Author: Natasha Boskic

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2.7 Children who are Chronically Ill: Diabetes

Children with Diabetes

Diabetes1 is a condition in which the body either does not produce enough insulin (see full Glossary) or does not use the insulin effectively (Fig.1 ).

Diabetes

Figure 1. Diabetes

Early Symptoms can include:

  • frequent peeing in large amounts
  • frequent thirst
  • dry mouth or throat
  • weight loss
  • increase in appetite
  • feeling tired, drowsy, or weak.

Another symptom in toddlers or infants includes having a diaper rash that doesn’t improve with medicated cream.

More serious symptoms may appear if the diabetes is not treated, or in some cases when it is undiagnosed. For example a child may have stomachaches, severe nausea and vomiting and heavy, rapid breathing.

There are two kinds of diabetes that a child can develop: Type 1 and Type 2. Type 2 diabetes is linked to obesity. This is when children rapidly gain too much weight. To learn more about diabetes Types 1 or 2 in young children, click on Children-with-diabetes.

Treatment and other Interventions

The first step for children with Type 1 or Type 2 diabetes is to understand how to use insulin or insulin dosing. Because the child’s body either can no longer make insulin, or cannot use it the right way, it must be replaced throughout the day, usually by injecting it.

These are vital steps to follow:

    • Test the level of sugar in the blood, or blood glucose testing at mealtimes and bedtime;
    • Know how to manage low levels of sugar, or blood glucose levels, a problem for kids with type 1 diabetes;
    • Eat right. A dietitian or nutritionist can help suggest the foods that help avoid changes in the level of sugar in the blood;
    • Exercise regularly to maintain a lower level of sugar in the blood.  Parents will need to check their child’s blood glucose levels before and after exercise.

To learn about diabetes in the middle childhood years, please visit the six to 12 part of this course.

1 see References
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2.7 Children who are Chronically Ill: HIV/AIDS

Children with HIV/AIDS

HIV (Human Immunodeficiency Virus)1 is a virus that attacks the immune system, or the body’s natural defense system. Without a strong immune system, the body has trouble fighting off disease. Both the virus and the infection it causes are called HIV.

White blood cells (Fig. 1) are an important part of the immune system. HIV invades and destroys certain white blood cells called CD4+ cells. If too many CD4+ cells are destroyed, the body can no longer defend itself against infection. Without treatment HIV infection progresses. When the infection is advanced, AIDS (Acquired Immunodeficiency Syndrome) can develop. People with AIDS have a low number of CD4+ cells and get infections or cancers that rarely occur in healthy people.

White Blood Cells

Figure 1. White blood cells (click on image to enlarge)

The rate of infection for children is low. The virus is primarily passed from mother to child during pregnancy or in utero, or during blood transfusions (see full Glossary). Parents with young children and their educators need to be reassured that their children’s peers and classmates with HIV/AIDS are not contagious.

The needs of children with HIV or AIDS and their families are complex. The world’s largest non-profit organization for children in need, UNICEF has a web page with information for children and families with HIV.

There are many excellent resources online if you want information on HIV and AIDS.

To learn about HIV/AIDS in the middle childhood years, please visit the six to 12 part of this course.

1 Source: HIV and AIDS in Canada: Surveillance Report to December 31st, 2013
https://www.canada.ca/en/public-health/services/hiv-aids/publications/hiv-aids-canada-surveillance-report-december-31-2013.html
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2.7 Children who are Chronically Ill: Cancer

Children with Cancer

Childhood cancer is a rare disease. How cancer behaves, its appearance, its rate of growth and response to treatment is different with children than it is with adults. The complications of treatment can be more extensive in children due to the effects on growth and development. Although the treatment is often complex, there is a high cure rate and more effective and less toxic therapies are always in development.

Children with cancer face special physical and emotional needs. Professionals (see full Glossary) who specialize in this illness can provide the type of counseling and therapy that may better help address the needs of these children.

