Introduction.
In order to understand disability in children and where the consequent needs differ significantly from those of a non disabled child it is necessary to have an understanding of the normal development process. The sequence of development is normally the same for all children, eg they sit before they can walk etc, but the rate of development varies. For example, up to 10% do not crawl before they walk but "bottom-shuffle", creep, roll, or just stand and walk. This may occur in those children who have an inherited pattern of low muscle tone and there is usually a history of affected relatives. Most children walk (even if its only a few steps) by the age of 2 years. The median age (ie the most commonly encountered age in years) of walking in shufflers, creepers and rollers is several months later than for crawlers and a few are still not walking by the age of 2, but eventually they function normally, with walking established by the age of 3 years in the majority of these children. Those who just stand and walk also have low tone and a similar family history but walk a month or two earlier than the crawler.
Development may be divided into four broad categories:
The table at the end of this section gives some examples of the normal development by chronological age of healthy children during the first six years of life in each of these main developmental areas.
Disability or disease in a child has a great impact on parents and the immediate family. Chronic illness or disability in the infant or young child may produce considerable additional care needs - usually provided by the parents themselves. Increasing numbers of children receive high dependency care provided at home over long periods.
The attention which is given, particularly to infants and very young children with disabilities, may differ in kind from that given to healthy children of the same age; but this may not mean that the amount of attention given is in excess of that usually required by a healthy child of the same age. Many healthy children waken at night for a variety of reasons and require attention. Likewise young children who are not disabled require care in relation to bodily functions such as eating, washing, dressing, undressing, and using the toilet. Some children, however, may not be receiving the attention they need as a result of their disabilities. The particular circumstances and needs in each case must be individually assessed and considered.
Assessment of care needs is also influenced by the fact that children develop both physically and mentally. This may result in decreased care needs; on the other hand, some care needs may increase. Physical development of the upper limbs in a child with defective lower limbs may enable him to move independently with mechanical aids where these are used. Increasing maturity may lead some children with chronic illness or disabilities (eg. the child with diabetes mellitus, or with cystic fibrosis, or arthritis, etc) to assume responsibility for the care of his condition and so require less supervision. Training received may also have its effect, notably with blind and deaf children. On the other hand, physical development may increase the burden of disablement: a child with learning disability may require more rather than less supervision as he gets older and becomes more mobile. Adolescents with disabilities will also have to cope with care and/or mobility needs against a background of changing patterns in body functions, social attitudes, and sometimes non-conforming and "rebellious" behaviour commonly encountered at this time.
The Care Needs of Infants.
The Non Disabled Infant.
An infant for the purposes of this text is taken to be a child aged less than one year old. Healthy infants require a great deal of attention in connection with their bodily functions. They must be fed, winded, changed and bathed frequently. In addition, if emotional development is to proceed normally, an infant must be handled, cuddled, talked to and played with regularly. Furthermore, during the times when the infant is sleeping periodic checks are made to ensure that all is well.
The Infant with Disabilities.
Because of the amount of care and supervision/watching over required by a healthy infant, that required by an infant with disabilities may not usually be much greater than that needed by a healthy child. The kind of attention given may differ: for example, instead of being handled in an ordinary manner, the infant with disabilities may need more specific stimulation or formal passive movements of the limbs in the form of physiotherapy, but the amount of care or supervision/watching-over may not be greater than that given to a healthy infant.
Disabilities Posing Very Substantial Needs.
Infants with certain disabilities will require considerable amounts of stimulation, care or supervision, in addition to the normal care routine. These disabilities include:
Care Involving Technical Procedures
The care of some infants with disabilities involves the use of technical procedures such that the attention or supervision/watching-over required from birth may be greatly in excess of that required by a healthy infant. These include:
The Older Infant/Young Child.
The Non-Disabled Infant.
As the healthy infant gets older the emphasis shifts from attention to supervision. Feeds become less frequent; winding is no longer necessary; the child begins to feed himself. However, from the age of about six months the development of investigative skills in tandem with increasing mobility puts the healthy child at risk of danger; the level of supervision required to avoid danger is considerable.
The Infant With Disabilities.
