HEALTH CARE OF THE PRE-SCHOOL CHILD

Introduction

A child is a growing being, thus he/she requires an adequate environment for appropriate
growth and development. According to the World Health Organization, a child is defined as a
person aged below 18 years, though there are other definitions including biological and legal.
There are many social issues that affect children such as childhood education, bullying, child
poverty, child labour and hunger. Until recently, a child was not required to start school until
the age of 6 years, making the parents, particularly the mothers, the care givers. It is clear that a
healthy child will be happy to attend classes and will be regular at school.

Presently, both parents work, making the child leave home earlier than usual, and placing their
care in the hands of the school teachers/daycare minders. The school child spends between 5-8
hours in school; most hours of the day time is spent in school. It therefore becomes imperative
that the school should be made safe, and the teachers must be impacted with enough skills to
ensure the wellbeing of the child and create a good learning environment.

The teachers must be able to identify early signs of ill health (physical or mental) and notify the
parents and employed health personnel (nurse attached to the clinic). The responsibilities of
educators therefore go beyond lesson planning and instruction.

This lesson will be discussed under the following sub-headings:

a. Requirements for proper health care in schools.

b. Common symptoms seen in some illnesses in school children.

c. Common chronic conditions that affect the academic performance of school children.

d. Uncommon chronic conditions that affect the academic performance of school children.

e. Emergencies skills that teachers and parents require.

Some of the common symptoms seen in some illnesses in school children include:

Fever

This simply means that the body is hot. A lot of diseases can make a child's body to be hot.
Some of the common diseases that causes fever include malaria, common cold (cough and
catarrh), ear infection, urinary tract infection etc. It is important that when a child's body is hot,
you bring down the temperature by tepid sponging (not cold water). Bringing down the
temperature can prevent a child from having convulsion (seizure) as a result of high
temperature. Drugs like paracetamol can also be given to bring down the temperature. Because
several diseases cause fever, it is important that the child sees trained health personnel for
further evaluation and treatment.

Difficulty with breathing

Any child with difficult breathing must be immediately referred to a health facility. However, if
you are aware that the child is an asthmatic, assist him/her to use his inhaler. Call the parents
and get the child to a health facility immediately.
Vomiting if persistent (2-3 times) refer to a hospital.

Diarrhea:get the child to take fluids, preferably salt sugar solution before he goes to the
hospital. To prepare this solution, add 5 cubes of St Louis sugar and 1 level teaspoon of salt to
60 ml of clean water (a beer bottle is about 60mls)

Convulsion: This is also called seizure and is usually a frightening sight. However, the event is
usually not life threatening. There are different types of convulsion. Convulsion is due to
abnormal electrical discharge in the brain. Several illnesses can cause seizure, but the
commonest cause in children is very high fever. Any illness that makes the body very hot like
cough and catarrh, ear infection and malaria can make the child convulse. With this knowledge,
it is important to ensure that a child that is febrile be given paracetamol and given a tepid bath
(not cold bath).

c. Common chronic conditions that affect the academic performance of a child

 Asthma
 •Epilepsy
 Sickle cell disease
 Bleeding disorder-Hemophilia
 Diabetes mellitus
 Challenges of vision
 Challenges with hearing

Asthma

What Teachers Should Know About Asthma.

 Asthma is a lung disease that makes it difficult for the person to move air in and out of
his/her lungs. Asthma is usually a chronic disorder and this means the disease may be
lifelong. Treatment for asthma is not to achieve a cure, but to relieve the symptoms so
that the child can live a normal life.

Symptoms Include:

 Wheezing (whistling sound when breathing)

 Coughing
 Tightness of the chest
 Shortness of breath

Pupils with asthma may:

 Have asthmatic attacks that cause wheezing, coughing and serious breathing challenge.
 There is need to take inhaled or oral medication, usually in the school clinic, or office.
 May need to be excused from physical education or otheractivities when they are having
asthmatic attacks. The triggers for attack include sweeping of dusty
rooms/environments, lying on rugs in the classroom/homes and playing with pets such
as dogs and cats.

What Teachers Can Do

 Must ensure that the child is brought to the school nurse and his/her drugs are always
available in situation of asthmatic attacks.
 Teachers should know how to apply the medication/inhaler.
  Pupils who have exercise induced asthma will need to use their inhalers before
participating in physical activities.
 Teachers should know their pupils' asthma triggers and allowthem to use their medicine
when needed.
 If a pupil's symptoms worsens after taking medication, call the school nurse.
 Extra time must be created to help the child catch up on missed lesson/ tests and exams

Epilepsy

 Epilepsy is a tendency to have seizures (convulsion).

