Care needs of children with disabilities – Use of the Pediatric Evaluation of Disability Inventory

AbstractObjectiveTo describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory.MethodsCross-sectional study with 181 children aged 7–10 years with physical or mental disabilities, undergoing the inclusion process in elementary school in 2007. Location: 31 schools of the Regional Education Board–District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas–self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant.ResultsThe lower means, with statistically significant differences, were observed for the items related to social function (55.8–72.0), followed by self-care functions (56.0–96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8).ConclusionsSocial function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention

Necessidades de assistência à criança com deficiência – Uso do Inventário de Avaliação Pediátrica de Incapacidade

ResumoObjetivoDescrever as necessidades de assistência referidas por cuidadores de crianças com deficiência em processo de inclusão escolar, por meio do Inventário de Avaliação Pediátrica de Incapacidade.MétodosEstudo transversal com 181 crianças de 7‐10 anos com deficiências físicas ou mentais, que se encontravam em processo de inclusão escolar no ciclo Fundamental I, em 2007. Local: 31 escolas da Diretoria Regional de Ensino – Distrito Penha, Zona Leste do Município de São Paulo. Foram avaliadas as necessidades de assistência do cuidador da criança em três áreas – autocuidado, mobilidade e função social, por meio do Inventário de Avaliação Pediátrica de Incapacidade, segundo a seguinte pontuação: 5 Independente, 4 Supervisão, 3 Assistência mínima, 2 Assistência moderada, 1 Assistência máxima e 0 Assistência total. Para análise estatística, usou‐se o teste t de Student e análise de variância (Anova) e foi significativo p<0,05.ResultadosAs menores médias, com diferença estatística, foram observadas para os itens relacionados à função social (55,8‐72), seguidas das funções de autocuidado (56‐96,5) para todos os tipos de deficiência, com exceção das crianças com deficiência física que apresentaram menores médias para autocuidado (56) e mobilidade (63,8).ConclusõesA função social foi a área referida como a que necessita de maior assistência do cuidador e o Inventário de Avaliação Pediátrica de Incapacidade é um instrumento que pode contribuir para identificar essas necessidades e para o desenvolvimento de uma intervenção mais dirigida.AbstractObjectiveTo describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory.MethodsCross‐sectional study with 181 children aged 7 to 10 years with physical or mental disabilities, undergoing the inclusion process in Elementary school in 2007. Location: 31 schools of the Regional Education Board ‐ District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas ‐ self‐care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t‐test and analysis of variance (ANOVA), with p<0.05 being statistically significant.ResultsThe lower means, with statistically significant differences, were observed for the items related to social function (55.8 to 72.0), followed by self‐care functions (56.0 to 96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self‐care (56.0) and mobility (63.8).ConclusionsSocial function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention

Children and adolescents with developmental disabilities in the pediatric outpatient clinic

OBJECTIVE: to review the literature on outpatient care of children and adolescents with developmental disabilities, focusing on prevention, early diagnosis, treatment, outcomes and rehabilitation. SOURCES OF DATA: search of Medline and Lilacs databases; publications of scientific committees of institutions for children with special needs; and outpatient care reports of reference centers for the treatment of children and adolescents with mental and developmental disabilities. SUMMARY OF THE FINDINGS: this population presents health problems associated with the basic pathology and its consequences in addition to the usual problems of the specific age group. The etiology of developmental disorders and the main characteristics of each type of disability are discussed. Special attention is given to outpatient pediatric care. CONCLUSIONS: the most recent study of the Brazilian population, performed in 2000, showed that 14.5% of this population presented some type of developmental deficiency. Therefore, developmental problems are one of the most prevalent health problems among children and adolescents. Consequently, pediatricians need to be prepared to evaluate and identify factors that may influence normal children development. Pediatricians are responsible for prevention, early diagnosis and coordination of the multidisciplinary treatment of these patients in addition to basic medical assistance, which is essential to guarantee the patients' good quality of life.OBJETIVO: revisar a literatura e os princípios básicos sobre o atendimento ambulatorial da criança e do adolescente com alterações no desenvolvimento, salientando os aspectos da prevenção, detecção e intervenção precoce, inclusão e reabilitação. FONTE DE DADOS: pesquisa nas bases de dados Medline, Lilacs, nas publicações de comitês científicos, de instituições para portadores de necessidades especiais e protocolos sobre assistência ambulatorial em centros de referência para crianças e adolescentes portadores de deficiências. SÍNTESE DOS DADOS: esta população-alvo apresenta, além dos problemas de saúde típicos de sua faixa etária, os relacionados à sua patologia de base, ou às conseqüências dessas. Este artigo traz ao pediatra as principais causas de distúrbios de desenvolvimento e as características de cada forma de deficiência, ressaltando os cuidados necessários na sua abordagem nos ambulatórios de pediatria. CONCLUSÕES: o censo brasileiro de 2000 aponta que 14,5% da população brasileira apresenta algum tipo de deficiência, posicionando os problemas de desenvolvimento como um dos mais prevalentes agravos da infância e da adolescência. Assim sendo, todo pediatra há que estar atento ao desenvolvimento das crianças e adolescentes e aos fatores que possam influir sobre ele. Do pediatra depende a prevenção, o diagnóstico precoce e o tratamento em tempo hábil, sendo insubstituível na coordenação da assistência multidisciplinar, bem como na inclusão desta clientela na assistência básica à saúde, fundamentais na definição do prognóstico e da qualidade de vida dos portadores de deficiências.SBP Grupo de Trabalho - Crianças e Adolescentes EspeciaisSBP Departamento Científico de Segurança Força-Tarefa de Prevenção da Deficiência AuditivaCoordenação Municipal da Rede de Proteção às Crianças e Adolescentes de CuritibaUniversidade Federal de São Paulo (UNIFESP) Projeto Desenvolver do Programa de Integração Docente AssistencialUniversidade Federal de São Paulo (UNIFESP) Pediatria Comunitária e AmbulatorialSBP Departamento de Pediatria AmbulatorialUniversidade Federal do Pará Departamento de Assistência Materno-Infantil IISecretaria Municipal de Saúde de BelémSBP e Adolescentes EspeciaisUNIFESP, Projeto Desenvolver do Programa de Integração Docente AssistencialUNIFESP, Pediatria Comunitária e AmbulatorialSciEL

