051

CHAPTIER 6

Guide for Identifying Disabilities

This chapter has a chart, 7 pages long, to help you find out what disability a child possibly has, and where to look up that disability in this book.

In the first column of the chart, we list the more noticeable signs of different disabilities. Some of these signs are found in more than one disability. So in the second column we add other signs that can help you tell apart similar disabilities. The third column names the disability or disabilities that are most likely to have these signs. And the fourth column gives the page numbers where you should look in this book. (Where it says WTND and then a number, this refers to the page in Where There Is No Doctor.)

If you do not find the sign you are looking for in the first column, look for another sign. Or check the signs in the second column.

This chart will help you find out which disabilities a child might have. It is wise to look up each possibility. The first page of each chapter on a disability describes the signs in more detail.

IMPORTANT: Some disabilities can easily be confused. Others are not included in this book. When you are not sure, try to get help from someone with more experience. At times, special tests or X-rays may be needed to be sure what the problem is.

Fortunately, it is not always necessary to know exactly what disability a child has. For example, if a child has developed weakness in his legs and you are not sure of the cause, you can still do a lot to help him. Read the chapters on disabilities that cause similar weakness, and the chapters on other problems that the child may have. For this child, you might find useful information in the chapters on polio, contractures, exercises, braces, walking aids or wheelchairs, and many others.

Sometimes it is important to identify the specific disability. Some disabilities require specific medicines or foods-for example, night blindness, rickets, or cretinism. Others urgently need surgery - for example, spina bifida or cleft lip and palate. Others require special ways of doing therapy or exercises-for example, cerebral palsy. And others need specific precautions to avoid additional problems-for example, spinal cord injury and leprosy. For this reason, it helps to learn as much about the disability as you can. Whenever possible, seek information and advice from more experienced persons. (However, even experts are not always right. Do not follow anyone's advice without understanding the reasons for doing something, and considering if and why the advice applies to the individual child.)

Logo of PROJIMO (shade)

In addition to this chart, 2 other guides for identifying disabilities are in this book :

GUIDE FOR IDENTIFYING CAUSES OF JOINT PAIN, Page 130. GUIDE FOR IDENTIFYING AND TREATING DIFFERENT FORMS OF FITS (EPILEPSY), Page 240.

052

GUIDE FOR IDENTIFYING DISABILITIES

IF THE CHILD HAS THIS

AND ALSO THIS

HE MAY HAVE

PAGE#

SIGNS PRESENT AT OR SOON AFTER BIRTH

born weak or 'floppy'

Born weak or 'floppy'.

slow to begin to lift head or move arms.

Slow to begin to lift head or move arms.

	often a difficult birth
	delayed breathing
	born blue and limp
	or born before 9 months and very small

	cerebral palsy
	developmental delay

87
277

	round face
	slant eyes
	thick tongue

	Down syndrome (mongolism)
	cretinism

279
282

small head, or small top part of head

microcephalia (small brain) mental retardation

278

none of above

developmental delay for other reasons

289

does not suck well or chokes on milk or food

does not suck well or chokes on milk or food.

	pushes milk back out with tongue
	or will not suck

cerebral palsy

	cannot suck well
	chokes or milk comes out nose

	check for cleft palate
	possibly severe retardation

120
277

one or both feet turned in or back.

One or both feet turned in or back.

no other signs

club foot

114

	hands weak, stiff or clubbed
	some joints stiff. in bent or straight positions

arthrogryposis

122

dark lump on back

spina bifida

167

'bag' or dark lump on back

'Bag' or dark lump on back

	clubbed feet
	or feet bend up too far
	or feet lack movement and feeling

spina bifida
(sometimes no 'bag' is seen, but foot signs may be present)

167

head too big; keeps growing.

may develop: Eyes like 'setting sun'.

	eyes like 'setting sun'
	increasing mental and/or physical disability
	blindness

hydrocephalus (water on the brain)

169

At birth, this is usually a sign of spina bifida.

167

in an older child, possibly tapeworm in brain, or a brain tumor

WTND 143

upper lip and/or roof of mouth incomplete.

	difficulty feeding
	later, speech difficulties

	cleft lip (hare lip)
	and cleft palate

120

birth deformities, defects, or missing parts.

Birth deformities, defects, or missing parts.

(may or may not be associated with other problems)

See

	birth defects
	amputations
	Down syndrome
	developmental delay

119
227
279
287

abnormal stiffness or position.

Abnormal stiffness or position.

	from birth
	some muscles weak
	some joints stiff
	head control and mind normal

arthrogryposis

122

	Muscles tighten more in certain positions.
	may grip thumb tightly

spastic cerebral palsy

Note: muscle tightness (spasticity) usually does not appear until weeks or months after birth.

