Recreational Therapy: An IntroductionChapter 10: Pediatric Practice

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Pediatric disability

“A disability is an environmentally contextualized health-related limitation in a child’s existing or emergent capacity to perform developmentally appropriate activities and participate, as desired, in society.”

(Halfon et al., 2012, p. 32)

Common disabling conditions in pediatric settings

Visual impairments

Hearing impairments

Developmental disabilities

Psychiatric disorders

Blood and immune system disorders

Diabetes

Cardiovascular and respiratory disorders

Musculoskeletal disorders

Cancer

Working with children with visual impairments

The RT will want to know the level of vision impairment of the child and the assistive technology available to the child.

A child with a mild or moderate vision impairment may need large-print items and images enlarged.

Children with severe visual impairment won’t be able to see print or images and may have to have items described to them.

Assistive technology such as computer software that will speak the text on the computer screen or enlarge letters on the screen can also be employed with children with severe visual impairments.

Clients with hearing impairments

As appropriate, RTs may use amplification devices, written directions, and sign language when communicating with children with hearing impairments.

RTs should be aware that nearly 40% of youth with hearing impairments are in need of mental health support or have experienced abuse.

Developmental disabilities (DD)

Developmental disabilities are present at birth or prior to age 18.

Developmental disabilities include: learning disabilities, cerebral palsy, muscular dystrophies, spina bifida, spinal muscular atrophies, and specific speech articulation disorder (e.g., stuttering).

Childhood psychiatric disorders

Anxiety disorders

Attention deficit hyperactivity disorder (ADHD)

Conduct disorder

Depressive disorders

Oppositional defiant disorder

Tic disorder

Reactive attachment disorder

Nonsuicidal self-injurious behavior

Blood and immune system disorders

Sickle cell disease

Anemia

Hemophilia

AIDS

Type 1 diabetes

Type 1 diabetes (formally called juvenile diabetes) occurs when the body cannot produce enough insulin.

Type 1 diabetes is a complex autoimmune disorder that affects approximately 150,000 youth under age 18 or 1 in every 400 to 500 youth. Approximately 13,000 youth are diagnosed annually with type 1 diabetes.

Unlike type 2 diabetes, which almost always can be managed with lifestyle changes (i.e., exercise and diet), type 1 diabetes is a chronic condition that requires the child to wear an insulin pump or receive insulin shots on a daily basis.

Type 2 diabetes

Type 2 diabetes typically occurs due to poor nutrition and obesity.

Type 2 diabetes can almost always be managed with lifestyle changes (i.e., exercise and diet).

Cardiovascular and respiratory disorders

The cardiovascular system is responsible for transporting blood and other substances throughout the body. The respiratory system exchanges carbon dioxide and oxygen through breathing.

Cardiovascular and respiratory disorders include: rheumatic heart disease; Kawasaki disease; asthma; and cystic fibrosis.

Musculoskeletal disorders

Clubfoot

Scoliosis

Hip dysplasia

Sustained injuries

Cancers in children

Leukemia

Lymphomas

Neuroblastoma

Brain tumors

Osteosarcoma

Rhabdomyosarcoma

Examples of clinical outcomes in pediatric RT

1. Developing psychosocial coping skills.

2. Learning healthy leisure pursuits that decrease alcohol or substance abuse.

3. Developing positive social skills that lead to friendship development.

4. Identifying adaptive techniques that lead to an increase in physical activity.

5. Understanding the importance of a healthy, balanced lifestyle.

Examples of pediatric service settings

Medically specialized camps (e.g., for campers with diabetes)

Children’s hospitals

Specialized children’s hospitals (e.g., psychiatric)

Outpatient mental health and substance abuse programs

Adapted sports programs

School programs