A medical guideline of the special needs children listed in CARA. This is just for basic understanding of the medical perspective of the conditions. For any further guidance please reach out to a paediatrician in your city.

   1. SEVERE RICKETS (BONES) – It does not respond to treatment with usual doses of vitamin D and adequate dietary calcium and phosphorus. Symptoms include bowed legs, stunted growth, bone pain, large forehead and trouble sleeping. It results in weak or soft bones in children. Complications may include bone fractures, muscle spasms, an abnormally curved spine, or intellectual disability. This can be treated with special dietary changes infused with extra doses of vitamin D, calcium and phosphorus.

2. PARTIALLY BLIND – It indicates some type of a visual problem with a need of person to receive special education in some cases. It is a severe visual impairment not necessarily limited to distance vision. The treatment depends on the cause of it.

Giving glasses might alleviate the problem. Some other kinds may need dietary changes, cataract surgery, medication in the form of drops or pills, corneal transplantation, etc.

3. BURNS (SKIN) – Damage to the skin or deeper tissues caused by sun, hot liquids, fire, electricity or chemicals. It is usually self-diagnosable depending on the size and depth of the burn. The treatment depends on severity. Treatment may include self-care, medications, supportive care and specialist treatment.

4.CHRONIC ASTHMA – It is a chronic lung disease that inflames and narrows the airways. It causes recurrent periods of wheezing, chest tightness, shortness of breath and coughing. Adherence to prescribed treatment can cure asthma with the help of inhaler and other medications.

5.CHRONIC ECZEMA – The most obvious symptom include dry, itchy skin. It is an overactive response by the body’s immune system to an irritant. Stronger or lighter medications can be used depending on the severity.

6.CLEFT LIP – Openings or splits in the roof of the mouth and lip. Symptoms include difficulty in speaking and feeding. People may also experience speech disorder, stuttering or impaired voice. Surgery can restore normal functioning with minimal scarring. Speech therapy also helps correct speaking difficulties

7.PARTIALLY DEAF – It is a condition where a person has difficulty in hearing. Comes as speech delay and no response to daily life sounds. No exercise or meditation will help. Speech therapy is a must after correction of deafness. Otherwise sign language. Treatment may include exercising, meditation, using prosthetic devices like a hearing aid or a cochlear implant placement.

8. DIABETES – It is a group of disease that results in too much sugar in the blood or high blood glucose. All types of diabetes are treatable. The common symptoms are frequent urination, disproportionate thirst, intense hunger, unusual weight loss, increased fatigue, irritability, weight gain, etc. Diabetes can be treated with the help of oral drugs, insulin injections, exercise and proper diet

9.  DISLOCATED HIPS – In such cases, the hip bone is displaced from its normal position. Symptoms include swollen, painful and visibly out of place hips. The leg may be hard to move or may feel tingly or numb. It requires a medical diagnosis. Immediate medical treatment is required and involves pushing the bone into place by hand or surgery. Other treatments include rehabilitation.

(Hip dislocation in babies is a congenital condition. None of these symptoms will be seen. Only Pediatricians can diagnose and later it manifests as gait abnormally while walking. Advice: Needs ortho management)

10. FINGERS / TOES JOINED (SYNDACTYLY) – It is the webbing of fingers or toes which occur when tissues connect two or more digits together. In rare cases, the fingers or toes may be connected by bone. Mostly it is an inherited trait or due to genetic defects. It can be treated through surgical and non-surgical methods. Surgeries mostly include orthopaedic and plastic surgeries.

11. FINGERS / TOES MISSING – The cause of this disease is unknown. One possible cause may be the interruption of the blood supply to the developing arm at four or six weeks of pregnancy. In most of the cases, such children are able to adapt to their physical limitations and experience a fully functional life with no treatment. Possible treatment includes surgery or a routine of regularly stretching the fingers. 