Resources include a Parent Handbook (see full Glossary) that makes it a bit easier for parents and families to understand the steps they need to follow in the treatment and intervention of this illness.

To learn about cancer in the middle childhood years, please visit the six to 12 part of this course.

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2.7 Children who are Chronically Ill: Asthma

Children with Asthma

Description

Asthma1 (see full Glossary) is a chronic condition, that may begin during a child’s early years.

Some of the symptoms include:

  • wheezing;
  • coughing;
  • shortness of breath;
  • chest tightening;
  • difficulty breathing (Fig. 1), that may require assisted ventilation

Difficulty with Breathing

Figure 1. Difficulty with breathing

Several factors can cause an asthma attack. These are called “asthma triggers” and include the following:

  • smoke;
  • pollen;
  • perfume;
  • mold;
  • dust mites (see full Glossary);
  • viral infectionslike the common cold.

What causes asthma?

  • It is now known that a child with one parent who has asthma has a 25% (or one out of four) risk of developing asthma. If both parents have asthma, the risk increases to 50%, or one out of two.
  • Children whose mothers smoked during pregnancy are more likely to develop asthma.
  • Asthma may be more likely to happen also because of other factors related to pregnancy. For example, children born to very young or older mothers, children born to mothers with little care and nutrition during the pregnancy, or children who grew up in smoking environments.
  • Children born premature or with low birth weight are also at a higher risk for asthma.

Diagnosis, Treatment and Intervention Options

A doctor will likely make a diagnosis of asthma in a child who has repeated episodes of wheezing. This is particularly the case when family members are known to have asthma or allergies. It is important to find out the cause for asthma; this is why doctors order allergy tests. X-rays are also needed to find out the condition of the child’s airways (i.e., lungs and bronchi).

Most children outgrow asthma (over 50% of children with this condition do). In some more severe cases, or for adults who smoke or live in house environments with mold and/or dust mites, the condition will persist.

Most asthma attacks may be prevented by avoiding triggers. Treatment includes different medications that expand the airways used with an inhaler (Fig. 2) that are called bronchodilators and cortico steroids.

Inhaler

Figure 2. Inhaler

Asthma flare-ups (Fig. 3) can often be prevented by avoiding whatever triggers a particular child’s attacks. Because exercise is so important for a child’s development, doctors usually encourage children to maintain physical activities, exercise, and sports participation and to use an asthma medication immediately before exercising if needed. An important treatment option for young children with asthma is physiotherapy, as respiratory exercises improve children’s quality of life.

Because asthma is a long-term condition with a variety of treatments, doctors work with parents and children to make sure they understand the condition as well as possible.

Asthma flareups

Figure 3. Asthma flare-ups

Parents and children are trained to use a peak flow meter (Fig. 4) on a regular basis in order to understand the level of airflow in the child. They are also taught to identify how severe an attack is, when and how to use drugs, and when to go to the emergency-room at the hospital.

Peak Flow Meter

Figure 4. Peak flow meter

It is recommended that parents and doctors inform school nurses, child care providers, and others of a child’s condition and the drugs being used to treat it. Some children may be permitted to use inhalers in school by themselves as needed, and others must be supervised by the school nurse.

To learn about asthma in the middle childhood years, please visit the six to 12 part of this course.

1 see References
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2.7 Children with Other Types of Chronic illness

Children with Other Types of Chronic Illness

Other types of chronic illnesses include conditions that weaken the child’s system as they progress, and that have a genetic link like cystic fibrosis and muscular dystrophy, that are described earlier in this Module.

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2.8 Children with Communication Disorders

Children with Communication Disorders

Language delay is commonly divided into receptive and expressive categories.

Receptive language is the process of understanding what is said to us. A child had receptive language disorder when he or she has difficulties with understanding what is said to them. Symptoms vary, but problems with language comprehension usually begin anytime between ages 2 and 4 years of age.

