Introduction
Children with disabilities and special healthcare needs (CSHCN) may have a wide range of medical issues that frequently call for immediate medical attention. The issues that pediatric surgeons encounter most frequently are spina bifida, Down syndrome, and cerebral palsy. Cerebral palsy (CP) is the most common cause of physical disability in developed countries and probably in most developing countries. The prevalence rates are less clear in developed countries. The incidence of CP is approximately two per 1000 live births, with variation in developed countries. Physical disability is defined as a person with a physical or mental impairment. These impairments have limitations on one or more major life activities, including the inability to work, or it affects quality of life. This article will focus on problems faced by disabled children with special healthcare needs (CSHCN) who are at risk for chronic physical, developmental, behavioral, or emotional conditions and require healthcare services.
What Is the Meaning of Children With Physical Disabilities?
The children who are at risk of long-term physical, developmental, behavioral, or emotional issues that call for treatment in their peer group are known as children with physical disabilities. These children get ill often. The history of these children is complex. Children with special healthcare needs remain more likely to seek emergency care than their peers and often for more complicated issues related to their unique needs.
What Are Surgical Problems of Children With Physical Disabilities?
There are a number of surgical problems that can affect children with physical disabilities. These may be related to the underlying condition that causes the physical disability or may be a result of other complications that arise as a result of the disability. Some common surgical problems include spinal deformities, joint contractures, pressure sores, gastrointestinal problems, breathing difficulties, and orthopedic injuries.
The following are the surgical problems of children with physical disabilities;
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Spinal Deformities: Cerebral palsy (CP) is the most common cause of physical disability in children. Cerebral palsy is defined as an abnormality in the brain that causes impairment in motor function-like movements. Most cases of CP are caused by abnormal brain development before birth. It causes neurological disorders and paralysis of the limbs, which makes children physically disabled. For the malformation to be corrected, surgery may be necessary, which can cause pain and limit mobility.
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Joint Contractures: For patients with severe lower extremity contractures, a laparoscopic operation may not be feasible if body habitus does not allow for adequate clearance of laparoscopic instrumentation because these patients have limited physical movements. These physical disabilities are caused due to scoliosis. Surgical correction of scoliosis is one of the more commonly performed surgical procedures in patients with CP.
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Neurological Problems: Patients with a seizure (a condition in which patients get sudden uncontrolled movement attacks in the limbs) disorder are often considered at high risk during procedures, based primarily on the risk of seizures occurring during or shortly after the procedure. These patients are at higher risk of allergies to the drugs after surgery.
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Gastrointestinal Problems: The usual causes of malnutrition in children with CP are inadequate caloric consumption due to poor oral-motor function (neurologic dysphagia), increased metabolic demand due to an excessive movement disorder, food aversion as a learned response to the discomfort of eating caused by either gastroesophageal reflux. Malnutrition is defined as a state of nutrition that is unable to meet the needs of the children for growth and health maintenance over time. Malnutrition causes poor growth, diminished bone growth, less social interaction, abnormal puberty changes, and overall poor health. Children with physical disabilities may have gastrointestinal problems such as reflux, constipation, or fecal incontinence, which need to be resolved either with medications, dietary changes, or surgical procedures.
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Breathing Difficulties: Children with physical disabilities may have breathing difficulties due to weak respiratory muscles or structural abnormalities in the chest or airways. Surgery may be required to correct these issues and improve respiratory function.
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Orthopedic injuries: Children with physical disabilities are at higher risk for orthopedic injuries such as fractures, dislocations, or sprains due to their decreased mobility and muscle tone. Surgery may be required to repair or stabilize these injuries.
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Gastroesophageal Reflux Disease (GERD): Neurologically impaired children have a high prevalence of gastroesophageal reflux disease. GERD in children with CP suffers from increased intra-abdominal pressure, retching, and constipation.
What Is the Treatment of Surgical Problems of Children With Physical Disabilities?
The following are the management of the children with physical disability:
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Role of Physicians: Children with physical disabilities need special care and attention. It is also essential that effective communication exists between the involved specialists and the child’s primary care physician. There should be good communication between the physician and family for a multidisciplinary approach to the treatment. Specialists and parents of the children need to be educated on successful means of interaction and shared management of patients. Lack of useful exchange between these physicians leads to disorganized, lower-quality care and reduced satisfaction of both specialists and parents. Children with physical disabilities need a carefully planned out division of responsibility negotiated between physicians in order to meet all of the child’s needs efficiently.
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Family-Centered Care: Families always play a vital role in seeing through the healthcare of the children. A child with a physical disability needs emotional, physical, and financial help from the family. In a survey on children with special healthcare needs, 40 percent indicated that the patient’s condition significantly impacted the financial condition of the family. The family is the primary source of children’s strength and support. The information related to the children, which is shared by the parents is important for making clinical decisions.
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Avoidance of Abuse and Neglect: The National Center on Child Abuse and Neglect reported that children with special needs or disabilities are at a greater risk of maltreatment and abuse than their nondisabled peers. This includes all forms of maltreatment: physical abuse, sexual abuse, neglect, and verbal or emotional abuse. This should be avoided. Children with compromised states need special care and attention. Pediatric surgeons should be vigilant about screening for and referring to suspicious cases in this vulnerable pediatric population.
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Medications: According to the cases of the children, medication should be prescribed by a pediatric surgeon.
Conclusion
It is important to note that not all children with physical disabilities will require surgical intervention, and the decision to undergo surgery should be made after consulting a trained healthcare expert. Additionally, it is important to remember that having a physical disability does not define a child or their abilities. With appropriate support and accommodations, children with physical disabilities can thrive and achieve their full potential. Early interventions will have more impact than later interventions and will be more cost-effective.