053

one arm weak or in strange position

does not move the arm much

Does not move the arm much.

Erb's palsy (weakness from damage to nerves in shoulder during birth)

127

leg on same side often affected

hemiplegic (one-sided) cerebral palsy

dislocated hip at birth.

Dislocated hip at birth.

On opening legs like this, leg 'pops' into place or does not open as far.

Opening legs

dislocated hip from birth (often both hips)

may be present with:

	spina bifida
	Down syndrome
	arthrogryposis

Also see Page 156.

155
167
279
122

slow to respond to sound or to look at things

(may be due to one or a combination of problems)

Check for signs of:

	developmental delay
	cerebral palsy
	blindness
	deafness

290
87
243 257

SIGNS IN CHILDREN

slower than other children to do things (roll, sit, use hands, show interest, walk, talk)

Slower than other children to do things.

slow in most or all areas:

Developmental delay, check for signs of:

287

Round face and single deep crease in hand.

	round face
	slant eyes
	single deep crease in hand

Down syndrome (mongolism)

279

	movements and response slow
	skin dry and cool
	hair often low on forehead
	puffy eyelids

cretinism

282

has continuous strange movements positions, and/or stiffness Continuous strange movement, positions, and stiffness.

cerebral palsy

also cheek for:

	blindness
	deafness
	malnutrition

87
243
257
320

does not respond to sounds, does not begin to speak by age 3

Signs in children - deafness, severe developmental delay, severe cerebral palsy.

may respond to some sounds but not others Check for ear infection (pus).

Check for:

	deafness
	severe developmental delay (with or without deafness)
	severe cerebral palsy

257
283
87

does not turn head to look at things, or reach for things until they touch her

Signs in children - blindness, severe mental retardation, severe cerebral palsy.

Eyes may or may not look normal.

	blindness and/or
	severe mental retardation
	severe cerebral palsy

243
277
87

Eyelids or eyes make quick, jerky, or strange movements.

Check for one or a combination of these.

	blindness
	fits
	too much medicine
	cerebral palsy
	other problems affecting or damaging the brain

243
233
15
87
14

054

All or part of body makes strange, uncontrolled movements.

	begins suddenly, child may fall or lose consciousness
	child is normal (or more normal) between 'fits'

epileptic fits
(Pattern varies a lot in different children-or even in the same child.)

233

slow, sudden, or rhythmic movements; fairly continuous (except in sleep);no loss of consciousness

athetoid cerebral palsy

(Note: Fits and cerebral palsy may occur in the same child.)

Body, or parts of it, stiffens when in certain positions: poor control of some or all movements.

Signs in children - spstic cerebral palsy.

	different positions in different children
	Body may stiffen backward and legs cross.

spastic cerebral palsy

PARTS OF BODY WEAK OR PARALYZED

IF THE CHILD HAS THIS

AND ALSO THIS

HE MAY HAVE

SEE PAGE

floppy or limp weakness in part or all of body

no loss of feeling in affected parts

no spasticity (muscles that tighten without control)

normal at birth

Floppy or limp weakness in part or all of body.

	usually began with a 'bad cold and fever before age 2
	irregular pattern of parts weakened. Often one or both legs-sometimes arm, shoulder, hand, etc.

polio

	begins little by little and steadily gets worse
	about the same on both sides of body
	often others in the family also have it

muscular atrophy

109
112

	Paralysis starts in legs and moves up; may affect whole body.
	or, pattern of paralysis variable

tick paralysis

Tick paralysis.

Guillain-Barre' paralysis (usually temporary)

paralysis from pesticides, chemicals, foods (lathyrism)

not in book

62
15

lump on back (See Page 57.)

tuberculosis of spine

165

floppy or limp weakness

usually some loss of feeling

	one or both hands or feet
	develops slowly in older child. Gets worse and worse.

leprosy

215

	born with bag on back (Look for scar.)
	feet weak, often without feeling

spina bifida A baby who has spina bifida.

167

	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

spinal cord injury

Paraplegia and Quadriplegia.

175

injury to nerves going to one part of body

hand weakness sometimes caused by using crutches wrongly

393

055

weakness usually with stiffness or spasticity of muscles

no loss of feeling

usually affects body in one of these patterns

1. one side 2. both legs 3. whole body

Muscles tighten and resist movement because of joint pain.