At this stage (often between 9 and 15 months), the gap between the care needs of a healthy child and a child with disabilities may have widened to the extent that the needs of the child with disability are significantly in excess. These may include continued attention to bodily functions no longer required by the healthy child, and more attention than needed by the healthy child for the development of new skills such as crawling, standing, and walking. The age at which the need for attention of the child with disability becomes greater than that of the healthy child cannot be defined precisely and judgement will depend on the evidence available in the individual case.
Disabilities Posing Substantial Needs.
There will be some children with disability with needs persisting or first manifesting at a level in excess of the norm at this age, for example:
The Older Child and Adolescent.
The variety and level of care needs and mobility requirements in the older child and adolescent with disabilities are dependent not only on chronological age but also on a number of other complex and interrelated factors which arise not only from the disabilities themselves but from consideration of the circumstances operating in the individual child/adolescent. Information on the care needs and mobility requirements likely to arise in the older child and adolescent are dealt with in the context of the remaining chapters of this section devoted to disabilities in children.
Night Needs in Infants and Young Children.
Healthy children under the age of two years normally require a considerable amount of attention, both in frequency and duration, during the night hours, for feeding, changing, or "settling" - the latter especially during teething. Specific, regular attention at night in excess of the norm may be required by some children with disabilities whose medical condition calls for parental intervention in the form of turning, nebulizer or oxygen therapy, suction, intubation, care during fits, etc.
If precautions are taken at night (such as the child being safely placed in a cot with sides, and bumpers if required and used) there may be few conditions requiring watching-over in the absence of attention needs which are substantially in excess of those needed by a child of comparable age.
However, the need for watching over in excess of normal will depend on the evidence available in an individual case. Notably, children with severe learning difficulties may have an abnormal tendency to develop a persistent habit of night wakening. In such cases attention from parents may be required more than once a night, and may last one hour or more.
"Difficult" Children.
Some healthy children are described by their parents as 'difficult' because they require more attention or supervision than other children of their age. However the increased needs here may not necessarily arise from severe physical or mental disability. It is however important to determine that children with disruptive behaviour at home have been assessed properly to ensure there is not a physical, intellectual or other reason for their behavioural problems.
Duration of Need.
It is not possible to give generalisations on the duration of needs. This will depend entirely on the particular disability or disabilities for which the child has care and/or mobility needs.
Further Evidence.
Most Child Development Centres provide parents with a report on the child's assessment which may be a useful source of additional information, should this be required. A report from the GP or hospital may also help in determining the level of disability and the likely duration of care needs. By the age of six the child may have been in some form of education for a year and assessment of potential will have been made. At that time, a school report may help in determining the level of any continuing care needs and their likely duration.
| Age | Vision and Manipulation | Hearing and Speech | Gross Motor | Social Behaviour | Feeding |
|---|---|---|---|---|---|
| Birth | Follow moving objects with eyes -Range 45 degrees 8-10 inches away - Hands remain closed (Involuntary grasp reflex) |
When baby is not crying the will respond to loud noises When baby is crying they will quieten to a noise |
New babies have no head control Head will flop backwards when laid down Head is to one side when laid on its tummy and knees under abdomen |
New born babies spend most of the day sleeping | |
| 6 Weeks | At 6 weeks a baby can focus and follow an object. They watch their mothers intently, when she speaks. |
May be startled by loud noises. | Is beginning to gain head control when pulled from lying down to sitting position. The head no longer flops backwards. |
Will smile at familiar and unfamiliar people. May begin to vocalise ie respond to speech by making sounds. |
|
