需要特殊照顧的兒童 Children with Special Needs

需要特殊照顧的兒童 Children with Special Needs
  1. 在學校中如何處理需要特殊照顧的兒童
  2. 患有特別敏感症的兒童
  3. 先天性心臟病
  4. 對胰島素有依賴性的糖尿病
  5. 癲癇症
  1. Cope with Children with Special Needs in School
  2. Child with Specific Allergies
  3. Congenital Heart Disease
  4. Insulin Dependent Diabetes Mellitus
  5. Epilepsy

在學校中如何處理需要特殊照顧的兒童

下列疾病是在學校中常常遇見但又需要小心處理的
  • 癲癇病
  • 哮喘
  • 心臟病
  • 食物敏感症,例如雞蛋、花生
  • 糖尿病
  • 地中海貧血症
  • 聽覺障礙
處理方法
  1. 成立一個標準而具有基本醫療設備之醫療室,例如血壓計、急救箱、毛毯及電話
  2. 保存需要特殊照顧學童之病歷
  3. 更新病童父母之電話號碼以備緊急時聯絡
  4. 父母或監護人應知會所有教師他們孩童之病情及背景,不論有沒有醫生之指示
  5. 學校應容許學童攜帶他們所需之藥物回校以備急用
  6. 對患有食物敏感症之學童,學校應指示他們自備所需之小食及午餐,並知會食物供應商要小心處理向其提供之食物
  7. 要求就該學童可參與的活動提供醫生証明
  8. 如需要重新安排學童參與某類活動,事前要與其醫護人員聯絡
  9. 提供健康講座給學生及教師以增加他們之知識,這些講座能令教師明瞭學生之病況而在需要時能提供協助

幼兒哮喘病

病徵
  • 喘鳴
  • 咳嗽,有時晚情況較差
  • 運動時咳嗽
  • 氣促
原因及誘因
  • 有哮喘,敏感及濕疹的家族史
  • 寒冷天氣
  • 敏感,例如對動物及塵埃,產生敏感
  • 呼吸道感染
  • 環境因素,例如住所或空氣污染
運動要留意之事項
  • 運動前要做十分鐘熱身運動
  • 避免太辛勞及過長運動
  • 運動過程中要適量休息
  • 運動完畢前要漸緩下來以便身體能漸漸適應
  • 感到身體不適便要停止運動
  • 天氣太乾燥及太冷都不適宜做運動
處理方法
  1. 保持冷靜
  2. 坐直
  3. 用氣管擴張劑
  4. 如有下列情況,應召喚救傷車
    • 呼吸困難
    • 因呼吸困難而不能說話或叫喊
    • 呼吸時發出哼哼聲
    • 口唇或舌變藍
    • 服藥後,食用敏感食物或被蜜蜂叮後,呼吸時發出喘鳴
如有下列情況,應召喚醫生
  • 在使用噴霧或吸入器二十分鐘後,呼吸因難仍未消除
  • 使用噴霧或吸入器二十分鐘後,呼吸時仍發出喘鳴
  • 每少於四小時便要服用哮喘藥物
  • 最高流氣率低於底線(個人最佳)50%
  • 使用噴霧或吸入器後,最高流氣率為底線之50 – 80%
  • 發燒高於40°C
  • 嚴重胸口痛
相關網址

過敏性鼻炎

6-7 歲小孩及 13-14 歲學童的鼻炎患病率分別為 35.1% 及 52%

原因
  • 敏感原如花粉,草及野草
  • 其他原因可能是塵蟎,寵物,二手煙及霉
過敏性鼻炎之病徵
  • 噴嚏,流鼻涕,鼻塞及痒
處理方法 - 控制環境以避開誘因
  • 棄置容易藏塵的物件,包括大件簾幕,彈簧傢俬及毛公仔
  • 用隔氣,防敏感膠蓋去覆蓋所有床墊及枕頭
  • 每 1-2 星期用溫水洗滌所有床單及毛公仔
  • 避開霉
  • 移走地毯
  • 定時吸塵
  • 用隔塵網覆蓋出氣口
  • 不要用吊扇
  • 保持室內濕度在低水平
  • 提供一個無煙環境給小童
敏感藥物
  • 藥物包括擴脹藥,抗組胺織藥及類固醇
  • 如病徵輕微,可購買不用醫生處方的藥
  • 使用外用擴脹藥,每次不能多於3至4天
  • 外用類固醇只能在醫生監察下使用
相關網址