Expressive language refers to the use of words and sentences to communicate to others.

Language delay can be a risk factor (see full Glossary) for other types of developmental delay, including social, emotional, and cognitive delay.  One common result of language delay is difficulty with reading.

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2.8 Children with Communication Disorders: Receptive Language Difficulties

Children with Receptive Language Difficulties

Description

A child has a receptive language disorder when he or she has difficulties with understanding what is said to them. Symptoms vary but problems with language comprehension usually begin before the age of 4 years. It is estimated that between 3% and 5% of children have a receptive or expressive language disorder, or a mixture of both. This means that he or she finds it hard to do something with what he or she hears1. Other names for receptive language disorder include central auditory processing disorder or CAPD (see full Glossary) and comprehension deficit (see full Glossary).

Signs a child may have receptive language difficulties:

  • Not seeming to listen when spoken to;
  • Lack of interest when story books are read to him or her;
  • Inability to understand complicated sentences;
  • Inability to follow verbal instructions;
  • Parroting words or phrases (echolalia);
  • Language skills below the expected level for their age.

Understanding spoken language is a complicated process. The child may have problems with one or more of the following skills:

  • Hearing: A hearing loss can be the cause of language problems.
  • Vision:  Understanding language involves visual cues, such as facial expression and gestures. A child with vision loss won’t have these additional cues, and may experience language problems.
  • Attention: The child’s ability to pay attention and concentrate on what’s being said may be impaired.
  • Speech sounds: There may be problems distinguishing between similar speech sounds.
  • Memory: The brain has to remember all the words in a sentence in order to make sense of what has been said. The child may have difficulties with remembering the string of sounds that make up a sentence.
  • Word and grammar knowledge: The child may not understand the meaning of words or sentence structure.
  • Word processing: The child may have problems with processing or understanding what has been said to them.

In order to determine if a receptive language difficulty exists, the following assessments might be made:

  • Hearing tests by an audiologist to make sure the language problems aren’t caused by hearing loss and to determine if the child is able to pay attention to sound and language (auditory processing assessment).
  • Testing the child’s comprehension (by a speech pathologist) and comparing the results to the expected skill level for the child’s age.
  • Close observation of the child in a variety of different settings while he or she interacts with a range of people.
  • Assessment by a neuropsychologist to help identify any cognitive problems.
  • Vision tests to check for vision loss.

Intervention Options

  • Speech-language therapy;
  • One-on-one therapy and group therapy, depending on the child;
  • Special education classes at school;
  • Integration support (see full Glossary) at preschool or school in cases of severe difficulty;
  • Referral to a mental health service for treatment (if there are also significant behavioral problems).

To learn about receptive language disorders in the middle childhood years, please visit the six to 12 part of this course.

1 According to Katz, Stecker and Henderson (1992).
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2.8 Children with Communication Disorders: Expressive Language Difficulties

Children with Expressive Language Difficulties

Description

Expressive language disorder means a child has difficulty with verbal and written expression. Language can either be delayed or disordered, or a combination of the two. Expressive language disorder can present in two forms, delayed or disordered language.

  1. Delayed – When a child’s language development is slow but follows the usual sequence or pattern of development it is identified as delayed;
  2. Disordered – When a child’s language is slow to develop and the sequence of development and pattern of grammatical errors is different from what is normally expected it is identified as disordered;

Signs a child may have expressive language difficulties include the following:

  • Frequently having trouble finding the right word;
  • Having a limited and basic vocabulary;
  • Using non-specific vocabulary such as ‘this’ or ‘thing’;
  • Using the wrong words in sentences or confusing meaning in sentences;
  • Making grammatical mistakes, leaving off words (such as helper verbs) and using poor sentence structure; Relying on short, simple sentence construction;
  • Using less words and sentences than children of a similar age;
  • Relying on “stock standard phrases ” (see full Glossary) and limited content in speech;
  • Repeating (or ‘echoing’) a speaker’s utterance;
  • Having difficulties to ‘come to the point’ or talking in circles;
  • Having problems with retelling a story or relaying information;
  • Finding it is very hard to start or hold a conversation;
  • Having difficulties with oral and written work and school assignments (for older children).
  • In order to determine if an expressive language difficulty exists, the following assessments might be made
  • Speech delays are assessed by speech language pathologists or SLP’s. Speech pathologists perform specific assessments in order to find out which areas of language appear to be difficult for your child. Early detection is important.

