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The Access Approach
11
Early Identification of Disability in Children and Provision
of Appropriate Advice
b
A Guide for Non-Specialist Health Professionals Working in
Primary Health Care
HEALTH
for
ALL
A Collaborative Study Between the Centre for International Child
Health, London, and the Disability and Rehabilitation Unit of the
WHO, Geneva
World Health
Centre for International
Inclusion
Organisation
Child Health. University
International
College London
World Federation of
World Confederation
for Physical Therapy
I
UNICEF
Occupational Therapists
CONTENTS
INTRODUCTION
Why Better Access to Health Care is Needed
Improving Access to Health Care
STAGE ONE: DESCRIBE THE TARGET COMMUNITY
Examples of Different Community Settings
Linking the Settings with the Right Materials
Stage One: Summary of Community Description
STAGE TWO: IDENTIFY CHILDREN WITH IMPAIRMENTS ....
Identification - Steps to Take
Choosing the Right Identification Materials
1
2
3
4
5
6
7
8
9
10
List of Identification Materials
1. Signs of Disability in Newborn Infants.........................
2. Home Based Records Cards
3. Normal Development Charts
4. .Jamaican Adaptation of the Denver Developmental Screening Checklist,
5 Ten Question Screen
6 Guide for Indentifying Disabilities
14
17
21
23
26
STAGE THREE: ADVISE PARENTS
33
List of Advice Materials for Example 2 Communities
1. Messages for Mothers and Other Carers
2. Inclusion Message
3. WHO Play Activities Charts and Leaflets - Introduction......
How to Use the WHO Play Activities Charts and Leaflets
What to do about different kinds of disabilities
WHO Play Activities Charts 1-7
.7?
WHO Play Activities Leaflets 1-7
4.1 Advice for families of a Deaf Child
4.2 Advice for Families of a Blind Child
5. Helping with Common Disabilities
34
35
37
39
40
41
42
49
59
60
61
SUMMARY OF STAGES
11
12
62
READING LIST
Note on the Use of the Term 'Disability'
63
64
APPENDICES
1. International Classification of Functioning and Disability - WHO 2001
2. The Child-to-Child Programme
65
66
INTRODUCTION
This manual explains how to improve access to health care for young children
W ™p^rmerits and make '* easier for them to be included into society. It deals
with children up to the age of three years who are slow to develop or who have
impairments and disabilities. Better access to health care means conditions
affecting the mind or body (impairments) can be identified earlier and advice can
be given. The word disability’ includes all the things that affect the child's life as a
result for example community reactions (see page 64). The WHO 2001 terms for
describing functioning and disability are used which are impairment’, ’activity’ and
participation’. See Appendix 1 on page 65.
The matenals in this manual are designed to be managed by non-specialist health
professionals woriong in Primary Health Care (PHC). See Table 1. Eady identification
materials, advice for families, and suggestions for helping children with impairments to
de^eLC?P9'Ven' ln cornmunities where there are no PHC services, materials
suitable to be managed by visiting non-specialist staff and local community workers
are also included.
mprovmg access to health care for children with impairments means reaching them
at an earlier age and providing them with services. By helping workers to assess the
eV^ Of-rtkl
resources available in the local community, realistic plans can be
made. The different types of identification and advice materials in this manual can be
chosen to suit the community resources.
Community Level 1
Workers:
Level II
teaafc
ggaWM
Table 1: Definition of Types of Staff__________________
PHC workers, CBR workers (first level), trained birth
attendants (two or more weeks training)
Traditional birth attendants, traditional healers, families and
volunteers, day care workers
rfflBesg®mt
1
^pSi®
_____
Specialists
Physiotherapists, occupational therapists,;. speech and
language therapists, specialist medical doctors, CBR
coordinators (post-professional training), specialist pre
______ school teachers, psychologists, and special educators
(* Most likely to be available)
--------------------There are three stages to improving availability of services.
>
First, the community is described so workers can choose the identification materials
which suit the community resources and especially the availability of specialist help.
> Second,, workers identify children with impairments by using the right questions and
assessments from the manual.
> Then parents and carers are offered the right advice about how to help their child.
The manual explains how the community is described and how the choice of
materials is made. The next section looks at why a new approach is needed.
Note. The words parents and carers’ have been used to reflect the variety of people
who may look after a child. Where ‘mother’ is used, this also includes other carers.
1
Why Bettor Access to Health Care is Needed
Developing Inclusive Services
P°Or' comPared to
that of the general popuiton^'Jofen !he last thlf6^'6
>
>
Children with impVmettetre
Orchildren with disabilities
°Ut °f nat,onal ^alth care plans - they are not
seen as a priority
>
- id^ed when children are oider, when he.p has .ess impacton
participation and inllulXttetJmmulSs^'
>
haVe less chance for
jnpainSente, es^XlJ whentheltare to SdalSdVbT^
Ch'ldren
> Fam'liesfind«difficuft to get the right advicetb^
who
unhelpful attitudes towards children
c Hdren's access to health serves conEel to<UN\-^tements, disabled
~n of Opportunities
community can make a
impairments can be provided with senrices at n
ISfneeded- lf children with
Health Care (PHC), their access to the health ra J / ,nclusive bas'c Primary
an approach involves the communitv anH r SLystem Wl11 be improved. Such
Rehabilitation (CBR). Messages for families abou Tnctu^ C°mmunity Based
next section explains the aim of improved access
00 Pa9e 37’ The
Summary: Points about better access to he;
•alth care:
> Children with disabilities
children
......... "J haVe ri9hts to the
same opportunities as other
> S>Hl^H-S0Cial attifudes towards children
anct parti^;-^^cWldren with disabilities lead to their inclusion
> By linking into PHC,
more children with disabilities
services
will access health care
> It is a community approach which links with CBR
2
Improving Access to Health Care
The Aim
The aim is to improve access to health care for young children with impairments by
reaching more children at an earlier age and providing them with services. This can
be done where specialist services are scarce, and even where there are no services
for children with disabilities. To fulfil this aim the steps for health professionals to
take are to:
>
Decide what types of workers are already available in the community
>
Decide what knowledge and skills they have, that could be used to help
children with impairments
>
Choose methods for identification and advice which fit the knowledge and
skills of the workers already available in the community
>
Identify children with impairments early so they have the best chance to
develop, are included in society, and have a better quality of life.
>
Provide the right advice, in partnership with families and carers, on ways in
which they can help their child.
Reasons for Identifying Children with Impairments Early
Children who are identified as having impairments are ‘at risk'. That is, without help,
their health and learning may suffer and progress will be slower than necessary. This
makes family life more difficult so children with impairments need help as early as
possible. They need equal access to health care so they can grow up participating in
the life of their family and their community. They need support from the community to
be included in education and social activities.
Reasons for Providing Early Advice
Children with disabilities can be helped to do many of the things other children do. It is
true that impairments stop children from doing some activities. But with training many
children will be able to do most of the activities that other children do, even if they do
them slowly or in a different way. For more information about this see the WHO
Training in the Community for People with Disabilities - Guide for Local Supervisors.
(See the reading list on page 63.)
Family and Community Participation
A partnership approach to rehabilitation that builds on community strengths and
resources is in line with CBR. It uses local workers from organizations like clinics
and schools. Although specialized staff will continue to supervise the whole
operation, non-specialists, community workers with minimal training, and families
will carry out most of it. Family members often have many responsibilities and
limited time for activities with their child. They should not be asked to do more
than they can manage. First non-specialist health professionals must describe the
target community. The next section looks at this.
Summary: For a better quality of life for children with disabilities:
> Reach more children with services at an earlier age
Make the most of their abilities so they can participate in family and
community life
> Work in partnership with families and draw on community strengths
3
STAGE ONE: DESCRIBE THE COMMUNITY
How to Describe the Community
Describe the types of health workers, and the health services, which already
exist in the community. From the examples on page 5 non-specialist health
professionals will be able to see which description fits their community. The
manual provides a variety of identification and advice materials to suit the different
communities in which they will be used. Health professionals will be able to
choose those which suit the resources in the community in which they are
working. This will provide better help for children and families.
Describing the Health Workers and Services in the Community
In some places specialist health professionals may be available, like therapists
and children's doctors. In other settings staff could be PHC professionals, such as
nurses, vaccinators and health volunteers. Workers like these, who already
come into contact with mothers, can be used to provide services. For example
when children attend for vaccination, there is an opportunity for development to be
checked (key ages 9 and 18 months). Advice can be given to families, if a child
seems slow to develop or has an impairment. See page 17 on differences in
development.
In some places there will be well-developed services for identifying and supporting
children with disabilities. These may be run by government and/or non
government organizations (NGOs). Other communities will have access to a CBR
programme, staffed by volunteers. In other places there are no special services
for children with disabilities. However non-specialist health professionals should
decide which types of health workers are already providing health services in the
community, or close by. Which of them could be used to check the development
of children or to provide advice?
Points to Think About
People may be unable to access services because:
> They are too far away
> They are too expensive or transport is too expensive
> The people are poor or from marginalised groups
Can the approach set out in the manual be used to overcome these barriers?
Places with well-developed services may be very close to places with minimal or
no services. Can links be set up?
Summary: Stage 1
> Describe all the workers and the health services in the community
Identify workers already in contact with mothers and young children
> Decide which workers could be trained to provide services for children
with impairments, using the materials in the manual
4
5TASE ONE: CONTINUED
Examples of Different Community Settings
Community Setting 3. A large proportion of people do not receive basic primary
health care. They are seeking ways to meet their basic human needs. In this
situation disabled people largely face the same issues as everyone else.
However, every community has resources, which can be explored and used for
the benefit of children with impairments and their families.
Community Setting 2. The majority of people do receive basic PHC, including
effective immunization against the major infectious diseases.
Community Setting 1. In addition to PHC, a small proportion of disabled people
in this community do receive disability services of some kind (rehabilitation, health
or education).
Most people find that Setting 2 describes their situation. They receive PHC, but
disabled people cannot access disability services.