12. GROWTH HORMONE DEFICIENCY – It is a medical condition due to not enough growth hormone. Symptoms may include short stature, low growth velocity or speed for age and pubertal stage, increased amount of fat around the waist, delayed tooth development and the child may look younger than other children of his/her age. Treatment should include balanced diet, plenty of sleep, regular exercises, medications and pituitary tumors may require surgery and radiation therapy.

13.HERNIA – Symptoms of an incarcerated hernia can include pain, vomiting, and irritability. If you touch the bulge it has created, it may feel hard. The two most common hernias in kids are inguinal hernias in the groin area and umbilical hernias in the belly-button area. In children, mostly boys, this happens when the abdominal wall has a weakness present at birth. Surgery can correct the hernia

14. INDETERMINATE SEX (GENETIC) –  Intersex people are born with any of several variations in sex characteristics including chromosomes, gonads, sex hormones, or genitals that, according to the UN Office of the High Commissioner for Human Rights, “do not fit the typical definitions for male or female bodies”. “Intersex” is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male. Treatment includes medications, surgery and ongoing care with support.

15.LIMBS MISSING –  A person who is missing or has had amputated both arms or both legs. Treatment includes medication, non-drug therapies like nerve stimulation, mirror-box therapy, acupuncture, spinal cord and brain stimulation, revision surgery, etc. The main treatment is prosthetics

16.LOW BIRTH WEIGHT (UNDER 1800 GMs) – Very low birth-weight is a term used to describe babies who are born weighing less than 1.5 kgs and Low birth weight babies is 2.5 kgs. Babies with very low birth-weight look much smaller than other babies of normal birth-weight. A very low birth-weight baby’s head usually appears to be bigger than the rest of the body and he or she often looks extremely thin, with little body fat. The skin is often quite transparent, allowing the blood vessels to be easily seen. The primary cause of very low birth-weight is preterm birth (born before 37 weeks gestation). Another cause of very low birth-weight is intrauterine growth restriction (IUGR). Treatment depends on the baby’s gestational age, overall health, and medical history; the baby’s tolerance for specific medications, procedures, or therapies; one’s opinion or preference; care in the NICU; temperature controlled beds; special feedings, sometimes with a tube into the stomach if a baby cannot suck; and other treatments for complications. Very low birth-weight babies may have a harder time “catching up” in physical growth because they often have other complications. Many very low birth-weight babies are referred to special follow-up health care programs.

17.ABSENCE OF ONE KIDNEY – Renal agenesis is a condition in which a newborn is missing one or both kidneys. Unilateral renal agenesis (URA) is the absence of one kidney. This condition may have no symptoms at all and is more common with intrauterine growth retardation (poor growth during pregnancy) and often results in premature birth. Most newborns with URA have few limitations and live normally. The outlook depends on the health of the remaining kidney and the presence of other abnormalities. To avoid injuring the remaining kidney, they may need to avoid contact sports when they’re older. Once diagnosed, patients of any age with URA need to have their blood pressure, urine, and blood tested annually to check kidney function. Treatment may include long-term dialysis, to do the work of their missing kidneys.

18.PERSON WITH DISABILITY – This is a vague term that CARA has laid down because a person with disability can be many things – intellectual, mental, physical, etc. CARA should be more specific with the terminologies when listing down the special needs section.

19.POLIO (PHYSICAL)India has eradicated Polio

Symptoms include slowly progressive muscle weakness, loss of reflexes, unaccustomed fatigue (both generalized and muscular), and, at times, muscle atrophy. The poliovirus attacks specific neurons in the brainstem and the anterior horn cells of the spinal cord. No cure for polio exists, therefore the focus is on increasing comfort, speeding recovery and preventing complications. Supportive treatments include pain relievers, portable ventilators to assist breathing and moderate exercise (physical therapy) to prevent deformity and loss of muscle function. However, polio is not something that cannot be handled.

