Hesperian Health Guides

Chapter 6: Guide for Identifying Disabilities

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HealthWiki > Disabled Village Children > Chapter 6: Guide for Identifying Disabilities


This chapter has a chart, 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 is linked to the page in the 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 hypothyroidism. 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.
GUIDE FOR IDENTIFYING AND TREATING DIFFERENT FORMS OF SEIZURES (EPILEPSY).

GUIDE FOR IDENTIFYING DISABILITES

To download a pdf of this chart, click here.

SIGNS PRESENT AT OR SOON AFTER BIRTH

IF THE CHILD HAS THIS AND ALSO THIS HE MAY HAVE
born weak or ‘floppy’
DVC Ch6 Page 52-1.png
  • often a difficult birth
  • delayed breathing
  • born blue and limp
  • or born before 9 months and very small
slow to begin to lift head or move arms
DVC Ch6 Page 52-3.png
  • round face
  • slant eyes
  • thick tongue

DVC Ch6 Page 52-2.png

small head, or small top part of head
DVC Ch6 Page 52-4.png
none of above developmental delay for other reasons
does not suck well or chokes on milk or food
DVC Ch6 Page 52-5.png
  • pushes milk back out with tongue
  • or will not suck
  • cannot suck well
  • chokes or milk comes out nose
one or both feet turned in or back
no other signs
club foot
DVC Ch6 Page 52-7.png
  • hands weak, stiff or clubbed
  • some joints stiff, in bent or straight positions
DVC Ch6 Page 52-8.png
arthrogryposis
dark lump on back spina bifida
‘bag’ or dark lump on back
DVC Ch6 Page 52-9.png
  • clubbed feet
  • or feet bend up too far
DVC Ch6 Page 52-10.png
  • or feet lack movement and feeling
spina bifida (sometimes no ‘bag’ is seen, but foot signs may be present)
head too big; keeps growing
DVC Ch6 Page 52-11.png
may develop: hydrocephalus (water on the brain)
  • eyes like ‘setting sun’
    DVC Ch6 Page 52-12.png
  • increasing mental and/or physical disability
  • blindness
At birth, this is usually a sign of spina bifida.
in an older child, possibly tapeworm in brain, or a brain tumor WTND page 143
upper lip and/or roof of mouth incomplete
DVC Ch6 Page 52-13.png
  • difficulty feeding
  • later, speech difficulties
DVC Ch6 Page 52-14.png
cleft lip (hare lip) and cleft palate
birth deformities, defects, or missing parts (may or may not be associated with other problems)

See

DVC Ch6 Page 52-15.png
abnormal stiffness or position
  • from birth
  • some muscles weak
  • some joints stiff
  • head control and mind normal
arthrogryposis

DVC Ch6 Page 52-17.png
DVC Ch6 Page 52-16.png
  • muscles tighten more in certain positions.
  • may grip thumb tightly
DVC Ch6 Page 52-18.png
spastic cerebral palsy


Note: muscle tightness (spasticity) usually does not appear until weeks or months after birth.
one arm weak or in strange position
DVC Ch6 Page 53-1.png
does not move the arm much
holds it like this.
DVC Ch6 Page 53-2.png
Erb’s palsy (weakness from damage to nerves in shoulder during birth)
leg on same side often affected hemiplegic (one-sided) cerebral palsy
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:
DVC Ch6 Page 53-3.png
leg held differently, shorter; flap covers part of vulva
DVC Ch6 Page 53-4.png
DVC Ch6 Page 53-5.png
arthrogryposis
Also see Hip Problems
slow to respond to sound or to look at things
DVC Ch6 Page 53-6.png
(may be due to one or a combination of problems)

Check for signs of:



SIGNS IN CHILDREN

IF THE CHILD HAS THIS AND ALSO THIS HE MAY HAVE
slow in most or all areas: developmental delay, check for signs of:
slower than other children to do things (roll, sit, use hands, show interest, walk, talk)