Table 2: Examples of Different Settings
Possible
workers
Community
Setting 3
Description of the Target Community Services
•
•
Community
Workers
Level 1/+1
I
•
C. Setting 2
•
•
•
Basic human needs are met with difficulty (clean water, food,
clothing, shelter, protection and consistent loving care); and/
or
The population faces serious public health threats'(vitamin A
or iodine deficiency); and
Basic primary health care, such as effective immunization, is
not received.
Most children do not access primary school education.
Maximize the use of community resources.
The population receives basic primary health care including
effective immunization against the major infectious diseases
(measles/polio/TB/DPT); and
• Generally oral re-hydration treatment (ORT) is available; but
• The population receives no disability services._____________
C. Setting 1
• The population have access to health services; and
• Disabled children receive some form of disability services
Specialists
(rehabilitation, health or education).
Community workers may include - Level I : CBR workers (first level), primary health
care workers, trained birth attendants (two or more weeks training). Level II volunteers,
traditional birth attendants, family members, carers and day care workers.
Non- specialist health professionals may include mid-level workers, nurses,
non-specialist medical doctors, midwives (a year or more medical training) and
CBR workers (one year training)/, •
Specialists may include physiotherapists, occupational therapists, specialist
medical doctors, community based rehabilitation coordinators, specialists pre
school teachers, psychologists and special educators.
The next section links the examples of community settings with the right
identification and advice materials.
Non
Specialist
Professionals
in PHC
5
A
STAGE ONE: CONTINUED
Linking the Settings with the Right Materials
Step 1
It is important not to think in terms of geographical areas, but
rather communities that share a number of common features.
The target community could be a neighbourhood within a large city,
a small village, a caste, a nomadic group, or an occupational, racial
or religious group.
GO TO NEXT STEP
L
Step 2
Decide which kind of setting you work in by referring to the examples
of settings in table 2 on page 5.
GO TO NEXT STEP
[
Step 3
Use the materials in the manual if the Community 2 Setting best
describes your target community. If the Community 1 Setting best
describes the one in which you work and you have identified a child
with an impairment, send the child to a specialist.
Community 3 Settings
Local community or voluntary workers in Community 3 Settings, supervised by non
specialist health professionals from Community 2 settings near by, can use some
identification materials from this manual in that setting. Suitable materials are clearly
shown where you see this. -► I' <
Community 2 Settings
Materials for identification and advice for Community 1 Settings are not included in
this manual. Specialist staff will probably use materials from their own professional
experience.
Note:
Managers of health care services are often responsible for undertaking Stage One.
They will describe the community. They may also continue to supervise work in
Community 3 and Community 2 Settings.
6
Stage One: Summary of Community Description
___________ Table 3: Community Settings and Services Available
BASIC SERVICES (HEALTH; EpUCATIQN) D(|^
When children
do not have
access to basic
services at all
COMMUNITY 3
SETTINGS
Use part of manual
as shown
•5;
Wc
ma1
^Dfaw
1
When children
access health
care but no
disability
services
COMMUNITY 2
SETTINGS
Use the manual
MLWs (if
available)
and Non
specialists
may
supervise
tw
Refer child
to specialist
if possible
8
lABILF
WMBB
When children
access some
type of
disability
service
COMMUNITY 1
SETTINGS
Refer to specialist
Specialists, and other health workers provide s
§3
Make sure the community is-ir
_
7
a®--
STAGE TWO: IDENTIFY CHILDREN WITH IMPAIRMENTS
Workers Involved in Identification in Community 2 Settings
Within a Community 2 Setting, workers from the Ministry of Health, the Ministry of
Education and NGOs may be involved with identification.
These non-specialist health professionals may be:
> Nurses (most likely to be available)
> Non-Specialist Medical Doctors
> Midwives (with one year training)
> CBRWs (with one year training) working in CBR or Child Development
> Pre school staff (with training) working in Early Child Development (ECD) or
Child Care
> Mid-Level Workers working in PHC*
Note: If they are available, these MLWs may also supervise in Community 3
Settings, where other community workers undertake the work.
Using Identification Materials
This manual contains identification materials for non-specialist health professionals
and MLWS (where they exist) working in Community 2 Settings. If materials can also
be used in Community 3 Settings this is made clear like this. —I •: <■
The materials are appropriate for children of various age groups, up to three
years.
> The supervisor should make the selection of material appropriate for the
setting and the age group of the children
>
Please note that a selection of these identification materials should be
photocopied and given to the workers who will use them
> It is important that workers are only given materials that suit their situation
> The materials that are given out, should be in the language which is used by
workers and families in that community
Children Who Show Positive Signs
When workers identify children with impairments, help for the family should follow. If
help is not provided it may be harmful for the child and the family. It is important that
children who show positive signs are referred to a non-specialist health professional,
such as a community nurse, who can provide advice and help.
Referring a Child:
In Community 2 Settings, non-specialist health professionals refer to specialists.
In Community 3 Settings, community level 1 workers refer to non-specialists.-
8
STAGE 2: CONTINUED
Identification - Steps to Take
This page, and the next, explain how to find professionals and others who could help
to improve access to health servjges for children and which materials they should
use.
Step 1
Identify who sees infants regularly in your target population, for example
vaccinators. These will be the workers for this programme.
> Where are vaccinations given?
This will be the place for the
programme.
> What is the schedule (regular time each month/week or mass
campaigns so many times a year)? On the basis of this, publicise
when mothers should bring children that concern them.
GO TO
Step 2
Match the workers to the identification materials.
> If the vaccinators are Community Workers Level I, use Signs of
Disability in Newborn and Infants Home Based Record Cards.
> If the vaccinators are Non-Specialist Health Professionals, use the Ten
Question Screen or Developmental Screening Test; Normal
Development Chart and Guide for Identifying Disabilities.
GO TO
[
Step 3
Train the vaccinators to use the identification tools and give appropriate
advice:
> They should use the screening tests for all children whose mothers are
worried and say they are not developing like other children
> Train the vaccinators how to use the tests, and the need for accuracy
> Teach them the dangers of labeling a child who may just be slow to
develop (page 17 explains normal differences in development)
> Teach them how to choose the right advice materials in the light of the
screening test results
> Teach them the importance of reassuring mothers of disabled children
The table on the next page shows which materials should be used, by which types of
workers, according to the age of the child.
9
STAGE TWO: CONTINUED
Choosing the Right Identification Materials
Table 4: Linking the Materials with the Age of the Child
For Newborn
Children
Workers
I
.Community .;
■ Workers.
«! . Level .1
• i(GWL !)•
’.and;:-;
i
ibi^Wjih
■ Newborn ’ ■ ’
’infants.
.................
Non
Specialist
Health
Professionals
=
Signs-of
■ (cwti pniy; •;
. Use With advice
• to mother' < ; ■
• Refer).
I
.ty-yy
i®
s
■S
I
I
w
I
r-
Home Based
Records Cards
I
Home Based
Records Cards
growth
monitoring is used)
fi (where
(where growth
monitoring is used)
(Advise and refer if
signs of delay)
(Advise and refer If
signs of delay)
it
■
ifSSnfi■I H
.•.®S
For Children Above
the Age of 2 years
For Children Under
the Age of 2 years
i
s
fl
‘Refer to ’
F
Os®
Non
Specialist
Health
Professionals
ONLY
Is
w
E
L®
SI
Oilii
•7’ •
::
11
| Development
3 Charts
j®
w
5
lOi
r
Development
Charts
I
Developmental
1 Screening
| Development
I Charts
|i
Ten Question
Screen
K
Checklist -Denver | S
y-wp
^1
Guide for
Identifying
Disabilities
Ii j
II
a
Guide for
Identifying
Disabilities
£
| Guide for
I Identifying
| Disabilities
li
-
> The points of contact with the child are at birth and at routine vaccination.
Mothers should be encouraged to bring children that concern them, including
those oVer 3 years old.
> If Community Workers identify newborn children with positive signs on testing,
they should refer the child to a non-specialist health professional. The next two
sections describe each of the six tests mentioned in Table 4.
10
STAGE TWO: CONTINUED
List of Identification Materials
; •: 1. < Signs of Disability' in Newborn ■' <
’ 1 rifants (CDR TDC Solo/1995)* X;
AND/OR
•ayrr-ww ■
I
A
2. Home Based Record Cards
(Growth Monitoring)
l^-arag-rer?-
3. Normal Development Charts
(Promoting the Development of
Children with Cerebral Palsy WHO
1993)
4.
Developmental Screening
Checklist
(Jamaican Adaptation of Denver
Developmental Screening Test) *
AND/OR
5. Ten Question Screen
(Zaman et al, 1990)
AND/OR
6. Guide for Identifying Disabilities
(David Werner, 1988)
Note:
*1. ‘Signs of Disability in Newborn Infants’ can also be used in Community 3
Settings by Community Level 1 workers. Use this assessment if it is
possible to refer children who show positive signs to a non-specialist
health professional.
*4.Or other appropriate adaptation if available in country/continent.
11
STAGE TWO: CONTINUED
1. Signs of Disability in
Newborn Infants
(Adapted from “Special Signs of Disability in Newborn Infants" CBRTDC, Solo, Indonesia, 1995).
Refer the baby to a mid-level health worker if s/he has any of the following
signs:
. Irr Communfty 3 settings.;.; 4} 4 weeks premature, birth. . ;2) Below 2Kg at birth
; check for these signs too.;. 3) Yellow at birth
.4) Mother worried about differences;.
His/her arms and legs are very floppy
and feel different than others babies.
1 o'
S/he has trouble sucking. S/he may not want
to drink or has trouble with the mouth and
will not be able to suck the bottle or breast
£££?»/
His/her upper lip or mouth roof is open and
may look like it is cut.
His/her head is too big compared to her/his
body and may grow faster than the rest of
his/her body.
12
Signs of Disability in Newborn Infants: Continued
Hl
One arm is weak and slow and seems
to be in a strange position. His/her leg
on the same side may also be slow.
ig»ag
One or both feet or hands are always
Turned in or towards the back.
There is a dark soft lump or spot on the back bone.