 Seizures can be frightening to most persons.
 Seizures may leave students temporarily confused or unaware of their surroundings.
 Students may lose consciousness, jerk violently or fallsuddenly, or appear to have
difficulty breathing.
 Some seizures are brief and minor. For example, a student may simply blink and stare
into space for a moment before resuming normal activity.
 Epilepsy is not infectious, hence saliva from the mouth of a child having seizure will not
make you develop epilepsy.

What Teachers Can Do

1. Ensure that the child lies down in a safe place and unbutton his/her shirt.

2. Allow the seizure activity to run its course and do not restrain the child. They normally stop
on their own.

3. If an anti-convulsant like diazepam is available, give it to the child. School/doctor/nurse's,

care is needed in giving this medicine (diazepam).

4. Most seizures are not life threatening, but if your student appears to have trouble breathing,
take him to the school clinic or a well-recognized hospital

5. After a seizure in your class, your student must go to the schoolclinic/hospital.

6. Most students with epilepsy can participate in school sports/physical education and other
activities 7. Provide extra time to make up any missed class work orassignment.

Sickle Cell Disease (SCD)

This is a genetic blood disease inherited from both parents who are called carriers.

It is a lifelong disease associated with complications called crisis. These complications may
result in frequent school absenteeism

Signs of Sickle cell disease:

 Small stature
 Yellow eyes
 Pallor (a pale look)
 Painful crisis; usually in the limbs, waist, stomach
 Recurrent febrile illnesses

What teachers must do:

 Identify any child with the disease in your class.

  Ensure that the child eats frequent nutritious meals. They are advised to eat as often as 6
times a day. The teacher should advise the parents to bring extra meals.
 Discourage the child from trashy meals like indomie, biscuits and doughnut.
 Ensure the child drinks a lot of water frequently, even during lessons. This will prevent
him from having pain crisis. This will also make him pass urine frequently. The teacher
must not rebuke the child for drinking often or excusing himself to go to the toilet.
 If the child appears dull and unwilling to play, get the parentsto take the child for proper
assessment in the hospital.
 Avoid stigmatizing such children.
 Allow them to participate in all school activities, including sports, but the child MUST
not be allowed to stay in a swimming pool for longer than 30 minutes because cold will
precipitate painful crisis. Make allowance for catch up lessons whenever the child
misses class because of his regular check-ups or illnesses
 Increased frequency of feeding is to be encouraged and implemented by the
parent/guardian.

Diabetes Mellitus

Diabetes mellitus is a chronic condition that disrupts the body's ability to use glucose. Insulin, a
hormone produced by the pancreas helps the body to convert glucose into energy.

In persons with diabetes mellitus, either the pancreas cannot make insulin or the insulin is not
functioning properly. In the absence of insulin, the body's main energy source which is glucose
cannot be used. Glucose builds up leading to a high glucose level in blood.Most school aged
youths with diabetes mellitus have the type 1. Persons with type 1 diabetes mellitus do not
produce insulin and they must receive insulin through either injections or an insulin pump.

There are however, some children with type 2 diabetes mellitus and may require diet and
exercise. Type 2 diabetes mellitus is usually seen in adults and require oral medication and /or
insulin injections

Signs and symptoms of diabetes mellitus:

 Excessive eating (polyphagia).

 Excessive urination (polyuria).
 Weight loss despite a good appetite.
 Abdominal pain.
 Urine that attracts ants. If the above signs are ignored the child can lose consciousness

What Teachers need to know/do

The class teacher should be trained in the necessary diabetes procedures (for example blood
glucose monitoring and insulin administration). They should be trained to recognize features of
low and high glucose in these pupils with diabetes mellitus. The pupils with diabetes mellitus
should have access to diabetes supplies such as insulin at all times. They should be supervised if
necessary.If a known diabetic is restless (possibly from a low glucose level), a teacher should be
able to put a lump of sugar in the child's mouth or give him/her a sugar drink such as sprite. If
the child is unconscious, the school nurse can give intramuscular glucose and then take the child
to the hospital. The pupil must go to the hospital immediately for assessment.

Staff should get training on dealing with diabetes mellitus related tasks or diabetic emergencies
such as low and high glucose levels. This training for nurses should be done annually.
Challenges of Hearing

The ear is responsible for hearing. Several diseases/events can cause hearing loss. However,
some children are born deaf. Common causes of hearing loss are recurrent ear infections (called
otitis media), frequent exposure to loud sounds (blaring music, frequent use of ear phone) and
foreign body insertion like cotton bud, match sticks and others.

The fluid in the ear can also block sound which can lead to temporal hearing problems.

Symptoms and signs of hearing impairment

 Ear pain
 Redness of the ear drum
 Fever.

The child manifests hearing loss by being inattentive and restless

Prevention

Do not use cotton bud to remove wax from the ears because this process pushes most of the wax
further into the ear. If ear wax is causing pain or discomfort, the child should be encouraged to
talk to the doctor.