DVC Ch6 Page 53-7.png
  • round face
  • slant eyes
  • single deep crease in hand
DVC Ch6 Page 53-8.png
Down syndrome
  • movements and response slow
  • skin dry and cool
  • hair often low on forehead
  • puffy eyelids
DVC Ch6 Page 53-9.png
hypothyroidism
has continuous strange movements or positions, and/or stiffness
DVC Ch6 Page 53-10.png
cerebral palsy

also check for:
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

DVC Ch6 Page 53-11.png
does not turn head to look at things, or reach for things until they touch her Eyes may or may not look normal.
DVC Ch6 Page 53-12.png
Eyelids or eyes make quick, jerky, or strange movements.
DVC Ch6 Page 53-13.png
Check for one or a combination of these NWTND bag arrow.png
All or part of body makes strange, uncontrolled movements.
  • begins suddenly, child may fall or lose consciousness
  • child is normal (or more normal) between seizures
epileptic seizures
(Pattern varies a lot in different children—or even in the same child.)
DVC Ch6 Page 54-1.png
slow sudden, or rhythmic movements; fairly continous (except in sleep); no loss of consciousness
DVC Ch6 Page 54-2.png
athetoid cerebral palsy
(Note: Seizures and cerebral palsy may occur in the same child.)
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.
    DVC Ch6 Page 54-3.png
spastic cerebral palsy



PARTS OF BODY WEAK OR PARALYZED

IF THE CHILD HAS THIS AND ALSO THIS HE MAY HAVE
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.

DVC Ch6 Page 54-4.png
polio
  • begins little by little and steadily gets worse
  • about the same on both sides of body
  • often others in the family also have it
DVC Ch6 Page 54-5.png
DVC Ch6 Page 54-6.png
  • paralysis starts in legs and moves up; may affect whole body.
  • or pattern of paralysis variable
tick paralysis
DVC Ch6 Page 54-7.png
Guillain-Barré paralysis (usually temporary)
paralysis from pesticides, chemicals, foods (lathyrism)
lump on back (See p. 57.) tuberculosis of spine
floppy or limp weakness

usually some loss of feeling
  • one or both hands or feet
  • develops slowly in older child. Gets worse and worse.
DVC Ch6 Page 54-8.png
leprosy
  • born with bag on back (Look for scar.)
  • feet weak, often without feeling
DVC Ch6 Page 54-9.png
spina bifida
DVC Ch6 Page 54-10.png
  • 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

paraplegia (lower body)

quadriplegia (upper and lower body)
DVC Ch6 Page 54-11.png
DVC Ch6 Page 54-12.png
injury to nerves going to one part of body hand weakness sometimes caused by using crutches wrongly
weakness usually
with stiffness or spasticity of muscles

no loss of feeling
usually affects body in one of these patterns
  • 1: cerebral palsy (or stroke, usually older persons)
  • 2 and 3: cerebral palsy
  • occasional other causes
DVC Ch6 Page 55-1.png
1.
2.
3.
one
side
both
legs
whole
body
Muscles tighten and resist movement because of joint pain. JOINT PAIN
(many causes—see below)



JOINT PAIN

IF THE CHILD HAS THIS AND ALSO THIS HE MAY HAVE
one or more painful joints
  • begins with or without fever
  • gradually gets worse, but there are better and worse periods
DVC Ch6 Page 55-2.png juvenile arthritis
other causes of joint pain
See chart on joint pain.



WALKS WITH DIFFICULTY OR LIMPS


IF THE CHILD HAS THIS AND ALSO THIS HE MAY HAVE
dips to one side with each step
DVC Ch6 Page 55-3.png
one leg often weaker and shorter

Check for:

  • usually begins age 4 to 8
  • may complain of knee pain
damaged hip joint
walks with knees pressed together
  • muscle spasm and tightness
  • upper body little affected
spastic diplegic or paraplegic cerebral palsy
DVC Ch6 Page 55-4.png
stands and walks with knees together and feet apart