| 3 Months | A baby will follow with its eyes a moving toy that is held in front of them through 180 degrees They will hold hands in front of face and observe them Holds a rattle momentarily when it is placed in the hand. |
A baby will babble when spoken to. | When laid on its tummy the baby is able to lift its head up and bear its weight on its forearms. The head is held up mostly when the baby is supported in a sitting position. |
Recognises Mother. Squeals with pleasure and becomes excited when given a toy. |
Feeding, winding and settling at 3 to 4 hourly intervals by day. To some extent by night are normal requirements of a healthy baby. Night feed is usually dropped at this stage |
| 6 to 8 Months | Can Grasp objects and enjoys playing with hands held in front. Will drop an object when another is handed to them. Can follow objects with their eyes and can also reach for them. |
Can respond to sound from behind. Will use their voice to babble - ie they will make different tuneful noises such as "baba", "dada" |
Child is able to sit unsupported. When held upright can support own weight to some extent. Can roll over when laid down, on the stomach to back and vice versa. |
Responsive to familiar people and apprehensive to unfamiliar people. Will talk using babble to familiar people. In a safe situation a baby can play on its own. |
Can drink from a cup, finger feed, chew and therefore eat solids. |
| 9 to 12 months | Can reach for and grasp toys and enjoys feeding self with his fingers. Can bring fingers and thumb together to pick up objects i.e. a piece of string. Index finger protrudes as the baby goes for the object Will respond to simple vision testing eg Stycar rolling balls. |
The baby is beginning to have meaningful babble May have one or two recognisable words. Will turn on hearing own name. |
Can crawl and can often walk. Some children will bottom shuffle instead of crawling, often these children are slower to walk than the children who crawl. |
Child is wary of unfamiliar adults. Can feed self and drink from cup. Waves bye-bye, plays pat-a-cake and peek-a-boo, and can also play for long periods of time. Enjoys dropping objects on the floor if there is someone to pick the objects up. Responds to "NO". |
|
| 15 months | Builds a tower with two bricks. | Has a lot of jargon speech | Can get to standing position without support. Can creep upstairs. |
Asks for objects by pointing. Displays negative behaviour. Begins to tell parent about wet pants. |
|
| 2 years | Turns pages singly. Copies a vertical stroke with a pencil with fist as opposed to the tripod grasp of an adult. Cooperates with a simple vision test. eg. Stycar toy test. |
Obeys four simple commands. eg."Take it to Mummy." Able to speak in small sentences and uses the words, " I, Me, You. " appropriately. |
Walks backwards in imitation. Is able to go up and down stairs using two feet per stair. |
Becomes more amenable to adult control. Often remains dry at night if lifted late in the evenings. |
2 years 6 months | Can build a tower of 6 bricks Holds pen with hand instead of in a fist. |
Knows his/her full name Can name one colour Can name 5 common objects eg. doggie, car. |
Is able to walk on tiptoe when asked. | Climbs onto the toilet seat. Attends toilet needs without help, except for wiping. |
| 3 years | Cooperates with Stycar vision testing ie matches letters on cards which are shown to him by the examiner. Develops a tripod grasp of a pencil. - Can build a tower of 8 bricks and can build a bridge with 3 bricks. |
Cooperates with a formal hearing test. i.e. will put pegs in a peg board in response to a quiet noise. Has a wide vocabulary of several hundred words. |
Child is a skilful climber. Can ride a bike with stabilisers. Can run, kick, and attempt to catch a ball. Goes up stairs one foot per step and goes down stairs two steps at a time. Can jump from the bottom step. Can stand on one foot for a few seconds. |
Is sociable, friendly and helpful. Joins in with other children to play. Can recite rhymes. Knows own sex. Is toilet trained by day, and in most cases by night. |
4 to 5 Years | Is able to cooperate with vision testing. Is skilful with a pencil and is able to draw recognisable pictures. Can copy a circle, square, and triangle. Can write own name. Read simple words. "Handedness" exhibits itself at around 4 years. |
Can often participate in a formal hearing test. Responds to a noise of a known type and volume played to through headphones (Audiometry). Has a wide vocabulary. Can sing tunefully. |
Can hop, skip, jump, etc skilfully. | Can dress, undress, wash, and bathe with supervision. |
| 6 years | Copies a diamond. Can draw an accurate picture of a person usually (mummy or daddy). Knows right from left. Can repeat five digits. |
Is able to name the days of the week, and name 4 coins. Can count to more than 10 objects which are not in a row. Can cooperate fully with audiometrical testing. |
Is able to ride a two wheeled bicycle. | Is able to undress, dress, wash and bathe independently. |