先天性心臟病

先天性心臟病之原因
  • 嬰兒出生時已患有心臟或心臟附近之大動脈畸型
  • 成因包括外在因素(例如化學品,藥物或感染)及遺傳因素(例如遺傳或染色體異常)
臨床病徵
  • 視乎心臟缺陷類別
  • 呼吸急促及皮膚呈現藍色(紫紺)
  • 心口痛,暈厥,餵食因難或發育不良
  • 心臟有雜音
先天性心臟缺陷之類別
  • 兩大類
    • (無紫紺缺陷):心室中隔缺損,房間隔缺損,房室隔缺損,肺動脈狹窄,動脈導管未閉,主動脈狹窄,
    • (有紫紺缺陷):法氏四聯症,大血管錯位,完全肺靜脈異常回流,肺動脈狹窄及單心室
如何照顧有先天性心臟病的小孩
  • 牙齒護理
    • 保持良好的口腔衛生
    • 在進行任何牙科手術之前,通知牙醫用預防性的抗生素
  • 注意惡化情況
    • 心臟病的症狀(呼吸加深及加快,心跳加速,胃口差,容易疲倦)
    • 紫紺變得越來越深
  • 營養及進食
    • 和其他嬰兒一樣,進食方面沒有特別限制
    • 如果嬰兒有增磅不夠的情況出現,就需要以其他營養食品補給
    • 諮詢營養師
  • 心臟病的藥物
    • 跟著醫生指示服藥
    • 如果小孩有病,胃口差,嘔吐或嚴重肚瀉,就要停止服用所有藥物,並立即去看醫生
  • 運動
    • 如果心臟病的情況並不嚴重,運動方面是沒有限制的
    • 如果有心力衰竭或發紺性心臟病,就要避免激烈的運動
    • 如果有嚴重的心臟缺憾,包括: 主動脈心瓣狹窄,長Q-T縱合症-及肥厚性心臟病,就要禁止運動
    • 如果有服用抗凝血藥,就要限制運動量
  • 免疫注射
    • 和一般小孩一樣,有心臟病的小孩都需要作常規免疫注射
先天性心臟病的治療
  • 如果是心臟結構的問題,就需要進行手術更正
  • 經心導管手術可以治療部份的先天性心臟病
  • 藥物一般來說都是有支持性的作用,但不能醫治結構性的心臟問題
  • 小型的心室中隔缺陷,房間隔缺損很大機會都可以自行關閉,因此大多數都不需要進行手術

對胰島素有依賴性的糖尿病

對胰島素有依賴性的糖尿病是因為身體不能正常製造及分泌胰島素。因此他們需要外來注射胰島素去維持適當的血糖濃度,胰島素及運動會減低血糖濃度。而食物及壓力會令血糖上升,所以飲食,運動及注射胰島素之間的平衡,對此類小童是十分重要的

低血糖症

是患有胰島素依賴性糖尿病的學生中最常見的問題

原因
  • 過量運動
  • 進食不夠
  • 過量胰島素劑量
病徵
  • 疲勞
  • 發抖
  • 頭痛
  • 飢餓
  • 冷汗
  • 心跳加速
  • 視野模糊
  • 精神紊亂
  • 失去知覺
處理方法
  1. 幫助小童用血糖試紙檢查血糖情況(少於4mmol/L 或快速下降)
  2. 給小童一點小食或有糖份的水
  3. 如果小童進食過小食或飲過有糖份的水之後都沒有改善,就要立即打999,亦可考慮注射高血糖素