Visual Challenge

Visual challenge is the same as poor eye sight. Some children are born blind but most of the
causes of poor vision and blindness are acquired. Common causes of poor vision include
cataract, measles with eye challenge, foreign body insertion (pencil) and eye tumor called
retinoblastoma.

How do we know a child has problem with his vision?

 Frequent squinting
 Bumping into objects when walking
 Sitting close to the board/television in classroom/home. Sometimes the parent/teacher
may observe a white patch or cataract in the child's eye.

What should the teacher/parents do?

See the eye doctor (ophthalmologist). Do not allow any quack to make attempts to remove the
white patch. This most often can lead to blindness.

d. Uncommon Disorders that affects a Child's Academic Performance

 Attention deficit disorders

 Autism
 Learning difficulty such as Dyslexia, dysgraphia and dyscalculia.

Attention Deficit/Hyperactivity Disorder (ADHD)

This is a common behavioral disorder in children and it is usually associated with academic
under achievement. Several factors have been attributed to cause this problem for example,
prolonged labour, complicated deliveries, maternal smoking or use of alcohol during pregnancy.
In addition, childhood exposure to lead from flaking paints and severe brain injuries can also be
the cause of this challenge.
How do we recognize a child with ADHD?

ADHD is characterized by:

1. Inattention, increased distractibility, and difficulty in sustaining their attention. Sufferers do
not pay attention to details, cannot complete given assignments and they do not listen
attentively

2. They have poor impulse control such as answering even before hearing the full question.
They cannot wait for their turns and often butt into other people's games/discussions.

3. Motor over activity seen as restlessness. They talk excessively and cannot stay on their seats.
They are always on the go, running about and climbing every object in the classroom.

Affected children are very distractible and inattentive. This kind of behavior is
commonly seen in toddlers making it difficult to diagnose the condition at that age.

Problems associated with this disorder

 Academic under achievement

 Inability to maintain cordial relationship with peers or family members. They may be
destructive.
 They may have other emotional problems

What Teachers should do?

Refer the child to a child neurologist and psychiatrist. Medication used in treating this condition
must be prescribed and monitored by the doctor.

Learning, Reading or Spelling Disorders

These disorders are often unrecognized in our environment and the affected children are
erroneously labeled as unintelligent children. There are different kinds of learning difficulties

1. Dyslexia: This is a reading disability. The affected child has difficulty in learning how to
read. They have difficulty informing association between sound, letters and also in decoding
individual words; hence it takes them time to comprehend what they read. Such children usually
avoid reading.

2. Spelling difficulty: There are different forms of spelling disabilities. A child with language
disorder will not be able to spell since he cannot pronounce the word. They use configurational
sense of the word to spell it for example, spelling fight as faght. Another type of spelling
difficulty is inability of the child to recall from memory the configuration of the word although
he can pronounce the word properly. They may write fight as'fite'.

3. Writing disorder: This is called dysgraphia. It can arise as a result of inability to picture the
configuration of the letters or words as they write. Their writing is poorly legible with
inconsistent spacing between words. Others have problem of visual recall of words. What is
written on the blackboard by the teacher cannot be reproduced in their notebook because by the
time they look at the board and pause to write; they would have forgotten what they saw on the
blackboard. This kind of child cannot learn to write in our setting where teaching is done on the
blackboard. He learns better if his text book is by him when he is writing.

4. Mathematical disability: This is called dyscalculia. The affected children have difficulty with
mathematics. They may be unable to grasp mathematical concepts.
Autism

This is a brain disorder of unknown cause but with a strong genetic basis. It is characterized by
behavioral problems like impairment in speech development, impairment in communication
skill, and inability to interact socially with other persons. It is usually diagnosed before the age
of 3 years. These children are initially normal and suddenly begin to manifest the abnormal
behaviors.

How do we recognize an autistic child?

 The severity of the above problems varies from child to child. Some children have mild
types while others have severe types.
 They are not able to interact socially with other children.
 They do not have joint attention. Joint attention is the ability to use eye contact and
pointing to things as a means of sharing experiences with others.
 They may not make eye contact with the person interacting with them and they seem
aloof.
 They have different verbal disabilities ranging from not speaking at all, or may have
delayed speech. Some have advanced speech challenges.
 The child does not gesticulate to express himself/herself.
 They usually do not initiate any conversation and they do not sustain conversations with
others.
 They do not perform 'make believe' plays like other children.
 They have restricted, repetitive and stereotyped patterns of behavior, interest and
activities. For example, persistent preoccupation with parts of objects and abnormal
body movement.Their intellectual capacity may vary from mental retardation to superior
intellectual functioning in certain areas.

What Teachers need to do

 The child will need an intensive behavioral therapy which can only be provided by
trained individuals to help him/her develop speech and language and modify their
behavior.
 They require alternate education approach as formal ways ofclassroom teaching are not
effective.
 They must be referred to a Pediatric neurologist and a child psychiatrist.