Treatment & Management

Medical Care 1. Early identification of children with developmental delays. 2. The mainstay of treatment of MR/ID is developing a comprehensive management plan for the condition. 3. Physical activity and obesity are major contributors to disease in MR/ID.

Treatment & Management

4. Pain: Manifestations of pain in people with severe to profound MR/ID include crying, screaming, grimacing, protective postures (eg, arching, fetal position), rocking, and aggression. Common causes of acute pain include dental caries/abscesses, GERD, constipation, UTI, spasticity (when MR/ID is associated with cerebral palsy), pressure sores, and fractures.

Treatment & Management

In addition, neuropathic pain due to dysautonomia or motor spasms may create chronic disturbances.

5. Written, verbal and pictoral forms of communication as well as gestures and demonstrations are helpful for those with MR/ID to ensure mutual understanding and improve treatment adherence.

Treatment & Management

6. Sedation/anesthesia: Patients with MR/ID requiring anesthesia may have different reactions than the general population, such as paradoxical reactions to benzodiazepines, and care should be taken to use the lowest dose and titrate slowly.

Treatment & Management

7. Sexuality/abuse: A significantly higher proportion of children and adults with MR/ID have experienced some form of abuse, with some estimates of up to 70%, which contributes to mental health issues. This should be addressed at each medical visit and especially in the setting of changes in behaviors, such as increased aggression.

Treatment & Management

Consultations Developmental pediatrician or psychologist Geneticist and counselor Psychiatrist Dentist Podiatrist Special education/educational therapist Occupational, speech and/or physical therapist Behaviorist Pharmacist Durable medical equipment providers Social services agencies/social workers

Treatment & Management

Diet Nutritional supplements are of no proven benefit. Activity Because obesity is more prevalent in those with MR/ID, regular physical activity should be included in the management plan. Adaptive exercise programs for those with concomitant physical disabilities should be recommended as needed.

Treatment & Management

Nursing Management 1. Assess all children for signs of developmental delays. 2. Administer prescribed medications for associated problems such as anticonvulsants for seizure disorders, and methylphenidate (Ritalin) for attention deficit hyperactivity disorder. 3. Support the family at the time of initial diagnosis by actively listening to their feelings and concerns and assessing their composite strengths.

Treatment & Management

4. Facilitate the childs self-care abilities by encouraging the parents to enroll the child in an early stimulation program, establishing a self-feeding program, initiating independent toileting, and establishing an independent grooming program (all developmentally appropriate). 5. Promote optimal development by encouraging self-care goals and emphasize the universal needs of children, such as play, social interaction and parental limit setting. 6. Promote anticipatory guidance and problem solving by encouraging discussions regarding physical maturation and sexual behaviors. 7. Assist the family in planning for the childs future needs (e.g. Alternative to home care, especially as the parents near old age); refer them to community agencies.

Treatment & Management

8. Provide child and family teaching Identify normal developmental milestones and appropriate stimulating activities including play and socialization. Discuss the need for patience with the childs slow attainment of developmental milestones. Inform parents about stimulation, safety and motivation. Supply information regarding normal speech development and how to accentual nonverbal cues, such as facial expression and body language, to help cue speech development.

Treatment & Management

Explain the need for discipline that is simple, consistent and appropriate to the child. Review an adolescents need for simple, practical sexual information that includes anatomy, physical development and conception. Demonstrate ways to foster learning other than verbal explanation because the child is better able to deal with concrete objects than abstract concepts. Point out the importance of positive self-esteem, built by accomplishing small successes in motivating the child to accomplish other tasks.

Treatment & Management

9. Encourage the prevention of mental retardation Encourage early and regular prenatal care. Provide support for high risk infants. Administer immunizations, especially rubella immunization. Encourage genetic counseling when needed. Teach injury prevention both intentional and unintentional.