高血糖症

不是一種急性的問題,但如果學生未能注射胰島素,就可能會導致糖尿病酮症酸中毒,如有這種情況,就要立刻送到醫院求醫

原因
  • 過少胰島素
  • 疾病
  • 感染
  • 受傷
  • 壓力
  • 情緒失落
  • 缺乏適當份量的胰島素去控制已進食的食物
  • 減少了運動或活動
病徵
  • 口渴
  • 噁心
  • 視野模糊
  • 疲勞
治療
  • 飲大量水
  • 額外的胰島素治理

糖尿病酮症酸中毒

是一種急症

原因
  • 血糖過高及胰島素不足
病徵
  • 高血糖的病徵
  • 虛弱
  • 噁心、嘔吐、腹痛
  • 呼吸快而速
  • 精神紊亂
處理方法
  1. 幫助小孩用血糖試紙檢驗(通常會高過11mmol/L)
  2. 幫助小孩檢驗小便的酮
  3. 給予短效的胰島素注射
  4. 叫小童飲大量水
  5. 送小童到醫院醫治
相關網頁

癲癇症

癲癇症
  • 發燒或不察覺的急性腦部損傷與反覆性的發羊吊是沒有關係的
  • 癲癇症是不會傳染的
  • 百分之五的小孩會在十五歲之前發作
發羊吊
  • 腦部突然產生一些同步又對立的電子訊號
  • 發作的神經衝動會蓋過腦部的正常運作
  • 有多種不同病狀但一般來說,手臂及腿部都會有節奏地抽搐
發羊吊的原因
  • 發高燒
  • 頭部受傷
  • 各種感染,例如腦膜炎
  • 藥物及毒素
  • 腦腫瘤
  • 神經疾病
  • 電解質紊亂及不正常的血糖濃度
誘發癲癇症病人發羊吊的原因
  • 強光或閃光
  • 過度剌激(例如對著電腦螢光幕或電視遊戲機太久)
  • 缺乏睡眠
  • 壓力
  • 發燒
  • 某些藥物
如何處理發羊吊病發
  • 保持冷靜
  • 讓小孩側臥,最好在一個舒適的平面,及支撐他的頭部
  • 不要強行束縛小孩
  • 不要把物件放入小孩的口裡
  • 把一些尖的物件移開
  • 除去小孩的眼鏡及書包及解鬆小孩的頸喉鈕
  • 在他/她的身旁陪伴,或叫一個可信任的人或朋友陪伴著他/她
  • 當發羊吊已經完結平靜地和他/她談話,使他/她安心
  • 觀察及能夠形容整件事情的事發經過
  • 癲癇症患者如有不嚴重的發羊吊情況,並不算一個醫學上的急症
  • 如果有以下情況,並不需要叫救護車
    • 小孩的醫療紀錄卡有“癲癇症”紀錄
    • 發羊吊的時間少於五分鐘
    • 恢復知覺並沒有再發病的跡象
    • 沒有受傷的徵兆、身體上的痛苦或懷孕
  • 如有以下情況,就要叫救護車
    • 發羊吊的情況是在水中發生
    • 不知道發羊吊的情況是否由癲癇症引起
    • 事發者是孕婦,受傷者或糖尿病人
    • 發羊吊的情況持續多過5分鐘
    • 當第一次發羊吊的情況完結之後,第二次很快又出現
    • 當身體抽搐完結後,當事人還未開始恢復知覺
正常生活
  • 癲癇症患者也能過完滿及正常的生活
  • 在不同情況下,都要提高警覺
  • 遵照醫生吩咐,依時服藥
  • 避免閃光
  • 告訴身邊的朋友、親戚、老師及教練關於癲癇症及教導他們病發時應怎樣做
  • 有充足睡眠,食得健康,做適量運作及享受生命
  • 不要用重型機器及在高空工作
  • 如果你的朋友有癲癇症,你要支持及扶持他/她
游泳
  • 如果一個小孩患有癲癇症,又沒有漂浮用品或救生衣,切勿讓他/她單獨游泳,或一個人划艇,或接近水池(包括後園淺水池)
  • 家長要小心在水旁監視
  • 一定要有一個懂得游泳,而又知道你的小孩有癲癇症的成年人陪同,當你的小朋友在水中發羊吊的時候,也可以立即懂得拯救
  • 當場告訴救生員或游水教練該小孩有發羊吊的紀錄
  • 如果小孩在水中有發羊吊的情況,上水之後,父母或救生員要為他/她進行檢查,如果小孩有可能吞了水或吸了水入肺部,就要立刻為他/她進行醫學檢查
相關網頁