Also his/her legs may seem in a strange position
and may not move. S/he may not have any feeling
when his/her legs are touched.
S/he has a lump around the navel especially when
s/he cries.
,y;
If any of the above signs are seen by a Community Level I Worker, the child
should be referred to a non-specialist health professional. Non-specialist
health professionals should use the Guide for Identifying Disabilities on page
26, if these signs are seen, and refer to a specialist if possible.
13
2. Home Based Records
Cards
Home Based Records Cards are used for growth monitoring in some
communities. Some cards also include basic stages of child development, or
developmental 'milestones’, on the Growth Monitoring Cards so developmental
delay can be identified.
Developmental delay means that a child is not developing in the same way
as most of the other children in their community of the same age.
Cards are widely used throughout the world, kept by mothers and brought by
them to clinic. If the adapted cards are in use locally, mothers should use them.
If such cards are available locally, copies and instructions for use can be obtained
from the local primary health care service or the Ministry of Health. Otherwise,
please use cards appropriate to your setting.
The next two pages give an example of a growth monitoring ‘Weight for Age’
chart and how to use it. The chart is taken from Integrated Management of
Childhood Illness WHO (1997)
For an example of a developmental chart see page 18. This is used to check what
activities the child can do at certain ages and identify any delay.
Summary
> Home Based Records Cards are widely used
> The milestones of Home Based Records Cards have been designed to
help mothers understand normal development
> The value of Home Based Records Cards in identifying children with
disabilities has not yet been validated
What to Do Next
If these cards, or similar, are used and a child seems slow to develop, the non
specialist health professional should check the child using the Development Charts
(pages 18-20) and the other tests in this manual. Choose the test which suits the age
of the child.
/ox-'
14
How the Use the Weight for Age Chart
Example: A child is 27 months old and weighs 8.0 kilograms. Here is how the
health worker determined the child’s weight for age.
From: WHO and UNICEF (1997) Integrated Management of Childhood Illness.
22
21
20
19
1«
17
W .........
16
iii!:iiii;iiiiii;iiiini
il!IIIEIIIIIIIIi:illllll
141
iiiiiKiiiiiiiiiiiiiiiii
lEEIISIEIEEiilEEIEEIIII!
!!iilEIE!liIIIEE!!!;;iii
IKIIEEEEiiillKiilllElt
ii:ill!li:!!ll!!!ll!IIIE
!IIIS!!!!]IE!!!!I1I!S!
ll>ll!!!!lillE!i!lll!E!l
15
15
14-
WEIGHT
1st year
13 rr
iiiiii:ii;iiiiiiiiiiiiii
IIIIIIIIIIIIIIEIIIIIIIIi
iiiiiiiiiimiiii
18r
13
12 --
12
11
10!
9j
2 “J
is
8
fTT..
A
/
X-
I
5
IrawiIgMIwm
wylra
vtifMtor
111
10 7
4
Hrvwetftt
toraft
A
2121 212<: 131 3233 343536
A
3
“
131415161718192021222324
nlyMtarift
1 434567 19 101112
111 lull fl
3rd
4ltiywr
Sth year
Nlllll
llllllllllll
2ndyar
AGE IN MtfMTHS
1
This line shows the child’s weight:
8.0 kg
2
This line shows the child's age:
27 months
7 K
3
This is the point where the lines for age
and weight meet. Because the point is
below the bottom curve, the child is
very low weight for age.
6
1Z7 f IL 15
ID Y 3.^
WEIGHT FOR AGE CHART
22
21
20
19
18
18
17
17
WEIGHT
1st year
13
16
16
15
15
14
14
13
12
12
11
11
10 (
10
9
9
2 8
<
rr 7
8
GO
CD
O
6
7
very low
weight lor
age
I
X -
i
5
25262728293031 323334 3536
4
3
13141516171819 2021222324
low weight tor agC
very low
weight for age
low weight
forage
1 2 3 4 5 6 7 8 9 101112
llllllllllll
u llllllll
3rd year
llllllllllll
2nd year
AGE IN MONTHS
16
4th year
Sth year
I
3. Normal Development Charts
(From Promoting the Development of Children with Cerebral Palsy WHO 1993)
Introduction
An understanding of child development helps to identify children who are not
developing as expected, to plan training and to check on progress.
Developmental stages are reached in a particular order.
'</■
A .s
A\A
The various stages in development, like sitting and standing are reached at
roughly the same age in all children. To decide how well a child is developing,
compare his or her development with other children of the same age. Progress
that is slower than expected is called developmental delay (see page 32).
Normal Variations in Development
Most children will crawl before they stand and walk. Some children do not crawl
but move around by sitting on the floor and shuffling on their butts (bottoms).
If the mother says the child is slow to walk, check this list. These children:
> Prefer to sit, rather than to try and stand
> Lift their feet off the ground, or sit down, when held in a standing position
> Are slow to walk compared with other children
> Have family members who also developed in this way
They gradually catch up with other children of the same age and walk.
Standing or walking on tiptoe with both feet is common in young children who
are learning to move and balance in an upright position. It will gradually stop.
Watch the child moving. The child should also stand and walk easily with the
heels touching the ground. Check that the ankles do not feel stiff (see page 29).
Reassure the mother and check the child at the next visit.
Any child who is not developing as expected should be considered ‘at risk’
and referred to a specialist if possible.
How to Use the Development Charts
These charts show the order in which some abilities develop and the age at which
most children learn them. They are divided by age into three stages. As they look
in more detail at movement, they are useful for children whose families are
worried about this area of development.
To use the charts:
> Record the date and the age of the child if known
> Watch what s/he can do
> Tick or circle the things s/he can do on the charts
This will identify what the child can do, what the child cannot do and what the
child needs to be trained to do next. A child may have abilities spread over two or
more stages. For example a child may be in Stage 3 for sitting, Stage 2 for
getting to sitting, and Stage 1 for standing. This will mean that training advice will
have to come from all three stages. See the WHO Play Activities Charts on page
42.
17
DEVELOPMENT CHART:
Stage 1: Birth to 6 months
Stage 2: 6 to 12 months
Movement
Stage 3: 12 to 24 months
Stage 4: 2 to 3 years
Head and
Body
Control
.Lies on
stomach and
holds head up
.Pushes up on
hands
.Rolls from
stomach
to back
.Rolls from back to stomach
.Rolls to side and gets Into
sitting
CD
Sitting
Sits only
with support
.Sits leaning
on hands
.Sits alone
.Twists and
reaches
.Catches self
If pushed
.Moves Into
and out of
sitting
.Balances self
If tilted
Moving
from
Place to
Place
.Maycrawl
j or shuffle
J on bottom
.Stands with
support
.Squats to
play
.Pulls to
stand
.Walks alone or
with one hand held
.Kicks a ball
.Balances on
one foot
.Jumps
DEVELOPMENT CHART:
Stage 1: Birth to 6 months
Communication and Behaviour
Stage 2-' 6 to 12 months
Stage 3: 12 to 24 months
.Can hold one
object In each
hand
.Holds between
thumb and finger
Stage 4: 2 to 3 years
Using
Hands
.Holds small
object briefly
CD
.Holds with
whole hand
Playing and
Social
Development
.Passes object
from hand to
hand
.Looks at
object
.Brings hands
together
.Bangs two
objects together
On
.Plays with body
.Hits object with
whole arm
.Plays social
games like
peek-a-boo
.Puts objects
Into container
and takes
them out
.Enjoys building
.Sorts different
objects
.Throws a ball
DEVELOPMENT CHART:
Stage 1: Birth to 6 months
Communication and Behaviour
Stage 2: 6 to 12 months
Stage 3: 12 to 24 months
Stage 4: 2 to 3 years
Self-Care
Dresses with
help
.Sucks
breast
f.
.Drinks from a cup and
feeds self most foods
without help
.Takes object
to mouth
ro
o
7;
.Chews solid food
.Feeds self biscuit
.Helps with undressing
.Uses the
latrine without
help
.Indicates toilet needs
.Responds to noises
Communication
Hello
.Likes being talked and sung to.
.Makes sounds
when talked to
.Smiles
Jiati
Shathanh
.Turns to
voices
Na na
Bye bye
.Repeats gestures
.Repeats sounds
made by others
Ball.
.Responds to
simple commands
.Says a few words "Ma ma',
"Da da", "Ba ba"
.Calls self by name
.Names familiar things like dog, bird
.Uses a lot of nonsense talk
.Asks for
things with
words and
gestures
.Begins to put
words together
.Points to body
parts when
asked
.Talks about what she does
.Begins to draw
Asks questions
. (Drink.
ire Is
■Helps.family \
members with Vd
their work
/
ISSESLsgrarfI
4. Developmental Screening
Checklist
(Jamaican Adaptation of the Denver Developmental Screening Test. After Molly Thorburn,
Kingston,Jamaica.)
1.
INTRODUCTION: this Checklist is a modified form of the Jamaican
adaptation of the Denver Developmental Screening Checklist. The checklist
assesses the skills a child may be expected to have learnt in the first 6 years
of life. For the purpose of this manual only material concerning 0-3 years
is relevant and may be used. A Sample of the Jamaican Screen is
reproduced here.
2. MATERIALS: the following materials are needed for the Checklist: shaker,
paper, pencil, ball.
PROCEDURE:
Calculate the child’s age, subtracting the number of weeks
(if any) of pre-maturity
Locate this age on the form.
[
Go back three age levels before the child's age and answer
all the questions from that point to the child’s present age.
Any ‘no’ answers alert to possible developmental delays
and suggests referral, if available.
What to.do next:
Any ‘no' answers mean that the child may be delayed so use the Guide for
Identifying Disabilities on page 26. Refer to a specialist if available.
21
Jamaican Adaptation of the Denver Developmental Screening Checklist
NAME
DATE OF BIRTH
AGE ADAPTED TO CONCENTRATE MAINLY ON 2-3 YEARS
9 months
“1
DATE OF TEST
YES
NO
Does s/he turn to a whispered voice?
Will s/he make an effort to get something out of reach?