20.PREMATURE BIRTH (LESS THAN 37 WEEK’s) –  Preterm is anything less than 37 weeks gestational age. If these “late preterm infants” have no other health problems, they generally do significantly better than those born earlier, though they still face a higher risk of problems than babies who are born later in pregnancy. The baby may have very mild symptoms of premature birth, or may have more-obvious complications. Some signs of prematurity include small size, with a disproportionately large head; sharper looking, less rounded features than a full-term baby’s features, due to a lack of fat stores; fine hair (lanugo) covering much of the body; low body temperature, especially immediately after birth in the delivery room, due to a lack of stored body fat; labored breathing or respiratory distress; and lack of reflexes for sucking and swallowing, leading to feeding difficulties. Possible tests for the premature baby may include breathing and heart rate monitor; fluid input and output; blood tests;  echocardiogram; ultrasound scan; eye exam; etc. If the baby develops any complications, other specialized testing may be needed. Other than all of this, treatment may include intensive care for your premature baby; specialized supportive care for the baby like being placed in an incubator; monitoring of the baby’s vital signs; sensors may be taped to the baby’s body to monitor blood pressure, heart rate, breathing and temperature; having a feeding tube; replenishing fluids; spending time under bilirubin lights; receiving a blood transfusion; medications and surgery.

21. SEVERE DISFIGURING BIRTH MARKS – Most of the birthmarks are harmless and some may even fade with time. Few of them may also be a sign of some underlying medical conditions. The exact cause of birthmarks are still not known. Some of the birthmarks are present due to excessive skin pigment, while others are because of the abnormal growth of blood vessels. Some of the symptoms of vascular birthmarks can be coloured patches or marks that appear shortly after birth, itchy skin, painful sore  patches of skin, infected skin or skin that has developed ulcer, bleeding skin and patches of skin more pronounced during fever. If a person finds a particular birthmark disfiguring or is stressed about his/her appearance, they may take up surgical and laser treatment. Moles are removed surgically, while cafe-au-lait may respond well to laser treatments. Haemangiomas may be a matter of concern if they have become infected, are blocking airways, or blocking vision. Then these are treated by medication, surgery or other therapies. Certain birthmarks can become a cause of social distress and disgrace. Myths and misconceptions about birthmarks, disfigurement, caused due to birthmarks are emotionally upsetting.

22. SEVERE ORTHOPAEDIC CONDITIONS – Common orthopaedic problems in kids are flatfeet where most babies are born with flatfeet and develop arches as they grow; toe walking which is common among toddlers as they learn to walk, especially during the second year of life; in-toeing (Pigeon Toes); bowlegs; knock-knees; etc. These can be treated through medications, surgeries, regular exercising and physiological therapies.

23. SPEECH DYSFUNCTION (DYSPHASIA)Developmental dysphasia refers to a dysfunction in the development of speech and language expression and/or reception, in the absence of other problems such as hearing impairment, muscle weakness, global intellectual disability, or other specific neurological disorders. Symptoms include language disorders like Doris Trauner, disorders of articulation, stuttering, Verbal Dyspraxia (sometimes called apraxia), Phonological Syntactic Syndrome (Mixed Receptive-Expressive Disorder/Expressive Dysphasia), Verbal Auditory Agnosia, Semantic Pragmatic Syndrome, etc. With time, dysphasic people may recover to some extent. Many learn to adapt to their situation and live accordingly. Speech therapy and using techniques like talking slowly and repeating things, using gestures or drawings, and avoiding noisy areas can be of great help in dealing with dysphasia. Apart from all the above, emotional support can prove to be extremely helpful for such people.

24. SPEECH IMPAIRED – It is a speech and language impairment that is basically a communication disorder such as stuttering, impaired articulation, a language impairment, or a voice impairment which adversely affects a child’s educational performance. Common symptoms experienced by people with speech disorders are repeating sounds, which is most often seen in people who stutter; adding extra sounds and words; elongating words; making jerky movements while talking, usually involving the head; blinking several times while talking; etc. Mild speech disorders may not require any treatment. Others can improve with speech therapy. Treatment varies and depends on the type of disorder. In speech therapy, a professional therapist will guide one through exercises that work to strengthen the muscles in one’s face and throat. One will learn to control one’s breathing while speaking. Some people with speech disorders experience nervousness, embarrassment, or depression. Talk therapy may be helpful in these situations. If the depression is severe, antidepressant medications can help.

