5.1 Sensory Disorders

Question 1

Visual Impairment

Answer 1

• Most are handled in outpatient pediatric setting

Question 2

Strabismus

Answer 2

• Being cross-eyed (both eyes do not look in the same place at the same time)
• One of the most common visual conditions
• Proper eye alignment is important to avoid seeing double, depth perception, and prevent poor vision.
• Untreated can lead to permanently reduced vision in the eye.

Amblyopia - Lazy eye. Children cannot outgrow this, must be treated.

Question 3

Treatment for Strabismus/Amblyopia

Answer 3

• Eye patch on stronger eye (so weaker eye is forced to compensate/adjust
• Corrective glasses/contacts
• Eye exercises
• Surgical correction of eye muscles

Question 4

Vision Screening

Answer 4

Visual Risk Factors
- Premature birth, down syndrome, cerebral palsy, family history of strabismus, amblyopia, retinoblastoma, childhood glaucoma, childhood cataracts, ocular/genetic systemic disease

• Visual acuity testing usually starts at age 3
• Most children don’t have 20/20 vision until school-age because they are still developing.

Question 5

Hearing

Answer 5

• Screening starts in infancy

Risk Factors
- Toxic Exposure (agent/noise) especially ototoxic medications such as mycin antibiotics, diuretics or high dose of NSAIDs.
- Down syndrome, asphyxia infection

Indicators a child may have hearing impairment
- Lack of Moro (startle) Reflex
- Absent of vocalization by 7 months
- Gestures rather than talking
- Speech not understandable by 24 months
- Yelling/monotone
- Withdrawn

Management
- Hearing aids, lip reading and gesture cues, sign language, visual-aids.

Question 6

Down Syndrome (Trisomy 21) Manifestations

Answer 6

• Very common to have intellectual disability
  (Ranges from mild-moderate-severe)
• Slow Motor Development
• Hypotonia (Increased laxity of joints) – Unstable due to floppy muscles
• More prone to cardiac disease

Abdomen Abnormalities
- Small penis
- Cryptorchidism (testes fail to descend)
- Intestinal atresia (more prone to bowel obstruction)
- Imperforated anus (opening of anus is missing/blocked)

Facial Anomalies
- Flat occiput
- Epicanthal folds (under the eye)
- Protruding tongue
- Flat nasal bridge
- Prominent pointy ears

Extremity Differences
- Small hands/feet
- Transverse Palmar Crease (only one crease across the hand)
- Wide space between toe and second toe
- Strabismus/Nystagmus (twitching eye)
- Small teeth/mouth

Risks
- Leukemia and compromised immune system
- Hearing loss
- Language delay
- Cardiac disease

Question 7

Down Syndrome Treatment

Answer 7

• Foster bonding relationship between parent and child is incredibly important
• Important to acknowledge that it might be challenging for parents to realize their baby might be born with down syndrome (there may be some sadness and grief)
• Especially with new parents it is important to support them in how to care for their child (anticipatory guidance) and how their life might look different.
• IMPORTANT EDUCATION, down syndrome children love to socialize and need interaction with people.