Will s/he feed herself / himself with a cracker of bread?
15 months
Can s/he walk without help?
Can s/he show what s/he wants without crying?
18 months
Can s/he drink from a cup, holding it herself / himself?
21 months
Does s/he imitate household tasks?
Can s/he say three words other than “mama" and “dada”?
24 months
Can s/he feed herself / himself with a spoon?
Can s/he remove some of her/his clothes?
Can s/he point to a named part of her/his body?
2yrs.3 months
Can s/he kick a ball?
Can s/he scribble with a pencil or crayon?
2yrs 6 months
Can s/he put two words together?
Can s/he fling a ball over-hand?
3 yrs
Can s/he jump with both feet over the ground?
Can s/he put on any of her/his clothes?
3yrs 3 months
Can s/he wash and dry her/his hands alone?
3yrs 6 months
Can s/he copy an”O"?
3yrs 9 months
Does s/he take turns or role-play in games?
a
inq
i
i
22
B.
5. Ten Question Screen
Zaman S. et al (1990) Validity of the 'Ten Questions’ for Screening Serious Childhood Disability:
Results from Urban Bangladesh. International Journal of Epidemiology, Vol 19, No 3, 1990.
Project identity number of child:
Name of fieldworker:
Relationship of interviewee to child:
Date of interview:
(The interviewer should introduce themselves, who they work with, and
why they are doing the questionnaire)
1. Compared with other children, did the child have any serious delays in
sitting, standing or walking?
NO □
YES □*
If NO, skip to Question 2
If YES, probe: “Did the child walk by the age of 2 years?”
YES
NO
2. Compared with other children does the child have any difficulty seeing,
either in the daytime or at night? YES □*
NO Ek
If NO, skip to Question 3
If YES, probe: "Is the difficulty only at night?" YES
NO
"Can s/he see that?" (point to a small object) YES
NO
"Does s/he have some other eye problem?" YES
NO
(If YES to this probe, write down what the mother says:)
3.
Does the child appear to have difficulty hearing? YES □*
NOD
If NO, skip to Question 4
If YES, probe: “Can the child hear at all?"
YES
NOD
"Does s/he have some other problems with her/his ears?" YES 0
(If YES to this probe, write down what the mother says:)
23
NO O
Ten Question Screen (continued)
4. When you tell the child to do something does s/he seem to understand
what you are saying? YES
NO □*
If YES, skip to Question 5
If NQ, probe: "If you ask her/him to bring you a cup, (but you do not point), is s/he able to
do it?"
YES D
NO D
5. Does the child have difficulty in walking or moving her/his arms or does
s/he have weakness and/or stiffness in the arms or legs? YES □*
NO
If NO, skip to Question 6
If YES, ask all of these questions: "Does s/he need help in walking?” YES D
NOD
"Do they use their hands to pick things up?" YES D NO D
"Does s/he have stiffness?"
YES
“Does s/he have weakness?" YES
D
NOD
NOD
6. Does the child sometimes have fits, become rigid, or lose consciousness?
YES □*
NOD
If NO, skip to Question 7
If YES, probe: “Has s/he had a fit in the last year?" YES D
NOD
“Do the fits interfere with her/his usual activities (like doing chores or going to
school, if old enough)?" YES D
NOD
“Do they occur only with fever?" YES D
NOD
7. Does the child learn to do things like other children her/his age?
YES
NO □*
If YES, skip to Question 8
If NO, probe: “Can you tell me about something s/he seemed to have difficulty learning?"
YES D
NOD
“Does the informant give an example?" YES D
(If YES, write down the example:)
24
NO D
Ten Question Screen (continued)
8a) Does the child speak at all (can s/he make her/himself understood in words; can
NO □*
s/he say any recognisable words)? YES
8b) For children over 3 years ask: is the child’s speech in any way different from
normal (not clear enough to be understood by people other than her/his
immediate family)? YES □*
NO
If the parent responds YES check YES. If the parent responds YES or NO because the
child cannot speak at all, leave question 9 blank and skip to question 10.
If NO, skip to Question 10
If YES, probe: “Does s/he stammer or stutter?" YES
NO
“Does s/he have some other problem with her/his speech?" YES
NO
(If YES to this probe, write down what the parent says:)
9. For a 2 year old child ask: can he/she name at least one object (for example, an
NO 0*
animal, a toy, a cup, a spoon)? YES
If YES, skip to Question 10
If NO, probe: “Do they use their own words for things, like bow-wow for dog? "YES
NO
10. Compared with other children of her/his age, does the child appear in any way
mentally backwards, dull or slow? YES □*
NO
If YES, probe: “Would you say that s/he is much behind other children her/his age, that
NO n
s/he acts like a much younger child?" YES
Does the child have any serious health problems not yet mentioned? YES
Is there a disability?
YES
NOD
NOD
(If YES, state the disability:)
Note: The questionnaire result is positive if the response to one or more of the
ten questions has an asterisk (*) next to it. If no response has an asterisk (*) next
to it, then the result is negative. “Check” means tick the box.
What to do Next
Use the Guide for Identifying Disabilities on page 26 with all children that screen
positive.
25
6. Guide for Identifying
Disabilities
(Adapted from David Werner 1988 for children up to the age of three years)
SIGNS PRESENT AT OR SOON AFTER BIRTH____________________________
IF THE CHILD HAS THIS
V
AND ALSO THIS - REFER TO A SPECIALIST
bom weak
or 'floppy'
often a difficult birth
delayed breathing
born blue and limp
or bom before 9 months and very small
^3
round face
slant eyes
thick tongue
slow to begin
to lift head
or move arms
~ s
small head
or small top
part of head
none of the above
does not suck
well or chokes
on food
pushes milk back out with tongue
or will not suck
cannot suck well
chokes or milk comes out of nose
one or both
feet turned
in or back
no other signs
hands weak, stiff
or clubbed
some joints stiff, in bent
or straight positions
dark lump on back
'bag' or
dark lump
on back
head too
big; keeps
growing
clubbed feet
or feet bend
up too far
or feet lack movement and feeling
may develop:
•
eyes like
setting sun'
•
increasing mental
and/or physical disability
•
blindness
upper lip and/or
roof of mouth
incomplete
difficulty feeding
later speech difficulties
birth deformities,
defects, or
missing parts
(may or may not be associated
with other problems)
abnormal stiffness
or position
from birth
some muscles weak
some joints stiff
head control and mind normal
muscles tighten more in certain positions
may grip thumb tightly
26
DISABILITY GUIDE CONTINUED
IF THE CHILD HAS THIS
AND ALSO THIS - REFER TO A SPECIALST
does not use the arm much
holds it like this
one arm
weak or in
strange position
leg on the same side often affected
dislocated hip
at birth
leg held
differently
shorter; flap
covers part
of vulva
slow to respond
to sound or to
look at things
on opening legs
like this, leg
’pops’ into place
or does not open
as far
4
may be due to one or a
combination of problems
SIGNS IN CHILDREN
slower than other
children to do things
(roll, sit, use hands,
show interest, walk, talk)
slow in most or all areas:
round face
slant eyes
single deep
crease in hand
movements and responses slow
skin dry and cool
hair often low on forehead
puffy eyelids
has continuous
strange movements o'positions, and/or
stiffness
does not respond
to sounds, does
not begin to
speak by age 3
may respond to some
sounds but not others
does not turn head to
look at things, or reach
for things until
they touch her
eyes may or may not look normal
check for ear infection (pus)
eyelids or eye% make
quick, jerky or strange
movements
27
DISABILITY GUIDE CONTINUED
IF THE CHILD HAS THIS
AND ALSO THIS - REFER^O A SPECIALIST
all or part of the body makes
strange uncontrolled
movements
•
•
begins suddenly, child
may fall or lose consciousness
child is normal (or more normal)
between ‘fits'
slow, sudden or rhythmic
movements: fairly
continuous (except in sleep);
no loss of consciousnes
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
Ul
backward and legs cross
PARTS OF BODY WEAK OR PARALYSED
floppy or limp weakness
in parts or all of body
no loss of feeling in
affected parts
usually began
with a ‘bad cold'
and fever before
age 2
no spasticity
(muscles that tighten
without control)
irregular pattern of parts weakened:
often one or both legs - sometimes
arm, shoulder, hand etc.
normal at birth
begins little by little
and steadily gets worse
about the same on
both sides of body
often others in the family
also have it
paralysis starts in legs and moves
up; may affect whole body
or pattern of paralysis variable
lump on back (see page 31)
floppy or limp weakness
one or both
hands or feet
develops slowly in older
child - gets worse and worse
usually some loss of
feeling
bom with bag on back
(look for scar)
feet weak, often without
feeling
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
injury to nerves going to one part of body
28
DISABILITY GUIDE CONTINUED
IF THE CHILD HAS THIS
AND ALSO THIS - REFER
TO A SPECIALIST
------------------------f--------------------
weakness usually
with stiffness or
spasticity of
muscles
usually affects body in
one of these patterns
1.
2.
