The child with a learning disability

With more and more advances in the understanding of children with behavioural, mental and learning-related problems, it is becoming increasingly difficult to separate one disorder from the other. Thus, compartmentalising a child as one with, say, Attention Deficit, or, say, Dyslexia, is useful for classification, for stratifying data, and for planning individualised care, in reality, children often have a mixture of problems from more than one specific category of a disorder. 

This, on the one hand, complicates rendering simplified information to parents, and our ability to deliver specific modalities of therapy. On the other hand, it enables us to better deliver holistic care to the affected child, as many of the therapeutic modalities are dependent on simple but standardised principles. 

LD is the new compact form of addressing children with some or the other mental disability. This does not include the deficiencies resulting from acute illnesses that often causes complex mental problems and not just LD. However, it does include dyslexia, problems with maths, problems with praxis (the carrying out of tasks) - the latter being also called dyspraxia.

Often, children with minor epilepsies will seemingly not pay attention in class and we would mistakenly name them as dyslexics. In the same vein, dyslexics might get labelled as "retards"- a rather pejorative use of the expression. Thus, one can easily see why managing a child with a LD can be very challenging. 

Fever is a symptom and not a disease, but ...

As I have mentioned in my earlier post, fever is not a disease by itself. Treating it with paracetamol merely causes the fever to subside, without actually affecting the underlying cause of the fever. It is important to know the following additional facts about fever:

1. High fever can produce fits in infants and toddlers; although these fits look very dangerous to parents and care-takers, they are merely a reflection of the immaturity of a small child's brain and nervous system pathways; no long-term medicine is needed except in the rarest of circumstances.
2. In children (and adults) of all ages, fever increases the thirst and fluid requirements of the patient; thus, febrile children or adults must be given extra liquids - usually 10% more than the usual for every degree Centigrade the fever is above 38 degrees.
3. A patient who is running a fever should never be force-fed food; nor should food be withheld from one who desires it. In short, let the patient decide what, how much and in what form he needs. Starving a child with fever is a criminal act, since it further weakens his/her body and prevents it from fighting the underlying cause of the fever (usually an infection with bacteria).
4. Very high fever (more than 105 degrees Fahrenheit) is termed malignant hyperpyrexia ... and in the extreme case, it can be potentially fatal, i.e. kill the patient due to complete derangement of all systems in the body.

While most causes of fever in children are easy to manage and not life-threatening, fever accompanied by any of the following additional symptoms should be considered as "not just fever" and such children should be referred to a Paediatrician immediately:           

• High grade fever
• Uncontrolled or repeated or very large-sized vomiting or loose stools
• Irritable, excessively jumpy or crying child
• Older child who remains in bed all the time and refuses to drink liquids or appears inactive, dull or lethargic
• Has had fever-associated fits in the past, or during the present illness
• There are significant symptoms pointing to a serious infection such as arching of the back (meningitis), dark coloured, blackish urine (malaria), stomach bloating (typhoid) or moist, hacking cough with sputum and chest pain (pneumonia)

Learn to understand fever and try not to panic.  Check out the link to my earlier detailed post on fever to learn how to manage fever at home. When in doubt, go to your child's doctor immediately.

Hidden Disabilities

I am writing this post to sensitise my dear readers about disabilities in people (here, I will stay with children, since this blog is about them) that are not obvious, but need attention all the same.

First of all, disabled people are also people. Just because a child is deaf, or visually challenged, does not mean he/she has no other aspects to his/her character; such a child can, and does, have emotional needs, ambitions, desires, etc. They still experience pain when hurt; they still laugh, cry, express anger, feel depressed, agonise, enjoy, and so on. We must look beyond the disability and express not just sympathy, but also try and understand what they need and how they must be integrated into society.

This post is about children whose disabilities belong to one of the following categories:

a) They are not routinely symptomatic, but can develop symptoms when stressed - e.g. a child with epilepsy, or one with allergy
b) A child who is physically normal but has neuro-developmental issues - e.g. a child with attention-deficit-hyperactivity disorder (ADHD), a child with autism spectrum disorder (ASD), or a child with behavioural issues related to a neurological disease (e.g. a child with sensory perception disorder (SPD)
c) A child with visible disability, but who is ignored or misunderstood - e.g. a dyslexic child is punished for getting poor grades because the teacher and parents think he is faking, or is naughty, or anti-social.

What is needed here is to understand that such children are all children with special needs. They need understanding of their condition. A sensitive healthcare policy at the national level, a sensitive person who is bearing the brunt of facing such a child, and a sensitive family are all important, nay, pivotal, to the well-being of such a child.

What such children can undergo are the following:

a) aggravation of their medical problem if they are not understood
b) violence and injury at the hands of disciplinarians, peers and parents
c) misdiagnosis leading to improper treatment
d) humiliation and ridicule - sometimes worse than physical violence
e) loss of opportunity/time/ etc. because the society has not begun to modify their environment for such children.

To prevent these from happening, let us all decide to try and be more empathetic towards children with hidden disabilities; let us be sensitive and non-judgemental towards them; let us be sincere and honest about our knowledge gaps and try and learn more about these problems; and, if we are caring for such children, let us be more caring and careful while dealing with them.

I welcome your comments. Thank you.