Cope with Children with Special Needs in School

Common medical illness required some care in normal school
  • Epilepsy
  • Asthma
  • Heart disease
  • Food allergy e.g. egg, peanuts
  • Diabetes
  • Thalasseamia
  • Hearing impairment
Management
  • Set up a standard medical room with basic medical equipments such as blood pressure machine, first aid kit, blankets and telephone
  • Keep medical records of those particular students
  • Update parents contact telephone number for emergency
  • All teaching staffs should be notified about the medical conditions of the students by parents or caretaker with or without doctors' reference
  • Allow the child to bring along his/her own drug to school for emergency use
  • Advise the child with food allergy to prepare his/her own snack and lunch. Inform the food supplier about the food caution.
  • Medical certificate for the activities that are tolerated by the students
  • Contact the health adviser for any rearrangement of the facilities
  • Provide health talks to both students and teachers in order to increase their knowledge. This can help them to understand the medical condition and how they can help the student if necessary.

Asthma

Clinical Features
  • Wheezing
  • Cough, sometimes worse at night
  • Cough on exercise
  • Shortness of breath
Causes and contributing factors
  • Family history of asthma, allergies and eczema
  • Cold weather
  • Allergies such as animal and dust
  • Respiratory infection
  • Environmental factors such as housing and air pollution
Advice on exercise
  • Warm up for 10 minutes before exercise
  • Avoid strenuous and prolonged exercise
  • Resting during exercise is recommended
  • Slow down gradually at the end of exercise and let the body adapt
  • Stop exercise if feeling sick
  • Avoid exercise during dry and cold weather
Management
  • Keep calm
  • Prop up
  • Start with bronchodilator
  • Call ambulance if
    • Struggling for breath
    • Unable to speak or cry because of difficult breathing
    • Grunting noise with each breath
    • Bluish lips/tongue
    • Wheezing started suddenly after medicine, an allergic food or bee sting
  • Call doctor if
    • Difficulty in breathing not resolved 20 minutes after neb or inhaler
    • Wheezing not resolved 20 minutes after using neb or inhaler
    • Asthma medicine needed more frequent than every 4 hours
    • Peak flow rate < 50% of baseline level (personal best)
    • Peak flow rate 50-80% of baseline level after using neb or inhaler
    • Fever > 40°C
    • Severe chest pain
Useful Websites

Allergic rhinitis

The prevalence of rhinitis for 6-7 years old and 13-14 years old are 35.1% and 52% respectively.

Causes
  • Allergens like tree pollens, grasses and weeds
  • Others such as dust mites, pets, second hand smoke and molds
Symptoms of allergic rhinitis

Sneezing, running nose, blocked nose and itchy eye

Management

Environmental control to avoid precipitating factors

  • Get rid of dust collectors, including heavy drapes, upholstered furniture and stuffy toys
  • Use an airtight, allergy-proof plastic cover on all mattresses and pillow
  • Wash all bedding and stuffy toys in warm water every 1-2 weeks
  • Avoid exposure to molds
  • Remove carpet if possible
  • Vacuum frequently
  • Cover air vent with filters
  • Avoid the use of ceiling fans
  • Keep indoor humidity low
  • Provide a smoke-free environment for the child
Allergy Medication
  • Medications include decongestant, antihistamine and steroid
  • Use over-the-counter medication if symptoms are mild
  • Avoid using topical decongestants for more than 3-4 days at a time
  • Topical steroid can only be used under doctor's supervision
Useful Websites