3.
no loss of feeling
one side
both legs
whole body
muscles tighten and resist
movement because of joint pain
JOINT PAIN
one or more
painful joints
begins with or without fever
gradually gets worse, but there
are better and worse periods
WALKS WITH DIFFICULTY OR LIMPS
dips to one
side with
each step
one leg often weaker and shorter
usually begins age 4 (to 8 )
may complain of knee pain
walks with
knees pressed
together
muscle spasm and tightness
upper body little affected
stands and walks with knees
together and feet apart
feet less than 3" apart'*
(7.5 cm) at age 3
no other problems
Feet more than 3" apart*
(7.5cm) at age 3
walks awkwardly
with one
foot tiptoe
muscle spasms and poor control
on that side; hand on that side often affected
jerky steps, poor balance
sudden uncontrolled movements
that may cause falling
walks awkwardly with
knees bent and legs
usually separated
slow 'drunken' way of walking
learns to walk late and falls often
weakness, especially in legs and feet
gradually gets worse and worse
walks with
both feet
tiptoe
legs and feet stiffen
(spasticity of muscle)
no other problems
29
DISABILITY GUIDE CONTINUED
| AND ALSO THIS - REFER TO A SPECIALIST
IF CHILD HAS THIS
Y
walks with hands pushing
thigh(s) or with knee(s)
bent back
weak thigh muscle
difficulty
lifting leg
foot hangs
down weakly
(foot drop)
dips from
side to side
with each step
walks with
one (or both)
hip, knee, or
ankle that
stays bent
child lifts foot high
with each step so that
it will not drag
due to muscle weakness at
side of hips, or double
dislocated hips, or both
joints cannot be slowly
straightened when child
relaxes
joints can gradually be
straightened when child relaxes
knees wide apart when
feet together (bow legs) waddles or dips from
side to side (if s/he walks)
under 18 months old
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
flat feet
no pain or other problems
pain may occur in arch of foot
deformity may get worse
BACK CURVES AND DEFORMITIES
sideways curve
of backbone »
when child bends
over, look for a
lump on one side
30
DISABILITY GUIDE CONTINUED
IF THE CHILD HAS THIS
AND ALSO THIS - REFER TO A SPECIALIST
▼
sway back
belly often sticks out
>
may be due to
contractures here, or
weak stomach muscles
(
rounded back
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
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 and lower body
OTHER DEFORMITIES
missing body parts
born that way
accidental or surgical loss of limbs
(amputation)
gradual loss of fingers,
toes, hands, or feet,
often in persons who
lack feeling__________
hand problems
floppy paralysis
(no spasticity)
without care may lead to
contractures so that
fingers cannot be opened
uncontrolled muscle
tightness (spasticity)
strange movements
or hand in tight fist
bum scars or deformities
clubbing or
bending of feet
may begin as a floppy weakness and
become stiff from contractures
if not prevented
31
07520
r J1
DISABILITY GUIDE CONTINUED
DISABILITIES THAT OFTEN OCCUR WITH, OR ARE SECONDARY TO, OTHER DISABILITIES
caused by slow or
incomplete brain function
or by severe physical
disability, or both
developmental delay:
child slow
to learn to
use his/her body
or develop
basic skills
caused by overprotection:
treating children like
babies when they could do
more for themselves
contractures
usually due to muscle
weakness or spasticity
joints that no longer
straighten because
muscles have shortened
often, muscles that pull a joint
one way are much weaker that
those that pull it the other
way (muscle imbalance)
joints
will not
straighten
sometimes due to scarring
from bums and injuries
behaviour 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.)
slow to learn certain
things only: otherwise
intelligent
often over-active or nervous
sometimes behaviour problems
speech and
communication problems
often, but not always,
due to deafness or retardation (or both)
some children can hear
well and are intelligent,
but still cannot speak
other problems that
sometimes occur secondary
to other disabilities
< JHOW MC
Bahama,
7
main disability
cerebral palsy
(some of these we have
already included in this chart)
many disabilities with paralysis
children who have lost
feeling: leprosy, spinal cord injury,
spina bifida.
32
STAGE THREE: ADVISE PARENTS
Introduction
Stage three contains advice for families, other carers and the community, to help
children identified as having an impairment and a disability. There are messages
about including children with disabilities in family life and in society. There are
also suggestions for activities to help promote the development of the child. The
advice materials in this section are designed to suit children of different ages and
the different types of professional staff available (see page 5, and Table 4 page
10). Materials which are also suitable for Community 3 Settings, are clearly
(See page 34.)
indicated. —
In communities where professional staff work, or where they are easy to employ,
there are other manuals that can be used to give advice to parents, family
members and other carers. A list of these manuals is on page 61 and in the
reading list on page 63.
What all young children need to learn
During the first three years of life children learn to:
>
>
>
>
>
>
>
>
>
Look and listen
Eat and drink
Use the latrine
Help with washing and dressing
Help with cleaning teeth
Play and move around inside and outside the home
Understand what other people say
Learn to express thoughts, needs, and feelings
Contribute to family and community activities.
With training, most children with impairments can learn to do all or most of these
activities. When children with impairments have been identified, families need the
right advice from non-specialist health professionals.
Please note that all the materials on the pages that follow can be photocopied
and given to the staff who will use them.
33
List of Advice Materials
These materials include basic advice for delivery by PHC workers in Community
2 Settings. Materials also suitable for use by Community Level 1 workers in
Community 3 Settings are shown.
1. M essages for Mothers, Fath ers a nd
Other Carers
■GBR TOG: Sdiq: i hdd'nesiaf.i 995)-
2Uncl<jsionMessage
GBR: TOC; $oip Inq'Qnesia (1995)
3.
3. WHO Play Activities Leaflets 1-7
Training in the Community for People with Disabilities
(1989) Training Package 26
-------- =1
4.1 Advice for Parents of Deaf
Children.
4.2 Advice for Parents of Bind
Blind Children
5. Helping with Common Disabilities
Other Material from WHO Manuals and David Werner
(1988) 'Disabled Village Children'
Where to Go
Good communication is needed to make advice effective, within Community 2 and
Community 3 Settings. Some messages may differ, but the way messages are
spread will be similar in both settings. When messages are given out about
screening, an announcement should also be made about where families can go for
more information and advice. This could be spoken or written information given out
through any of the following:
>
>
>
>
>
>
local/national radio
national TV
women’s cooperatives
mosques/churches/other religious or social gatherings
schools (‘child-to-child’ approach whether established or not - see page 66)
traditional/trained birth attendants and vaccinator
For any child that is ‘causing their mother concern’, and/or screens positively using
any identification test in this manual, the mother should know where to go next for
the right advice. The child should be referred to a specialist for advice where
possible. (In Community 3 Settings, refer to a non-specialist health professional if
possible.)
34
i; M essages for Mothers
Fathers andOtherCarers
(Adapted from ‘Preventing Disability', CBR Development and Training Center, Solo, Indonesia, 1995.)
Also suitable for use in Community 3 Settings by Community workers.
1. Breastfeeding
All babies fed on breast milk are more likely to be
healthy and strong. Start feeding your baby as
soon as possible after birth and continue as long as
possible up to the age of two. Babies need other
foods following your breast milk from the age of 4-6
months.
2. Vaccinations
Immunization can protect all children against many
kinds of dangerous diseases. To protect your child
be sure that they attend for vaccination five times in
their first year. Remember that not all vaccinations
are given by injection (the polio vaccine is give by
drops).
3. High Fever
One of the major causes of mental and physical
handicap is high fever that is not treated. Therefore
when your child has a high fever, battuhim/her in
cool water at least every hour. Do not put too many
extra clothes or blankets on the child. If the fever
remains high seek medical help.
'6
fkc-
O
35
Vitamin A is essential for good eyesight in all
children. Ensure that your child gets vitamin A
through a varied diet. Dark green leafy vegetables,
liver, fish, milk and eggs are all good sources of
vitamin A. Some local health services provide
vitamin A in capsule form (two each year).
Iodine is important for the physical and mental
growth of all children. Without it young children
will not grow properly and may become mentally
handicapped. Therefore always try to use salt that
has iodine added.
The development of healthy children starts when
the mother is pregnant. For the good welfare of both
mother and child all pregnant women should eat at
least as much food as usual, if not a little more and
make an extra effort to eat a varied diet, including
iodised salt. They should also take more rest.
A difficult childbirth can endanger both mother
and child. If a trained birth attendant is available
locally they should be present at the birth of your
children.
36
2. Inclusion Message
(From CBR Development and Training Centre, Solo, Indonesia 1995)
Also suitable for use in Community 3 Settings by Community Level 1 workers
. Inclusion in Society
Disabled children should be included in everything
that other children are involved in. As a disabled
child grows up s/he has the same needs as other
children.
Family Life
Disabled children need to be included in all of the
usual activities of family life. The child should not be
over protected, with the family doing almost
everything for their child, as this will hold him/her
back from developing skills and learning to care for
him/herself. Neither should the child be ‘put to one
side’ and ignored.
3. Public Health Programmes
Disabled children should be included in any special
public health programmes that take place in the
community, such as micro-nutrient supplements or
de-worming programmes. These help all children to
live healthier lives.
4. Primary Health Care
Disabled children should have access to the local
primary health care provision, such as vaccination
programmes. These can prevent further disabilities v
and help all children to live healthier lives.
37
jckpespe^
Like all children, disabled children need friendship
and to be loved and respected. They need to feel
welcome and appreciated by their family and in their
community.
BI
Wi
As with other children, disabled children should be
encouraged to play alone and with others. Play is
one way that children explore their world and test
limits and it stimulates their development.
■T’^Heipinc
All children learn by joining in the household tasks.
Disabled children too need these opportunities to
develop and use their bodies and minds to their
fullest ability, whatever that may be.
X,
J
life
r?
wU
Disabled children need the same educational
opportunities as other children. If children locally go
to pre-schools (such as nurseries or traditional
schools like Koranic schools) then disabled children
should go too. At the appropriate age disabled
children will need access to primary school
education.
38
irt ixirv Xies OVA STuborTH
f
3.
3. WHO Play Activities Charts
and Leaflets 1-7
WHO Manual (1989). Training in the Community for People with Disabilities. Training package 26 for a
family member of a child with a disability - Play Activities.
Introduction
The advice on pages 40 to 58 is adapted from the above manual for children up to
the age of three. Only material for children up to the age of three years has been
used. The final eighth chart and leaflet of Training Package 26 is not in this manual^-^^
There are three sections:
‘Play Activities Charts 1-7’
> These can be used to find out how far a child has developed. The picture charts
show activities that children do as they grow and develop.
> ‘What to do About Different Disabilities’
This section gives advice to families about how different disabilities might affect the
way their child develops.
> ‘Play Activities Leaflets 1-7’.
These show the sort of play activities which mothers, fathers, family members and
other carers can do to help their child to develop.
Material from all three sections can be photocopied and given to families.
39
t-
How to Use the WHO Play Activities Leaflets
>
WHO Training Package 26 has seven leaflets, one for each of the seven
groups of activities shown on the identification charts. The leaflets give
you examples of how to use play to encourage your child to do the
activities on the charts.
