Chapter 6: Guide for Identifying Disabilities

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

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In this chapter:

 

In this chapter:

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, specific tests or X-rays may be needed to be sure what the conditions.

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 disabilities that the child may have. For this child, you might find useful information in the chapters on 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 specific 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’	often a difficult birth delayed breathing born blue and limp or born before 9 months and very small		cerebral palsy cognitive delay
takes longer to begin to lift head or move arms	round face slant eyes thick tongue		Down syndrome hypothyroidism
	small head, or small top part of head		microcephalia (small brain) cognitive delay
	none of above		developmental delay for other reasons
does not suck well or chokes on milk or food	pushes milk back out with tongue or will not suck		cerebral palsy
	cannot suck well chokes or milk comes out nose		check for cleft palate possibly severe mental slowness
one or both feet turned in or back	no other signs		club foot
	hands weak, stiff or clubbed some joints stiff, in bent or straight positions		arthrogryposis
	dark lump on back		spina bifida
‘bag’ or dark lump on back	clubbed feet or feet bend up too far or feet lack movement and feeling		spina bifida (sometimes no ‘bag’ is seen, but foot signs may be present)
head too big; keeps growing	may develop:		hydrocephalus (water on the brain)
	eyes like ‘setting sun’ increasing mental and/or physical disability loss of vision		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	difficulty feeding later, speech difficulties		cleft lip and cleft palate
disabilities at birth limbs, fingers or toes not typical	(may or may not be associated with other problems)		See disabilities present at birth amputations Down syndrome developmental delay
unusual stiffness or position	from birth some muscles weak some joints stiff typical head control and mind		arthrogryposis
	muscles tighten more in certain positions. may grip thumb tightly		spastic cerebral palsy Note: muscle tightness (spasticity) usually does not appear until weeks or months after birth.
one arm weak or in strange position	does not move the arm much holds it like this.		Erb’s palsy (weakness from injury 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:
leg held differently, shorter; flap covers part of vulva			spina bifida Down syndrome arthrogryposis Also see Hip Problems
slow to respond to sound or to look at things	(may be due to one or a combination of conditions)		Check for signs of: developmental delay cerebral palsy loss of vision hearing loss

SIGNS IN CHILDREN

IF THE CHILD HAS THIS		AND ALSO THIS		HE MAY HAVE
		delayed in most or all areas:		developmental delay, check for signs of:
takes longer than other children to do things (roll, sit, use hands, show interest, walk, talk)		round face slant eyes single deep crease in hand		Down syndrome
		movements and response slow skin dry and cool hair often low on forehead puffy eyelids		hypothyroidism
		has continuous movements or positions, and/or stiffness		cerebral palsy also check for: loss of vision hearing loss malnutrition
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 hearing loss severe developmental delay (with or without hearing loss) severe cerebral palsy
does not turn head to look at things, or reach for things until they touch her		Eyes may or may not look typical.		loss of vision and/or severe mental slowness severe cerebral palsy
Eyelids or eyes make quick, jerky, or strange movements.		Check for one or a combination of these		loss of vision seizures too much medicine cerebral palsy other conditions that affect or cause brain injuries
All or part of body makes strange, uncontrolled movements.		begins suddenly, child may fall or lose consciousness typical movements and behaviors between seizures		epileptic seizures (Pattern varies a lot in different children—or even in the same child.)
		slow sudden, or rhythmic movements; fairly continuous (except in sleep); no loss of consciousness		athetoid cerebral palsy (Note: Seizures and cerebral palsy may occur in the same child.)
Body, or parts of it, stiffens when in certain positions: difficulty with control of some or all movements.		different positions in different children body may stiffen backward and legs cross.		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) typical 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.			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			muscular dystrophy muscular atrophy
	paralysis starts in legs and moves up; may affect whole body. or pattern of paralysis variable			tick paralysis Guillain-Barré syndrome (usually temporary)
				paralysis from pesticides, chemicals, foods (lathyrism)
	lump on back			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.			leprosy
	born with bag on back (Look for scar.) feet weak, often without feeling			spina bifida
	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)
	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
	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		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		one leg often weaker and shorter		Check for: polio cerebral palsy dislocated hip
		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
stands and walks with knees together and feet apart no other problems			feet less than 3” apart at age 3	typical from ages 2 to 12
			feet more than 3” apart at age 3	knock-kneed
walks awkwardly with one foot tiptoe		muscle spasms and difficulty with control on that side. Hand on that side often affected.		hemiplegic cerebral palsy
				(stroke in older persons)
walks awkwardly with knees bent and legs usually separated		jerky steps, difficulty with balance sudden, uncontrolled movements that may cause falling		athetoid cerebral palsy
		slow “drunken” way of walking learns to walk late and falls often		difficulty with balance (ataxia)— often with cerebral palsy Down syndrome hypothyroidism
walks with both feet tiptoe		weakness, especially in legs and feet gradually gets worse and worse		muscular dystrophy
		legs and feet stiffen (spasticity of muscle)		spastic cerebral palsy
		no other problems		typical? (some typical children at first walk on tiptoes)
walks with hand(s) pushing thigh(s) or with knee(s) bent back		weak thigh muscle difficulty lifting leg		polio muscular dystrophy arthritis (joint pain) other causes of muscle weakness
Foot hangs down weakly (foot drop).		Child lifts foot high with each step so that it will not drag.		polio spina bifida muscular dystrophy muscular atrophy nerve or muscle injury other cause of weakness
dips from side to side with each step		due to muscle weakness at side of hips, or double dislocated hips, or both		polio cerebral palsy spina bifida Down syndrome muscular dystrophy child who stays small arthrogryposis dislocated hips (may occur with any of the above)
walks with one (or both) hip, knee, or ankle that stays bent		joints cannot be slowly straightened when child relaxes.		contractures (shortened muscles) joined or fused joints may be secondary to: polio joint infection other causes
		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 typical
		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.		Consider: rickets (lack of vitamin D and sunlight) brittle bone disease children who stay very short (dwarfism) hypothyroidism Down syndrome dislocated hips
flat feet		no pain or other problems		normal in many children
		Pain may occur in arch of foot. Deformity may get worse.		may be problems in: cerebral palsy polio spina bifida Down syndrome