no other problems
DVC Ch6 Page 55-6.png feet less than 3” apart at age 3 normal from ages 2 to 12
DVC Ch6 Page 55-5.png DVC Ch6 Page 55-7.png feet more than 3” apart at age 3 knock-kneed
walks awkwardly with one foot tiptoe muscle spasms and poor control on that side. Hand on that side often affected. hemiplegic cerebral palsy
DVC Ch6 Page 55-8.png (stroke in older persons)
walks awkwardly with knees bent and legs usually separated
  • jerky steps, poor balance
  • sudden, uncontrolled movements that may cause falling
athetoid cerebral palsy
DVC Ch6 Page 55-9.png
  • slow ‘drunken’ way of walking
  • learns to walk late and falls often
walks with both feet tiptoe
  • weakness, especially in legs and feet
  • gradually gets worse and worse
muscular dystrophy
DVC Ch6 Page 55-10.png legs and feet stiffen (spasticity of muscle) spastic cerebral palsy
no other problems normal? (some normal children at first walk on tiptoes)
walks with hand(s) pushing thigh(s) or with knee(s) bent back
DVC Ch6 Page 56-2.png
weak thigh muscle
difficulty lifting leg
DVC Ch6 Page 56-1.png
Foot hangs down weakly (foot drop). DVC Ch6 Page 56-3.png Child lifts foot high with each step so that it will not drag. DVC Ch6 Page 56-4.png
dips from side to side with each step due to muscle weakness at side of hips, or double dislocated hips, or both
DVC Ch6 Page 56-5.png
walks with one (or both) hip, knee, or ankle that stays bent DVC Ch6 Page 56-6.png joints cannot be slowly straightened when child relaxes (see page 79).
Joints can gradually be straightened when child relaxes. spasticity, often cerebral palsy
Knees wide apart when feet together (bow legs).

Waddles or dips from side to side (if he walks).
under 18 months old often normal
DVC Ch6 Page 56-7.png

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.
DVC Ch6 Page 56-8.png

Consider:

flat feet DVC Ch6 Page 56-9.png no pain or other problems normal in many children
  • Pain may occur in arch of foot.
  • Deformity may get worse.

may be problems in:



BACK CURVES AND DEFORMITIES

IF THE CHILD HAS THIS AND ALSO THIS HE MAY HAVE
sideways curve of backbone DVC Ch6 Page 56-10.png When child bends over, look for a lump on one side. DVC Ch6 Page 56-11.png

‘scoliosis’—may occur alone or as complication of:

DVC Ch6 Page 57-1.png
sway
back
  • belly often sticks out
  • may be due to contractures here, or weak stomach muscles
‘lordosis’—may occur in:
rounded back DVC Ch6 Page 57-2.png

‘kyphosis’—often occurs with:

hard, sharp bend of or bump in backbone
DVC Ch6 Page 57-3.png
  • starts slowly and without pain
  • often family history of tuberculosis
  • may lead to paralysis of lower body
tuberculosis of the spine
dark soft lump over backbone DVC Ch6 Page 57-4.png
  • 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’)



OTHER DEFORMITIES

missing body parts born that way
DVC Ch6 Page 57-5.png
born with missing or incomplete parts
accidental or surgical loss of limbs (amputation) DVC Ch6 Page 57-6.png amputations
gradual loss of fingers, toes, hands, or feet, often in persons who lack feeling DVC Ch6 Page 57-7.png

sometimes seen with:

hand problems

(For hand problems from birth, see p. 305.)
  • floppy paralysis (no spasticity)
  • without care may lead to contractures so that fingers cannot be opened
DVC Ch6 Page 57-8.png

may occur with:


All may lead to contractures.
  • uncontrolled muscle tightness (spasticity
  • strange movements or hand in tight fist)
DVC Ch6 Page 57-9.png
spastic cerebral palsy

may lead to contractures
burn scars and deformities
DVC Ch6 Page 57-10.png
burns
clubbing or bending of feet

(For club feet from birth, see Chapter 11.)
may begin as floppy weakness and become stiff from contractures, if not prevented

may occur with many physical disabilities, including:

DVC Ch6 Page 57-11.png



DISABILITIES THAT OFTEN OCCUR WITH OR ARE SECONDARY TO OTHER DISABILITIES

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:

DVC Ch6 Page 58-1.png
caused by overprotection: treating children like babies when they could do more for themselves some delay can occur with almost any disability
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:

DVC Ch6 Page 58-2.png
Joints will not straighten.
sometimes due to scarring from burns or injuries burns
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:


and for emotional reasons, with:

DVC Ch6 Page 58-3.png
Slow to learn certain things only; otherwise intelligent.
  • often over-active or nervous
  • sometimes behavior problems
learning disability
Speech and communication problems
  • often, but not always, due to deafness or mental slowness (or both)
  • Some children can hear well and are but still cannot speak.

may occur with:

(Deafness may occur together with these and other disabilities.)
DVC Ch6 Page 58-4.png
other problems that sometimes occur secondary to other disabilities

Main disability

Common secondary disabilities
(Some of these we have already included in this chart.)
  • many disabilities with paralysis




This page was updated:19 Jan 2018