>
The leaflets have activities for communication and behaviour, and
activities for movement and self care.
>
Use the charts 1 to 7 to see what activities your child can do. First find
the chart where your child does some or none of the activities. Begin by
training your child with the leaflet which has the same number as that
chart.
>
Often a child will show the same result for ‘Communication and
Behaviour’ as for ‘Movement and Self Care’.
With such a child you will begin with only one leaflet.
For example, if the child can do all of the activities in Chart 1, but only
some of the communication and behaviour activities, and some of the
movement and self care activities in Chart 2, begin by using Leaflet 2.
>
Sometimes a child will be able to do better in ‘Communication and
Behaviour’ than in ‘Movement and Self Care’. Or the reverse will happen.
Then you will start with one leaflet for communication and behaviour
activities and another leaflet for movement and self care activities.
For example, the child may be able to do only some of the
communication and behaviour activities and all of the movement and self
care activities in Chart 2. But only some of the movement and self care
activities in Chart 3. If that happens, use Leaflet 2 for communication and
behavior activities and Leaflet 3 for movement and self care activities.
>
7
When you child is able to do the communication and behaviour activities
in’ one leaflet, go to the next leaflet for communication and behaviour
activities.
Do the same for movement and self care activities
>
You should continue with the play activities until the child goes to school.
40
What to do about different kinds of disabilities
>
Most children who have fits will be able to do all the activities described
in the leaflets.
>
Most children with difficulty learning will also be able to follow the
activities. However, these children will be slower than others to learn new
activities. If so, you may have to continue using the play activities even
after other children of the same age have started school.
> A child who has difficulty seeing may not be able to follow the charts
and activity suggestions in the same way as children who can see.
The child who does not see at all will not be able to do some of the
activities. For example, the child will not be able to look at or pick up
small objects, catch a ball, name colours, and so on.
The child who can see a little may be able to do more of these play
activities, but not all of them.
> The child with difficulty hearing or speaking may not be able to repeat
sounds made by others, understand questions, talk about what he or she
does, and so on.
The child who can hear a little may be able to do more of these play
activities, but not all of them.
> The child who has difficulty moving the arms may not be able to push
up on the hands, to play with objects, drink from a cup, and so on. The
child who has difficulty moving the legs may not be able to walk, go up
and down steps, to run and so on.
>
Some children have more than one difficulty. For example, a child may
have difficulty with both moving and seeing. This child may be able to do
only some of the activities in the leaflets.The child may be able to do
some activities in several leaflets, but may not be able to do all of the
activities in any leaflet.
> You and your Local Supervisor should which play activities your child
may be able to do. Then, you can decide which parts of the leaflets your
child will use.
>
In order to, go on with the activities, you will, in each chart, write the
answer All when the child is doing all the activities which he or she can
possibly do. When your child is able to do all the activities in one chart,
you can go on to the next chart and leaflet.
41
Play Activities - Chart 1
>
Look at the two groups of pictures. See if the <
child does the activities in each
group
>
>
Then do the same for ‘Movement’
Communication and Behaviour
—---------- --------------------------------Npne Some
'you
All
\
A BEAUflfv*BABY. J
QA
&
Makes sounds
when talked to
Turns in
response to
sounds
Looks at
objects
Smiles when
talked to
If the child does none or some of these activities, try the
communication and
behaviour activities in Leaflet 1.
>
If the child does all of these activities,
see if the child can do the communication
and behaviour activities in Chart 2.
Movement
None
Lies on back and
reaches arms up
Holds small object
briefly
42
Some
All
Lies on stomach
and holds head up
Play Activities - Chart 2
>
Look at the two groups of pictures. See if the child does the activities in each
group.
>
Mark one of the boxes next to ‘Communication and Behaviour’. Mark ‘None’ if
your child does none of the activities. Mark ‘Some’ if your child does one or more
of the activities. Mark ‘All’ if your child does all the activities in the pictures.
> Then do the same for ‘Movement and Self Care’.
Communication and Behaviour
None
All
Some
I
Makes specific
sounds
Laughs at a person’s
actions
Reaches out to
be picked up
>
If the child does none or some of these activities, try the communication and
behaviour activities in Leaflet 2
>
If the child does all of these activities, see if the child can do the communication
and behaviour activities in Chart 3
Movement and Self-Care
--------r----- r----None Some
Plays with objects
using both hands
Takes objects to the
mouth
Rolls from stomach
to back
Sits briefly
Lies on stomach
Pushes up on
hands
z
All
a
Drinks from cup
held by another
>
If the child does none or some of these activities, try the movement and self care
activities in Leaflet 2
>
If the child does all of these activities, see if the child can do the movement and
self care activities in Chart 3
43
Play Activities - Chart 3
>
Look at the two groups of pictures. See if the child does the activities in each
group
>
Mark one of the boxes next to ‘Communication and Behaviour’. Mark ‘None’ if
your child does none of the activities. Mark 'Some' if your child does one or more
of the activities, but does not do all the activities. Mark ‘All’ if your child does all
the activities in the pictures.
> Then do the same for ‘Movement and Self Care'
Communication and Behaviour
Repeats sounds
made by others
None Some
Responds to
name
Stops when
hears ’’No"
All
Recognizes
family members
>
If the child does none or some of these activities, try the communication and
behaviour activities in Leaflet 3
>
If the child does all of these activities, see if the child can do the communication
and behaviour activities in Chart 4
Movement and Self care
None Some
Sits without
falling
Picks up small
objects
Crawls
All
Rolls from back
to stomach
Feeds himself or
herself biscuit
>
If the child does none or some of these activities, try the movement and self care
Activities in Leaflet 3
>
If the qhild does all of these activities, see if the child can do the movement and
self care activities in Chart 4
44
Play Activities - Chart 4
>
Look at the two groups of pictures. See if the child does the activities in each
group.
> Mark one of the boxes next to 'Communication and Behaviour’. Mark ‘None’ if
your child does none of the activities. Mark ‘Some’ if your child does one or more
activities, but does not do all the activities. Mark ‘AH’ if your child does all the
activities in the pictures.
> Then do the same for 'Movement and Self Care’
Communication and Behaviour
None Some
All
MAMA
Dao a
3A 6A
Says a few words
Repeats gestures
of other people
Understands
simple questions
Responds to
simple commands
> If the child does none or some of these activities, try the communication and
behaviour activities in Leaflet 4
> If the child does all of these activities, see if the child can do the communication
activities in Chart 5
Movement and Self-Care
None Some
Stands alone
Walks alone
Feeds self most
foods without help
All
Puts objects into
box and takes
them out
Holds out arm or
leg for dressing
>
If the child does none or some of these activities, try the movement and self care
activities in Leaflet 4
>
If the child does all of these activities, see if the child can do the movement and
self care activities in Chart 5
45
Play Activities - Chart 5
Look at the two groups of pictures. See if the child does the activities in each
group.
>
Mark one of the boxes next to ’Communication and Behaviour’. Mark ‘None’ if
your child does none of these activities. Mark ‘Some’ if your child does one or
more activities, but does not do all the activities. Mark ‘All’ if your child does all
the activities in the pictures.
> Then do the same for 'Movement and Self Care’.
Communication and Behaviour
None Some All
w
MlNt
Calls himself or'
herself by name
Points to body parts
when asked
Asks for things
>
If the child does none or some of these activities, try the communication and
behaviour activities in Leaflet 5
>
If the child does all of these activities, see if the child can do the communication
and behaviour activities in Chart 6
Movement and Self-Care
None Some All
©
iMiiimiiiiiiiiii;
Puts things together
and takes them apart
Walks up and
down steps
Runs
Helps
with
undressing
A
Jr
Knows when to use the
latrine
>
If the child does none or some of these activities, try the movement and self-care
activities in Leaflet 5
>
If the child does all of these activities, see if the child can do the movement and
self-care activities in Chart 6
46
Play Activities - Chart 6
>
Look at the two groups of pictures. See if the child does the activities in each
group.
>
Mark one of the boxes next to ‘Communication and Behaviour’. Mark ‘None’ if
your child does none of the activities. Mark ‘Some’ if your child does one or more
activities, but does not do all of the activities. Mark ‘All’ if your child does all the
activities in the pictures.
>
The do the same for ‘Movement and Self Care’.
Communication and Behaviour
Names things that
are familiar
None Some All
Plays with other
children
Tries to help
parents
>
If the child does none or some of these activities, try the communication and
behaviour activities in Leaflet 6
>
If the child does all of these activities, see if the child can do the communication
and behaviour activities in Chart 7
Movement and Self-Care
None Some
All
J
Likes
to climb
Undresses
without help
Jumps
Kicks ball
Uses the latrine
without help
>
If the child does none or some of these activities, try the movement and self care
activities in Leaflet 6
>
If the child does all of these activities, see if the child can do the movement and
self care activities in Chart 7
47
Play Activities - Chart 7
> Look at the two groups of pictures. See if the child does the activities in each
group.
>
Mark one of the boxes next to ‘Communication and Behaviour’. Mark ‘None’ if
your child does none of the activities. Mark 'Some' if your child does one or more
activities, but does not do all of the activities. Mark 'AH’ if your child does all the
activities in the pictures.
> Then do the same for ‘Movement and Self Care’.
Communication and Behaviour
None Some
All
[why ?
Talks about what
he or she does
Matches shapes
Asks questions
RED
Names colours
Arranges objects
according to size
>
If the child does none or some of these activities, try the communication and
behaviour activities in Leaflet 7
>
If the child does all of these activities, you do not have to use any of the leaflets
for communication and behaviour activities.
Movement and Self-Care
Hops on one
foot
>
Walks on tip-toe
None Some
Dresses without
help
All
Bathes without
help
If the child does none or some of these activities, try the movement and self care
activities in Leaflet 7
If the child does all of these activities, you do not have to use any of the leaflets
for movement and self care activities.
