Hesperian Health Guides
Examining the Disabled Child
After finding out what we can by asking questions, our next step is to examine the child. In as friendly a way as possible, we carefully observe or test what parts of the child work well, what parts work poorly, and how this affects the child’s ability to do things and respond to the world around him.
CAUTION! Although we sometimes examine separately different aspects of the child’s body and mind, our main purpose is to find out how well the child’s body and mind work together as a whole: what can the child do and not do, and why? This information helps us decide how to help the child to do things better.
In examination of a disabled child, we may check on many things:
In addition, a complete physical examination would include checking the health of systems inside the body. Although this part of the examination, if needed, is usually done by health workers, rehabilitation workers need to know that with certain disabilities inner body systems may also be affected. Depending on the disability, these may include:
||the breathing system (respiratory system)||
||the body’s cleaning system (urinary tract)||
||the heart and blood system (circulation system)||
||the food processing system (digestive system)|
Rehabilitation workers need to work in close cooperation with health workers.
A detailed examination of all a child’s parts and functions could take hours or days. Fortunately, in most children this is not necessary. Instead, start by observing the child in a general way. Based on the questions you have already asked and your general observations, try to find anything that seems unusual or not quite right. Then examine in detail any body parts or functions that might relate to the disability.
Part of the art of examining a child is KNOWING WHEN TO STOP. It is important to check everything that might help us understand the child’s needs. But it is equally important to win the child’s confidence and friendship. Too much examining and testing can push any child to the point of fear and anger. Some children reach their limit long before others. So we must learn how much each child can take—and try to examine the child in ways that she accepts.
Some children require a much more complete examination than others. For example:
Examining techniques: Winning the child’s confidence
Depending on how you go about it, the physical examination can help you become a child’s friend or turn you into his enemy. Here are a few suggestions:
we try to win,
- Dress as one of the people, not as a professional. White uniforms often scare a child—especially if at some time he was injected by a nurse or doctor.
- Before starting the examination, take an interest in the child as a person. Speak to him in a gentle, friendly way. Help him relax. Touch him in ways that show you are a friend.
- Approach the child from the same height, not from above. (Try to have your head at the same level as his.)
- Start the examination with the child sitting or lying on mother’s lap, on the floor, or wherever he feels most safe and comfortable.
- If the child seems nervous about a stranger touching or examining her, have the parent do as much of it for you as possible. This will let the mother know that you respect and want to include her. And she may learn more.
- Make the waiting area and place where you do the examining as pleasant and as much like home as you can. Have lots of toys, from very simple to complex, where the children can choose and play with them. By watching if, how, for how long, with what, and with whom a child plays, you can learn a lot about what a child can and cannot do, his level of physical and mental development, the types of problems he has, and the ways he has (or has not yet) adapted to them.
|Watching how a child plays— by herself, with people, and with toys—is an essential part of evaluating the child.|
- Try to make the examination interesting and fun for the child. Turn it into a game whenever possible. For example:
When you want to test a child’s ‘eye-to-hand coordination’ (for possible balance problems or brain damage) you might make a game out of having the child touch the nose of a doll. Or have her turn on a flashlight (torch) by pushing its button.
Also, when he begins to get restless, stop examining for a while and play with him, or let him rest.
It is best to examine a child when he is well-rested, well-fed, and in a ‘good mood’— and when you are, too. (We know this will not always be possible.)
- When a child is weaker or has less control on one side than the other, and then the weaker side.
|first test the stronger side,||and then the weaker side.|
Please lift this knee off the floor.
Now let's see if you can lift your other knee off the floor.
I'm trying to —but I can't.
OK. Thanks for trying.
- As you examine the child, give her lots of praise and encouragement. When she tries to do something for you and cannot, praise her warmly for trying.
Ask her to do things she can do well and not just the things she finds difficult, so that she gains a stronger sense of success.