25. INTELLECTUAL DISABILITY – Intellectual disability (ID), also known as general learning disability and mental retardation (MR), is a generalized neurodevelopmental disorder characterized by significantly impaired intellectual and adaptive functioning. It requires a medical diagnosis and the main symptom is difficulty in thinking and understanding. Life skills that can be impacted upon include certain conceptual, social and practical skills. People may experience behavioural: hyperactivity, impulsivity, or restlessness and also common problems like difficulty in thinking and understanding. Treatment consists of therapy mainly. Special education and behavioural therapy can help a person live to his or her fullest. Therapies include developmental social-pragmatic model, applied behavior analysis, behaviour therapy, sensory processing, and animal-assisted therapy. Another possible treatment is to take self-care like through physical exercise and special education. Intervention of the specialists might also be required like occupational therapist, speech therapist, paediatric neurologist, clinical psychologist, psychiatrist, and paediatrician.

26. SEVERE LEARNING DISABILITY – The term learning disability refers to a range including mild, moderate, severe and profound/multiple learning disabilities. Common signs that a person may have learning disabilities include difficulties with reading and/or writing, problems with math skills, difficulty remembering, problems paying attention, trouble following directions, poor coordination, difficulty with concepts related to time, problems staying organized, etc. People with learning disabilities and disorders can learn strategies for coping with their disabilities. Getting help earlier increases the likelihood for success in school and later in life. Interventions vary depending on the nature and extent of the disability. For more on SLD  visit  http://padme.in/specific-learning-disabilities/

27. PARALYSISParalysis – commonest causes in children are cerebral palsy and stroke.  Paralysis is a loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage as well as motor. Signs and symptoms include numbness, weakness and muscle cramps. Age may have a bearing on how long you take to recover from paralysis, as your body will take longer to heal. Also, if you are suffering from any other type of health condition, it will have a direct impact on the overall time it takes for you to recover from paralysis. Some of the rehabilitation treatments used for people with paralysis include physical therapy which uses treatments such as heat, massage, and exercise to stimulate nerves and muscles. Currently, there is no cure for paralysis itself. In certain cases, some or all muscle control and feeling returns on its own or after treatment of the cause for the paralysis. Some of the rehabilitation treatments used for people with paralysis are occupational therapy that concentrates on ways to perform activities of daily living; mobility aids including manual and electric wheelchairs and scooters; supportive devices include braces, canes, and walkers; assistive technology such as voice-activated computers, lighting systems, and telephones; adaptive equipment such as special eating utensils and controls for driving a car; etc.

28. EPILEPSY / SEIZURES / CONVULSIONS 

Children – most common is febrile seizures/convulsions (only with fever). Even otherwise children almost always respond very well to medication and many are able to stop the medication in a few years time.

Seizures are sudden events that cause temporary changes in physical movement, sensation, behavior or consciousness. They are caused by abnormal electrical and chemical changes in the brain. The term epilepsy is used to describe seizures that occur repeatedly over time without an acute illness (like fever) or an acute brain injury. Sometimes, the cause of the recurring seizures is known and sometimes it is not. Convulsions are a sudden, violent, irregular movement of the body, caused by involuntary contraction of muscles and associated especially with brain disorders such as epilepsy, the presence of certain toxins or other agents in the blood, or fever in children. Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure, convulsion or epilepsy signs and symptoms may include temporary confusion, a staring spell, uncontrollable jerking movements of the arms and legs, loss of consciousness or awareness and psychic symptoms such as fear, anxiety or déjà vu. Today, most epilepsy, seizure or convulsions are treated with medication. Drugs do not cure epilepsy, but they can often control seizures very well.

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