Childcare and children's healthcare: historical factors and challenges

This paper reviews the history of puericulture and attention to children's health in Brazil and establishes relationships between this history and the concept of childhood at different times and within different sociocultural contexts, and between this history and the way in which the Brazilian healthcare system has been organized. The characteristics of the Brazilian educational process, the state's role in healthcare, the creation of the national health system and the creation of the children's and adolescent's laws are highlighted as determinants of healthcare that consider children and their families as subjects under the law. These important achievements within Brazilian society have stimulated changes in clinical practice and, especially, in childcare. Today, the state no longer has a controlling role over families' childcare through regulation of individuals' conduct. Rather, childcare is undertaken scientifically, through a multiprofessional team in partnership with families and communities.This paper reviews the history of puericulture and attention to children’s health in Brazil and establishes relationships between this history and the concept of childhood at different times and within different sociocultural contexts, and between this history and the way in which the Brazilian healthcare system has been organized. The characteristics of the Brazilian educational process, the state’s role in healthcare, the creation of the national health system and the creation of the children’s and adolescent’s laws are highlighted as determinants of healthcare that consider children and their families as subjects under the law. These important achievements within Brazilian society have stimulated changes in clinical practice and, especially, in childcare. Today, the state no longer has a controlling role over families’ childcare through regulation of individuals’ conduct. Rather, child care is undertaken scientifically, through a multiprofessional team in partnership with families and communities

Functional skills of children with deficiencies in school inclusion: barriers to effective inclusion

The scope of this article is to describe the disabilities of students in the process of inclusion by means of the PEDI - Pediatric Evaluation of Disability Inventory. A cross-sectional analysis was conducted. The population studied included 181 students (7-10 years old) from 31 public schools in São Paulo. Using a questionnaire applied to the caregiver, 197 activities were evaluated in the areas of self-care, mobility and social function. In accordance with the PEDI, differences (p < 0.05) in student performance were observed between grades in the scales of self-care (average of 77.8% in the 1st grade and 95.2% in the 4th grade) and mobility (average of 90% in the 1st grade and 99.8% in the 4th grade); social function had the lowest averages, except for those with physical disabilities, in which the most affected area was mobility (average of 62.7%). The PEDI enabled the identification of disabilities per group and individual disability, which may constitute an important tool for targeted intervention and follow-up at school.O objetivo deste artigo é descrever as incapacidades de alunos em processo de inclusão por meio do PEDI (Inventário de Avaliação Pediátrica de Incapacidades). Estudo transversal analítico. População: 181 alunos (7-10 anos) de 31 escolas municipais de São Paulo. Por meio de questionário aplicado ao cuidador, foram avaliadas 197 atividades nas áreas de autocuidado, mobilidade e função social. Diferenças (p < 0,05) no desempenho dos alunos, segundo o PEDI, foram observadas entre as séries nas escalas de autocuidado (média de 77,8% na 1ª série e de 95,2% na 4ª série) e mobilidade (média de 90,0% na 1ª série e 99,8% na 4ª série); a função social apresentou as menores médias, exceção ao grupo com deficiência física, cuja área mais afetada foi a mobilidade (média de 62,7%). O PEDI permitiu a identificação de incapacidades por grupo de deficiências e individual, podendo constituir instrumento importante para intervenção direcionada e acompanhamento na escola.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

Knowledge and practices regarding child development among primary healthcare professionals