BACK CURVES AND DEFORMITIES

IF THE CHILD HAS THIS		AND ALSO THIS		HE MAY HAVE
sideways curve of backbone		When child bends over, look for a lump on one side.		scoliosis—may occur alone or as complication of: polio cerebral palsy muscular dystrophy spina bifida other physical disability
sway back (lordosis)		belly often sticks out may be due to contractures here, or weak stomach muscles		lordosis—may occur in: polio spina bifida cerebral palsy muscular dystrophy Down syndrome hypothyrodism child who stays small many other disabilities
rounded back (kyphosis)				kyphosis—often occurs with: arthritis spinal cord injury severe polio brittle bone disease
hard, sharp bend of or bump in backbone		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		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		born with missing or incomplete parts
		accidental or surgical loss of limbs (amputation)		amputations
		gradual loss of fingers, toes, hands, or feet, often in persons who lack feeling		osteomyelitis (bone infections) sometimes seen with: leprosy (hands or feet) spina bifida (feet only)
hand problems (For hand problems from birth, see "Activities to Help Develop Gripping, Reaching, and Hand‑Eye Coordination".)		floppy paralysis (no spasticity) without care may lead to contractures so that fingers cannot be opened		may occur with: polio muscular dystrophy muscular atrophy spinal cord injury (at neck level) leprosy damage to nerves or cords of arms All may lead to contractures.
		uncontrolled muscle tightness (spasticity strange movements or hand in tight fist)		spastic cerebral palsy may lead to contractures
		burn scars and deformities		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: polio cerebral palsy spina bifida muscular dystrophy arthritis spinal cord injury

DISABILITIES THAT OFTEN OCCUR WITH OR ARE SECONDARY TO OTHER DISABILITIES

Developmental delay: child takes longer 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: mental slowness cerebral palsy children with severe or multiple disabilites
	caused by overprotection: treating children like babies when they could do more for themselves	some delay can occur with almost any disability or lack of stimulation
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: polio cerebral palsy spina bifida arthritis muscular dystrophy Erb’s palsy amputations leprosy
Joints will not straighten.	sometimes due to scarring from burns or injuries	burns
Behavior problems	may come from: brain injury difficulty understanding things overprotection difficult home situation (Some children with epilepsy from brain injury may pull out hair, bite themselves, etc.)	behavior problems common with: cognitive delay seizures (epilepsy) cerebral palsy and for emotional reasons, with: spinal cord injury muscular dystrophy hearing loss learning disability
Slow to learn certain things; otherwise typical development.	often over-active or nervous sometimes behavior problems	learning disability
Speech and communication problems	often, but not always, due to hearing loss or cognitive delay (or both) Some children can hear well and are but still cannot speak.	may occur with: hearing loss cognitive delay cerebral palsy Down syndrome hypothyroidism children who stay small brittle bone disease cleft lip and palate (Hearing loss may occur together with these and other disabilities.)
other disabilities that sometimes occur secondary to other disabilities	Main disability cerebral palsy	Common secondary disabilities loss of vision hearing loss seizures
(Some of these we have already included in this chart.)	many disabilities with paralysis	spinal curve
	persons who have lost feeling: leprosy, spinal cord injury, spina bifida	pressure sores osteomyelitis (bone infection) loss of urine and bowel control

This page was updated:18 Sep 2024