title: Health maintenance and management in childhood disability.
abstract: Health and health-related needs of children with disabilities are very broad in scope, and it is impossible to adequately cover all aspects in a single article. This article has tried, however, to highlight the issues common to disability, and lay the groundwork for the development of health maintenance guidelines for this population. The prevalence of childhood disability is on the rise, yet life expectancies are improving, and it is not uncommon for children even with severe disabilities to live well into adulthood. The ICIDH2 paradigm shift to focus on health and function rather than impairment and disability fits well with the national initiative to promote health for all. There is a paucity of information on the impact of childhood interventions on health in adulthood, yet it would be prudent to surmise that early interventions will be effective. Directed attention to the basic health needs and preventive measures for the management of children with disabilities is required. This can be difficult because the management of a child with disability is dynamic and challenging, and health care providers may find their time and energies consumed with just managing the more obvious and striking disability-related problems. The widespread ramifications of disability on both the individual and society, call for teamwork between family, health care providers, and the community. Although the specific needs of such a diverse group vary widely; as a group, children with disabilities have many common needs. These include the need for basic health maintenance and health promotion measures such as nutrition, immunizations and physical fitness, as well as coordination of services, psychologic and family support, technical assistance, funding resources, communication between health and education fields, and access to a "medical home," the site for primary care of the child. As a tree is bent, so it will grow. Efforts to promote growth and maximize opportunities for development, to inculcate healthy eating habits, to encourage exercise and socialization behaviors, and to strengthen the bond between the child with disability, family, and community will help minimize disability-related problems in adulthood. As children with disabilities are drawn into the mainstream of the concept of health, we should start to see the much awaited change in societal attitudes toward disability. The conditions resulting in childhood disability are many varied. Rather than developing condition specific health guidelines, it would be more advantageous to use a general health framework of anticipatory guidance, growth, development, medical management, psychologic and vocational counseling, and resource planning. Working off this framework, health maintenance and promotion measures can then be further individualized to suit the child and family's specific needs.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109-0230, USA.
authors.forename: Rita
authors.initials: R
authors.lastname: Ayyangar
mesh_terms: D002547:Cerebral Palsy; D002648:Child; D015897:Comorbidity; D019988:Children with Disabilities / Q000534:rehabilitation; D005242:Fecal Incontinence / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D007114:Immunization; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology; D010809:Physical Fitness; D003668:Pressure Ulcer / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000453:epidemiology; D012917:Social Adjustment; D016135:Spinal Dysraphism; D014549:Urinary Incontinence / Q000453:epidemiology