Congenital Heart Disease

Causes
  • Baby born with malformation of the heart or great blood vessels near the heart
  • Causes include environmental factors (such as chemicals, drugs or infections) and genetic factors (such as inheritance or chromosomal abnormalities)
Clinical Features
  • Depends on the type of heart defects
  • Shortness of breath and blue coloration of skin (cyanosis)
  • Chest pain, syncope, poor feeding or poor growth
  • Heart murmur
Types of congenital heart defects
  • 2 broad categories
    • Acyanotic lesions: ventricular septal defect (VSD), atrial septal defect (ASD), atrioventricular septal defect, pulmonary stenosis, patent ductus arteriosus, aortic stenosis and coartation of aorta
    • Cyanotic lesion: Tetralogy of Fallot, transposition of the great arteries, total anomalous pulmonary venous return, pulmonary atresia and single ventricle.
Care of children with congenital heart disease
  • Dental care
    • Maintain good oral hygiene
    • Notify dentist for prophylactic antibiotics before any dental procedures
  • Note for deterioration
    • Signs of cardiac failure (breathing harder or faster, fast heart rate, poor appetite or tiring easily)
    • Getting more cyanotic (deeper in colour)
  • Feeding and nutrition
    • Same as other baby with no restriction on their intake
    • Supplementation needed if weight gain insufficient
    • Consult dietitian
  • Medicines for the heart
    • Follow doctors' instruction on taking medicines
    • Stop all medication and contact doctors if the child become ill, feeds poorly, vomits or gets severe diarrhea.
  • Exercise
    • No restriction for those with mild congenital heart disease
    • Avoid strenuous exercise for those with cardiac failure or cyanotic heart disease
    • Restrict exercise for those with severe heart lesion including aortic stenosis, prolonged Q-T syndrome, hypertrophic cardiomyopathy
    • Limited exercise for those taking anticoagulants
  • Immunization
    • Routine immunization as scheduled as for normal children
Treatment of congenital heart diseases
  • Structural defects require surgical correction
  • Some can be treated with interventional cardiac catheterization
  • Medicines, in general, are supportive in nature and cannot cure the structural defects
  • Small VSD and ASD have high chance of spontaneous closure and do not always require surgery.

Insulin Dependent Diabetes Mellitus

Insulin Dependent Diabetes Mellitus (IDDM) is a condition of lack of intrinsic insulin secretion. As a result, they require exogenous insulin injection to maintain their blood sugar at a reasonable level. Insulin and exercise will decrease the blood sugar level while food and stress will raise blood sugar level. The balance between diet, exercise and insulin injection is very important for these children.

Hypoglycaemia (Low Blood Sugar)

Hypoglycaemia (Low Blood Sugar) is the most commonly encountered problem for IDDM children in school setting.

Causes
  • excessive exercise
  • inadequate food intake
  • excessive insulin dosage
Clinical Features
  • fatigue
  • trembling
  • headache
  • hungry
  • cold sweat
  • rapid heart rate
  • blurred vision
  • confusion
  • loss of consciousness
Management
  1. Help the child to check his/her H'stix (<4mmol/L or rapid drop)
  2. Give the child a snack or drink containing sugar
  3. Call 999 if early signs of low blood sugar do not improve after the child has eaten a snack or drink containing sugar Consider give glucagon injection

Hyperglycaemia (High Blood Sugar)

Hyperglycaemia (High Blood Sugar) does not usually result in acute problems. But if the student fails to take insulin, it may ends up as diabetic ketoacidosis which requires urgent hospital admission.