	1: cerebral palsy (or stroke, usually older persons)
	2 and 3: cerebral palsy
	occasional other causes

JOINT PAIN

(many causes-see below)

87
130

JOINT PAIN

IF THE CHILD HAS THIS

AND ALSO THIS

HE MAY HAVE

SEE PAGE

one or more painful joints

	begins with or without fever
	gradually gets worse, but there are better and worse periods

juvenile arthritis

135

other causes of joint pain

See chart on joint pain.

130

WALKS WITH DIFFICULTY OR LIMPS

dips to one side with each step

Dips to one side with each step.

one leg often weaker and shorter

Check for:

	polio
	cerebral palsy
	dislocated hip

59
87
155

	usually begins age 4 to 8
	may complain of knee pain

damaged hip joint

157

walks with knees pressed together

Walks with knees pressed together.

	muscle spasm and tightness
	upper body little affected

spastic diplegic or paraplegic cerebral palsy

stands and walks with knees together and feet apart

Stands and walks with knees together.

no other problems

feet less than 3" apart at age 3

normal from ages 2 to 12

113

feet more than 3" apart at age 3

knock-kneed

114

walks awkwardly with one foot tiptoe

Walks awkwardly with one foot tiptoe.

muscle spasms and poor control on that side. Hand on that side often affected.

hemiplegic cerebral palsy

(stroke in older persons)

not in book

walks awkwardly with knees bent and legs usually separated

Walks awkwardly with knees bent and legs usually separated.

jerky steps, poor balance sudden, uncontrolled movements that may cause failing

athetoid cerebral palsy

slow 'drunken' way of walking learns to walk late and falls often

	poor balance (ataxia)-often with cerebral palsy
	Down syndrome (mongolism)
	cretinism

90
279
282

walks with both feet tiptoe

Walks with both feet tiptoe.

	weakness, especially in legs and feet
	gradually gets worse and worse

muscular dystrophy

109

legs and feet stiffen (spasticity of muscle)

spastic cerebral palsy

no other problems

normal? (some normal children at first walk on tiptoes)

292

056

walks with hand(s) pushing thigh(s) or with knee(s) bent back

Walks with hands pushing thighs. Walks with knees bent back

	polio
	muscular dystrophy
	arthritis (joint pain)
	other causes of muscle weakness

59
109
135
112

Foot hangs down weakly (foot drop).

Foot hangs down weakly.

Child lifts foot high with each step so that it will not drag.

	polio
	spina bifida
	muscular dystrophy
	muscular atrophy
	nerve or muscle injury
	other cause of weakness

59
167
109
112
35
139

dips from side to side with each step

Dips from side to side with each step.

due to muscle weakness at side of hips, or double dislocated hips, or both

	polio
	cerebral palsy
	spina bifida
	Down syndrome
	muscular dystrophy
	child who stays small
	arthrogryposis
	dislocated hips (may occur with any of the above)

59
87
167
279
109
126
122
155

walks with one (or both) hip, knee, or ankle that stays bent

Walking with one hip, knee, or ankle that stays bent.

joints cannot be slowly straightened when child relaxes (see page 79).

	contractures (shortened muscles)
	joined or fused joints

may be secondary to:

	polio
	joint infection
	other causes

77
80

59
131
231

Joints can gradually be straightened when child relaxes.

spasticity, often cerebral palsy

Knees wide apart when feet together (bow legs). Waddles or dips from side to side (if he walks).

Knees wide apart when feet rogether.

under 18 months old

often normal

113

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.

Consider:

	rickets (lack of vitamin D and sunlight)
	brittle bone disease
	children who stay very short (dwarfism)
	cretinism
	Down syndrome
	dislocated hips

125
125
126
282
279
155

flat feet

Flat feet.

no pain or other problems

normal in many children

113

	Pain may occur in arch of foot.
	Deformity may get worse.

may be problems in:

	cerebral palsy
	polio
	spina bifida
	Down syndrome

87
59
167
279

BACK CURVES AND DEFORMITIES

sideways curve of backbone

Sideways curve of backbone.

When child bends over, look for a lump on one side.

Look for a lump on one side.

'scoliosis' - may occur alone or as complication of: polio cerebral palsy muscular dystrophy spina bifida other physical disability

59
87
109
167
162

057

swayback

Swayback may be due to contractures, or weak stomach muscles.

	belly often sticks out
	may be due to contractures here, or weak stomach muscles

'lordosis' - may occur in:

	polio
	spina bifida
	cerebral palsy
	muscular dystrophy
	Down syndrome
	cretinism
	child who stays small many other disabilities

59
167
87
109
279
282
126
161

rounded back

Rounded back.