48
WHO Play Activities Leaflets
Communication and Behaviour - From Leaflet 1
Play Activities
> Sing and talk to the child. Use the
child’s name and call to him or her. The
child will listen to the sound of your voice
and make sounds of his or her own.
Even if the child does not respond to
you, continue singing and talking to the
child. This will help to get a response
from him or her.
> Hold the child in front of you so the
child can see your face. Talk to the child
and look at the child's eyes. Smile at the
child. This will encourage the child to
look at you and to smile.
>
Let the child know you are pleased when he or she looks at you, smiles, or
makes sounds. Do this by talking to the child and playing with his or her hands or
feet.
> Make a rattle by putting a few
pebbles into a tin or bamboo. The rattle
will make sounds when you shake it.
7
<0
Shake the rattle in front of the child. Get
the child’s attention so that he or she will
listen, look, and turn to where the sound
comes from. The child can also respond
by making sounds of his or her own.
I
'/
Shake the rattle on each side of the
child. The child should turn and look for
the rattle.
Make rattles that have different sounds.
Put sand into one rattle, large pebbles
into another and seeds and nuts into
another. ’Then the child can hear
different spunds when you shake each
rattle.
49
Communication and Behaviour - From Leaflet 2
MA-\
MA-
Play Activities
>
Hold the child on your lap
Sing to the child. Rock and move the child about to
the rhythm of the song.
> Your child may make some sounds, such as
"ba ba" or “ma ma".
When your child makes these sounds you can also
make the sounds. Then your child will know that you
like to hear the sounds and he or she will repeat
them.
> You can make your child laugh by making
sounds and movements with your face and hands.
You can also move the child’s arms and legs back
and forth. Or move the child up and down on your
knees. These movements will make the child laugh.
> Make sure that the other family members spend
time with the child. Show them how to play with the
child and to make the child laugh. Ask them to give
the child love and security.
> Encourage the child to make sounds and to
laugh by talking and making sounds to the child as
often as possible.
> Hold out your arms to the child and ask the child
if he or she likes to come to you. Encourage the
child to hold his or her arms out to you.
If the child does not hold his or her arms out, tell
another family member to stand behind the child.
When you hold your arms out to the child, the family
member can hold the child’s arms out to you.
Then take the child in your arms and talk to him or
her to let the child know that you are pleased.
50
Moment and Self Care - From Leaflet 2
Play Activities
> When the child is lying on the stomach, hold a
toy in front of the child. Get the child’s attention
and tell the child to touch the toy.
> As the child reaches for the toy, move it in
such a way that he or she will try to turn and get it.
In this way you will make the child roll over.
When the child rolls over, give him or her the toy. Speak to him
or her in a voice that will tell the child that you are pleased. Then
the child will repeat what he or she did to please you.
> Support your child in sitting. You can use pillows to support the child or support
him or her against a wall or in a box. Place a pillow between the child’s legs to keep
them apart if necessary.
Let the child play whilst he or she sits in this position
>
Then let your child sit without support.
\-.=,
v
At first he or she will sit briefly, then fall.
You can sitvclose to your child, or you can put pillows
near him or her. This will protect the child when he or she falls.
51
o
1
Communication and Behaviour - From Leaflet 3
Play Activities
> Sit in front of the child. Put a cloth over your
head. Pull it off and laugh at the child. Encourage
the child to pull the cloth. Then laugh with the child.
Point to the child and say the child’s name. Take
the child’s hand and point it at the child and say his
or her name.
Put a cloth over the child’s head. Say the child’s
name pulling the cloth down so the child will look at
you. Repeat this until the child will pull the cloth
down when you say his or her name. Laugh with
the child when he or she pulls the cloth down.
f No
> When the child touches an object that he or
she must not touch, say "No” very firmly.
The next time you see the child going near the
object or trying to touch it again, say “No" to the
child. Teach the child to repeat “No" after you.
Move the child away from the object.
Do not give the child a lot of attention when he or
she starts to do something you do not want the
child to do. Say “No" and move the child away from
what he or she is doing.
Later when the child does something you like him
or her to do, show the child that you are pleased.
52
A’
07520
-'V ..
Ora
I
v- I
Movement and Self Care - From Leaflet 3
Play Activities
> When your child is lying on the back, he or she may play
with the feet and toes. If the child does not do this, help him
or her to bring the feet up to the hands. The child may put the
toes in the mouth and play with the feet.
> Your child may roll from the back to the stomach. At first he or she may do this
by turning to reach for an object.
> When your child is able to roll from back to stomach, he or she will do this
because it is easier for him or her to move on the stomach.
At first the child may move forward or backward with the stomach on the ground.
When your child is on the stomach, move a noisy toy in front of him or her. Let the
child touch the toy.
Then move the toy away. Ask the child to come and get the toy.
> After the child learns to move on the
stomach, he or she may try to move on
the hands and knees. You can help the
child learn to do this. Put your hands
under the child’s stomach and lift him or
her up until the child is on the hands and
knees. Then help the child to move and
get the toy.
53
Communication and Behaviour - From Leaflet 4
Play Activities
> Your child should also learn to follow simple directions
Play games with the child to help him or her learn.
For example, teach the child to follow directions, to sit
down and stand up. Do this by sitting down and saying
“Sit down". Then stand up and say “Stand up”. Or ask
another family member to follow your directions. Then
ask the child to do the same.
You can give your child other simple directions, such as
"Give me the cup”. If the child does not follow your
directions, repeat what you said to him or her. Then help
the child to follow the direction. Play a game passing the
cup or other objects to each other.
'5ir
DOWN
a
's
me)
cup J
Talk to the child and point to things you are talking about.
Results
> If your child does these activities, try the communication and behaviour activities
in the next leaflet of this package.
If your child does not do these activities, he or she may have difficulty hearing,
seeing, or learning. Continue to try the activities. It may take your child a long time to
learn them. Talk with your local supervisor.
Movement and Self Care - From Leaflet 4
Play Activities
> Put your child on the ground in front of a box or chair. Put
some of the toys on the chair. Encourage the child to pull
himself or herself up next to the chair and get the toys.
At first you can put the toys on the edge of the chair so the child
can reach the toys by kneeling beside the chair.
54
o
ill
Movement and Self Care - From Leaflet 4 continued
After the child can do this, put the toys in the centre of
the chair or on a higher chair. Then encourage the
child to move to standing and to play with the toys in
the standing position.
If the child cannot pull up to kneeling or standing, you can
help him or her.
Then help the child to stand and play with the toys
> Your child may begin to walk holding on to boxes,
chairs, tables or walls.
>
Hold the child's hands to help him or her to walk
> After walking with help, your child may try to stand
alone.
55
Movement and Self Care - from Leaflet 5
Play Activities
> Teach the child how to use the wood and boxes to build
houses, schools, bridges, and so on.
> You can give your child objects to put on a string. Give
the child a thick string and large beads or seeds with large
holes in them. You can also use cloth to make small rings
which can be put on a string.
Help the child to put the beads on the string and to take the
beads off the string.
Then let the child put the beads on the string without help.
> Give the child a large bowl, tin or bucket of sand and a
few small tins. Teach the child how to put sand into the
tins.Teach the child to hold a tin in each hand and pour the
sand from one tin to another.
Let the child play with the sand.
> Give the child a large bowl, tin or bucket filled with water.
Let the child move his or her hands in the water and play.
Give the child small sticks, boxes, or boats made from paper
or leaves. Show the child how these move on the water. Let
the child feel the way they move on the water. Let the child
play with them.
56
Movement and Self Care - From Leaflet 6
Play Activities
Each time you help the child to undress, ask him or her to
do as much as possible without help.
As the child learns to undress, give less help until he or
she can do it without help.
The child may continue to need help to put his or her
clothes on.
a
> After your child has learned to use the latrine, he or
she can learn to go to the latrine without help.
a
If the latrine that the adults use is too big for the child, train
the child to use a pot or tin.
I
If the child has difficulty squatting over the latrine, you can
put one or two poles beside the latrine for the child to hold.
57
Movement and Self Care - From Leaflet 7
Play Activities
>
You can also teach your child to bathe without help.
Help the child first to pour water over himself or herself.
Next place your hand over the child’s hands and pick up
the soap. Help the child to rub the soap on his or her
body.
Show the child how to wash the different parts of his or
her body: face, hair, arms, legs, front, and back.
Talk with the child as you bathe him or her. Teach the
child names of different parts of the body.
Then help the child to wash the soap away.
With your hands over the child's hands, help the child to
dry himself or herself with a clean cloth.
As the child does more for himself or herself, give less
help until the child can wash and bathe without help.
Each time the child does something without help or does
something well, let the child know that you are pleased.
Results
>
If your child does these activities, you and the child
have done well.
If your child does not do these activities, he or she may
have difficulty moving or learning. Continue to try the
activities. Talk with your local supervisor.
58
RiB
4.1. Advice for Families of a Deaf
Child
Activity Suggestions for Learning to Look, Listen and Communicate
Your deaf child can learn to communicate and do the same physical and
daily living tasks as other children. Your child may need some help and
may do these things in his or her own way. Many children called ‘deaf are
not completely without hearing. It is important that they learn to listen and
use whatever hearing they do have.
>
Give your child the same experiences (play, conversation) as all children.
>
Give your child a chance to communicate like other children and the time
to do it.
> Take the first step to talk to your child.
> Talk to your child face to face, where you can look at one another as
much as possible. Encourage him or her to watch your mouth when you
talk. Do not cover your mouth.
> Try to communicate with your child in his or her own way. For example try
to understand the pointing, gestures and signs he or she makes.
>
If your child is very deaf, be careful about trying to force him or her to
learn how to speak. It may be better to let him or her learn sign language.
Deaf adults in the community may be able to help with this.
59
f=-
4.2. Advice for Families of a
Blind Child
Activity Suggestions for Learning to Look, Listen, Touch and Feel
Your blind child can learn to communicate, and do the same physical and
daily living tasks as other children. Your child may need help and may do
some of these things in his or her own way. Many children called ‘blind’ are
not completely without sight. It is important that they learn to look and use
whatever sight they do have.