OBJECTIVE: To evaluate the knowledge and practices regarding child development among physicians working in primary healthcare units. METHOD: Cross-sectional descriptive study carried out at primary healthcare units in Embu, São Paulo, Brazil. Study procedures: 1) Evaluation of knowledge: test consisting of 20 multiple-choice questions on child development applied to all 31 physicians who were providing pediatric care at the primary healthcare units; 2) Evaluation of practices: semi-structured interview applied to a sample of 154 mothers/caregivers of children aged up to 36 months during follow-up visits at primary healthcare units in the municipality. For the comparisons of categorical variables (evaluation/advices about development in visits of children at different ages), the chi-square test was employed. RESULTS: The mean number of correct responses among physicians was 14.8. The error rate for seven questions was greater than 30% (sensory development, language acquisition, physiology of the nervous system, clinical and laboratory diagnosis of congenital infections and innate errors of metabolism) and the rate of correct responses was greater than 85% for four questions (motor and personal-social development markers, risk factors and genetic syndromes). Regarding practices, in 69 (45%) visits, the doctor asked the mother/caregiver's opinion about the child's development; in 80 (52%), the mother/caregiver said that the doctor assessed the development; and in 64 (42%), the mother/caregiver said that the doctor advised them on practices for child's stimulation. CONCLUSIONS: Faulty knowledge and practices regarding child development were identified among primary care professionals, indicating the need for continued education.OBJETIVO: Avaliar o conhecimento e as práticas sobre desenvolvimento infantil de médicos que atuam em Unidades Básicas de Saúde (UBS). MÉTODO: Estudo transversal, descritivo, realizado nas UBS de Embu (SP). Procedimentos do estudo: 1) avaliação do conhecimento por teste contendo 20 questões de múltipla escolha sobre desenvolvimento da criança aplicado a 31 médicos (universo) que prestam assistência pediátrica em UBS; 2) avaliação das práticas - entrevista semiestruturada aplicada para uma amostra de 154 mães/cuidadores que acompanhavam crianças com idade menor ou igual a 36 meses em consulta médica agendada em UBS do município. Para comparação de variáveis categóricas (avaliação/orientações sobre desenvolvimento em consultas de crianças de diferentes faixas etárias), utizou-se o qui-quadrado. RESULTADOS: A média de acertos dos médicos foi de 14,8 questões; sete questões apresentaram índices de erros superiores a 30% (desenvolvimento sensorial, aquisição de linguagem, fisiologia do sistema nervoso, diagnóstico clínico e laboratorial de infecções congênitas, erros inatos do metabolismo) e quatro questões apresentaram acertos acima de 85% (marcos do desenvolvimento motor, pessoal-social, fatores de risco e síndrome genética). Quanto às práticas, em 69 (45%) consultas o médico perguntou a opinião da mãe/cuidador sobre o desenvolvimento da criança, em 80 (52%) a mãe/cuidador referiu que o médico fez alguma pergunta e/ou avaliou o desenvolvimento e em 64 (42%) orientou sobre como estimular a criança. CONCLUSÕES: Identificaram-se falhas de conhecimento e nas práticas dos profissionais referentes ao desenvolvimento da criança, o que indica a necessidade de implementar educação permanente.UNIFESP Curso de MedicinaUNIFESP Projeto DesenvolverSecretaria Municipal de Saúde do EmbuUNIFESP Departamento de Pediatria Disciplina de Pediatria Geral e ComunitáriaUNIFESP, Curso de MedicinaUNIFESP, Projeto DesenvolverUNIFESP, Depto. de Pediatria Disciplina de Pediatria Geral e ComunitáriaSciEL

Care needs of children with disabilities - Use of the Pediatric Evaluation of Disability Inventory

Abstract Objective: To describe the care needs reported by caregivers of children with disabilities going through the school inclusion process using the Pediatric Evaluation of Disability Inventory. Methods: Cross-sectional study with 181 children aged 7-10 years with physical or mental disabilities, undergoing the inclusion process in elementary school in 2007. Location: 31 schools of the Regional Education Board-District of Penha, East Side the city of São Paulo. The children's care needs according to the caregivers were assessed in three areas-self-care, mobility and social function, using the Pediatric Evaluation of Disability Inventory, according to the following score: 5, Independent; 4, Supervision; 3, Minimum Assistance; 2, Moderate Assistance; 1, Maximum Assistance and 0, Total Assistance. For statistical analysis, we used Student's t-test and analysis of variance (ANOVA), with p<0.05 being statistically significant. Results: The lower means, with statistically significant differences, were observed for the items related to social function (55.8-72.0), followed by self-care functions (56.0-96.5); for all types of disabilities, except for children with physical disabilities, who had lower means for self-care (56.0) and mobility (63.8). Conclusions: Social function was the area referred to as the one that needed a higher degree of assistance from the caregiver and the Pediatric Evaluation of Disability Inventory is a tool that can help identify these needs and develop a more targeted intervention