Causes
  • Too little insulin
  • Illness
  • Infection
  • Injury
  • Stress
  • Emotional upset
  • Ingestion of food not covered by appropriate amount of insulin
  • Decreased exercise/activity
Signs/Symptoms
  • Thirst
  • Nausea
  • Blurring vision
  • Fatigue
Treatment
  • Drinking extra water
  • Administer supplemental insulin

Diabetic Ketoacidosis

Diabetic Ketoacidosis is a medical emergency.

Causes
  • Hyperglycaemia and insufficient insulin
Signs/Symptoms
  • Signs and Symptoms of hyperglycaemia
  • Weakness
  • Nausea, Vomiting, Abdominal Pain
  • Fast/Rapid breathing
  • Confusion
Management
  • Help the child to check H'stix (usually >11mmol/L)
  • Help the child to check urine for ketone
  • Give short acting insulin injection
  • Ask the child to drink water
  • Send the child to hospital
Useful Websites

Epilepsy

Epilepsy
  • Recurrent seizures unrelated to fever or identifiable acute damage to the brain
  • Epilepsy is never contagious
  • 5% of children will have seizure before the age of 15
Seizures
  • Burst of simultaneous, contradictory electrical signals in the brain
  • The seizure impulses override the normal functioning of the brain
  • Presentation variable but commonly with rhythmic jerky movements of arms and legs
Causes of seizures
  • High fever
  • Head injury
  • Infections of various types e.g. meningitis
  • Drugs and toxin
  • Brain tumour
  • Neurological syndrome
  • Electrolytes disturbance and abnormal sugar level.
Factors that may trigger seizures in people with epilepsy
  • Flashing or bright lights
  • Overstimulation (like staring at a computer screen or playing video games for too long)
  • Lack of sleep
  • Stress
  • Fever
  • Certain medications
Management for seizure attack
  • Stay calm
  • Lie the child down on his/her side, preferably on a soft surface, and support his/her head
  • Do not restrain the child
  • Do not put things into the child's mouth
  • Move sharp objects away from the child
  • Take her glasses or backpack off and loosen any tight clothing near her neck
  • Stay with her or make sure another friend or trusted person stays with her
  • Talk with her in a calm, reassuring way after the seizure is over
  • Observe the event and be able to describe what happened before, during, and after the seizure
  • An uncomplicated seizure in epileptics is not a medical emergency
  • No need to call an ambulance if
    • medical I.D. jewelry or card says "epilepsy", and
    • the seizure ends in under five minutes, and
    • consciousness returns without further incident, and
    • there are no signs of injury, physical distress, or pregnancy
  • An ambulance should be called if
    • the seizure has happened in water
    • not knowing whether the seizure is caused by epilepsy
    • the person is pregnant, injured, or diabetic
    • seizure continues for more than five minutes
    • a second seizure starts shortly after the first has ended
    • if consciousness does not start to return after the shaking has stopped
Living normally
  • People with epilepsy can and do live full, normal lives
  • Take precautions in various situations
  • Good compliance to medical treatment
  • Avoid flashing light
  • Tell the people close to you - friends, relatives, teachers, coaches - about epilepsy and teach them what to do in case you experience a seizure when they're with you
  • Get plenty of sleep. Eat right. Exercise. Enjoy life!
  • Don't work with heavy machinery or at heights
  • If your friend has epilepsy, be supportive
Swimming
  • A child with epilepsy should never swim alone, or be on a boat or close to water (including backyard wading pools) without a flotation device or life jacket
  • Carefully supervise children near water
  • Make sure an adult is present who knows your child has epilepsy and is a good enough swimmer to help if your child has a seizure in the water
  • Tell lifeguards or swimming instructors at local pools or beaches that your child has seizures
  • If a child has a seizure in water, he or she should be checked by a lifeguard or parent. If there is any possibility that water has been swallowed or breathed into the lungs, get a medical check up.
Useful Websites