have lost feeling: leprosy, spinal cord injury, spina bifida	pressure sores osteomyelitis (bone infection) loss of urine and bowel control	195 159 203

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Disabled Village Children A guide for community health workers, rehabilitation workers, and families by David Werner

Published by The Hesperian Foundation P.O. Box 11577 Berkeley, CA 94712-2577

Copyright © 1987 by the Hesperian Foundation 2nd edition, 5th printing February 1999