>
If your child can see a little let him or her explore everyday objects like
wooden bowls/cloths (things that he/she cannot break). Let your child
explore the house to find out where everything is. Try to keep things in
the same place to make this easier.
>
If your child cannot see at all, he or ‘she still needs ;to explore
i_;
everyday
objects but will need help. Talk about the objects as you explore them
together.
>
Encourage your child to wash and dress like other children.
>
Your child may see better
I
in daylight. If so, when your child can do
something in the daylight, then encourage him or her to do the same
things when it is dark.
>
Blind children will fall more often than other children. Teach your child to
put out his or her hands to help check the fall. This should enhance your
child s confidence when moving about and exploring things.
>
Train your child to listen to sounds to help him or her know what is
happening. Help your child to learn danger sounds such as fire burning,
water boiling and traffic, for example.
>
Blind children need to be helped and encouraged to join in with other
children’s activities.
>
When your child is old enough, encourage him or her to explore outside
,the house and compound. The child will need help to learn his or her way
around.
60
5. Helping with Common
Disabilities
Other material from WHO Manuals and David Werner (1988) 'Disabled Village Children’
In communities where trained professionals are available and/or easy to
employ, the following WHO manuals can be used to provide further advice to
families. Materials can be photocopied to give to family members.
WHO (1993). Promoting the
Development of Young Children
with Cerebral Palsy
WHO (1990). Guidelines for the
Prevention of Deformities in Polio.
WHO (1989). Promoting the
Development of Infants and Young
Children with Spina Bifida and
Hydrocephalus
^gawgsaaoTOtsesfll
WHO (1996). Promoting
Independence Following Spinal
Cord Injury
Ifeu-gTSWK-K
WHO (1989). Training Package 1, for
a Family Member of a Child Who
Has Difficulty Seeing
^fyqSaTiMCWCT.-TOtl
K’/,;
David Werner (1988) Disabled
Village Children
Wirz S. and Winyard S. (1993).
Hearing and Communication
Disorders
61
SUMMARY OF STAGES
Stage 1
Describe the community,
professionals to assess:
Stage 1 allows non-specialist health
> What services (if any) already exist
> What kinds of workers are involved
> What level of skills and knowledge they might have for identifying
children with impairments and advising parents.
Identification and advice materials from the manual are chosen to suit the
setting. It is essential to find out what level of professional knowledge and
skills are available in that community. Different materials are needed for
different situations.
Stage 2
Identify children with impairments. Choose identification materials that
suit the knowledge and skills of the professionals in that community. The
main aim is to identify children early. Then the family can be offered the
right advice to help the child develop.
A second important aim is to find out if links can be made with a
specialist. Children should be referred on to a specialist if they show
positive signs when tested. Where this is practical for the child and
family (taking into account locally available services, cost and distance) it
will lead to positive help.
Stage 3
Advise families and carers of children identified as having an
impairment. Use the activity suggestions to help the child develop. Use
messages that encourage their participation and inclusion in family and
local community life. Work with families and the community to reduce
disabling social barriers. The biggest challenge is to make sure children
who are identified as having impairments get help. It may be harmful to
families if they are led to expect help but do not get it.
62
READING LIST
>
Dubowitz L. et al (1999) The Neurological Assessment of the Pre-term and
Full-term New Born Infant, (2nd Ed). Clinics in Developmental Medicine No.
148. Mac Keith Press, London.
>
Flower J. and Wirz S. (2000) 'Rhetoric or Reality? The participation of
disabled people in NGO planning.’ Health Policy & Planning, 15 (2).
>
Levitt S. (1992) We Can Play and Move: A manual to help disabled children
learn how to move by playing with others. Healthlink Worldwide, Cityside, 7
Adler Street, London E1 1EE.
> Soeharso (1995) Training Materials for Community Based Rehabilitation
Workers. Community Based Rehabilitation and Development Training
Centre, Solo, Indonesia
> Thorburn, M. (undated) Jamaican Adaptation of the Denver Developmental
Screening Test. 3D Project, Kingston, Jamaica.
>
Vazir S. et al (1994) ‘Screening Test Battery for Assessment of
Psychological Development’. Indian Paediatrics, 31, Dec, 1994.
>
Werner D. (1988) Disabled Village Children. Hesperian Foundation, PO Box
1692, Palo Alto. California 94302, USA.
>
WHO (1989) Training in the Community for People with Disabilities-Training
Package 1, for a Family Member of A Child Who Has Difficulty Seeing.
WHO, Geneva.
>
WHO (1989) Training in the Community for People with Disabilities-Training
Package 26 for a Family Member of a Child with a Disability. WHO, Geneva.
>
WHO (1990) Guidelines for the Prevention of Deformities in Polio. WHO,
Geneva.
WHO (1993) Promoting the Development of Infants and Young Children with
Cerebral Palsy: A Guide for Mid-Level Rehabilitation Workers. WHO,
Geneva.
>
>
WHO (1996) Promoting the Development of Infants and Young Children with
Spina Bifida and Hydrocephalus: A Guide for Mid-Level Rehabilitation
Workers and Families. WHO, Geneva
>
WHO (1996) Promoting Independence Following Spinal Cord Injury: A Guide
for Mid-Level Rehabilitation Workers. WHO, Geneva.
>
WHO (1998) Let's Communicate. WHO, Geneva.
>
Wirz S. and Winyard S. (1993) Hearing and Communications Disorders: A
Manual for CBR Workers. Macmillan, London.
> Zaman S. et al (1990) ‘The Validity of the “Ten Questions” for Screening
Seridus Childhood Disability: Results from Urban Bangladesh.’ International
Journal of Epidemiology 19 (3).
63
See the following United Nations’ conventions and declarations:
> UNICEF (1995) The Convention on the Rights of the Child. London: UK
Committee for UNICEF.
> United Nations (1994) The Standard Rules on the Equalization of
Opportunities for Persons with Disabilities. UN, New York, USA. (see below)
> WHO (1978) Alma-Ata Declaration on Health for All: Primary Health Care:
Report of the International Conference on Primary Health Care, Alma-Ata,
USSR 6-12 September 1978. WHO. Geneva.
> World Health Organisation (2001). International Classification of Functioning
and Disability. Geneva: WHO.
Note on the Use of the Term ‘Disability’
Extract from the Standard Rules on the Equalization of Opportunities for
Persons with Disabilities page 9:
17.
The term “disability” summarizes a great number of different
functional limitations occurring in any population in any country
of the world. People may be disabled by physical, intellectual or
sensory impairment, medical conditions or mental illness. Such
impairments, conditions or illnesses may be permanent or
transitory in nature.
18.
The term “handicap” means the loss or limitation of
opportunities to take part in the life of the community on an
equal level with others. It describes the encounter between the
person with a disability and the environment. The purpose of
this term is to emphasize the focus on the shortcomings in the
environment and in many organized activities in society, for
example, information, communication and education, which
prevent persons with disabilities from participating on equal
terms.
S’1'
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Appendix 1
INTERNATIONAL CLASSIFICATION OF FUNCTIONING
ANO DISABILITY - WHO 2001
WHO has worked with governments and disabled people’s organisations to create
an international system of classification for functioning and disability. In the older
classification system explained below, disability was mainly seen as the result of a
physical or mental condition. The new system looks at the medical, social and
environmental reasons for a person’s difficulties. It recognises that unjust and unfair
social attitudes towards disabled people create barriers. These restrict their activity
and participation in the community. Examples of the problems a child might
experience are given below.
WHO International Classification of Impairment, Disability and Handicap 1980
Example and Possible Solution
Level of Difficulty
Terms
Impairment
Person affected by mental or physical
condition or accident
Polio: muscles paralysed - rehabilitation
Disability
Function restricted
Unable to walk unaided beyond the homesometimes special school available
Social role restricted
Not accepted in regular school
1
Handicap
Access to health and education is a basic human right for all children with impairments. Services,
which take account of social barriers and try to change the environment, belong to the social model.
The new WHO classification (see below) brings the medical and social aspects together.
Families need help to understand that with encouragement their child can learn and make progress.
Teachers, community leaders and those in local government should be positive towards including
children with disabilities into society. Services should help them participate in activities like everyone
else, supported by the law.
WHO Classification of Functioning and Disability - May 2001
Terms
Example-Poss/b/e Solution
Level of Difficulty
Impairment
Person affected by mental or physical
condition or accident
Polio: muscles paralysed - rehabilitation
Activity
Activity restriction
Unable to walk to school - assess child’s
equipment needs (splints; wheelchair)
Participation
Participation restriction
Not accepted at school - change social attitudes;
support teachers, change environment (ramp
instead of steps into building), make laws, help
enforce law
Summary - Services which help disabled people best are those which:
>
are designed with their help
>
have a flexible inclusive approach - social, and medical as appropriate
It is important that the terms used to describe people with disabilities are
ones, which they are happy to use.
65
/oCA
Appendix 2
THE CHILb-TO-CHILD PROGRAMME
(Adapted from Disabled Village Children, David Werner. 19^8)
Introduction
CHILD-to-child is a non-formal education programme in which school children learn
ways to protect the health and well-being of other children, especially those who are
young or who have special needs because of an impairment or disability. The
children learn simple preventive and curative ways of helping which suit their
community setting. They pass on what they learn to other children and their families.
The CHILD-to-child programme began in 1979 as part of the International Year of
the Child. Health workers and educators from many countries designed a series of
activity sheets for use by teachers and health workers for children in different
countries and community settings.
Starting Child-to-child Activities
Teachers, community health workers or people in the community, who wish to
improve children's access to health messages and simple advice can start child-tochild activities. Some activities are about disability. The purpose of these activities is
to help children to:
>
Learn about different disabilities and what it might be like to be disabled
>
Learn that although a disabled person may have difficulties doing some things,
he or she may do other things better than other people
>
Think of ways to welcome disabled children and include them in whatever the
local children are doing, for example playing games and going to school.
>
Become the friends and defenders of any child who is different or has special
needs.
—
’
Refer to David Werner’s book Disabled Village Children for more information.
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