Other assessments that may be recommended:

  • Hearing and auditory processing tests;
  • Tests for learning difficulties;
  • Assessments of cognitive function (thinking and intelligence).

Intervention Options

To learn about expressive language disorders in the middle childhood years, please visit the six to 12 part of this course.

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2.8 Children with Communication Disorders: Articulation Difficulties

Children with Articulation Difficulties

Description

Articulation Delay/Disorder is an atypical production of speech sounds created by sound substitutions, omissions, additions, or distortions. This may interfere with a parent’s ability to understand what the child is saying. The child may make sound substitutions: a child at age 6 will say “wabbit” instead of “rabbit” and “thwim” for “swim.”

Difficulty with some sounds is common for children under the age of 8. Articulation disorders can often be successfully treated with speech therapy.

Children develop speech sounds in a fairly predictable sequence, however the age of onset for these sounds can vary from child to child.

For example:

  • A three year old might say “nana” for banana or “tar” for car:
  • A four year old might say “sanwit” for sandwich;
  • A five or six year old might say “wed” for red.

Age ranges when correct sounds should appear:

p,b,d,t,m,n,w,h By two years*
k,g,f,v,ing, By four years*
s,z,ch,sh,j, l By five years*
r,th By six years*

By 7 years of age a child should master all these sounds.

  • Articulation delay: When the child acquires the sounds in the expected sequence but the developmental errors persist beyond the age we expect.
  • Articulation disorder: When a child’s error patterns and/or sound acquisition sequence are different from most children their age.
  • Phonological disorder: When a child’s error patterns are more severe and affect an entire group of sounds with similar characteristics.

Intervention Options:

In all cases, a referral to a Speech Language Pathologist is suggested.

To learn about articulation disorders in the middle childhood years, please visit the six to 12 part of this course.

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2.8 Children with Communication Disorders: Apraxia

Children with Apraxia

Description

Apraxia1 (see full Glossary) of speech, also known as verbal apraxia or dyspraxia, is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. The severity of apraxia of speech can range from mild to severe.

There are two types of apraxia:

  • Acquired apraxia can affect a person at any age and is caused by damage to the part of the brain involved in speaking. Acquired apraxia can occur together with muscle weakness affecting speech production (dysarthria) or difficulties due to damage to the nervous system (aphasia).
  • Developmental apraxia of speech occurs in children. It is present since birth, and affects boys more often than girls. Children with developmental apraxia of speech generally can understand language much better than they are able to use language to express themselves. Some children with the disorder may also have other problems. These can include the following:
    • Other speech problems, such as dysarthria;
    • Language problems such as poor vocabulary, incorrect grammar, and difficulty in clearly organizing spoken information;
    • Problems with reading, writing, spelling, or math;
    • Coordination or “motor-skill” problems;
    • Chewing and swallowing difficulties.

Intervention Options:

A speech language pathologist makes the diagnosis and plans for the treatment and intervention. Therapy needs to be designed specifically for each individual because  no single intervention has proven to be the most effective to-date. In severe cases children with apraxia may need to use other ways to express themselves such as the use of sign language (Fig. 1) or of communication devices (Fig. 2) such as a portable computer.

Sign Language

Figure 1. Sign Language

Communication Device

Figure 2. Communication Device

To learn about apraxia in the middle childhood years, please visit the six to 12 part of this course.

1 see References

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