'kyphosis' - often occurs with:

	arthritis
	spinal cord injury
	severe polio
	brittle bone disease

136
175
59
125

hard, sharp bend of or bump in backbone

Hard, sharp bend.

	starts slowly and without pain
	often family history of tuberculosis
	may lead to paralysis of lower body

tuberculosis of the spine

165

dark soft lump over backbone

Dark soft lumb over backbone.

	present at birth
	sometimes only a soft or slightly swollen area over spine
	weakness and loss of feeling in feet or lower body

spina bifida ('sack on the back')

167

OTHER DEFORMITIES

missing body parts

born that way

born with missing or incomplete parts

121

accidental or surgical loss of limbs (amputation)

amputations

227

gradual loss of fingers, toes, hands, or feet, often in persons who lack feeling

osteomyelitis (bone infections)

sometimes seen with

	leprosy (hands or feet)
	spina bifida (feet only)

159
215
167

hand problems

(For hand problems from birth, see Page 305)

	floppy paralysis (no spasticity)
	without care may lead to contractures so that fingers cannot be opened

may occur with:

	polio
	muscular dystrophy
	muscular atrophy
	spinal cord injury (at neck level)
	leprosy
	damage to nerves or cords of arms

All may lead to contractures.

59
109
112
175
215
127

	uncontrolled muscle tightness (spasticity)
	strange movements
	or hand in tight fist

spastic cerebral palsy

may lead to contractures

burn scars and deformities

burns

231

clubbing or bending of feet (For club feet from birth, see Page 114.)

may begin as floppy weakness and become stiff from contractures, if not prevented

Clubbing or bending of feet may begin as floppy weakness and become stiff from contractures.

may occur with many physical disabilities, including:

	polio
	cerebral palsy
	spina bifida
	muscular dystrophy
	arthritis
	spinal cord injury

59
87
167
109
139
175

058

DISABILITIES THAT OFTEN OCCUR WITH
OR ARE SECONDARY TO OTHER DISABILITIES

Developmental delay: child slow to learn to use her body or develop basic skills

Developmental delay.

caused by slow or incomplete brain function or by severe physical disability, or both

often seen in:

	mental retardation
	cerebral palsy
	severely or multiply disabled children

277
87
283

caused by overprotection: treating children like babies when they could do more for themselves

some delay can occur with almost any disability

287

Contractures joints that no longer straighten because muscles have shortened

Contractures

	usually due to muscle weakness or spasticity
	Often, muscles that pull a joint one way are much weaker than those that pull it the other way (muscle imbalance).

often secondary to:

	polio
	cerebral palsy
	spina bifida
	arthritis
	muscular dystrophy
	Erb's palsy
	amputations
	leprosy

59
87
167
135
109
127
227
215

sometimes due to scarring from burns or injuries

burns

231

Behavior problems

Behavior 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.)

behavior problems common with:

	mental retardation
	fits (epilepsy)
	cerebral palsy

and for emotional reasons, with:

	spinal cord injury
	muscular dystrophy
	deafness
	learning disability

277
233
87

175
109
257
365

Slow to learn certain things only; otherwise intelligent.

	often over-active or nervous
	sometimes behavior problems

learning disability

365

Speech and communication problems

	often, but not always, due to deafness or retardation (or both)
	Some children can hear well and are

Speech and communication problems.

but still cannot speak.

may occur with:

	deafness
	developmental delay
	cerebral palsy
	Down syndrome
	cretinism
	children who stay small
	brittle bone disease
	cleft lip and palate

(Deafness may occur together with these and other disabilities.)

257
287
87
279
282
126
125
120

other problems that sometimes occur secondary to other disabilities

(Some of these we have already included in this chart.)

Main disability

cerebral palsy

Common secondary disabilities

	blindness
	deafness
	fits

243
257
233

many disabilities with paralysis

spinal curve

161

persons who have lost feeling: leprosy, spinal cord injury, spina bifida

	pressure sores
	osteomyelitis (bone infection)
	loss of urine and bowel control

195
159
203

CHAPTIER 6

Guide for Identifying Disabilities

GUIDE FOR IDENTIFYING DISABILITIES

SIGNS PRESENT AT OR SOON AFTER BIRTH

SIGNS IN CHILDREN

PARTS OF BODY WEAK OR PARALYZED

JOINT PAIN

WALKS WITH DIFFICULTY OR LIMPS

BACK CURVES AND DEFORMITIES

OTHER DEFORMITIES

DISABILITIES THAT OFTEN OCCUR WITH OR ARE SECONDARY TO OTHER DISABILITIES

DISABILITIES THAT OFTEN OCCUR WITH
OR ARE SECONDARY TO OTHER DISABILITIES