Dr Pracheth R Assistant Professor Community Medicine Yenepoya

Dr. Pracheth R, Assistant Professor, Community Medicine, Yenepoya Medical College 3/1/2021 CONGENITAL MALFORMATIONS & HANDICAPPED CHILDREN 1

Some facts …think about it • Zika virus-what does it cause? ? 3/1/2021 • Two in hundred infants in India-congenital anomalies • Surveillance of birth defects 2

1. To explain the causes and prevention of congenital malformations 3/1/2021 Objectives 2. To describe the causes and prevention of handicap 3

Congenital malformations • Incidence 3/1/2021 • Definitions • Causes • Prenatal diagnosis • Prevention 4

• Determined before/during birth, recognizable in early life 3/1/2021 Definition • Malformation: only structural defects • Anomaly: biochemical, structural, functional disorders. 5

Incidence • Most common: üHeart defects üNeural tube defects üDowns syndrome. 3/1/2021 • Affects: 1 in 33 infants 6

• Genetic: üChromosomal abnormalities: Down’s , Klinefelter’s, Turner’s 3/1/2021 Causes üInborn errors of metabolism: PKU, Tay-Sachs disease, galactosemia üOthers: dominant (Hungtington’s chorea), recessive (thalassemia, sickle cell disease), sex-linked (haemophillia). üProbable genetic aetiology: CDH, club foot 7

• Environmental: ü Infections üDrugs (thalidomide, stilboestrol) üMaternal diseases complicated-pregnancy (diabetes, cardiac failure) • Risk factors: üMaternal age üConsanguinity 3/1/2021 Continued…… 8

3/1/2021 Causes 9

• Alpha fetoprotein: in maternal blood and amniotic fluid • Ultrasound: abnormalities-foetus 3/1/2021 Prenatal diagnosis • Chorionic villi sampling: 9 -11 weeks. Chromosome status-determined. • Amniocentesis: only second trimester (>12 weeks)- Downs, NTD 10

3/1/2021 Non-invasive, invasive 11

3/1/2021 Triple Test 12

3/1/2021 Chorionic villi sampling 13

3/1/2021 Amniocentesis 14

• Discourage pregnancy -after malformed child: 10 times risk üMaternal age- Down’s Syndrome 3/1/2021 Prevention ü Avoid teratogenic drugs (thalidomide, steroids, anticonvulsants) ü Early detection, treatment: infections( TORCH) üRestrict (X rays, irradiation). • Prenatal Diagnostic Technique Act (PNDT) 15

3/1/2021 Genetic counseling 16

Some facts…think again • India is home to 40 -8 -0 million disabled persons 3/1/2021 • What is impairment, disability and handicap? • Issues: low literacy, less jobs, social stigma • Age-related and road traffic accidents ? 17

Handicapped children • Incidence 3/1/2021 • Definitions • Classification • Prevention 18

3/1/2021 Definition 19

20 3/1/2021

Problem statement • Hearing loss : 3 rd most common 3/1/2021 • Mentally retarded: 83 million in world • India -16. 15 million: physically disabled 21

• Physically handicapped: blind, deaf, mute, crippled ü Birth defects, infections, accidents 3/1/2021 Classification • Mentally handicapped: ü Sub-normal intelligence+ behavioural deficits üGenetic , environmental causes 22

• Genetic: Down’s, Klinefelter’s syndrome, Phenylketonuria 3/1/2021 Causes of mental handicap • Antenatal: Neural Tube Defects, Rh incompatibility, TORCH infection • Perinatal: birth injuries, hypoxia, cerebral palsy • Postnatal: Head injuries, accidents, encephalitis. 23

• Socially handicapped: ü Healthy personality development hampered due to: ØParental inadequacy ØEnvironmental deprivation ØEmotional disturbances ØLoss of parents ØDestitute 3/1/2021 Continued…. . 24

• Primary prevention: ü Genetic counseling üAt risk approach: chromosomal/ sex-linked diseases üImmunization: poliomyelitis üNutrition 3/1/2021 Prevention 25

• Secondary prevention: üEarly diagnosis of handicap üTreatment üTraining and Education: vocational guidance 3/1/2021 Continued…. ØNational Institute of Mentally Handicapped. Secunderabad ØNGOs 26

Summary-Congenital malformations • Incidence 3/1/2021 • Definitions • Causes • Prevention 27

Summary-Handicapped children • Incidence 3/1/2021 • Definitions • Classification • Prevention 28

1. Define congenital malformation. Add a note on its causes and prevention (1+2= 3 marks) 3/1/2021 Questions 2. Define handicap. Enumerate its types and preventive measures (1+2= 3 marks) 3. What are the causes of mental handicap? (2 marks) 29

Juvenile Delinquency Dr. Pracheth R.

Objectives 1. To describe the causes and preventive measures of juvenile delinquency 2. To explain the services delivered in a child guidance clinic

Outline-Juvenile Delinquency • Definition • Incidence • Causes • Preventive measures

Definition • Children’s Act 1960: child –committed offence • Juvenile: boy -16 years, girl- 18 years (Children’s Act 1960, Juvenile Justice Act 1986) • 2000 Act: same age

Continued…. • All deviations-from normal youthful behaviour, • Incorrigible, ungovernable, habitually disobedient, • Desert homes: mix –immoral people, antisocial practices

Social pathology

Incidence • US: 1 in 4 (75 million ) • Unavailable –India • IPC: 2011 - 888 murders, 1149 rapes, 2609 burglaries • 4 -5 time more boys than girls

Continued… • 2014: ‘theft’ (20. 0%), ‘rape’ (5. 9%) and ‘grievous hurt’ , 'assault on women with intent to outrage her modesty' (4. 7% each). • These four crimes: 39. 7% of total IPC cases (33, 526 cases) of juveniles in conflict with law.

Causes • Biological: ü Hereditary defects, feeble mindedness, physical defects. XYY • Social: ü Broken homes : eg-death of parents, separation, poverty, parental neglect • Others: no recreation, cinemas, urbanization

Preventive measures • Improvement of family life • Schooling, improve education facilities • Social welfare services: recreation facilities, parent-counseling, child guidance

Continued…. • Remand homes: üDoctors-psychiatrists üImprove mental, physical well being üEducation +recreation • Borstals: üBoys > 16 years üSentence: 3 years; training and reformation

Outline –Child Guidance Clinic • Meaning • Team work • Services rendered

Meaning • Chicago, 1909 • Originally-juvenile delinquency • Not fully adjusted to environment • Objective: prevent psychotics, neurotics

Team work • Psychiatrist: central • Clinical psychologist • Educational psychologist • MSW • Public Health Nurses • Paediatrician • Speech therapist

Services • Paediatrician: physical health • Psychotherapy: restore positive feelings üPlay therapy, counseling, reduce parental tension • Foundation of mental health laid in childhood.

Summary

Questions 1. What is juvenile delinquency ? Enumerate the causes and preventive measures for the same. (2+1=3 marks) 2. What is the meaning of a Child Guidance Clinic ? Enumerate its services (2+1=3 marks)

THANKS

3/1/2021 THANKS 49