General healthcare needs of children with developmental disabilities
Of course, children with developmental disabilities can be healthy. However, there is good evidence that children with developmental disabilities are more vulnerable to poor health.
For instance, a large international study across 30 countries found that children with disabilities were around 5 times more likely to report a serious health condition than non-disabled peers.1 Other studies have also shown that children with disabilities are 2-3 times more likely to experience malnutrition.2 And data from high income settings indicates that mortality rates are far higher for children with developmental disabilities. For instance, a study from USA found three times as many deaths among children and adolescents with developmental disabilities as would be expected from the national standards.3
© Holt International
Reasons for vulnerability to poor health among children with developmental disabilities
There are a number of reasons why children with developmental disabilities are more vulnerable to poor health:
- Children with developmental disabilities, have an underlying health condition which can cause further health consequences. For example, children with Down syndrome are at higher risk of congenital heart defects and leukaemia.4,5
- Children with developmental disabilities also have functional impairments that may affect health. For instance, children with cerebral palsy may have difficulties with mobility and feeding. Poor mobility results in pressure sores, which may become infected and take weeks to heal. Feeding difficulties may make a child vulnerable to malnutrition, but also to aspirating food and consequent respiratory infections and problems. In this way, impairments can cause health problems, increasing the rates of morbidity and mortality in this vulnerable group.
- Children with developmental disabilities may also face challenges in accessing healthcare services, and this can contribute towards their vulnerability to poor health. We will discuss these challenges in more detail later in the week.
- Children with disabilities are on average poorer than other children, and may live in more vulnerable housing.6 These factors are negatively linked to health outcomes.
- Children with disabilities are often excluded from school, where many healthcare programmes are provided. For example, a school feeding programme provided the majority of food to children in Turkana, Kenya, but many children with disabilities did not attend school and so were likely to become malnourished and consequently ill.2
Johanna (8) at a mainstream school in Bolivia. © CBM/Foto Backofen Mhm
Need for mainstream healthcare services
Although children with developmental disabilities may require specialist healthcare services, such as physiotherapy, it is clear that they also need access to mainstream healthcare services, including vaccination and preventive healthcare, if they are to remain healthy. Good health is important for living a good life (regardless of disability) and it is important that children with developmental disabilities remain as healthy as possible, so they can maximise their development and participation in their community.
Primary healthcare will likely be the first point of contact for identifying and addressing the health of children with developmental disabilities, whether for pneumonia, diarrhoea or malnutrition, or other common conditions. Ongoing healthcare programmes need to be inclusive of children with developmental disabilities and account for their individual needs. For instance, food and nutrition programmes need to account for the specific dietary issues associated with a child’s spina bifida to provide adequate fibre to counteract constipation, and micronutrients to promote skin health and healing. Other important programmes may include vaccinations, dental hygiene and sexual health education.
Over the past few steps, we have discussed both the specialist and general healthcare needs of children with developmental disabilities. This brings us back to the concept of the twin-track approach, in which children with developmental disabilities require access to mainstream services, as well as specialist, targeted programmes. The combination of these two tracks can help children with developmental disabilities maintain a good level of health and wellbeing.
In the next step, we will discuss the healthcare needs of our case study characters – Justin, Thandi, Mai and Lucas. After this, we will consider how a child’s healthcare needs will change and evolve as they age, before we discuss how children with developmental disabilities may face barriers to accessing healthcare services, despite their greater need.
© The London School of Hygiene & Tropical Medicine